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Getahun GK, Gezahegn E, Endazenawe G, Shitemaw T, Negash Z, Dessu S. Survival status and risk factors for mortality among multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia: A retrospective follow-up study. J Clin Tuberc Other Mycobact Dis 2023; 33:100398. [PMID: 37767135 PMCID: PMC10520522 DOI: 10.1016/j.jctube.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background Tuberculosis continues to be a major health concern around the world. It kills an estimated 1.6 million people each year. The World Health Organization (WHO) removed Ethiopia from its list of thirty countries having a high prevalence of MDR/RR-TB in 2021. As a result, the aim of this study was to assess the current context of survival status and risk factors of multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia, in 2022. Methods An institutional-based retrospective cohort study with 245 patients was undertaken using multidrug-resistant tuberculosis patients who were recruited from January 1st, 2018 to December 30th, 2021, in St. Peter's specialized hospital. To find independent predictors of survival status, Cox regression analysis was used. An adjusted hazard ratio with a 95% confidence interval and a p-value of < 0.05 was used to establish association and statistical significance. Results The result of the study revealed that the incidence of mortality in this study was 13.1% (95% CI: 10.3-16.5). Moreover, being male (AOR = 3.7: 95% CI = 1.2, 11.4), old age (AOR = 14: 95% CI = 3.0, 60.4), site of TB (AOR = 0.2: 95% CI = 0.03, 0.6), and presence of comorbidity (AOR = 9.2: 95% CI = 2.4, 35.3), were independent predictors of time to death. Conclusion Generally, the death rate among research participants was high. Moreover, male gender, old age, site of tuberculosis, and presence of other comorbidity were predictors of mortality among MDR-TB patients.
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Affiliation(s)
| | | | | | | | | | - Samuel Dessu
- College of Medicine and Health Sciences, Wolkite University, Ethiopia
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2
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Silva JE, Silva C, Pacheco M, Pereira E, Almeida JS. Simultaneous Systemic Lupus Erythematosus Flare and Disseminated Tuberculosis: Balancing Anti-Mycobacterial and Autoimmune Treatments. Cureus 2021; 13:e18944. [PMID: 34815895 PMCID: PMC8605789 DOI: 10.7759/cureus.18944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
Here, we report the case of a 53-year-old man with suspected autoimmune arthritis on low-dose corticosteroid therapy. He was recently hospitalized due to presumed bacterial pneumonia and a seizure episode attributed to high fever. His condition deteriorated after discharge, and he presented to our institution with a persistent cough, weight loss, skin rash, arthralgias, fever, and altered mental status. The investigation led to the simultaneous diagnosis of a systemic lupus erythematosus (SLE) flare and disseminated tuberculosis (TB), both pulmonary and intracranial. Proteinuria and peripheral edema were identified, suggesting renal involvement of SLE. Anti-mycobacterial drugs and high-dose corticosteroid therapy were initiated. Given the risk of starting other immunosuppressive drugs in the presence of intracranial TB, in a patient with stable renal function and a significant decrease in proteinuria with corticosteroids and supportive therapy alone, renal biopsy was postponed. Prednisolone was progressively tapered down during the next six months, always maintaining anti-mycobacterial therapy, which resulted in a second SLE flare and the need to increase corticosteroids again. At this time, a renal biopsy was performed, showing class II lupus nephritis and confirming the diagnosis of SLE. After one year of anti-mycobacterial therapy with complete resolution of cerebral and pulmonary TB lesions, we chose to initiate mycophenolate mofetil as an immunosuppressive steroid-sparing agent with increased SLE control, allowing for corticosteroid reduction.
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Affiliation(s)
- João E Silva
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Clara Silva
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Mariana Pacheco
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Edite Pereira
- Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Jorge S Almeida
- Medicine, Faculdade de Medicina da Universidade do Porto, Porto, PRT.,Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
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3
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Addo SO, Mensah GI, Mosi L, Abrahams A, Bonfoh B, Kazwala R, Zinsstag J, Addo KK. Trends in extrapulmonary TB cases at three teaching hospitals in Ghana, 2008-2017. Public Health Action 2021; 11:26-32. [PMID: 33777718 PMCID: PMC7987251 DOI: 10.5588/pha.20.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Three teaching hospitals in Ghana. OBJECTIVE To elucidate trends in demographics, clinical characteristics and treatment outcomes in extrapulmonary TB (EPTB) patients. DESIGN This was a retrospective study involving the review and comparison of EPTB and pulmonary TB (PTB) data from 1 January 2008 to 31 December 2017 in TB registers and treatment cards. RESULTS Of 15,392 TB cases, 4607 (30%) were EPTB, including 4477/4607 (97%) new cases. There were 2,679/4607 (58%) males and the age range was 0.3 to 96 years. Pleural TB (1021/4607, 22%) was the most common. Treatment success rates for EPTB and PTB were respectively 72% and 84%. HIV positivity was high among patients with disseminated/miliary TB (429/779, 55%) and TB meningitis (242/526, 46%). To note, disseminated/miliary TB (χ2 = 33.53, P < 0.0001) increased, whereas TB meningitis (χ2 = 19.43, P < 0.0001) decreased over the 10-year period. Mortality among EPTB patients was associated with increasing age (⩾25 years), disseminated/miliary TB, TB meningitis and HIV positivity. CONCLUSIONS There is male preponderance for both EPTB and PTB in Ghana. Increasing age, disseminated/ miliary TB, TB meningitis and HIV are risk factors for mortality among EPTB patients. This emphasises the need for public education on the risk factors for EPTB and preventive strategies.
