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Teo AKJ, Morishita F, Islam T, Viney K, Ong CW, Kato S, Kim H, Liu Y, Oh KH, Yoshiyama T, Ohkado A, Rahevar K, Kawatsu L, Yanagawa M, Prem K, Yi S, Tran HTG, Marais BJ. Tuberculosis in older adults: challenges and best practices in the Western Pacific Region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100770. [PMID: 37547037 PMCID: PMC10398605 DOI: 10.1016/j.lanwpc.2023.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 08/08/2023]
Abstract
The Western Pacific has one of the fastest-growing older adult populations globally, and tuberculosis (TB) remains one of the foremost infectious causes of disease and death in the region. Older adults are at higher risk of TB due to immunosenescence, comorbidities, and increased institutionalisation. Atypical symptoms and reduced access to health services may delay care-seeking and TB diagnosis, while co-morbidity and increased risk of adverse drug reactions complicate TB treatment. Post-TB sequelae and socioeconomic challenges may decrease the quality of life after TB treatment completion. Despite their high disease burden and special challenges, there is a lack of regionally coordinated policies and guidelines to manage TB among older adults. Routine TB screening at aged-care facilities, age-friendly infrastructure and services, awareness of atypical TB features, integration of TB and non-communicable diseases services, and person-centred approaches to treatment support could improve TB management among older adults. Addressing these challenges and adopting the best practices identified should inform policy formulation and implementation. Funding This project was funded by 1) the World Health Organization Regional Office for the Western Pacific, with financial contributions from the Government of the Republic of Korea through the Korean Disease Control and Prevention Agency and the Government of Japan through the Ministry of Health, Labour and Welfare, and 2) NUS Start-up Grant. The funders had no role in the paper design, collection, analysis, and interpretation of data and in writing of the paper.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
| | - Fukushi Morishita
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Tauhid Islam
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- World Health Organization, Global Tuberculosis Programme, Geneva, Switzerland
| | - Catherine W.M. Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Seiya Kato
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - HeeJin Kim
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Yuhong Liu
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Kyung Hyun Oh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Takashi Yoshiyama
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kalpeshsinh Rahevar
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Lisa Kawatsu
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Manami Yanagawa
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA, USA
| | - Huong Thi Giang Tran
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Ben J. Marais
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW, Australia
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Zenatti G, Raviglione M, Tesfaye F, Bobosha K, Björkman P, Walles J. High variability in tuberculosis treatment outcomes across 15 health facilities in a semi-urban area in central Ethiopia. J Clin Tuberc Other Mycobact Dis 2023; 30:100344. [PMID: 36578805 PMCID: PMC9791025 DOI: 10.1016/j.jctube.2022.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Despite reported tuberculosis (TB) treatment success rate of 86%, TB remains a leading cause of death in Ethiopia. We investigated patient and provider-specific factors associated with unfavorable treatment outcomes in Ethiopian health facilities providing TB care. Methods Data on characteristics and treatment outcomes of patients registered for TB treatment at 15 public health facilities (4 hospitals and 11 health centres) were collected from clinic registers. Proportions of unfavorable outcomes (defined as deaths, loss-to-follow-up [LTFU] and treatment failure), were compared across facilities using multivariable logistic regression, with separate analyses for death and LTFU. Results Among 3359 patients (53.5 % male, median age 28 years, 19.6 % HIV-positive), 296 (8.8 %) had unfavorable treatment outcome. Proportions of unfavorable outcomes across facilities ranged from 2.0 % to 21.1 % (median 8.3 %). Median proportions of death and LTFU among facilities were 3.3 % (range 0-10.9 %) and 2.6 % (range 0.6 %-19.2 %), respectively. Three facilities had significantly higher rates of LTFU, whereas two facilities had higher rates of death. The two facilities with full-time TB-nurses had higher proportions of successful outcomes (95.2 % vs 90.1 %, adjusted odds ratio 2.27, p < 0.0001). Conclusion Substantial variability of TB treatment outcomes was observed across the assessed health facilities providing TB care, independently of age and HIV co-infection, reflecting possible differences in service structure and related quality of care.
