1
|
Kaboré OD, Millogo A, Sanogo B, Birba E, Poda A, Nacro B, Marcy O, Godreuil S, Ouédraogo AS. Analytical performances of the Xpert MTB/RIF assay using stool specimens to improve the diagnosis of pulmonary tuberculosis in Burkina Faso, a tuberculosis endemic country. PLoS One 2023; 18:e0288671. [PMID: 37523357 PMCID: PMC10389731 DOI: 10.1371/journal.pone.0288671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/01/2023] [Indexed: 08/02/2023] Open
Abstract
Timely diagnosis of Pulmonary Tuberculosis (PTB) is associated with good prognosis, but remains difficult in primary healthcare facilities and particularly in children and patients living with HIV. The aim of this study was to compare the GeneXpert ® MTB/RIF assay (Xpert) performed using a stool sample (3-5 g) and using the first Respiratory Tract Sample (RTS; i.e., sputum, bronchoalveolar or gastric aspirate; as normally done) concomitantly collected from 119 patients with suspected PTB to improve PTB diagnosis in Burkina Faso, a high tuberculosis burden country with limited resources. Overall, microbiological, microscopic and molecular analysis of the 119 first RTS and 119 stool specimens led to Mycobacterium tuberculosis complex detection in 28 patients (23 positive RTS cultures and 5 negative RTS cultures-RTS Xpert positive). When using the 28 clinical confirmed cases as reference standard, the sensitivities of the stool-based and RTS-based Xpert assays were not different (24/28, 85.7%, versus 26/28, 92.86%; p > 0.30), and 22 results were fully concordant. Considering the first RTS culture as the gold standard, the sensitivities of the stool-based and RTS-based Xpert assays to detect PTB in patients with positive RTS culture were 100% (23/23) and 91.3% (21/23), respectively (p >0.05). The stool-based Xpert assay specificity for excluding PTB was 99% (95/96) (compared with 95%, 91/96, when using RTS) and its negative and positive predictive values were 100% (95/95) and 96% (23/24), respectively. Compared with the 23 positive RTS cultures, the incremental yield rates of the RTS-based and stool-based Xpert assays were 4.2% (5/119) and 0.84% (1/119), respectively. Overall, our findings support using the stool-based Xpert assay as an alternative method for earlier PTB diagnosis, when RTS are difficult to obtain.
Collapse
Affiliation(s)
- Odilon D Kaboré
- Department of Bacteriology and Virology, Souro Sanou University Hospital, Bobo Dioulasso, Burkina Faso
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens, School of Health Sciences Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | - Anselme Millogo
- Department of Bacteriology and Virology, Souro Sanou University Hospital, Bobo Dioulasso, Burkina Faso
| | - Bintou Sanogo
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Département de Pédiatrie du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Emile Birba
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Service de Pneumologie-Phtisiologie du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens, School of Health Sciences Nazi Boni University, Bobo Dioulasso, Burkina Faso
- Service des Maladies Infectieuses du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Boubacar Nacro
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Département de Pédiatrie du Centre Hospitalier Universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Olivier Marcy
- Bordeaux Population Health Research Center Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, CHU de Montpellier, MIVEGEC (IRD, CNRS, Université de Montpellier), Montpellier, France
| | - Abdoul-Salam Ouédraogo
- Department of Bacteriology and Virology, Souro Sanou University Hospital, Bobo Dioulasso, Burkina Faso
- Superior Institute of Health Sciences, NAZI BONI University, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens, School of Health Sciences Nazi Boni University, Bobo Dioulasso, Burkina Faso
- Muraz Center, Bobo Dioulasso, Burkina Faso
| |
Collapse
|
2
|
McIvor A, Gordhan BG, Waja Z, Otwombe K, Martinson NA, Kana BD. Supplementation of sputum cultures with culture filtrate to detect tuberculosis in a cross-sectional study of HIV-infected individuals. Tuberculosis (Edinb) 2021; 129:102103. [PMID: 34144375 DOI: 10.1016/j.tube.2021.102103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/02/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
While some healthcare systems have shifted to molecular diagnostics, culture still remains the gold standard for tuberculosis diagnosis, but it is limited by its long duration to a positive result. Methods to reduce time to culture positivity (TTP) are urgently required. We determined if growth factor supplementation in the mycobacterial growth indicator tube (MGIT) culture system reduces TTP. MGITs were supplemented with fresh culture filtrate (CF) as a source of growth stimulatory molecules from axenic Mycobacterium tuberculosis culture. Different volumes of CF and media components were tested. The performance of these modified MGITs was assessed with sputum from HIV-TB co-infected individuals. Reducing the volume of MGIT cultures and removal of detergent from cultures grown to generate CF had a marginal but significant benefit on reducing TTP. In a subset of specimens, CF inhibited growth. Following optimization of methods, a reduced TTP occurred in specimens with low bacillary load as measured by GeneXpert, smear microscopy and colony forming units. Three specimens that were negative under standard conditions flagged positive following CF supplementation. Our data provide preliminary evidence that addition of CF to MGIT cultures can enhance detection of M. tuberculosis in HIV-TB co-infected patients with low sputum bacillary loads.
Collapse
Affiliation(s)
- Amanda McIvor
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, South Africa
| | - Bhavna Gowan Gordhan
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, South Africa
| | - Ziyaad Waja
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Neil A Martinson
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, South Africa; Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa; John Hopkins University, Centre for Tuberculosis Research, Baltimore, MD, USA
| | - Bavesh Davandra Kana
- DST/NRF Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, South Africa; CAPRISA, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.
| |
Collapse
|
3
|
Spener-Gomes R, Costa AG, Melo HFD, Souza ABD, Beraldi-Magalhães F, Jesus JS, Arriaga MB, Kritski A, Safe I, Andrade BB, Trajman A, Cordeiro-Santos M. Examination of respiratory specimens improves microbiological diagnosis of patients with presumptive extrapulmonary tuberculosis. Int J Infect Dis 2021; 105:743-745. [PMID: 33722683 PMCID: PMC8941595 DOI: 10.1016/j.ijid.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Bacteriological confirmation of extrapulmonary tuberculosis (EPTB) is challenging for several reasons: the paucibacillary nature of the sample; scarce resources, mainly in middle and low-income countries; the need for hospitalization; and unfavorable outcomes. We evaluated the diagnostic role of respiratory specimen examination prospectively in a cohort of patients with presumptive EPTB. METHODS From July 2018 to January 2019, in a tuberculosis (TB)/HIV reference hospital, a cohort of 157 patients with presumed EPTB was evaluated. Xpert® MTB/RIF Ultra or a culture-positive result was considered for bacteriologically confirmed TB. RESULTS Out of 157 patients with presumptive EPTB, 97 (62%) provided extrapulmonary and respiratory specimens and 60 (38%) extrapulmonary specimens only. Of the 60 patients with extrapulmonary samples, 5 (8%) were positive. Of those with respiratory and extrapulmonary samples, 27 (28%) were positive: 10 in both the respiratory and extrapulmonary samples, 6 in the extrapulmonary sample only, and 11 in the respiratory sample only. A respiratory specimen examination increased by 6-fold the chance of bacteriological confirmation of TB (odds ratio = 5.97 [1.11-47.17]). CONCLUSION We conclude that respiratory samples should be examined in patients with presumptive EPTB.
Collapse
Affiliation(s)
- Renata Spener-Gomes
- Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade Federal do Amazonas, Manaus, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade Federal do Amazonas, Manaus, Brazil; Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil
| | - Hilda Ferreira de Melo
- Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil
| | - Alexandra Brito de Souza
- Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Francisco Beraldi-Magalhães
- Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Secretaria de Estado da Saúde do Paraná, Curitiba, Brazil; Faculdades Pequeno Príncipe, Curitiba, Brazil
| | | | - María B Arriaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Afrânio Kritski
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Izabella Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Anete Trajman
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; McGill International TB Centre, McGill University, Montreal, Canada
| | - Marcelo Cordeiro-Santos
- Programa de Pós-graduação em Medicina Tropical da Universidade do Estado do Amazonas, Manaus, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade Nilton Lins, Manaus, Brazil.
| |
Collapse
|
4
|
Point-of-Care Ultrasound Predictors for the Diagnosis of Tuberculosis in HIV-Positive Patients Presenting to an Emergency Center. J Acquir Immune Defic Syndr 2020; 83:415-423. [PMID: 31904699 DOI: 10.1097/qai.0000000000002279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The performance of point-of-care ultrasound (PoCUS) to diagnose HIV-associated tuberculosis has not been evaluated in large prospective studies. We determined the diagnostic accuracy of individual PoCUS features, performed an external validation of the focused assessment with sonography for HIV/TB (FASH) protocol, and determined independent PoCUS predictors of HIV-associated tuberculosis appropriate for use by emergency center practitioners. SETTING A cross-sectional diagnostic study was performed at the emergency center of Khayelitsha Hospital (Cape Town, South Africa). METHODS HIV-positive adults with the suspicion of having tuberculosis were prospectively enrolled. PoCUS was performed according to a standardized protocol. Reference standard was the detection of Mycobacterium tuberculosis using Xpert MTB/RIF or culture. RESULTS We enrolled 414 participants: 243 female, median age 36 years, median CD4 cell count 86/mm, and 172 (42%) had tuberculosis. Sensitivity and specificity were ≥1 individual PoCUS feature [73% (95% CI: 65 to 79), 54% (95% CI: 47 to 60)], FASH protocol [71% (95% CI: 64 to 78), 57% (95% CI: 50 to 63)]. Independent PoCUS predictors identified were intra-abdominal lymphadenopathy of any size (aDOR 3.7 (95% CI: 2.0 to 6.7)], ascites [aDOR 3.0 (95% CI: 1.5 to 5.7)], and pericardial effusion of any size [aDOR 1.9 (95% CI: 1.2 to 3.0)]. The c-statistic for the derivation model was 0.680 (95% CI: 0.631 to 0.729), compared with 0.630 (95% CI: 0.576 to 0.684) of the FASH protocol. Two or more independent PoCUS predictors had 91% (95% CI: 86 to 94) specificity. CONCLUSION The presence of 2 or more independent PoCUS predictors (intra-abdominal lymphadenopathy, ascites, and pericardial effusion) had moderate discrimination for HIV-associated tuberculosis in patients presenting to the emergency center.