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Affiliation(s)
- S O Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- West African Center for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - G I Mensah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - L Mosi
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- West African Center for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - A Abrahams
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - B Bonfoh
- Centre Suisse de Recherches Scientifique en Cote d'Ivoire, Abidjan, Cote d'Ivoire
| | - R Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - J Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - K K Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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4
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Nikonajad A, Azimi SA, Allami A, Qasemi Bargi R, Tabarraei A. Epidemiology of extrapulmonary tuberculosis in Northeast of Iran. MEDICAL LABORATORY JOURNAL 2021. [DOI: 10.29252/mlj.15.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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5
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Atif M, Fatima R, Ahmad N, Babar ZUD. Treatment outcomes of extrapulmonary tuberculosis in Bahawalpur, Pakistan; a record review. J Pharm Policy Pract 2020; 13:35. [PMID: 32724657 PMCID: PMC7382058 DOI: 10.1186/s40545-020-00227-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is limited published data form Pakistan on treatment success rate among extrapulmonary tuberculosis (EPTB) patients. The aim of this study was to assess clinical form, treatment outcomes, and identify the factors associated with unfavorable treatment outcome among EPTB patients. Methods A retrospective study was conducted at the Chest Disease Unit of the Bahawal Victoria Hospital, Pakistan. Medical records of EPTB patients, registered at the study site from January 1, 2015 to September 30, 2017, were reviewed to obtain the data. Final treatment outcomes among EPTB patients were evaluated in accordance with the standard Word Health Organization (WHO) criteria. Multivariate binary logistic regression analysis was used to identify the factors associated with unfavorable treatment outcome. Results A total of 651 EPTB patients were included in the study. Highest proportion of patients had pleural TB (n = 217, 33.3%). Out of the total 651 patients, 463 (71.1%) successfully completed the treatment. Among 177 (27.2%) patients with unfavorable treatment outcome, 10 (1.5%) died, while 165 (25.4%) lost to follow-up the treatment. Lymph node TB (AOR 0.65, 95% CI 0.422, 0.989) and meningeal TB (AOR 2.1, 95% CI 1.065, 4.144) were significantly associated with unfavorable treatment outcome. Conclusion The treatment success (favorable outcome) rate among EPTB patients was less than the target (i.e., ≥ 90%) set by the WHO. Highest proportion of patients lost to follow-up during the treatment.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Razia Fatima
- Research Unit, National TB Control Program, Islamabad, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy, University of Baluchistan, Quetta, Pakistan
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6
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Humphrey JM, Mpofu P, Pettit AC, Musick B, Carter EJ, Messou E, Marcy O, Crabtree-Ramirez B, Yotebieng M, Anastos K, Sterling TR, Yiannoutsos C, Diero L, Wools-Kaloustian K. Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium. Open Forum Infect Dis 2020; 7:ofaa006. [PMID: 32010735 PMCID: PMC6984675 DOI: 10.1093/ofid/ofaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain. Methods We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed. Results In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death. Conclusions There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.
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Affiliation(s)
- John M Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Philani Mpofu
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - April C Pettit
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Beverly Musick
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - E Jane Carter
- Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Eugène Messou
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Centre de Prise en Charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire
| | - Olivier Marcy
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Marcel Yotebieng
- The Ohio State University, College of Public Health, Columbus, Ohio, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Timothy R Sterling
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Lameck Diero
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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7
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Banta JE, Ani C, Bvute KM, Lloren JIC, Darnell TA. Pulmonary vs. extra-pulmonary tuberculosis hospitalizations in the US [1998-2014]. J Infect Public Health 2019; 13:131-139. [PMID: 31422038 DOI: 10.1016/j.jiph.2019.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/06/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Few studies have explored the relative burden and trends in pulmonary (PTB) vs. extra-pulmonary (EPTB) tuberculosis in the United States using a nationally representative sample. METHODS This study examined trends in hospitalization rates, length-of-stay (LOS), in-hospital mortality and inflation-adjusted charges, for PTB vs. EPTB using the Nationwide/National Inpatient Sample (NIS) from 1998 to 2014. Descriptive and multivariable analyses (linear, negative binomial and logistic) were utilized adjusting for demographics, co-morbidity and hospital characteristics. RESULTS During the study period there were a survey-adjusted, estimated 258,631 PTB (75.5%), 76,476 EPTB (22.3%) and 7552 concurrent PTB and EPTB (2.2%) discharges. Whites accounted for 27.6% of PTB, 21.9% of EPTB and 17.6% of concurrent discharges; and self-pay or no insurance accounted for 22.2%, 18.4%, and 25.9%, respectively. EPTB was more common among blacks (22.5%), and combined TB more common among Hispanics (24.8%). Mean LOS was 11.4 days, 13.2 days, and 19.5 days; with mean nominal charges of $48,031, $62,255, and $89,364 for PTB, EPTB and combined TB respectively. Inpatient mortality for all three groups was approximately 5.7%. Miliary TB and TB of meninges and central nervous system were positively associated with mortality (odds ratios of 2.44 and 2.11, respectively), as was alcohol abuse (OR 1.21). Trend analyses showed decreased hospitalizations for all TB types, no change in LOS trends, decreased mortality for PTB and ETB and increased charges for PTB and ETB from 1998 to 2014. Increased utilization, higher charges and higher risk of mortality (to some extent) among the EPTB cases warrant improved methods for screening, diagnosis and treatment. CONCLUSION Though rates of TB hospitalization are declining, EPTB is becoming relatively more common and is more costly compared to pulmonary TB. Screening methods that focus on identification of ETB contrary to current practice guidelines are needed to aid ETB case finding.
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Affiliation(s)
- Jim E Banta
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, United States.
| | - Chizobam Ani
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, United States; Department of Medicine, Charles Drew University of Medicine and Science, Los Angeles, CA 90059, United States; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States.
| | - Kushinga M Bvute
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, United States.
| | - Jan Irene C Lloren
- School of Public Health, Loma Linda University, Loma Linda, CA 92354, United States.
| | - Tunis A Darnell
- Department of Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA 92354, United States.