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Affiliation(s)
- Giuseppe Zenatti
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Mario Raviglione
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Fregenet Tesfaye
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Central Hospital Kristianstad, Kristianstad, Sweden
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Sakthivadivel V, Gaur A, Geetha J. Tuberculosis in elderly population: A cross-sectional comparative study. Int J Mycobacteriol 2023; 12:38-42. [PMID: 36926761 DOI: 10.4103/ijmy.ijmy_235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
Background Tuberculosis (TB) is a common but neglected infectious disease of global significance. It has a varied presentation in the elderly compared to adults. The present study was conceived to study the resemblances and differences shared in terms of clinical profile, comorbidities, and laboratory investigations by TB in adults and the elderly population. Methods In this cross-sectional study, 68 adults and 72 elderly patients of both genders were enrolled. We collected information on demographics, comorbidities, clinical presentations, and laboratory investigations. The comparison of data between groups was done using the unpaired t-test for continuous variables and the Chi-square test for frequency distribution analysis. Results The mean age of the adults and elderly population was 42.13 ± 10.7 years and 68.78 ± 7.62 years, respectively. The elderly TB group demonstrated loss of weight, appetite, the prevalence of comorbid conditions (coronary artery disease, hypertension, and malnutrition), bilateral, predominantly lower lobe, and diffuse involvement of lungs. Conclusion As the elderly population increases, nonspecific clinical manifestations or laboratory results in this population mandate awareness of these atypical features for effective management of TB in this group.
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Affiliation(s)
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jeganathan Geetha
- Department of General Medicine, Karpaga Vinayaga Institute of Medical Sciences and Research Center, Maduranthagam, Tamil Nadu, India
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Hassani S, Mohammadi Shahboulagi F, Foroughan M, Nadji SA, Tabarsi P, Ghaedamini Harouni G. Factors Associated with Medication Adherence in Elderly Individuals with Tuberculosis: A Qualitative Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4056548. [PMID: 36937803 PMCID: PMC10017217 DOI: 10.1155/2023/4056548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/17/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
Methods This qualitative study was conducted in two phases, using an integrative literature review and individual interviews. Studies were gathered without time restriction from MEDLINE databases, Institute for Scientific Information (ISI), Google Scholar, Scopus, and EMBASE, as well as national databases, including Scientific Information Database and Magiran. The findings of 38 studies that met the inclusion criteria were analyzed through the conventional content analysis method based on the ecological approach. After reviewing and forming the data matrix, purposive sampling was performed among healthcare professionals, elderly tuberculosis patients aged 60 and over, and family caregivers of elderly patients to conduct individual interviews. Data obtained from 20 interviews were analyzed using the directed content analysis method. After coding, the data from individual interviews were entered based on similarity and difference in the categories of data matrix obtained from the literature review. Results In general, the aforementioned codes were placed in four main categories, including individual factors (i.e., biological factors, affective-emotional factors, behavioral factors, cognitive factors, tuberculosis-related factors, and economic factors), interpersonal factors (i.e., patient's relationship with treatment team and family-related factors), factors related to healthcare service provider centers (i.e., medical centers' facilities and capacity building in healthcare service provider), and extraorganizational factors (i.e., social factors and health policymaking). Conclusion The results of this study showed that medication adherence in elderly patients with tuberculosis was a complex and multidimensional phenomenon. Therefore, society, policymakers, and healthcare providers should scrutinize the factors affecting medication adherence in this group of patients to plan and implement more effective interventions.
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Affiliation(s)
- Somayeh Hassani
- 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Farahnaz Mohammadi Shahboulagi
- 2Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahshid Foroughan
- 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Seyed Alireza Nadji
- 3Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- 4Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Ghaedamini Harouni
- 5Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
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Jali M, Kavital A, Hiremath M. "Challenges of diabetes in elderly TB patients". Indian J Tuberc 2022; 69 Suppl 2:S264-S266. [PMID: 36400521 PMCID: PMC9613800 DOI: 10.1016/j.ijtb.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/29/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Diabetes mellitus (DM) and tuberculosis (TB) are worldwide health burdens post-COVID-19. TB is the second-leading cause of death by a single infectious microbe. There is much evidence around the world about the responsibility of TB-DM co-morbidity. Both TB and DM prevalence is high in low- and middle-income countries. Especially the elderly with diabetes are more prone to TB infection due to compromised immune systems. Diabetic patients are three times as likely to develop tuberculosis as non-diabetic patients. DM interferes with the status of TB and leads to undesirable outcomes in the treatment of TB. This may later lead to the development of multidrug-resistant tuberculosis (MDR-TB). The coexistence of TB and DM leads to a high mortality rate and therefore becomes an enormous challenge for the medical field. This viewpoint includes the most current information about TB and DM, disease complications, treatment strategies, challenges to be faced in disease management and the importance of TB-DM bidirectional screening in older adults, which helps in early detection and better treatment programme.