Collapse
|
5
|
Van Hoving DJ, Griesel R, Meintjes G, Takwoingi Y, Maartens G, Ochodo EA. Abdominal ultrasound for diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals. Cochrane Database Syst Rev 2019; 9:CD012777. [PMID: 31565799 PMCID: PMC6766789 DOI: 10.1002/14651858.cd012777.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Accurate diagnosis of tuberculosis in people living with HIV is difficult. HIV-positive individuals have higher rates of extrapulmonary tuberculosis and the diagnosis of tuberculosis is often limited to imaging results. Ultrasound is such an imaging test that is widely used as a diagnostic tool (including point-of-care) in people suspected of having abdominal tuberculosis or disseminated tuberculosis with abdominal involvement. OBJECTIVES To determine the diagnostic accuracy of abdominal ultrasound for detecting abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals.To investigate potential sources of heterogeneity in test accuracy, including clinical setting, ultrasound training level, and type of reference standard. SEARCH METHODS We searched for publications in any language up to 4 April 2019 in the following databases: MEDLINE, Embase, BIOSIS, Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Conference Proceedings Citation Index- Science (CPCI-S), and also ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform to identify ongoing trials. SELECTION CRITERIA We included cross-sectional, cohort, and diagnostic case-control studies (prospective and retrospective) that compared the result of the index test (abdominal ultrasound) with one of the reference standards. We only included studies that allowed for extraction of numbers of true positives (TPs), true negatives (TNs), false positives (FPs), and false negatives (FNs). Participants were HIV-positive individuals aged 15 years and older. A higher-quality reference standard was the bacteriological confirmation of Mycobacterium tuberculosis from any clinical specimen, and a lower-quality reference standard was a clinical diagnosis of tuberculosis without microbiological confirmation. We excluded genitourinary tuberculosis. DATA COLLECTION AND ANALYSIS For each study, two review authors independently extracted data using a standardized form. We assessed the quality of studies using a tailored Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We used the bivariate model to estimate pooled sensitivity and specificity. When studies were few we simplified the bivariate model to separate univariate random-effects logistic regression models for sensitivity and specificity. We explored the influence of the type of reference standard on the accuracy estimates by conducting separate analyses for each type of reference standard. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 11 studies. The risks of bias and concern about applicability were often high or unclear in all domains. We included six studies in the main analyses of any abnormal finding on abdominal ultrasound; five studies reported only individual lesions.The six studies of any abnormal finding were cross-sectional or cohort studies. Five of these (83%) were conducted in low- or middle-income countries, and one in a high-income country. The proportion of participants on antiretroviral therapy was none (1 study), fewer then 50% (4 studies), more than 50% (1 study), and not reported (5 studies). The first main analysis, studies using a higher-quality reference standard (bacteriological confirmation), had a pooled sensitivity of 63% (95% confidence interval (CI) 43% to 79%; 5 studies, 368 participants; very low-certainty evidence) and a pooled specificity of 68% (95% CI 42% to 87%; 5 studies, 511 participants; very low-certainty evidence). If the results were to be applied to a hypothetical cohort of 1000 people with HIV where 200 (20%) have tuberculosis then:- About 382 individuals would have an ultrasound result indicating tuberculosis; of these, 256 (67%) would be incorrectly classified as having tuberculosis (false positives).- Of the 618 individuals with a result indicating that tuberculosis is not present, 74 (12%) would be incorrectly classified as not having tuberculosis (false negatives).In the second main analysis involving studies using a lower-quality reference standard (clinical diagnosis), the pooled sensitivity was 68% (95% CI 45% to 85%; 4 studies, 195 participants; very low-certainty evidence) and the pooled specificity was 73% (95% CI 41% to 91%; 4 studies, 202 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS In HIV-positive individuals thought to have abdominal tuberculosis or disseminated tuberculosis with abdominal involvement, abdominal ultrasound appears to have 63% sensitivity and 68% specificity when tuberculosis was bacteriologically confirmed. These estimates are based on data that is limited, varied, and low-certainty.The low sensitivity of abdominal ultrasound means clinicians should not use a negative test result to rule out the disease, but rather consider the result in combination with other diagnostic strategies (including clinical signs, chest x-ray, lateral flow urine lipoarabinomannan assay (LF-LAM), and Xpert MTB/RIF). Research incorporating the test into tuberculosis diagnostic algorithms will help in delineating more precisely its value in diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement.
Collapse
Affiliation(s)
- Daniel J Van Hoving
- University of Cape Town and Stellenbosch UniversityDivision of Emergency MedicineFaculty of Health Sciences, University of Cape TownAnzio Road ObservatoryCape TownSouth Africa7701
| | - Rulan Griesel
- University of Cape TownDivision of Clinical Pharmacology, Department of MedicineCape TownSouth Africa
| | - Graeme Meintjes
- University of Cape TownDepartment of MedicineCape TownSouth Africa
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
| | - Gary Maartens
- University of Cape TownDivision of Clinical Pharmacology, Department of MedicineCape TownSouth Africa
| | - Eleanor A Ochodo
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241Cape TownSouth Africa8000
| | | |
Collapse
|
6
|
Tweed CD, Crook AM, Dawson R, Diacon AH, McHugh TD, Mendel CM, Meredith SK, Mohapi L, Murphy ME, Nunn AJ, Phillips PPJ, Singh KP, Spigelman M, Gillespie SH. Toxicity related to standard TB therapy for pulmonary tuberculosis and treatment outcomes in the REMoxTB study according to HIV status. BMC Pulm Med 2019; 19:152. [PMID: 31412895 PMCID: PMC6694514 DOI: 10.1186/s12890-019-0907-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The phase III REMoxTB study prospectively enrolled HIV-positive (with CD4+ count > 250 cells, not on anti-retroviral therapy) and HIV-negative patients. We investigated the incidence of adverse events and cure rates according to HIV status for patients receiving standard TB therapy in the trial. METHODS Forty-two HIV-positive cases were matched to 220 HIV-negative controls by age, gender, ethnicity, and trial site using coarsened exact matching. Grade 3 and 4 adverse events (AEs) were summarised by MedDRA System Organ Class. Kaplan-Meier curves for time to first grade 3 or 4 AE were constructed according to HIV status with hazard ratios calculated. Patients were considered cured if they were culture negative 18 months after commencing therapy with ≥2 consecutive negative culture results. RESULTS Twenty of 42 (47.6%) HIV-positive and 34 of 220 (15.5%) HIV-negative patients experienced ≥1 grade 3 or 4 AE, respectively. The majority of these were hepatobiliary disorders that accounted for 12 of 40 (30.0%) events occurring in 6 of 42 (14.3%) HIV-positive patients and for 15 of 60 (25.0%) events occurring in 9 of 220 (4.1%) HIV-negative patients. The median time to first grade 3 or 4 AE was 54 days (IQR 15.5-59.0) for HIV-positive and 29.5 days (IQR 9.0-119.0) for HIV-negative patients, respectively. The hazard ratio for experiencing a grade 3 or 4 AE among HIV-positive patients was 3.25 (95% CI 1.87-5.66, p < 0.01). Cure rates were similar, with 38 of 42 (90.5%) HIV-positive and 195 of 220 (88.6%) HIV-negative patients (p = 0.73) cured at 18 months. CONCLUSIONS HIV-positive patients receiving standard TB therapy in the REMoxTB study were at greater risk of adverse events during treatment but cure rates were similar when compared to a matched sample of HIV-negative patients.
Collapse
Affiliation(s)
- Conor D Tweed
- MRC Clinical Trials Unit at University College London, London, UK.