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8
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Khan AH, Sulaiman SAS, Laghari M, Hassali MA, Muttalif AR, Bhatti Z, Ming LC, Talpur BA. Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities. BMC Infect Dis 2019; 19:691. [PMID: 31382889 PMCID: PMC6683549 DOI: 10.1186/s12879-019-4312-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 01/06/2023] Open
Abstract
Background Extra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes. Methods A retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes. Results There were 1222 EPTB patients presenting 13.1% of all TB cases during 2006–2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231–1.028]; p = 0.05). On multivariate analysis, age group 56–65 years (1.658 [1.157–2.376]; p = 0.006), relapse cases (7.078 [1.585–31.613]; p = 0.010), EPTB-DM (1.773 [1.165–2.698]; p = 0.008), patients with no formal (2.266 [1.254–4.095]; p = 0.001) and secondary level of education (1.889 [1.085–3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311–1.746]; p < 0.001), Malays (1.251 [1.056–1.482]; p = 0.010) and Indians (1.450 [1.142–1.842]; p = 0.002), TB-HIV (3.215 [2.347–4.405]; p < 0.001), EPDM-HIV (4.361 [1.657–11.474]; p = 0.003), EPTB-HIV-HEP (4.083 [2.785–5.987]; p < 0.001), those living in urban areas (1.272 [1.109–1.459]; p = 0.001) and no formal education (1.361 [1.018–1.820]; p = 0.037). Conclusion The findings of this study extend the knowledge of EPTB epidemiology and highlight the need for improved EPTB detection in Malaysia, especially in subpopulations with high risk for EPTB and unsuccessful treatment outcomes.
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Affiliation(s)
- Amer Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Madeeha Laghari
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Abdul Razak Muttalif
- Department of Respiratory Medicine, Penang General Hospital, George Town, Penang, Malaysia
| | - Zohra Bhatti
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia.,Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Bandeh Ali Talpur
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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9
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Extra-pulmonary tuberculosis: A retrospective study of patients in Accra, Ghana. PLoS One 2019; 14:e0209650. [PMID: 30625188 PMCID: PMC6326428 DOI: 10.1371/journal.pone.0209650] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background Information on extrapulmonary TB (EPTB) patients is limited in many African countries including Ghana. The study objective was to describe the epidemiology of EPTB patients diagnosed from different categories of health facilities in Accra, Ghana compared to pulmonary TB (PTB) patients and identify risk factors for mortality among EPTB patients. Method We conducted retrospective analyses of demographic and clinical data accessed from medical records of EPTB and PTB patients from different types of health facilities from June 2010 to December 2013. Factors at diagnosis associated with EPTB compared to pulmonary TB (PTB) and factors associated with treatment outcome death among EPTB patients were assessed using logistic regression. Results Out of 3,342 new TB patients ≥15 years diagnosed, 728 (21.8%) had EPTB with a male: female ratio of 1.17. The EPTB sites commonly affected were disseminated 32.8%, pleura 21%, spine 13%, and Central Nervous System (CNS) 11%. Treatment success rate for EPTB was 70.1% compared to 84.2% for PTB (p<0.001). In logistic regression, HIV positivity (adjusted Odds Ratio [aOR] 3.19; 95% confidence interval [CI] 2.69–3.79) and female gender (aOR 1.59; 95% CI 1.35–1.88) were found to be significantly associated with EPTB compared with PTB. Older age, being HIV positive (aOR 3.15; 95% CI 1.20–8.25) and having CNS TB (aOR 3.88; 95% CI 1.14–13.23) were associated with mortality among EPTB patients. While more EPTB patients were diagnosed in the tertiary hospital, health facility type was not associated with mortality. Conclusion EPTB patients in Accra have a worse treatment outcome compared to PTB patients with mortality of EPTB being associated with HIV, older age and CNS TB. Being HIV positive and female gender were found to be significantly associated with EPTB. Increased awareness of these factors may facilitate early case finding and better management outcomes for these patients.
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10
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Time to death and risk factors among tuberculosis patients in Northern Ethiopia. BMC Res Notes 2018; 11:696. [PMID: 30286801 PMCID: PMC6172746 DOI: 10.1186/s13104-018-3806-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The main objective of this study was to assess time to death and associated risk factors among tuberculosis (TB) patients. RESULTS A total of 769 TB patients were studied and of those, 87 (11.3%) patients died. All of the deaths occurred within 7 months of anti-tuberculosis therapy. Extra-pulmonary TB (AHR = 17.376, 95% CI; 3.88-77.86, p < 0.001) as compared to pulmonary TB and cotrimoxazole prophylaxis therapy (CPT) (AHR = 0.15, 95% CI; 0.03-0.74, p = 0.02) were found to be the predictors of mortality. We noticed higher rates of mortality. Extra-pulmonary TB patients have high risk and TB-HIV co-infected patients who received CPT have low risk of death. Improving early diagnosis of extra-pulmonary TB and early CPT initiation of TB-HIV co-infected patients could minimize patient's mortality.
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11
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Rai DK, Pandey S. A Hospital-Based Cross-sectional Study on Clinico-demographic Characteristic of Extrapulmonary Tuberculosis Cases Coming to a Tertiary Hospital of Bihar. Indian J Community Med 2018; 43:122-123. [PMID: 29899614 PMCID: PMC5974828 DOI: 10.4103/ijcm.ijcm_308_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deependra Kumar Rai
- Departments of Pulmonary Medicine and Physical Medicine & Rehabilitation, AIIMS, Patna, Bihar, India
| | - Sanjay Pandey
- Departments of Pulmonary Medicine and Physical Medicine & Rehabilitation, AIIMS, Patna, Bihar, India
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12
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Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa. Epidemiol Infect 2017; 145:2500-2509. [PMID: 28748775 DOI: 10.1017/s095026881700156x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Scale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has reduced the incidence of pulmonary tuberculosis (PTB) in South Africa. Despite the strong association of HIV infection with extrapulmonary tuberculosis (EPTB), the effect of ART on the epidemiology of EPTB remains undocumented. We conducted a retrospective record review of patients initiated on treatment for EPTB in 2009 (ART coverage <5%) and 2013 (ART coverage 41%) at four public hospitals in rural Mopani District, South Africa. Data were obtained from TB registers and patients' clinical records. There was a 13% decrease in overall number of TB cases, which was similar for cases registered as EPTB (n = 399 in 2009 vs. 336 in 2013; P < 0·01) and for PTB (1031 vs. 896; P < 0·01). Among EPTB cases, the proportion of miliary TB and disseminated TB decreased significantly (both P < 0·01), TB meningitis and TB of bones increased significantly (P < 0·01 and P = 0·02, respectively) and TB pleural effusion and lymphadenopathy remained the same. This study shows a reduction of EPTB cases that is similar to that of PTB in the context of the ART scale-up. The changing profile of EPTB warrants attention of healthcare workers.