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Affiliation(s)
- M.V. Jali
- KLES Diabetes Centre, KLES Dr Prabhakar Kore Hospital & J N Medical College KLE Academy of Higher Education & Research (Deemed-To-Be-University), Belagavi 590010,Corresponding author, , KLES Dr Prabhakar Kore Hospital & J N Medical College KLE Academy of Higher Education & Research (deemed to be a university), Belgaum 590010
| | - Apsara Kavital
- Department of Biotechnology & Microbiology, Karnataka University, Dharwad, India
| | - M.B. Hiremath
- Department of Biotechnology & Microbiology, Karnataka University, Dharwad, India
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Health-Related Quality of Life of Tuberculosis Patients during the COVID-19 Pandemic in Conakry, Guinea: A Mixed Methods Study. Trop Med Infect Dis 2022; 7:tropicalmed7090224. [PMID: 36136635 PMCID: PMC9506107 DOI: 10.3390/tropicalmed7090224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023] Open
Abstract
The COVID-19 pandemic has had a significant impact on all facets of life and has exacerbated many challenges faced by people living with tuberculosis (TB). This study aimed to assess the health-related quality of life (HRQoL) of TB patients in Guinea during the first wave of the COVID-19 pandemic. A mixed methods study was conducted using two validated tools to assess HRQoL and qualitative interviews among TB patients enrolled in treatment at 11 health centers in Conakry, Guinea. Logistic regression was used to identify factors associated with the deterioration of HRQoL. We included 439 participants in the study, among whom 44% and 31% experienced pain and anxiety, respectively. We found that an increase in the number of household size and the distance from participants' residence to the health centers were significantly associated with lower HRQoL. Qualitative interviews highlighted nutritional and financial issues, which were exacerbated during the COVID-19 pandemic and beliefs that the Guinean Government's assistance plan was insufficient. This study supports the implementation of specific relief plans for TB patients, which includes nutritional and psychological support, especially those whose movements are limited by travel restrictions, preventing access to TB care, reducing work opportunities and exacerbating financial needs and stress.
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Van't Hoog A, Viney K, Biermann O, Yang B, Leeflang MM, Langendam MW. Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status. Cochrane Database Syst Rev 2022; 3:CD010890. [PMID: 35320584 PMCID: PMC9109771 DOI: 10.1002/14651858.cd010890.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Systematic screening in high-burden settings is recommended as a strategy for early detection of pulmonary tuberculosis disease, reducing mortality, morbidity and transmission, and improving equity in access to care. Questioning for symptoms and chest radiography (CXR) have historically been the most widely available tools to screen for tuberculosis disease. Their accuracy is important for the design of tuberculosis screening programmes and determines, in combination with the accuracy of confirmatory diagnostic tests, the yield of a screening programme and the burden on individuals and the health service. OBJECTIVES To assess the sensitivity and specificity of questioning for the presence of one or more tuberculosis symptoms or symptom combinations, CXR, and combinations of these as screening tools for detecting bacteriologically confirmed pulmonary tuberculosis disease in HIV-negative adults and adults with unknown HIV status who are considered eligible for systematic screening for tuberculosis disease. Second, to investigate sources of heterogeneity, especially in relation to regional, epidemiological, and demographic characteristics of the study populations. SEARCH METHODS We searched the MEDLINE, Embase, LILACS, and HTA (Health Technology Assessment) databases using pre-specified search terms and consulted experts for unpublished reports, for the period 1992 to 2018. The search date was 10 December 2018. This search was repeated on 2 July 2021. SELECTION CRITERIA Studies were eligible if participants were screened for tuberculosis disease using symptom questions, or abnormalities on CXR, or both, and were offered confirmatory testing with a reference standard. We included studies if diagnostic two-by-two tables