| | - Angela M Crook
- MRC Clinical Trials Unit at University College London, London, UK
| | - Rodney Dawson
- University of Cape Town Lung Institute, Cape Town, South Africa
| | | | - Timothy D McHugh
- Division of Infection and Immunity, University College London, London, UK
| | | | - Sarah K Meredith
- MRC Clinical Trials Unit at University College London, London, UK
| | - Lerato Mohapi
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Michael E Murphy
- Division of Infection and Immunity, University College London, London, UK
| | - Andrew J Nunn
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Kasha P Singh
- The Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia
| | | | | |
Collapse
|
7
|
Zhou M, Liu S, Li Q, Wang Q, Zhu M, Cao L, Wang D, Xu Y, Zheng T, Ye Q, Hu X, Zuo H, Pei X. Drug resistance characteristics of Mycobacterium tuberculosis isolates between 2014 and 2017 in Sichuan, China: A retrospective study. PLoS One 2018; 13:e0209902. [PMID: 30596768 PMCID: PMC6312223 DOI: 10.1371/journal.pone.0209902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 12/13/2018] [Indexed: 02/05/2023] Open
Abstract
Background The prevalence of drug-resistant tuberculosis (DR-TB) has brought severe challenges to the prevention and control of tuberculosis. Studies have explored the status of antituberculosis drug (ATD) resistance in different regions of China. However, few studies have focused on DR-TB in Sichuan to date. Due to the large population in Sichuan, detailed investigations of the DR-TB burden in Sichuan are needed. The objective of this study was to investigate the drug resistance characteristics of TB isolates from tuberculosis patients with and without HIV (TB-HIV patients and TBw/oHIV patients) in Chengdu, Sichuan, China. Methods Isolates from respiratory samples of TBw/oHIV patients and TB-HIV patients hospitalized between January 2014 and December 2017 were collected. Nontuberculosis mycobacteria (NTM) were excluded. Drug sensitivity testing (DST) was performed according to the dilution method in microplates with 4 first-line ATDs and 8 second-line ATDs. TB strains were separated according to patient treatment history, patient age, calendar year and GeneXpert MTB/RIF (GeneXpert) assay results for further analysis. Results For the 7470 patients recruited, the multidrug-resistant tuberculosis (MDR-TB) rate was 2.1-fold (14.6% vs. 6.8%) higher than the national baseline level. The repeatedly admitted patients were more likely to have a resistance profile than the first-time-admitted cases in both the TB-only group (P<0.05) and the TB-HIV corresponding group (P<0.05). Among the 7273 TBw/oHIV cases and 197 TB-HIV cases, the positivity rates of acid-fast bacilli (AFB) in the TB-HIV group were significantly lower than those in the TBw/oHIV group (P<0.05). The repeatedly admitted TB-HIV patients had lower resistance rates to INH than the repeatedly admitted TBw/oHIV patients (24.4% vs. 41.5%, P<0.05). The Rifampicin-resistant TB strains in the TBw/oHIV group were more likely to be resistant to INH in the repeatedly admitted group than those in the first-time admitted patients (P<0.05). The proportions of XDR (3.6% vs. 1.3%, P<0.05) and XDR-TB/MDR-TB (7.3% vs. 2.2%, P<0.05) in all TB-HIV patients were significantly higher than those in all TBw/oHIV patients. The ratio of XDR-TB was significantly higher in the TB-HIV group than in the TBw/oHIV group (30.4% vs. 9.0%, P<0.05) and the all TB group (9.0% vs. 10.1%, P<0.05). Regarding age, the <25-year-old TB-HIV patients (9.1% vs. 0.7%, P<0.05) and 25~44-year-old TB-HIV patients (5.2% vs. 2.4%, P<0.05) were more likely to have a higher XDR proportion than their TBw/oHIV counterparts. The ATD-resistance profile in terms of different years from high to low was 2014>2015>2016≈2017 for TBw/oHIV patients. The same trend was also observed for TB-HIV patients: 2014>2015>2016≈2017. The GeneXpert TB-positive rate in the TBw/oHIV group was higher than that in the TB-HIV group [81%(639/792) vs. 65% (13/20), P<0.05]. In TBw/oHIV cases, the agreement was 92.3% and the Kappa value was 0.75. In TB-HIV cases, the agreement was 85.0% and the Kappa value was 0.32. Conclusion In Sichuan, ATD resistance has improved since 2014, but to date, it remains severe. The different resistance profiles of TBw/oHIV patients and TB-HIV patients indicates the need for personalized treatment plans. Specifically, the GeneXpert assay might be more suitable for TBw/oHIV patients than for TB-HIV patients.
Collapse
Affiliation(s)
- Mi Zhou
- Department of Public Health Laboratory Sciences, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Shan Liu
- Department of Clinical Laboratory, Affiliated Hospital of University of Electronic Science and Technology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
| | - Qingfeng Li
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Qiming Wang
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Ma Zhu
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Ling Cao
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Dongmei Wang
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Yuanhong Xu
- Department of Clinical Laboratory, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - Tianli Zheng
- Department of Public Health Laboratory Sciences, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Qian Ye
- No.4 West China Teaching Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiuying Hu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Haojiang Zuo
- Department of Public Health Laboratory Sciences, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
- * E-mail: (HZ); (XP)
| | - Xiaofang Pei
- Department of Public Health Laboratory Sciences, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
- * E-mail: (HZ); (XP)
| |
Collapse
|
8
|
Vechi HT, Oliveira ETGD, Freitas MRD, Rossi F, Britto MHMFD, Alves MDM. Chronic cavitary pneumonia by Rhodococcus equi in a highly prevalent tuberculosis country: a diagnosis challenge. Rev Inst Med Trop Sao Paulo 2018; 60:e74. [PMID: 30462797 PMCID: PMC6235427 DOI: 10.1590/s1678-9946201860074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022] Open
Abstract
Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects.
Collapse
Affiliation(s)
- Hareton Teixeira Vechi
- Universidade Federal do Rio Grande do Norte, Departamento de Infectologia, Natal, Rio Grande do Norte, Brazil
| | | | - Marise Reis de Freitas
- Universidade Federal do Rio Grande do Norte, Departamento de Infectologia, Natal, Rio Grande do Norte, Brazil
| | - Flávia Rossi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão Laboratório Central, São Paulo, São Paulo, Brazil
| | | | - Manoella do Monte Alves
- Universidade Federal do Rio Grande do Norte, Departamento de Infectologia, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
9
|
Pereira GR, Barbosa MS, Dias NJD, de Almeida CPB, Silva DR. Impact of introduction of Xpert MTB/RIF test on tuberculosis (TB) diagnosis in a city with high TB incidence in Brazil. PLoS One 2018. [PMID: 29518135 PMCID: PMC5843278 DOI: 10.1371/journal.pone.0193988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Xpert MTB/RIF is increasingly used in many countries as the initial diagnostic test for tuberculosis (TB). Few studies have evaluated the effect of Xpert on TB diagnosis under programmatic conditions in Brazil. The aim of the present study was to evaluate the impact of introduction of Xpert MTB/RIF on TB diagnosis in a city with high TB incidence in Brazil. Methods We included patients evaluated with conventional diagnostic tests during one year before Xpert introduction (pre-Xpert group) and patients evaluated using Xpert during one year after the test introduction (post-Xpert group). Results 620 patients met the inclusion criteria (208 in the pre-Xpert group and 412 in the post-Xpert group) and were included in the analysis. The time until TB diagnosis was shorter in post-Xpert group (0.7 day, IQR: 0.5–1.0 day) than in pre-Xpert group (2.0 days, IQR: 2.0–2.0 days) (p<0.0001). Atypical disease characteristics, such as less weight loss, fever, dyspnea, night sweats, and hemoptysis; a negative sputum smear; a negative culture, and a chest X-ray atypical of TB were more common in post-Xpert group than in pre-Xpert group (p<0.0001 for all). Conclusions We found that the implementation of the Xpert MTB/RIF assay, under programmatic conditions, improve and facilitate TB diagnosis, especially in cases with atypical disease manifestations. These results are likely to be generalizable to settings with a similar high TB incidence.
Collapse
Affiliation(s)
- Giovana Rodrigues Pereira
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Setor de Tuberculose, Laboratório Municipal de Alvorada, Alvorada, Brazil
| | | | | | | | - Denise Rossato Silva
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
| |
Collapse
|
10
|
Van Hoving DJ, Meintjes G, Takwoingi Y, Griesel R, Maartens G, Ochodo EA. Abdominal ultrasound for diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive adults. Hippokratia 2017. [DOI: 10.1002/14651858.cd012777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel J Van Hoving
- University of Cape Town and Stellenbosch University; Division of Emergency Medicine; Faculty of Health Sciences, University of Cape Town Anzio Road Observatory Cape Town South Africa 7701
| | - Graeme Meintjes
- University of Cape Town; Department of Medicine; Cape Town South Africa
| | - Yemisi Takwoingi
- University of Birmingham; Institute of Applied Health Research; Edgbaston Birmingham UK B15 2TT
| | - Rulan Griesel
- University of Cape Town; Division of Clinical Pharmacology, Department of Medicine; Cape Town South Africa
| | - Gary Maartens
- University of Cape Town; Division of Clinical Pharmacology, Department of Medicine; Cape Town South Africa
| | - Eleanor A Ochodo
- Stellenbosch University; Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences; PO Box 241 Cape Town South Africa 8000
| |
Collapse
|
11
|
Scott L, da Silva P, Boehme CC, Stevens W, Gilpin CM. Diagnosis of opportunistic infections: HIV co-infections - tuberculosis. Curr Opin HIV AIDS 2017; 12:129-138. [PMID: 28059955 PMCID: PMC6024079 DOI: 10.1097/coh.0000000000000345] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Tuberculosis (TB) incidence has declined ∼1.5% annually since 2000, but continued to affect 10.4 million individuals in 2015, with 1/3 remaining undiagnosed or underreported. The diagnosis of TB among those co-infected with HIV is challenging as TB remains the leading cause of death in such individuals. Accurate and rapid diagnosis of active TB will avert mortality in both adults and children, reduce transmission, and assist in timeous decisions for antiretroviral therapy initiation. This review describes advances in diagnosing TB, especially among HIV co-infected individuals, highlights national program's uptake, and impact on patient care. RECENT FINDINGS The TB diagnostic landscape has been transformed over the last 5 years. Molecular diagnostics such as Xpert MTB/RIF, which simultaneously detects Mycobacterium tuberculosis (MTB) resistance to rifampicin, has revolutionized TB control programs. WHO endorsed the use of Xpert MTB/RIF in 2010 for use in HIV/TB co-infected patients, and later in 2013 for use as the initial diagnostic test for all adults and children with signs and symptoms of pulmonary TB. Line probe assays (LPAs) are recommended for the detection of rifampicin and isoniazid resistance in sputum smear-positive specimens and mycobacterial cultures. A second-line line probe assay has been recommended for the diagnosis of extensively drug-resistant (XDR)-TB Assays such as the urine lateral flow (LF)-lipoarabinomannan (LAM), can be used at the point of care (POC) and have a niche role to supplement the diagnosis of TB in seriously ill HIV-infected, hospitalized patients with low CD4 cell counts of less than 100 cells/μl. Polyvalent platforms such as the m2000 (Abbott Molecular) and GeneXpert (Cepheid) offer potential for integration of HIV and TB testing services. While the Research and Development (R&D) pipeline appears to be rich at first glance, there are actually few leads for true POC tests that would allow for earlier TB diagnosis or rapid, comprehensive drug susceptibility testing, especially when considering the very high attrition rates observed between biomarker discovery and product market entry. SUMMARY In this review, we describe diagnostic strategies specifically for HIV and TB co-infected individuals. Molecular diagnostics in particular within the past 5 years have revolutionized and 'disrupted' this field. They lend themselves to integration of services with platforms capable of polyvalent testing. Impact on patient care is, however, still debatable. What has been highlighted is the need for health system strengthening and for true POC testing that can be used in active case finding.