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13
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Hannah HA, Miramontes R, Gandhi NR. Sociodemographic and Clinical Risk Factors Associated With Tuberculosis Mortality in the United States, 2009-2013. Public Health Rep 2017; 132:366-375. [PMID: 28394707 DOI: 10.1177/0033354917698117] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The objectives of our study were (1) to determine risk factors associated with tuberculosis (TB)-specific and non-TB-specific mortality among patients with TB and (2) to examine whether risk factors for TB-specific mortality differed from those for non-TB-specific mortality. METHODS We obtained data from the National Tuberculosis Surveillance System and included all patients who had TB between 2009 and 2013 in the United States and its territories. We used multinomial logistic regression analysis to determine the adjusted odds ratio (aOR) of each risk factor for TB-specific and non-TB-specific mortality. RESULTS Of 52 175 eligible patients with TB, 1404 died from TB, and 2413 died from other causes. Some of the risk factors associated with the highest odds of TB-specific mortality were multidrug-resistant TB diagnosis (aOR = 3.42; 95% CI, 1.95-5.99), end-stage renal disease (aOR = 3.02; 95% CI, 2.23-4.08), human immunodeficiency virus infection (aOR = 2.63; 95% CI, 2.02-3.42), age 45-64 years (aOR = 2.57; 95% CI, 2.01-3.30) or age ≥65 years (aOR = 5.76; 95% CI, 4.37-7.61), and immunosuppression (aOR = 2.20; 95% CI, 1.71-2.83). All of these risk factors except multidrug-resistant TB were also associated with increased odds of non-TB-specific mortality. CONCLUSION TB patients with certain risk factors have an elevated risk of TB-specific mortality and should be monitored before, during, and after treatment. Identifying the predictors of TB-specific mortality may help public health authorities determine which subpopulations to target and where to allocate resources.
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Affiliation(s)
- Haylea A Hannah
- 1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Roque Miramontes
- 2 Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neel R Gandhi
- 1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Cherian JJ, Lobo I, Sukhlecha A, Chawan U, Kshirsagar NA, Nair BL, Sawardekar L. Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme. Indian J Tuberc 2017; 64:104-108. [PMID: 28410692 DOI: 10.1016/j.ijtb.2016.11.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/04/2016] [Accepted: 11/11/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Extrapulmonary tuberculosis (EPTB) constitutes 15-20% of tuberculosis cases in India. Earlier studies have evaluated treatment outcomes of EPTB with little information on outcomes of individual site of EPTB. AIMS The objective was to study the outcome of Directly Observed Treatment Short course (DOTS) treatment of EPTB in different organ systems under Revised National Tuberculosis Control Programme. METHODS Multi-centric retrospectives record review was carried out in three states in India. Data were collected from TB registers and analysed. RESULTS Of the total 2219 patients studied, there were more males in age group 15-45. The commonest sites of EPTB were lymph node (34.4%) and pleural effusion (25.2%) followed by abdominal (12.8%) and central nervous system (CNS) (9.4%). Lymph node involvement was more common in females (58%) and pleural effusion in males (70%). Overall treatment completion rate was 84% in EPTB patients. Treatment completion was 86% in HIV negative EPTB patients compared to 66% in HIV positive patients. Individually, treatment completion rate observed as follows: lymph node 90.9%, genitourinary 92.6%, bone and joint 86%, pleural effusion 84.7%, abdominal 76% and CNS (tuberculoma and meningitis) 63.7%. The site of EPTB was not recorded in 173 (7.8%) patients. CONCLUSION Treatment outcome of EPTB was poor in HIV infected patients and those with CNS tuberculosis. More efforts are needed to improve the treatment completion rates in these groups of patients.
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Affiliation(s)
- J J Cherian
- Department of Pharmacology, Government Medical College, Trivandrum 695011, Kerala, India
| | - I Lobo
- Professor, Department of Pulmonary Medicine, ESI-PGIMSR MGM Hospital, Dr. S.S. Rao Road, Parel, Mumbai 400 012, India.
| | - A Sukhlecha
- Assistant Professor in Pharmacology, Department of Pharmacology, M P Shah Medical College, Jamnagar 361008, Gujarat, India
| | - U Chawan
- Associate Professor, Department of Pediatrics, Government Medical College Nagpur, India
| | - N A Kshirsagar
- National Chair in Clinical Pharmacology, Indian Council of Medical Research, Government of India, New Delhi, India
| | - B L Nair
- Additional Professor, Department of Pharmacology, Government Medical College, Trivandrum 695011, India
| | - L Sawardekar
- Scientist E, National Institute for Research in Reproductive Health, Jehangir Merwani Street, Parel, Mumbai 400012, India
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MAGEE MJ, FOOTE M, RAY SM, GANDHI NR, KEMPKER RR. Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality. Epidemiol Infect 2016; 144:2209-16. [PMID: 26926092 PMCID: PMC5388926 DOI: 10.1017/s0950268816000364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 01/13/2023] Open
Abstract
Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ⩾16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27·8%) had any EPTB including 258 (19·5%) with only EPTB and 111 (8·4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11·9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1·04, 95% confidence interval (CI) 0·70-1·56]. The risk of death was 23·8% in patients with EPTB and diabetes vs. 9·8% in those with no diabetes (P < 0·01); after adjusting for covariates the difference was not significant (aRR 1·19, 95% CI 0·54-2·63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.