could be generated for one or more index tests, even if not all participants were subjected to a microbacteriological reference standard. We excluded studies evaluating self-reporting of symptoms. DATA COLLECTION AND ANALYSIS We categorized symptom and CXR index tests according to commonly used definitions. We assessed the methodological quality of included studies using the QUADAS-2 instrument. We examined the forest plots and receiver operating characteristic plots visually for heterogeneity. We estimated summary sensitivities and specificities (and 95% confidence intervals (CI)) for each index test using bivariate random-effects methods. We analyzed potential sources of heterogeneity in a hierarchical mixed-model. MAIN RESULTS The electronic database search identified 9473 titles and abstracts. Through expert consultation, we identified 31 reports on national tuberculosis prevalence surveys as eligible (of which eight were already captured in the search of the electronic databases), and we identified 957 potentially relevant articles through reference checking. After removal of duplicates, we assessed 10,415 titles and abstracts, of which we identified 430 (4%) for full text review, whereafter we excluded 364 articles. In total, 66 articles provided data on 59 studies. We assessed the 2 July 2021 search results; seven studies were potentially eligible but would make no material difference to the review findings or grading of the evidence, and were not added in this edition of the review. We judged most studies at high risk of bias in one or more domains, most commonly because of incorporation bias and verification bias. We judged applicability concerns low in more than 80% of studies in all three domains. The three most common symptom index tests, cough for two or more weeks (41 studies), any cough (21 studies), and any tuberculosis symptom (29 studies), showed a summary sensitivity of 42.1% (95% CI 36.6% to 47.7%), 51.3% (95% CI 42.8% to 59.7%), and 70.6% (95% CI 61.7% to 78.2%, all very low-certainty evidence), and a specificity of 94.4% (95% CI 92.6% to 95.8%, high-certainty evidence), 87.6% (95% CI 81.6% to 91.8%, low-certainty evidence), and 65.1% (95% CI 53.3% to 75.4%, low-certainty evidence), respectively. The data on symptom index tests were more heterogenous than those for CXR. The studies on any tuberculosis symptom were the most heterogeneous, but had the lowest number of variables explaining this variation. Symptom index tests also showed regional variation. The summary sensitivity of any CXR abnormality (23 studies) was 94.7% (95% CI 92.2% to 96.4%, very low-certainty evidence) and 84.8% (95% CI 76.7% to 90.4%, low-certainty evidence) for CXR abnormalities suggestive of tuberculosis (19 studies), and specificity was 89.1% (95% CI 85.6% to 91.8%, low-certainty evidence) and 95.6% (95% CI 92.6% to 97.4%, high-certainty evidence), respectively. Sensitivity was more heterogenous than specificity, and could be explained by regional variation. The addition of cough for two or more weeks, whether to any (pulmonary) CXR abnormality or to CXR abnormalities suggestive of tuberculosis, resulted in a summary sensitivity and specificity of 99.2% (95% CI 96.8% to 99.8%) and 84.9% (95% CI 81.2% to 88.1%) (15 studies; certainty of evidence not assessed). AUTHORS' CONCLUSIONS The summary estimates of the symptom and CXR index tests may inform the choice of screening and diagnostic algorithms in any given setting or country where screening for tuberculosis is being implemented. The high sensitivity of CXR index tests, with or without symptom questions in parallel, suggests a high yield of persons with tuberculosis disease. However, additional considerations will determine the design of screening and diagnostic algorithms, such as the availability and accessibility of CXR facilities or the resources to fund them, and the need for more or fewer diagnostic tests to confirm the diagnosis (depending on screening test specificity), which also has resource implications. These review findings should be interpreted with caution due to methodological limitations in the included studies and regional variation in sensitivity and specificity. The sensitivity and specificity of an index test in a specific setting cannot be predicted with great precision due to heterogeneity. This should be borne in mind when planning for and implementing tuberculosis screening programmes.