Collapse
Affiliation(s)
- Lesley Scott
- aDepartment of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa bNational Priority Programs, National Health Laboratory Service, Johannesburg, Gauteng, South Africa cFoundation for Innovative New Diagnostics, Geneva dGlobal TB Program, WHO, Geneva, Switzerland
| | | | | | | | | |
Collapse
|
12
|
Abstract
Despite significant improvements in the diagnosis and treatment of tuberculosis achieved during the last 3 decades, tuberculosis still remains one of the deadliest communicable diseases worldwide. Tuberculosis is still present in all regions of the world, with a more significant impact in developing countries. This article reviews the most common imaging manifestations of primary and postprimary tuberculosis, their complications, and the critical role of imaging in the diagnosis and follow-up of affected patients.
Collapse
Affiliation(s)
- Carlos Santiago Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229-3900, USA.
| | - Rashmi Katre
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229-3900, USA
| | - Amy Mumbower
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229-3900, USA
| |
Collapse
|
13
|
Maimaiti R, Zhang Y, Pan K, Mijiti P, Wubili M, Musa M, Andersson R. High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China. BMC Infect Dis 2017; 17:15. [PMID: 28056848 PMCID: PMC5217583 DOI: 10.1186/s12879-016-2152-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis and HIV co-epidemics are problems in many parts of the world. Xinjiang is a high tuberculosis and HIV prevalence area in China. We aimed to investigate the prevalence and cure rate of tuberculosis among HIV positive patients in Xinjiang. Methods In a retrospective study between 2006 and 2011, clinical and laboratory data on 333 patients with HIV and tuberculosis were compared to 2668 patients with HIV only. There were 31 HIV positive patients with no data on tuberculosis. Results The prevalence of tuberculosis co-infection among the HIV positive patients was 11% (95% CI 10–12%), significantly higher than the national figure in China of 2%. In most cases HIV was diagnosed late, with advanced immunodeficiency. The use of isoniazid preventive therapy was only 57.9% in patients without tuberculosis who fulfilled the criteria for receiving this prevention. The cure rate one year after diagnosis was 69.2%, which was lower than the officially reported 91.4% in all tuberculosis cases in Xinjiang in 2011. The hazard of not surviving over the five years was significantly higher in patients with HIV + tuberculosis compared to HIV only after adjusting for sex and Intravenous drug use with HR = 1.84 (95% CI 1.43-2.35; p < 0.0001). Conclusions The prevalence of tuberculosis among HIV positive patients in Xinjiang was higher than in China taken as a whole, and HIV was diagnosed late, with underuse of isoniazid preventive therapy. The low cure rate and reduced survival can be due to late diagnosis of HIV and no testing for antibiotic resistance, together with insufficient control of adherence to the treatment regimens for tuberculosis and HIV.
Collapse
Affiliation(s)
- Rena Maimaiti
- Department of Prevention and Health Care, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuexin Zhang
- Department of Infection Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kejun Pan
- Department of Infection Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Peierdun Mijiti
- Department of Epidemiology and Biostatistics, Xinjiang Medical University, Urumqi, China
| | - Maimaitiali Wubili
- Department of Infection Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | | | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden.
| |
Collapse
|
14
|
Abstract
BACKGROUND Tuberculosis (TB) remains a major contributor to morbidity and mortality in HIV-positive individuals, causing 1.1 million incident cases and 0.32 million deaths in 2012. Diagnosis of TB is particularly challenging in HIV-coinfected individuals, due to a high frequency of smear-negative disease, atypical presentations, and extrapulmonary TB. OBJECTIVE The aim of this article was to review the current literature on molecular diagnostics for TB with an emphasis on the performance of these diagnostic tests in the HIV-positive population. METHODS We searched the PubMed database using at least one of the terms TB, HIV, diagnostics, Xpert MTB/RIF, nucleic acid amplification tests, drug susceptibility testing, RNA transcription, and drew on World Health Organization publications. FINDINGS With increased focus on reducing TB prevalence worldwide, a new set of tools for diagnosing the disease have emerged. Molecular tools such as Xpert MTB/RIF and line-probe assays are now in use or are being rolled out in many regions. The diagnostic performance of these and other molecular assays are discussed here as they pertain to the HIV-positive population. CONCLUSIONS Molecular diagnostics offer a useful addition and at times, alternative, to traditional culture methods for the diagnosis of TB. However, most of these tests suffer from decreased accuracy in the HIV-positive population.
Collapse
|
15
|
Barnett B, Gokhale RH, Krysiak R, Kanyemba C, Chikaonda T, Bokosi M, Mukuzunga C, Saidi F, Phiri S, Hoffman IF, Hosseinipour MC. Prevalence of drug resistant TB among outpatients at an HIV/TB clinic in Lilongwe, Malawi. Trans R Soc Trop Med Hyg 2016; 109:763-8. [PMID: 26626340 DOI: 10.1093/trstmh/trv092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We sought to determine the prevalence of drug resistant TB among outpatients initiating TB treatment in Lilongwe, Malawi. METHODS This was a prospective cohort study of patients 18 years and older initiating TB treatment at Martin Preuss Centre, the primary integrated HIV/TB clinic in Lilongwe, Malawi, from April 2011 to July 2012. Procedures included questionnaires, physical exam, chest x-ray, full blood count and sputum collection. Sputum samples underwent acid-fast bacilli (AFB) smear testing and culture by Lowenstein-Jensen (LJ) and liquid Mycobacteria Growth Indicator Tube (MGIT) methods. Drug sensitivity was investigated using the Hain GenoType MTBDRplus line probe assay. RESULTS Of the 702 patients, 219 (31.2%) were female and 653 (93.0%) were presenting for first-time TB treatment. HIV co-infection was present in 420 (59.8%) cases, with 137 (32.6%) of those patients receiving antiretroviral therapy at presentation. TB was culture-confirmed in 375 (53.4%) patients, 349 of which were first time treatment and 26 retreatment. Ten cases of isoniazid-resistant TB (2.9% of culture confirmed cases of newly treated TB), one of rifampin-resistant TB (0.3% culture confirmed cases of newly treated TB) and one of multi-drug resistant TB (MDR-TB) (3.8% of culture confirmed cases of retreatment TB) were detected. CONCLUSIONS MDR-TB prevalence is low among outpatients initiating TB treatment in Lilongwe.
Collapse
Affiliation(s)
- Brian Barnett
- University of North Carolina Project, Lilongwe, Malawi Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | | | | | | | | | | | | | - Friday Saidi
- University of North Carolina Project, Lilongwe, Malawi
| | - Sam Phiri
- Light House Clinic Trust, Lilongwe, Malawi
| | - Irving F Hoffman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Mina C Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| |
Collapse
|
16
|
Campos LC, Rocha MVV, Willers DMC, Silva DR. Characteristics of Patients with Smear-Negative Pulmonary Tuberculosis (TB) in a Region with High TB and HIV Prevalence. PLoS One 2016; 11:e0147933. [PMID: 26808299 PMCID: PMC4725950 DOI: 10.1371/journal.pone.0147933] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/11/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Smear-negative pulmonary TB (SNPT) represents 30–60% of all pulmonary TB cases. The mortality of these patients can reach 25% in populations with high prevalence of HIV infection, and 10–20% of TB transmission at the population level are attributable to SNPT cases. Methods We conducted a retrospective study to evaluate epidemiological, clinical, and radiological characteristics of patients with SNPT and to compare these with patients who were diagnosed as having smear-positive pulmonary TB (SPPT). All adult patients (≥ 18 years old) with a positive culture for Mycobacterium tuberculosis, and a diagnosis of pulmonary TB were included in the study. Results 198 patients met the inclusion criteria (positive culture for Mycobacterium tuberculosis) and were included in the analysis. Of these patients, 69 (34.8%) were smear positive (SPPT) and 129 (65.2%) were smear negative (SNPT). In univariate analysis, cough, dyspnea, and hemoptysis were less frequent in SNPT patients in comparison with SPPT patients. In a multivariate model, having no cough and no radiographic pattern typical of TB were the characteristics independently associated with a diagnosis of SNPT. Conclusions We found a very high prevalence of SNPT among patients with TB in a setting with high TB and HIV prevalence. The absence of cough in the presence of other symptoms suggestive of TB, and having no radiographic pattern typical of TB where independent predictors of SNPT.
Collapse
Affiliation(s)
- Leandro Cruz Campos
- Programa de Pós-Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Brazil
| | | | | | - Denise Rossato Silva
- Programa de Pós-Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Brazil
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- * E-mail:
| |
Collapse
|
17
|
Aliyu G, El-Kamary SS, Abimiku A, Hungerford L, Obasanya J, Blattner W. Cost-effectiveness of point-of-care digital chest-x-ray in HIV patients with pulmonary mycobacterial infections in Nigeria. BMC Infect Dis 2014; 14:675. [PMID: 25495355 PMCID: PMC4269933 DOI: 10.1186/s12879-014-0675-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022] Open
Abstract
Background Chest-x-ray is routinely used in the diagnosis of smear negative tuberculosis (TB). This study assesses the incremental cost per true positive test of a point-of-care digital chest-x-ray, in the diagnosis of pulmonary mycobacterial infections among HIV patients with presumed tuberculosis undetected by smear microscopy. Methods Consecutive patients with clinical suspicion of pulmonary tuberculosis were serially tested for Human immunodeficiency virus (HIV), their sputum examined for Acid Fast Bacilli then cultured in broth and solid media. Cultures characterized as tuberculous (M.tb) and non-tuberculous (NTM) mycobacteria by Hain assays were used as gold standards. A chest-x-ray was classified as: (1) consistent for TB, (2) not consistent for TB and (3) no pathology. Results Of the 1391 suspected cases enrolled, complete data were available for 952 (68%): 753/952 (79%) had negative smear tests while 150/753 (20%) had cultures positive for TB. Of those, 82/150 (55%) had chest-x-ray signs consistent with TB and 29/82 (35%) were positive for HIV. Within the co-infected, 9/29 (31%) had NTM infections. Among all suspects, the cost per positive case detected using smear microscopy test was $52.84; the overall incremental cost per positive case using chest-x-ray in smear negatives was $23.42, and in smear negative, HIV positive patients the cost was $15.77. Conclusion Point-of-care chest-x-ray is a cost-effective diagnostic tool for smear negative HIV positive patients with pulmonary mycobacterial infection. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0675-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gambo Aliyu
- Health and Human Services, Federal Capital Territory, Abuja, Nigeria.