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Affiliation(s)
- M. J. MAGEE
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - M. FOOTE
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - S. M. RAY
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - N. R. GANDHI
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R. R. KEMPKER
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality. Pulm Med 2015; 2015:546106. [PMID: 26600948 PMCID: PMC4639647 DOI: 10.1155/2015/546106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/08/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR = 2.05; 95% CI = 1.15–3.65) and nonadherence to previous treatment (OR = 3.14; 95% CI = 1.96–5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14–0.76). The following risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76–3.85), coinfection with HIV (OR = 6.01, 95% CI = 3.78–9.56), illiteracy (OR = 1.88, 95% CI = 1.27–2.75), the presence of severe extrapulmonary TB (OR = 2.33, 95% CI = 1.24–4.38), and retreatment after relapse (OR = 1.95, 95% CI = 1.01–3.75). Conclusions. Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality.
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Jamtsho T, Harries AD, Malhotra S, Wangchuk D, Dophu U, Dorji T, Dendup T. The burden and treatment outcomes of extra-pulmonary tuberculosis in Bhutan. Public Health Action 2015; 3:38-42. [PMID: 26392994 DOI: 10.5588/pha.12.0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/30/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING All tuberculosis (TB) registration sites in Bhutan. DESIGN Cross-sectional study involving a retrospective review of TB registers and TB treatment cards. OBJECTIVES To determine: 1) the number and proportion of all TB cases registered as extra-pulmonary TB (EPTB) from 2001 to 2010, 2) the age and sex of the patients and the categories and types of EPTB registered in 2010, and 3) their treatment outcomes. RESULTS The proportion of all TB cases registered as EPTB over a period of 10 years varied from 30% to 40%. In 2010, 505 patients were registered with EPTB, of whom 50% were male, 21% were children, and 96% were new EPTB cases. TB lymph node enlargement and pleural effusion were the two most common types of EPTB, accounting for 67%, followed by abdominal TB and spinal/bone/kidney disease. The overall treatment success rate was 90%, and was generally similar with respect to sex, age and different types of EPTB. CONCLUSION Bhutan has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Further work is needed to better understand how EPTB is diagnosed throughout the country.
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Affiliation(s)
- T Jamtsho
- Health Management and Information System, Ministry of Health, Thimphu, Bhutan
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - S Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - D Wangchuk
- Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - U Dophu
- Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - T Dorji
- Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - T Dendup
- National Tuberculosis Control Programme, Department of Public Health, Ministry of Health, Thimphu, Bhutan
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Reis-Santos B, Gomes T, Locatelli R, de Oliveira ER, Sanchez MN, Horta BL, Riley LW, Maciel EL. Treatment outcomes in tuberculosis patients with diabetes: a polytomous analysis using Brazilian surveillance system. PLoS One 2014; 9:e100082. [PMID: 25003346 PMCID: PMC4086729 DOI: 10.1371/journal.pone.0100082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 05/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The impact of non-communicable diseases on tuberculosis incidence has received significant attention. It has been suggested that the risk of tuberculosis is higher among subjects with diabetes and these subjects also has poor TB treatment outcomes.This study was aimed at assessing the socio-demographic and clinical factors that may influence different outcome of TB in patients with DM (TB-DM) identified in the Brazilian national database from 2001 to 2011. METHODS TB-DM cases reported in the Brazilian information system were identified and compared.Covariates associated with the outcomes of interest (cure, default, deaths, and development of TB MDR) were included in a hierarchical regression model. RESULTS TB-DM cases increased from 380/100,000/year in 2001 to 6,150/100,000/year in 2011. Some of the main associations found are pointed. The odds of default was higher among those in the age group 20-39 years (OR = 2.07, 95%CI 1.32-3.24); alcoholics (OR = 2.17, 95%CI 1.86-2.54), and HIV/AIDS (OR = 2.16, 95%CI 1.70-2.74);positive monitoring smear (OR = 1.94, 95%CI 1.55-2.43); prior default (OR = 5.41, 95%CI 4.47-6.54), and unknown type of treatment (OR = 3.33, 95%CI 1.54-7.22). The odds of death was greater for subjects ≥60 years old (OR = 2.74, 95%CI 1.74-4.29); institutionalized in shelter (OR = 2.69, 95%CI 1.07-6.77); alcoholics (OR = 2.70, 95%CI 2.27-3.22); HIV/AIDS (OR = 2.87, 95%CI 2.13-3.86); pulmonary+extrapulmonary TB (OR = 2.49, 95%CI 1.79-3.46); with unknown type of treatment (OR = 14.12, 95%CI 7.04-28.32).Development of MDR TB was more related to relapse (OR = 9.60, 95%CI 6.07-15.14);previous default (OR = 17.13, 95%CI 9.58-30.63); and transfer of treatment center (OR = 7.87, 95%CI 4.74-13.07). CONCLUSIONS Older subjects and those with comorbidities and with a previous treatment of TB had poorest outcomes. TB control program in Brazil will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination.
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Affiliation(s)
- Bárbara Reis-Santos
- Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Teresa Gomes
- Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rodrigo Locatelli
- Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Elizabete R. de Oliveira
- Post-Graduate Programme in Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Mauro N. Sanchez
- Department of Public Health, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil
| | - Bernardo L. Horta
- Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Lee W. Riley
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ethel L. Maciel
- Lab-Epi UFES Laboratory of Epidemiology of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Post-Graduate Programme in Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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Ade S, Harries AD, Trébucq A, Ade G, Agodokpessi G, Adjonou C, Azon S, Anagonou S. National profile and treatment outcomes of patients with extrapulmonary tuberculosis in Bénin. PLoS One 2014; 9:e95603. [PMID: 24755603 PMCID: PMC3995824 DOI: 10.1371/journal.pone.0095603] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB). OBJECTIVE To describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment. MATERIAL AND FINDINGS This was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children <15 years (p<0.001) and HIV-positive patients (p = 0.005) with EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children <15 years represented 16% of cases, with lymph node disease being most common among them (p<0.001). Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001) with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0-14.8) while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART). HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03). CONCLUSION Patients with EPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients.
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Affiliation(s)
- Serge Ade
- National TB Programme, Cotonou, Benin
| | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arnaud Trébucq
- International Union against Tuberculosis and Lung Disease, Paris, France
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Magee MJ, Foote M, Maggio DM, Howards PP, Narayan KMV, Blumberg HM, Ray SM, Kempker RR. Diabetes mellitus and risk of all-cause mortality among patients with tuberculosis in the state of Georgia, 2009-2012. Ann Epidemiol 2014; 24:369-75. [PMID: 24613196 DOI: 10.1016/j.annepidem.2014.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/14/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate the association between diabetes mellitus (DM) and all-cause mortality during tuberculosis (TB) treatment. METHODS From 2009 to 2012, a retrospective cohort study among reported TB cases in Georgia was conducted. Patients aged 16 years or older were classified by DM and human immunodeficiency virus (HIV) status at the time of TB diagnosis and followed during TB treatment to assess mortality. Hazard ratios were used to estimate the association between DM and death. RESULTS Among 1325 patients with TB disease, 151 (11.4%) had DM, 147 (11.1%) were HIV-infected, and seven (0.5%) had both DM and HIV. Patients with TB-DM were more likely to have cavitary lung disease compared with those with TB alone (51.0% vs. 34.7%) and those with TB-HIV were more likely to have military/disseminated disease (12.9% vs. 3.4%) and resistance to rifampin or isoniazid (21.8% vs. 9.0%) compared with those without HIV infection (P < .05). In multivariable analysis, DM was not associated with death during TB treatment (hazard ratio, 1.22; 95% confidence interval, 0.70-2.12) or any death (adjusted odds ratio, 1.05; 95% confidence interval, 0.60-1.84). CONCLUSIONS Among TB patients in Georgia, the prevalence of comorbid DM and coinfection with HIV was nearly identical. In adjusted models, TB patients with DM did not have increased risk of all-cause mortality.
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Affiliation(s)
- Matthew J Magee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Mary Foote
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - David M Maggio
- Division of Health Protection, Georgia Department of Public Health, Atlanta, GA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - K M Venkat Narayan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Henry M Blumberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Susan M Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Rapid Diagnosis of Pulmonary and Extrapulmonary Tuberculosis in HIV-Infected Patients. Comparison of LED Fluorescent Microscopy and the GeneXpert MTB/RIF Assay in a District Hospital in India. Tuberc Res Treat 2012; 2012:932862. [PMID: 22966426 PMCID: PMC3433122 DOI: 10.1155/2012/932862] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/23/2012] [Indexed: 12/11/2022] Open
Abstract
HIV-related tuberculosis is difficult to diagnose and is associated with high morbidity and mortality. Recently, the World Health Organization has endorsed the GeneXpert MTB/RIF (Xpert) assay for the diagnosis of pulmonary tuberculosis in HIV-infected patients from developing countries, but information about the use of Xpert for the diagnosis of extrapulmonary tuberculosis is scarce. In this study, we compared the performance of light-emitting diode (LED) auramine fluorescent microscopy and the Xpert assay for the diagnosis of tuberculosis in HIV infected patients in a district hospital of India. Although at higher cost, Xpert outperformed LED fluorescent microscopy in all type of specimens, especially in cerebrospinal fluid where the number of positive results was increased 11 times. Pleural fluid, ascitic fluid, pus, and stool specimens also yielded positive results with the Xpert assay. When collecting two additional early-morning sputum samples, the increase of the number of positive results with the Xpert assay was lower than previously reported for HIV infected patients. Rifampicin resistance was observed in 2.2% of the cases. The results of this study show that the Xpert assay can dramatically improve the rapid diagnosis of tuberculous meningitis and other types of extrapulmonary tuberculosis of HIV infected patients.
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The PCR-Based Diagnosis of Central Nervous System Tuberculosis: Up to Date. Tuberc Res Treat 2012; 2012:831292. [PMID: 22666577 PMCID: PMC3359676 DOI: 10.1155/2012/831292] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/14/2012] [Indexed: 11/22/2022] Open
Abstract
Central nervous system (CNS) tuberculosis, particularly tuberculous meningitis (TBM), is the severest form of Mycobacterium tuberculosis (M.Tb) infection, causing death or severe neurological defects in more than half of those affected, in spite of recent advancements in available anti-tuberculosis treatment. The definitive diagnosis of CNS tuberculosis depends upon the detection of M.Tb bacilli in the cerebrospinal fluid (CSF). At present, the diagnosis of CNS tuberculosis remains a complex issue because the most widely used conventional “gold standard” based on bacteriological detection methods, such as direct smear and culture identification, cannot rapidly detect M.Tb in CSF specimens with sufficient sensitivity in the acute phase of TBM. Recently, instead of the conventional “gold standard”, the various molecular-based methods including nucleic acid amplification (NAA) assay technique, particularly polymerase chain reaction (PCR) assay, has emerged as a promising new method for the diagnosis of CNS tuberculosis because of its rapidity, sensitivity and specificity. In addition, the innovation of nested PCR assay technique is worthy of note given its contribution to improve the diagnosis of CNS tuberculosis. In this review, an overview of recent progress of the NAA methods, mainly highlighting the PCR assay technique, was presented.