| | | | | | | | | | | |
Collapse
|
18
|
Oshi DC, Chukwu JN, Nwafor CC, Aguwa EN, Onyeonoro UU, Meka A, Ikebudu JN, Anyim MC, Ekeke N, Omotowo B, Ogbudebe C, Madichie NO. Diagnosis of smear-negative tuberculosis in Nigeria: Do health care workers adhere to the national guidelines? Int J Mycobacteriol 2014; 3:163-7. [PMID: 26786483 DOI: 10.1016/j.ijmyco.2014.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The study sought to assess the extent to which healthcare workers (HCWs) adhere to the National Tuberculosis Program (NTP) guidelines for the diagnosis of smear negative tuberculosis in Nigeria. METHOD This was a cross-sectional retrospective desk analysis of case files of 280 smear negative pulmonary TB in six States in southern Nigeria. RESULTS About 93% of the 280 patients had their first set of sputum smear microscopy tests done, but only 3.6% had the second set of diagnostic tests as prescribed by the NTP guidelines. Only 45.7% (128/280) received broad spectrum antibiotics after their first smear microscopy. 98% had a chest X-ray done, while 93.6% (262/280) had HIV counseling and testing (HCT), out of which 45.0% were HIV positive. Overall, only 2 patients (0.7%) were diagnosed in strict compliance with the NTP guidelines. There was no significant difference in the pattern of diagnosis of smear negative TB cases and smear positive TB cases. CONCLUSION The adherence of HCWs to the NTP guidelines for diagnosis of smear negative TB is apparently sub-optimal and needs improvement.
Collapse
Affiliation(s)
- Daniel C Oshi
- German Leprosy and TB Relief Association, Enugu, Nigeria.
| | | | | | | | | | - Anthony Meka
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Joy N Ikebudu
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Moses C Anyim
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Ngozi Ekeke
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | | | | | | |
Collapse
|
19
|
Kirenga BJ, Levin J, Ayakaka I, Worodria W, Reilly N, Mumbowa F, Nabanjja H, Nyakoojo G, Fennelly K, Nakubulwa S, Joloba M, Okwera A, Eisenach KD, McNerney R, Elliott AM, Mugerwa RD, Smith PG, Ellner JJ, Jones-López EC. Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study. PLoS One 2014; 9:e90614. [PMID: 24608875 PMCID: PMC3948371 DOI: 10.1371/journal.pone.0090614] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/02/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART.
Collapse
Affiliation(s)
- Bruce J. Kirenga
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jonathan Levin
- Medical Research Council–Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Irene Ayakaka
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
| | - William Worodria
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nancy Reilly
- Department of Medicine, New Jersey Medical School – Rutgers University, Newark, New Jersey, United States of America
| | - Francis Mumbowa
- Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Helen Nabanjja
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
| | - Grace Nyakoojo
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
| | - Kevin Fennelly
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
- Southeastern National Tuberculosis Center, Division of Mycobacteriology, Department of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Susan Nakubulwa
- Medical Research Council–Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Moses Joloba
- Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alphonse Okwera
- Medical Research Council–Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Mulago Hospital Tuberculosis Clinic, Mulago Hospital, Kampala, Uganda
| | - Kathleen D. Eisenach
- Departments of Pathology and, Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ruth McNerney
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, England
| | - Alison M. Elliott
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Medical Research Council–Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, England
| | - Roy D. Mugerwa
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
| | - Peter G. Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England
| | - Jerrold J. Ellner
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Edward C. Jones-López
- Makerere University – Boston Medical Center Research Collaboration, Kampala, Uganda
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America
| |
Collapse
|
20
|
El-Hazmi MM, Al-Otaibi FE. Predictors of pulmonary involvement in patients with extra-pulmonary tuberculosis. J Family Community Med 2012; 19:88-92. [PMID: 22870411 PMCID: PMC3410185 DOI: 10.4103/2230-8229.98287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: The aim of this study is to assess the value of chest radiographs (CXRs) and sputum examinations in detecting pulmonary involvement of tuberculosis (TB) in patients with extra-pulmonary tuberculosis (EPTB). Materials and Methods: A retrospective analysis was performed among 248 EPTB patients with culture-proven diagnosis of tuberculosis seen between January 2001 and December 2007 at a tertiary teaching hospital, Riyadh, Saudi Arabia. Demographics, clinical, laboratory and radiological findings were reviewed and assessed. This study was approved by the hospital ethics and research committee. Results: One hundred twenty five of 233 EPTB patients (53.6%) had abnormal CXR findings. There was a significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings (30/57) and those with normal CXR findings (4/17) (P = 0.04). Of 17 HIV-negative/unknown HIV-status EPTB patients with normal CXR results, 4 patients (23.5%) had positive sputum culture results. Intrathoracic lymphadenopathy (P < 0.001), pleural TB (P < 0. 001) and disseminated TB (P = 0.004) were associated with an increased risk of abnormal CXR findings. Patients with cough (52.9%), weight loss (41.2%) and night sweats (26.5%) are more likely to have positive sputum culture results. Conclusion: CXR findings are predictive of positive sputum culture results. However, the rate of normal CXR among EPTB patients with positive sputum culture results was relatively high. Therefore, respiratory specimen cultures should be obtained in TB suspects with a normal CXR to identify potentially infectious cases of TB.
Collapse
Affiliation(s)
- Malak M El-Hazmi
- Department of Microbiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | |
Collapse
|
21
|
What a Differential a Virus Makes: A Practical Approach to Thoracic Imaging Findings in the Context of HIV Infection??? Part 1, Pulmonary Findings. AJR Am J Roentgenol 2012; 198:1295-304. [DOI: 10.2214/ajr.11.8003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
22
|
The relative frequency of Mycobacterium tuberculosis and Mycobacterium avium infections in HIV positive patients, Ahvaz, Iran. ASIAN PAC J TROP MED 2012; 5:71-4. [DOI: 10.1016/s1995-7645(11)60249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/30/2011] [Accepted: 10/15/2011] [Indexed: 11/21/2022] Open
|
23
|
Yoo SD, Cattamanchi A, Den Boon S, Worodria W, Kisembo H, Huang L, Davis JL. Clinical significance of normal chest radiographs among HIV-seropositive patients with suspected tuberculosis in Uganda. Respirology 2011; 16:836-41. [PMID: 21518124 DOI: 10.1111/j.1440-1843.2011.01981.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The frequency, aetiologies and outcomes of normal chest radiographs (CXRs) among HIV-seropositive patients with suspected pulmonary tuberculosis (TB) have been infrequently described. METHODS Consecutive HIV-seropositive adults hospitalized for cough of ≥2 weeks duration at Mulago Hospital (Kampala, Uganda), between September 2007 and July 2008, were enrolled. Baseline CXRs were obtained on admission. Patients with sputum smears that were negative for acid-fast bacilli (AFB) were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii and other fungi. Patients were followed for 2 months after enrolment. RESULTS Of the 334 patients, 54 (16%) had normal CXRs. These patients were younger (median age 30 vs 34 years, P = 0.002), had lower counts of CD4+ T lymphocytes (median 13 vs 57 cells/µL, P < 0.001), and were less likely to be smear positive for AFB (17% vs 39%, P = 0.002) than those with abnormal CXRs. Pulmonary TB was the most frequent diagnosis (44%) among those with normal CXRs, followed by unknown diagnoses, pulmonary aspergillosis and pulmonary cryptococcosis. The frequency of normal CXRs was 12% among pulmonary TB patients. There was a trend towards increased 2-month mortality among patients with normal CXRs compared to those with abnormal CXRs (40% vs 29%, P = 0.15). CONCLUSIONS Normal CXR findings were common among HIV-seropositive patients with suspected TB, especially those who were young, those with low CD4+ T cell counts and those with sputum smears that were negative for AFB. Mortality was high among those with normal CXRs. Normal CXR findings should not preclude further diagnostic evaluation in this population.
Collapse
Affiliation(s)
- Samuel D Yoo
- Department of Medicine, Mulago Hospital, Makerere University (MU) MU-UCSF Research Collaboration, Kampala, Uganda
| | | | | | | | | | | | | |
Collapse
|
24
|
Achkar JM, Jenny-Avital ER. Incipient and subclinical tuberculosis: defining early disease states in the context of host immune response. J Infect Dis 2011; 204 Suppl 4:S1179-86. [PMID: 21996700 DOI: 10.1093/infdis/jir451] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Latent Mycobacterium tuberculosis infection (LTBI) and active tuberculosis (TB) are 2 ends of a spectrum of states ranging from asymptomatic infection to overt disease. While progressing from LTBI to TB, patients often undergo asymptomatic states with detectable manifestations indicative of disease. Such asymptomatic disease states frequently remain undiagnosed, and their manifestations and duration are mostly dependent on host immune response. Various terms referring to such states are used in the literature, often interchangeably and without explicit definitions. Defining these intermediate states in concrete terms is important for pragmatic reasons, as they might impact upon the diagnostic performance of TB biomarkers and could also present targets for therapeutic interventions. We here propose definitions for 2 commonly used terms, "incipient" and "subclinical" TB, to describe asymptomatic disease states occurring at opposite ends of the host response spectrum. We propose using the term "incipient TB" when referring to early, contained disease in asymptomatic, relatively immunocompetent persons. In contrast, we propose using the term "subclinical TB" to refer to disease in asymptomatic, immunocompromised individuals in whom it is largely associated with loss of effective containment. The rationale for this article is to facilitate the discussion of such early disease states, especially in relation to their impact on TB biomarker discovery and assessment of new diagnostics, and with regard to treatment decisions and ultimately outcome.