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Leeds IL, Magee MJ, Kurbatova EV, del Rio C, Blumberg HM, Leonard MK, Kraft CS. Site of extrapulmonary tuberculosis is associated with HIV infection. Clin Infect Dis 2012; 55:75-81. [PMID: 22423123 DOI: 10.1093/cid/cis303] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the United States, the proportion of patients with extrapulmonary tuberculosis (EPTB) has increased relative to cases of pulmonary tuberculosis. Patients with central nervous system (CNS)/meningeal and disseminated EPTB and those with human immunodeficiency virus (HIV)/AIDS have increased mortality. The purpose of our study was to determine risk factors associated with particular types of EPTB. METHODS We retrospectively reviewed 320 cases of EPTB from 1995-2007 at a single urban US public hospital. Medical records were reviewed to determine site of EPTB and patient demographic and clinical characteristics. Multivariable logistic regression analyses were performed to determine independent associations between patient characteristics and site of disease. RESULTS Patients were predominantly male (67%), African American (82%), and US-born (76%). Mean age was 40 years (range 18-89). The most common sites of EPTB were lymphatic (28%), disseminated (23%), and CNS/meningeal (22%) disease. One hundred fifty-four (48.1%) were HIV-infected, 40% had concomitant pulmonary tuberculosis, and 14.7% died within 12 months of EPTB diagnosis. Multivariable analysis demonstrated that HIV-infected patients were less likely to have pleural (adjusted odds ratio [AOR] 0.3; 95% confidence interval [CI] .2, .6) as site of EPTB disease than HIV-uninfected patients. Among patients with EPTB and HIV-infection, patients with CD4 lymphocyte cell count <100 were more likely to have severe forms of EPTB (CNS/meningeal and/or disseminated) (AOR 1.6; 95% CI, 1.0, 2.4). CONCLUSIONS Among patients hospitalized with EPTB, patients coinfected with HIV and low CD4 counts were more likely to have CNS/meningeal and disseminated disease. Care for similar patients should include consideration of these forms of EPTB since they carry a high risk of death.
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Affiliation(s)
- Ira L Leeds
- Emory University School of Medicine, Atlanta, GA 30322, USA.
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Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies. BMC Infect Dis 2011; 11:324. [PMID: 22111760 PMCID: PMC3241214 DOI: 10.1186/1471-2334-11-324] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diseases caused by Mycobacterium tuberculosis (TB) among adult patients with hematological malignancies have rarely been investigated. METHODS Adult patients with hematological malignancies at National Taiwan University Hospital between 1996 and 2009 were retrospectively reviewed. Patients with positive serology for HIV were excluded. TB disease is diagnosed by positive culture(s) in the presence of compatible symptoms and signs. The demographics, laboratory and, microbiological features, were analyzed in the context of clinical outcomes. RESULTS Fifty-three of 2984 patients (1.78%) were diagnosed with TB disease. The estimated incidence was 120 per 100,000 adult patients with hematological malignancies. Patients with acute myeloid leukemia had a significantly higher incidence of TB disease than other subtypes of hematological malignancies (2.87% vs. 1.21%, p = 0.002, odds ratio, 2.40; 95% confidence interval, 1.39-4.41). Thirty-eight patients (72%) with non-disseminated pulmonary TB disease presented typically with mediastinal lymphadenopathy (53%), pleural effusion (47%) and fibrocalcific lesions (43%) on chest imaging. The 15 (28%) patients with extra-pulmonary disease had lower rates of defervescence within 72 h of empirical antimicrobial therapy (13% vs 45%, p = 0.03) and a higher 30-day in-hospital mortality (20% vs. 0%, p = 0.004) compared to those with disease confined to the lungs. CONCLUSIONS TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity.
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Fortún J, Martín-Dávila P, Navas E, López-Vélez R, Pintado V, Cobo J, González A, Bonilla M, Aneiros V, Gómez-Mampaso E, Moreno S. Changes in the epidemiology of tuberculosis: the influence of international migration flows. Enferm Infecc Microbiol Clin 2011; 29:654-9. [PMID: 21723001 DOI: 10.1016/j.eimc.2011.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/17/2011] [Accepted: 04/27/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The epidemiological characteristics of patients with tuberculosis (TB) in European hospitals have changed in recent years. METHODS A prospective study of patients with culture-proven pulmonary TB admitted to our institution from 1997 to 2008 is shown. RESULTS We analyzed 661 patients with pulmonary TB. An increase in the incidence of TB was confirmed during the study period (P<.001). The proportion of patients with HIV infection decreased from 26% during 1997-2000 to 12% during 2005-2008. However, the proportions of older (>40 years old) and foreign-born patients increased significantly, from 37% to 59% and from 12% to 35%, respectively. Multivariate analysis confirmed previous antituberculous therapy and immigration as factors associated with resistance to isoniazid and to isoniazid+rifampin. After the year 2000, mortality was independently associated with extrapulmonary TB (OR: 3.1; CI 95%: 1.4-7.2), hepatitis C virus infection (OR: 6.0; CI 95%: 2.2-16.3), and diabetes (OR: 6.4; CI 95%: 2.4-16.8). CONCLUSION Immigration from countries with high rates of TB infection has replaced HIV infection as the most relevant risk factor associated with TB. The increase in the number of older patients with TB and the presence of specific comorbid conditions, especially chronic liver dysfunction, could explain the more difficult management and increased mortality.
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Affiliation(s)
- Jesús Fortún
- Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
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Munseri PJ, Talbot EA, Bakari M, Matee M, Teixeira JP, von Reyn CF. The bacteraemia of disseminated tuberculosis among HIV-infected patients with prolonged fever in Tanzania. ACTA ACUST UNITED AC 2011; 43:696-701. [DOI: 10.3109/00365548.2011.577802] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Clevenbergh P, Maitrepierre I, Simoneau G, Raskine L, Magnier JD, Sanson-Le-Pors MJ, Bergmann JF, Sellier P. Lymph node tuberculosis in patients from regions with varying burdens of tuberculosis and human immunodeficiency virus (HIV) infection. Presse Med 2010; 39:e223-30. [PMID: 20646895 DOI: 10.1016/j.lpm.2010.02.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 10/29/2009] [Accepted: 02/18/2010] [Indexed: 11/26/2022] Open
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In-hospital mortality of disseminated tuberculosis in patients infected with the human immunodeficiency virus. Clin Dev Immunol 2010; 2011. [PMID: 20811589 PMCID: PMC2929489 DOI: 10.1155/2011/120278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 07/02/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a cause of significant morbidity and mortality in patients with AIDS. The goal of our study was to determine predictors of in-hospital mortality in patients with AIDS and disseminated tuberculosis in a middle-income country. MATERIAL AND METHODS We conducted a retrospective cohort study in a tertiary care center, for patients with AIDS in southern Brazil. From 1996 to 2008, all patients with the diagnosis of disseminated TB were included. RESULTS Eighty patients were included. In-hospital mortality was 35% (N = 28). On multivariate Cox regression analysis, low basal albumin (P < .01) was associated with death, and fever at admission was related to better survival (P < .01). CONCLUSION Albumin levels or fever are independent predictors of survival in patients with HIV and disseminated TB. They can serve as indirect markers of immunodeficiency in patients with disseminated TB and AIDS.
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Wang GJ, Phypers M, Ellis E. Demographic, laboratory and clinical characteristics of HIV-positive tuberculosis cases in Canada. J Infect Public Health 2009; 2:112-9. [PMID: 20701870 DOI: 10.1016/j.jiph.2009.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 07/09/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is an important risk factor for the global incidence and mortality of tuberculosis (TB) and has had a tremendous impact on the epidemiology and the control of the disease. The purpose of this study was to determine the demographic, laboratory and clinical characteristics of HIV-positive TB cases in Canada as compared to HIV-negative cases. METHODS TB cases reported to the Canadian TB Reporting System (CTBRS) from 1997 to 2006 were retrospectively reviewed and for those with known HIV serostatus, the distributions of age, sex, country of birth, smear and culture positivity, drug resistance, site of disease and treatment outcome were compared. RESULTS 2710 TB cases had a report of an HIV test with a 12.9% positivity rate. HIV-positive cases were more likely to be 30-44 years old, male, Canadian born non-Aboriginal or African born. Sputum and lymph node biopsies were significantly more likely to be smear-positive and sputum was more likely to be culture positive. Anti-TB drug resistant rates were similar, except for lower streptomycin resistance in new HIV-positive cases. HIV-positive cases were significantly more likely to present with miliary or central nervous system TB, to have multi-system disease, to have lower treatment success rates (66.4% versus 88.5%) and to have a 5.6 higher case-fatality rate. INTERPRETATION HIV-positive cases have a different demographic profile, present with more advanced and severe forms of disease, have poorer treatment outcomes and higher mortality. All TB cases should be tested for HIV so as to offer appropriate case management and treatment.
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Affiliation(s)
- G J Wang
- Anti-Tuberculosis Institute, Henan Provincial Centre for Disease Control and Prevention, 105 Nongye East Road, Zhengdong New District, Zhengzhou, Henan 450016 People's Republic of China
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HIV-associated extrapulmonary tuberculosis in Thailand: epidemiology and risk factors for death. Int J Infect Dis 2009; 13:722-9. [PMID: 19196530 DOI: 10.1016/j.ijid.2008.11.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 11/14/2008] [Accepted: 11/26/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We conducted a prospective, multicenter observational cohort study in Thailand to characterize the epidemiology of extrapulmonary tuberculosis (TB) in HIV-infected persons and to identify risk factors for death. METHODS From May 2005 to September 2006, we enrolled, interviewed, examined, and performed laboratory tests on HIV-infected adult TB patients and followed them from TB treatment initiation until the end of TB treatment. We conducted multivariate proportional hazards analysis to identify factors associated with death. RESULTS Of the 769 patients, pulmonary TB only was diagnosed in 461 (60%), both pulmonary and extrapulmonary TB in 78 (10%), extrapulmonary TB at one site in 223 (29%), and extrapulmonary TB at more than one site in seven (1%) patients. Death during TB treatment occurred in 59 of 308 patients (19%) with any extrapulmonary involvement. In a proportional hazards model, patients with extrapulmonary TB had an increased risk of death if they had meningitis, and a CD4+ T-lymphocyte count <200 cells/microl. Patients who received co-trimoxazole, fluconazole, and antiretroviral therapy during TB treatment had a lower risk of death. CONCLUSIONS Among HIV-infected patients with TB, extrapulmonary disease occurred in 40% of the patients, particularly in those with advanced immune suppression. Death during TB treatment was common, but the risk of death was reduced in patients who took co-trimoxazole, fluconazole, and antiretroviral therapy.
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Hofman A. Recent trends in publications in the European Journal of Epidemiology. Eur J Epidemiol 2008; 23:757-60. [PMID: 19039670 DOI: 10.1007/s10654-008-9305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Novel wide-range quantitative nested real-time PCR assay for Mycobacterium tuberculosis DNA: clinical application for diagnosis of tuberculous meningitis. J Clin Microbiol 2008; 46:1698-707. [PMID: 18337387 DOI: 10.1128/jcm.02214-07] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although the "gold standard" for diagnosis of tuberculous meningitis (TBM) is bacterial isolation of Mycobacterium tuberculosis, there are still several complex issues. Recently, we developed an internally controlled novel wide-range quantitative nested real-time PCR (WR-QNRT-PCR) assay for M. tuberculosis DNA in order to rapidly diagnose TBM. For use as an internal control calibrator to measure the copy number of M. tuberculosis DNA, an original new-mutation plasmid (NM-plasmid) was developed. Due to the development of the NM-plasmid, the WR-QNRT-PCR assay demonstrated statistically significant accuracy over a wide detection range (1 to 10(5) copies). In clinical applications, the WR-QNRT-PCR assay revealed sufficiently high sensitivity (95.8%) and specificity (100%) for 24 clinically suspected TBM patients. In conditional logistic regression analysis, a copy number of M. tuberculosis DNA (per 1 ml of cerebrospinal fluid) of >8,000 was an independent risk factor for poor prognosis for TBM (i.e., death) (odds ratio, 16.142; 95% confidence interval, 1.191 to 218.79; P value, 0.0365). In addition, the copy numbers demonstrated by analysis of variance statistically significant alterations (P < 0.01) during the clinical treatment course for 10 suspected TBM patients. In simple regression analysis, the significant correlation (R(2) = 0.597; P < 0.0001) was demonstrated between copy number and clinical stage of TBM. We consider the WR-QNRT-PCR assay to be a useful and advanced assay technique for assessing the clinical treatment course of TBM.
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Gerstein W. One patient, many lessons. South Med J 2007; 100:865-6. [PMID: 17902284 DOI: 10.1097/smj.0b013e3181484462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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