Collapse
Affiliation(s)
- Jacqueline M Achkar
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
| | | |
Collapse
|
25
|
Bonnet M. Les nouveaux tests diagnostiques de la tuberculose maladie : de la théorie à la pratique dans les pays du Sud. Rev Mal Respir 2011; 28:1310-21. [DOI: 10.1016/j.rmr.2011.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/02/2011] [Indexed: 11/16/2022]
|
26
|
Mugusi SF, Ngaimisi E, Janabi MY, Mugusi FM, Minzi OMS, Sasi PG, Bakari M, Lindquist L, Aklillu E, Sandstrom EG. Risk factors for mortality among HIV-positive patients with and without active tuberculosis in Dar es Salaam, Tanzania. Antivir Ther 2011; 17:265-74. [PMID: 22293579 DOI: 10.3851/imp1956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND The aim of this study was to describe risk factors for mortality and clinical characteristics of HIV-infected patients with and without tuberculosis (TB) coinfection. METHODS A cohort of HIV-infected patients with CD4(+) T-cell counts of ≤200 cells/μl was recruited, consisting of 255 HIV-infected patients without active TB and 231 patients with active TB. All received a well-supervised treatment with an efavirenz-based HAART, and those coinfected with TB received appropriate anti-TB treatment. They were followed up for 48 weeks after HAART initiation. RESULTS Common presenting symptoms in HIV-only patients were fever (36.5%), headache (34.5%), skin rash (34.5%) and weight loss (32%), while in HIV-TB patients the symptoms were weight loss (58%), cough (57.6%), night sweats (44.6%) and fever (34.2%). HIV-TB patients had significantly lower body mass index, Karnofsky scores and haemoglobin levels compared to those infected with HIV only, despite similar baseline CD4(+) T-cell counts. Overall, 12 (4.7%) HIV patients developed TB and 7 (3%) HIV-TB patients had worsening of their TB symptoms during the study period. Mortality was similar in the two groups, being 10.9% (16 deaths per 100 person years) and 11.3% (17 deaths per 100 person years) in HIV-only and HIV-TB patients, respectively. Overall, more males (13.1%) died compared to females (9.6%). Predictors of mortality were presence of oral candidiasis, Kaposi's sarcoma, low Karnofsky score, and low baseline white blood cell and CD4(+) T-cell counts. CONCLUSIONS The outcomes following well-supervised treatment of HIV-TB patients are similar to those in patients with HIV alone. Predictors of mortality were those of advanced disease.
Collapse
Affiliation(s)
- Sabina F Mugusi
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Angthong W, Angthong C, Varavithya V. Pretreatment and posttreatment radiography in patients with pulmonary tuberculosis with and without human immunodeficiency virus infection. Jpn J Radiol 2011; 29:554-62. [PMID: 21927997 DOI: 10.1007/s11604-011-0597-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/06/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to determine differences in pretreatment and posttreatment radiographic findings in pulmonary tuberculosis (PTB) patients with and without human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS All patients were reviewed in terms of pre- and posttreatment radiographic findings comparing non-HIV-related versus HIV-related PTB. RESULTS Among 177 PTB patients, 38 (22%) were HIV seropositive and 139 (78%) were HIV-seronegative. The most common radiographic finding in non-HIV-related TB was reticular infiltration (66.2%), whereas the miliary pattern was the most common radiographic finding in HIV-related TB (34.2%). Radiographic findings in HIV related TB significantly presented with higher prevalence of the miliary pattern (P < 0.0001) and lower prevalence of reticular infiltration (P < 0.0001), cavitation (P = 0.003), and mass-like lesions (P = 0.039) compared to non-HIV-related TB. During the posttreatment period, normal chest radiographs were significantly present in the patients who had HIV-seropositivity, the miliary pattern, and sputum negative for acid-fast bacilli during the pretreatment period (P < 0.05). CONCLUSION Pretreatment radiographic features of HIV-related TB had a significantly higher prevalence of the miliary pattern and lower prevalence of reticular infiltration, cavitation, and mass-like lesions. HIV-related TB and the miliary pattern seen by pretreatment radiography were significantly associated with normal chest radiographs during the posttreatment period.
Collapse
Affiliation(s)
- Wirana Angthong
- Department of Radiology, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, 62 Moo 7, Khlong Sip, Ongkharak, Nakhon Nayok 26120, Thailand.
| | | | | |
Collapse
|
28
|
Safety and tolerability of sputum induction in adolescents and adults with suspected pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis 2011; 31:529-37. [PMID: 21796347 DOI: 10.1007/s10096-011-1344-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
Sputum induction by the inhalation of hypertonic saline may increase the yield of microbiological diagnosis of pulmonary tuberculosis (TB). This is particularly relevant in paucibacillary TB, such as in children or human immunodeficiency virus (HIV)-infected patients. Sputum induction must be shown to be safe and tolerable in community settings where invasive diagnostic methods are unavailable. The objective of this study was to describe the changes in physiological parameters and adverse events occurring during sputum induction in ambulatory adult and adolescent TB suspects recruited in community clinics. Sputum induction was performed in HIV-infected (n = 35) and HIV-uninfected (n = 67) TB suspects (n = 102). Oxygen saturation (%), blood pressure (mm Hg), heart rate (/minute), respiratory rate (/minute), and adverse events were monitored at baseline, continuously during the salbutamol pre-treatment and saline nebulization phases, and for 30 min afterwards. During nebulization, there was a statistically significant increase in oxygen saturation (1%, p < 0.0001), systolic BP (7 mm Hg, p < 0.0001), and diastolic BP (2 mm Hg, p = 0.008). Post-nebulization decrease in the systolic BP occurred (4 mm Hg, p = 0.016). These changes were not considered to be clinically significant. Eight minor, transitory, self-resolving adverse events occurred (labored breathing, n = 2; chest pain, n = 2; paroxysmal coughing, n = 1; elevated heart rate, n = 1; vomiting, n = 1; hypotension, n = 1), leading to procedure termination in four participants. No serious adverse events occurred. Induced sputum is safe, tolerable, and feasible in adult and adolescent TB suspects in a community healthcare setting.
Collapse
|
29
|
Chartier L, Leng C, Sire JM, Le Minor O, Saman M, Bercion R, Rahalison L, Fontanet A, Germany Y, L'her P, Mayaud C, Vray M. Factors associated with negative direct sputum examination in Asian and African HIV-infected patients with tuberculosis (ANRS 1260). PLoS One 2011; 6:e21212. [PMID: 21731675 PMCID: PMC3121737 DOI: 10.1371/journal.pone.0021212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 05/23/2011] [Indexed: 11/19/2022] Open
Abstract
Objective To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. Design Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic. Methods Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. Results Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm3. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1–7.0]), dyspnea (OR = 2.5 [95%CI:1.1–5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3–7.6]), but was less frequent with CD4≤50/mm3 (OR = 0.4 [95%CI:0.2–0.90), adenopathies (OR = 0.4 [95%CI:0.2–0.93]) and cavitation (OR = 0.1 [95%CI:0.03–0.6]). Conclusions One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial burden.
Collapse
|
30
|
Shah NS, Moodley P, Babaria P, Moodley S, Ramtahal M, Richardson J, Heysell S, Li X, Moll A, Friedland G, Sturm AW, Gandhi NR. Rapid Diagnosis of Tuberculosis and Multidrug Resistance by the Microscopic-Observation Drug-Susceptibility Assay. Am J Respir Crit Care Med 2011; 183:1427-33. [DOI: 10.1164/rccm.201009-1449oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
31
|
Almeida LAD, Barba MF, Moreira FA, Bombarda S, Felice SAD, Calore EE. Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000100007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Foram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em 31 (68,8%) dos casos, derrame pleural em 29 (64,4%), nódulos centrolobulares de distribuição segmentar em 26 (57,7%), consolidação em 24 (53,3%), confluência de micronódulos em 17 (37,7%), nódulos mal definidos com distribuição centrolobular em 16 (35,5%), padrão de "árvore em brotamento" em 13 (28,9%), espessamento de parede brônquica em 12 (26,6%), cavidade de parede espessa em 10 (22,2%), nódulos miliares em 9 (20%) e bronquiectasias cilíndricas em 6 (13,3%). Dos 45 pacientes, 35 (77,8%) apresentaram CD4 < 200 cel/mm³ e 10 (22,2%) apresentaram CD4 > 200 cel/mm³. CONCLUSÃO: Concluímos que neste estudo, diversamente do descrito na literatura, linfonodomegalia mediastinal e/ou hilar e consolidação foram significativamente mais frequentes em pacientes com CD4 > 200 cel/mm³. No entanto, linfonodos com centro hipodenso foram mais frequentemente observados em pacientes com severa imunodepressão, ou seja, CD4 < 200 cel/mm³.
Collapse
|
32
|
Performance of abdominal ultrasound for diagnosis of tuberculosis in HIV-infected persons living in Cambodia. J Acquir Immune Defic Syndr 2011; 55:500-2. [PMID: 20574410 DOI: 10.1097/qai.0b013e3181e6a703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In resource-limited settings, abdominal ultrasound is often used to assist the diagnosis of tuberculosis (TB) in people with HIV (PLHIV), although data on performance characteristics are missing. METHODS Cross-sectional study of PLHIV in Cambodia receiving a standardized TB diagnostic evaluation, including history, physical examination, chest radiography, microscopy and culture of various specimens, and abdominal ultrasound. Patients with at least one specimen culture positive for Mycobacterium tuberculosis were classified as having TB. RESULTS TB was diagnosed in 37 (18%) of 212 PLHIV. Abdominal ultrasound was abnormal in 15 of 37 (41%) patients with TB compared with 14 of 175 (8%) without TB (P < 0.01). Predictors of TB disease included multiple enlarged (1.2 cm or greater) abdominal lymph nodes on ultrasound (adjusted odds ratio [OR], 6.4; 95% confidence interval [CI], 1.8-22.4), abnormal chest radiography (OR, 6.8; CI, 2.7-17.0), anorexia (OR, 4.6; CI, 1.8-11.7), and CD4 less than 200 cells/mm (OR, 3.3; CI, 1.2-9.1). Having multiple enlarged abdominal lymph nodes on ultrasound was 97.1% (CI, 93.5%-99.1%) specific for TB with a positive likelihood ratio of 11.4 (CI, 4.3-30.3). CONCLUSIONS Abdominal ultrasound is a useful diagnostic test for TB disease in PLHIV, increasing the posttest probability of TB when multiple enlarged abdominal lymph nodes are visualized. Its wider use may accelerate access to TB treatment, potentially reducing mortality in PLHIV.
Collapse
|
33
|
Is spinal tuberculosis contagious? Int J Infect Dis 2010; 14:e659-66. [DOI: 10.1016/j.ijid.2009.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 07/18/2009] [Accepted: 11/04/2009] [Indexed: 11/23/2022] Open
|
34
|
Aderaye G, G/Egziabher H, Aseffa A, Worku A, Lindquist L. Comparison of acid-fast stain and culture for Mycobacterium tuberculosis in pre- and post-bronchoscopy sputum and bronchoalveolar lavage in HIV-infected patients with atypical chest X-ray in Ethiopia. Ann Thorac Med 2010; 2:154-7. [PMID: 19727366 PMCID: PMC2732096 DOI: 10.4103/1817-1737.36549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 07/14/2007] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND: Smear-negative tuberculosis occurs more frequently in human immunodeficiency virus (HIV)-infected patients than in non-HIV-infected patients. Besides, there are substantial numbers of patients who cannot produce sputum, making the diagnosis of pulmonary tuberculosis (PTB) difficult. AIMS: To evaluate the relative yield of pre- and post-bronchoscopy sputum and bronchoalveolar lavage (BAL) in ‘sputum smear’-negative, HIV-positive patients. SETTINGS: A tertiary care referral hospital in Addis Ababa. MATERIALS AND METHODS: Acid-fast stain (AFS) using the concentration technique was done on 85 pre-bronchoscopy sputum and 120 BAL samples. Direct AFS was done on all BAL and 117 post-bronchoscopy sputum samples. Culture for Mycobacterium tuberculosis (MTB) was done for all sputa and BAL. RESULTS: MTB was isolated from 26 (21.7%), 23 (19.7%) and 13 (15.3%) of BAL, post- and pre-bronchoscopy sputum cultures respectively. AFS on pre-bronchoscopy sputum using concentration technique and direct AFS on BAL together detected 11 (41%) of the 27 culture-positive cases. In patients who could produce sputum, the sensitivity of pre-bronchoscopy sputum culture (13/85, 15.3%) was comparable to BAL (12/85, 14%) and post-bronchoscopy sputum (12/85, 14%). In patients who could not produce sputum, however, both BAL (12/35, 40%) and post-bronchoscopy sputum (12/32, 31.4%) detected significantly more patients than those who could produce sputum (P=0.002, P=0.028 respectively). CONCLUSION: In HIV-infected patients, AFS by concentration method on pre-bronchoscopy sputum and direct AFS on BAL in patients who cannot produce sputum are the preferred methods of making a rapid diagnosis. BAL culture seems to add little value in patients who can produce sputum; therefore, bronchoscopy should be deferred under such circumstances.
Collapse
Affiliation(s)
- Getachew Aderaye
- Department of Internal Medicine, Medical Faculty, Addis Ababa University, Ethiopia.
| | | | | | | | | |
Collapse
|
35
|
Reddy KP, Brady MF, Gilman RH, Coronel J, Navincopa M, Ticona E, Chavez G, Sánchez E, Rojas C, Solari L, Valencia J, Pinedo Y, Benites C, Friedland JS, Moore DAJ. Microscopic observation drug susceptibility assay for tuberculosis screening before isoniazid preventive therapy in HIV-infected persons. Clin Infect Dis 2010; 50:988-96. [PMID: 20192727 PMCID: PMC2947458 DOI: 10.1086/651081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Active tuberculosis (TB) must be excluded before initiating isoniazid preventive therapy (IPT) in persons infected with human immunodeficiency virus (HIV), but currently used screening strategies have poor sensitivity and specificity and high patient attrition rates. Liquid TB culture is now recommended for the detection of Mycobacterium tuberculosis in individuals suspected of having TB. This study compared the efficacy, effectiveness, and speed of the microscopic observation drug susceptibility (MODS) assay with currently used strategies for TB screening before IPT in HIV-infected persons. METHODS A total of 471 HIV-infected IPT candidates at 3 hospitals in Lima, Peru, were enrolled in a prospective comparison of TB screening strategies, including laboratory, clinical, and radiographic assessments. RESULTS Of 435 patients who provided 2 sputum samples, M. tuberculosis was detected in 27 (6.2%) by MODS culture, 22 (5.1%) by Lowenstein-Jensen culture, and 7 (1.6%) by smear. Of patients with any positive microbiological test result, a MODS culture was positive in 96% by 14 days and 100% by 21 days. The MODS culture simultaneously detected multidrug-resistant TB in 2 patients. Screening strategies involving combinations of clinical assessment, chest radiograph, and sputum smear were less effective than 2 liquid TB cultures in accurately diagnosing and excluding TB (P<.01). Screening strategies that included nonculture tests had poor sensitivity and specificity. CONCLUSIONS MODS culture identified and reliably excluded cases of pulmonary TB more accurately than other screening strategies, while providing results significantly faster than Lowenstein-Jensen culture. Streamlining of the ruling out of TB through the use of liquid culture-based strategies could help facilitate the massive up-scaling of IPT required to reduce HIV and TB morbidity and mortality.
Collapse
Affiliation(s)
- Krishna P Reddy
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Gadkowski LB, Hamilton CD, Allen M, Fortenberry ER, Luffman J, Zeringue E, Stout JE. HIV-specific health care utilization and mortality among tuberculosis/HIV coinfected persons. AIDS Patient Care STDS 2009; 23:845-51. [PMID: 19803793 DOI: 10.1089/apc.2009.0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Persons coinfected with tuberculosis (TB) and HIV are at high risk of death, in part due to suboptimal utilization of HIV-specific health care. We sought to better understand HIV-associated health care utilization and mortality in a retrospective cohort of TB/HIV coinfected cases reported in North Carolina 1993-2003. In this cohort, HIV was newly diagnosed during TB presentation for 34.2% of coinfected patients. Patients had advanced HIV (median CD4 104 cells/mm(3)) at TB diagnosis. Of 260 patients previously known to be HIV positive, 32.3% had seen a physician for HIV care in the previous 6 months and only 18.5% were taking antiretrovirals when TB was diagnosed; 34.8% of patients started antiretrovirals during TB treatment. Twenty-seven (5%) patients died prior to starting TB treatment; of those who survived, 13.6% (70/515) died prior to completing TB treatment, and 42.7% (220/515) died during a median 1408 days of follow-up. CD4 count (relative risk [RR] 0.53 per 100 cell increase, 95% confidence interval [CI] 0.34, 1.02) and highly active antiretroviral therapy (HAART) use during TB therapy (RR 0.37, 95% CI 0.13, 1.02) were independently associated with decreased mortality, while age greater than 45 (RR 2.18, 95% CI 1.11, 4.29) was independently associated with increased mortality during TB treatment. We conclude that TB/HIV coinfected patients had low utilization rates of HIV-specific care prior to TB diagnosis. Many did not receive potentially lifesaving HIV treatment while on TB therapy, and mortality was high as a result. Interventions to enhance utilization of HIV-related health care and integration of TB and HIV services should be studied to improve outcomes.
Collapse
Affiliation(s)
- L. Beth Gadkowski
- Division of Infectious Diseases and International Health, Health, Duke University Medical Center, Durham, North Carolina
| | - Carol D. Hamilton
- Division of Infectious Diseases and International Health, Health, Duke University Medical Center, Durham, North Carolina
| | - Myra Allen
- North Carolina Tuberculosis Control Program, Raleigh, North Carolina
| | | | - Julie Luffman
- North Carolina Tuberculosis Control Program, Raleigh, North Carolina
| | | | - Jason E. Stout
- Division of Infectious Diseases and International Health, Health, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
37
|
Reid MJA, Shah NS. Approaches to tuberculosis screening and diagnosis in people with HIV in resource-limited settings. THE LANCET. INFECTIOUS DISEASES 2009; 9:173-84. [PMID: 19246021 DOI: 10.1016/s1473-3099(09)70043-x] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tuberculosis is the main cause of morbidity and mortality in people living with HIV/AIDS worldwide. Early diagnosis and treatment is essential to addressing the dual epidemic of tuberculosis and HIV. Increasing recognition of the importance of integrating tuberculosis services--including screening--into HIV care has led to global policies and the beginnings of implementation of joint activities at the national level. However, debate remains about the best methods of screening for pulmonary tuberculosis among people living with HIV/AIDS in resource-limited settings. Mycobacterial culture, the gold standard for tuberculosis diagnosis, is too slow and complex to be a useful screening test in such settings. More widely available methods, such as symptom screening, sputum smear microscopy, chest radiography, and tuberculin skin testing have important shortcomings, especially in people living with HIV/AIDS. However, until simpler, cheaper, and more sensitive diagnostics for tuberculosis are available in peripheral healthcare settings, a strategy must be developed that uses current evidence to combine available screening tools.
Collapse
Affiliation(s)
- Michael J A Reid
- Department of Social Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | | |
Collapse
|
38
|
Janossy G, Barry SM, Breen RAM, Hardy GAD, Lipman M, Kern F. The role of flow cytometry in the interferon-gamma-based diagnosis of active tuberculosis and its coinfection with HIV-1--A technically oriented review. CYTOMETRY PART B-CLINICAL CYTOMETRY 2008; 74 Suppl 1:S141-51. [PMID: 18061950 DOI: 10.1002/cyto.b.20381] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
TB remains uncontrolled. In resource-rich countries, only approximately 60% of diagnoses are confirmed by culture. The number is lower in resource-poor environments. Huge scope therefore exists for alternative diagnostic strategies. Counting antigen-specific lymphocytes by virtue of cytokine production following 8-16 h stimulation with tuberculosis antigens is currently the strategy of choice. Several methods exist, including ELISA, ELISpots, and flow cytometry. Although it is clear that blood samples stimulated by ESAT-6 and CFP-10 antigens discriminate between TB infection and BCG vaccination, it is flow-cytometry that seems to be able to distinguish active TB disease from mere TB exposure. Of the various flow-protocols including four-color tests (CD45-CD3-CD4-IFNgamma), three-color tests (CD3-CD4-IFNgamma) and two-color tests (CD4-IFNgamma), even the simplest is performing well, provided that the results are expressed as percentage of IFN-gamma+ cells per CD4+ lymphocytes (%IFNgamma/CD4+). Studies using broncho-alveloar lavage (BAL) and Induced-Sputum (ISp) show that TB-specific CD4+IFN-gamma+ T cells accumulate in the lung in pulmonary and extra-pulmonary TB at frequencies >5-20-fold more frequent than in blood. This pulmonary homing is absent following BCG immunization. The use of PPD to stimulate CD4+IFN-gamma+ cells in the lung in active TB leads to >3-12-fold greater responses than seen with CFP-10 or ESAT-6, and any interference from BCG vaccination is absent. This method is unaffected by HIV coinfection, which has always been the problem for other immune-based diagnostics. Further, lung-based samples provide material for rapid tests of both the IFN-gamma assay and bacteriology, and importantly, these tests are amenable for future simplification with automated fluorescence-image cytometers.Another development of the multiparameter analytical power of flow-cytometry is to use markers for "lung-seeking" populations of CD4+ T cells in blood, obviating lung sampling. In active TB, but not in BCG vaccinees, TB-specific memory CD4+ T cells can be found in blood that are dominantly CD27-negative and probably lung seeking and can be diagnostically useful.
Collapse
Affiliation(s)
- George Janossy
- Department of Immunology, Royal Free and University College Medical School, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
39
|
Arend SM, Leyten EMS, Franken WPJ, Huisman EM, van Dissel JT. A Patient with De Novo Tuberculosis during Anti-Tumor Necrosis Factor-- Therapy Illustrating Diagnostic Pitfalls and Paradoxical Response to Treatment. Clin Infect Dis 2007; 45:1470-5. [DOI: 10.1086/522993] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 07/13/2007] [Indexed: 01/14/2023] Open
|
40
|
Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics 2007; 27:1255-73. [PMID: 17848689 DOI: 10.1148/rg.275065176] [Citation(s) in RCA: 256] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tuberculosis has shown a resurgence in nonendemic populations in recent years, a phenomenon that has been attributed to factors such as increased migration and the human immunodeficiency virus epidemic. Although the thorax is most frequently involved, tuberculosis may involve any of a number of organ systems (eg, the respiratory, cardiac, central nervous, musculoskeletal, gastrointestinal, and genitourinary systems), and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity. Unfortunately, a history of infection with or exposure to tuberculosis may or may not be present, and evidence of active tuberculosis is present in less than 50% of cases. A negative tuberculin skin test does not in itself exclude infection. Furthermore, the clinical and radiologic features of tuberculosis may mimic those of many other diseases. Therefore, although in many cases biopsy or culture specimens are required to make the definitive diagnosis, it is imperative that radiologists and clinicians understand the typical distribution, patterns, and imaging manifestations of tuberculosis.
Collapse
Affiliation(s)
- Joshua Burrill
- Department of Radiology, Central Middlesex Hospital, London, England, UK
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
While microscopy and culture are still the major backbone for laboratory diagnosis of tuberculosis (TB), new methods including molecular diagnostic tests have evolved over the last two decades. The majority of molecular tests have been focused on: (i) detection of nucleic acids both DNA and RNA, which are specific to Mycobacterium tuberculosis, by amplification techniques such as polymerase chain reaction (PCR); and (ii) detection of mutations in the genes which are associated with resistance to anti-tuberculosis drugs by sequencing or nucleic acid hybridization. In the session of the conference on diagnosis of TB, there were two presentations: one on the development of new diagnostic tools for drug resistant M. tuberculosis, and the other on issues involved in the application of new diagnostic tools for multidrug resistant (MDR)-TB, pediatric TB and HIV-TB.
Collapse
Affiliation(s)
- Sang-Nae Cho
- Department of Microbiology, Yonsei University College of Medicine, 134 Shinchon-dong, Seoul 120-752, South Korea.
| | | |
Collapse
|
42
|
Lawson L, Yassin MA, Ramsay A, Emenyonu EN, Thacher TD, Davies PDO, Squire SB, Cuevas LE. Short-term bleach digestion of sputum in the diagnosis of pulmonary tuberculosis in patients co-infected with HIV. Tuberculosis (Edinb) 2007; 87:368-72. [PMID: 17392025 DOI: 10.1016/j.tube.2007.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 01/23/2007] [Accepted: 02/01/2007] [Indexed: 11/20/2022]
Abstract
The bleach digestion of sputum may improve the yield of smear microscopy but has not been validated in patients with HIV. Therefore we assessed the performance of bleach-digested smear microscopy among patients with HIV. One thousand three hundred and twenty one patients with chronic cough submitted three sputum samples for direct smear microscopy and were offered HIV tests. One sample was selected for a bleach-digested smear and another one was cultured. Patients were classified as having 'definite' (>or=2 positive smears), 'very likely' (smear-negative, culture- positive), 'less likely' (one smear-positive, culture-negative) and 'unlikely' (smear and culture negative) tuberculosis (TB). In all, 566/1045 (54%) patients were HIV positive and 731/1186 (62%) were culture positive. The digested smears were positive in 123/125 (98%) 'definite', 4/118 (3%) 'very likely' and 1/174 'unlikely' TB patients with HIV and in 125/127 (98%) 'definite', 2/74 (3%) 'very likely', 4/4 'less likely' and 2/127 'unlikely' TB without HIV. Three direct smears identified 252 (57%) and one digested smear 254 (57%) of the 444 patients with 'definite' or 'very likely' TB. One bleach-digested smear performed similarly to three direct smears. Both methods were less sensitive in HIV-positive patients. Further studies are needed to compare the performance of the two methods under operational conditions.
Collapse
Affiliation(s)
- L Lawson
- Zankli Medical Centre, Plot 1021, B5 Shehu Yar'adua Way, Abuja, Nigeria
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Getahun H, Harrington M, O'Brien R, Nunn P. Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes. Lancet 2007; 369:2042-2049. [PMID: 17574096 DOI: 10.1016/s0140-6736(07)60284-0] [Citation(s) in RCA: 346] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The HIV epidemic has led to large increases in the frequency of smear-negative pulmonary tuberculosis, which has poor treatment outcomes and excessive early mortality compared with smear-positive disease. We used a combination of systematic review, document analysis, and global expert opinion to review the extent of this problem. We also looked at policies of national tuberculosis control programmes for the diagnosis of smear-negative pulmonary tuberculosis to assess their coverage, identify the diagnostic difficulties, and find ways to improve the diagnosis of this type of tuberculosis, with a focus on resource-constrained settings with high HIV infection rates. We propose that the internationally recommended algorithm for the diagnosis of smear-negative pulmonary tuberculosis should be revised to include HIV status, severity of AIDS and tuberculosis, and early use of chest radiography in the decision tree. Increased use of promising methods of diagnosis such as sputum liquefaction and concentration and increased availability of fluorescence microscopy should be explored and encouraged. Culturing of sputum in resource-constrained settings with high HIV infection rates should also be encouraged, existing facilities should be made full use of and upgraded, and effective quality-assurance systems should be used. Innovative ways to address human resources issues involved in addressing the diagnostic difficulties are also needed. The development of rapid, simple, and accurate tuberculosis diagnostic tools with applicability at point of care and remote location is essential. To achieve these goals, greater political commitment, scientific interest, and investment are needed.
Collapse
Affiliation(s)
| | | | - Rick O'Brien
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Paul Nunn
- Stop TB Department, WHO, Geneva, Switzerland
| |
Collapse
|
44
|
|
45
|
Guwatudde D, Debanne SM, Diaz M, King C, Whalen CC. A re-examination of the potential impact of preventive therapy on the public health problem of tuberculosis in contemporary sub-Saharan Africa. Prev Med 2004; 39:1036-46. [PMID: 15475039 PMCID: PMC2860297 DOI: 10.1016/j.ypmed.2004.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To estimate the effect size of tuberculosis preventive therapy (PT) on the public health problem of tuberculosis in contemporary sub-Saharan Africa. METHODS A compartmental flow model that considers high levels of tuberculosis and human immunodeficiency virus (HIV) infection in contemporary sub-Saharan Africa was used to assess the impact of PT on the prevalence of tuberculosis and tuberculosis-associated mortality. RESULTS Model implementation shows that giving PT to 25% of HIV-positive individuals with latent tuberculosis infection (LTBI) leads to a 3.9% reduction in the prevalence of tuberculosis in 10 years and a 5.1% reduction in 20 years. This intervention also prevents a cumulative total of 3.0% of tuberculosis-associated deaths in a decade and 5.5% in two decades. Doubling PT coverage to 50% approximately doubles the effect size, suggesting a linear relationship within the 20-year period. The effect size is slightly sensitive to changes in level of HIV transmission, level of tuberculosis transmission, and level of case detection and treatment cure rates in the population. CONCLUSIONS Contrary to suggestions by previous authors that PT can significantly reduce the public health problem of tuberculosis in sub-Saharan Africa, this model-based analysis suggests that the impact of PT on tuberculosis in the population is likely to be small.
Collapse
Affiliation(s)
- D Guwatudde
- Department of Epidemiology and Biostatistics, Institute of Public Health, Makerere University, Kampala, Uganda.
| | | | | | | | | |
Collapse
|