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Affiliation(s)
- Anja Van't Hoog
- Anja van't Hoog, Health Research & Training Consultancy, Utrecht, Netherlands
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- School of Public Health, The University of Sydney, Sydney, Australia
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bada Yang
- Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Miranda W Langendam
- Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Ordaz-Vázquez A, Torres-González P, Cruz-Hervert P, Ferreyra-Reyes L, Delgado-Sánchez G, García-García L, Kato-Maeda M, Ponce-De-León A, Sifuentes-Osornio J, Bobadilla-Del-Valle M. Genetic diversity and primary drug resistance transmission in Mycobacterium tuberculosis in southern Mexico. INFECTION GENETICS AND EVOLUTION 2021; 93:104994. [PMID: 34245908 DOI: 10.1016/j.meegid.2021.104994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/28/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
Tuberculosis is a global human health threat, especially in developing countries. The present study aimed to describe the genetic diversity of Mycobacterium tuberculosis and to measure the transmission rates of primary and acquired resistance. A total of 755 M. tuberculosis isolates from a cohort study of patients with culture-confirmed pulmonary tuberculosis in Orizaba, Veracruz, performed between 1995 and 2010 were genotyped by the 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) method. Drug susceptibility was determined. Logistic regression models were constructed to identify the variables associated with resistance and clusters. The recent transmission index (RTI), the Hunter-Gaston discrimination index (HGDI) for the MIRU-VNTR test and allelic diversity (h) were calculated. The Haarlem and LAM lineages were the most common in the population. A total of 519 isolates were grouped into 128 clusters. The overall drug resistance rate was 19%, isoniazid monoresistance (10%) was the most common, and 3.4% of the isolates were multidrug resistant. Among the 116 isolates resistant to at least one drug, the primary and acquired resistance rates were 81.9% and 18.1%, respectively. Primary resistance was associated with belonging to a cluster (aOR 4.05, 95% CI 1.5-11.2, p = 0.007). Previous treatment history (aOR 9.05, 95% CI 3.6-22.5, p < 0.001) and LAM lineage (aOR 4.25, 95% CI 1.4-12.7, p = 0.010) were associated with multidrug-resistant tuberculosis (MDR-TB). The RTI was 51.7%, and the 24-locus MIRU-VNTR HGDI was 0.98. The alleles with the greatest diversity were 4056-QUB26 (h = 0.84), 2163b-QUB11b (h = 0.79), and 424-Mtub04 (h = 0.72). Primary resistance transmission, high LAM lineage prevalence and its association with MDR-TB represent public health problems. The implementation of molecular tools is needed to improve the existing control surveillance tuberculosis program.
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Affiliation(s)
- Anabel Ordaz-Vázquez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Pedro Torres-González
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Pablo Cruz-Hervert
- Departamento de Salud Pública y Epidemiología Oral, Facultad de Odontología, Universidad Nacional Autonoma de Mexico, Ciudad de México, Mexico
| | - Leticia Ferreyra-Reyes
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Lourdes García-García
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Midori Kato-Maeda
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alfredo Ponce-De-León
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - José Sifuentes-Osornio
- Departamento de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Miriam Bobadilla-Del-Valle
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.
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Yoo JE, Kim D, Choi H, Kang YA, Han K, Lee H, Shin DW. Anemia, sarcopenia, physical activity, and the risk of tuberculosis in the older population: a nationwide cohort study. Ther Adv Chronic Dis 2021; 12:20406223211015959. [PMID: 34104377 PMCID: PMC8170360 DOI: 10.1177/20406223211015959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/20/2021] [Indexed: 01/17/2023] Open
Abstract
Background: The aim of this study was to investigate whether physical activity,
sarcopenia, and anemia are associated an with increased risk of tuberculosis
(TB) among the older population. Methods: We included 1,245,640 66-year-old subjects who participated in the National
Screening Program for Transitional Ages for Koreans from 2009 to 2014. At
baseline, we assessed common health problems in the older population,
including anemia and sarcopenia. The subjects’ performance in the timed
up-and-go (TUG) test was used to predict sarcopenia. The incidence of TB was
determined using claims data from the National Health Insurance Service
database. Results: The median follow-up duration was 6.4 years. There was a significant
association between the severity of anemia and TB incidence, with an
adjusted hazard ratio (aHR) of 1.28 [95% confidence interval (CI),
1.20–1.36] for mild anemia and 1.69 (95% CI, 1.51–1.88) for moderate to
severe anemia. Compared with those who had normal TUG times, participants
with slow TUG times (⩾15 s) had a significantly increased risk of TB (aHR
1.19, 95% CI, 1.07–1.33). On the other hand, both irregular (aHR 0.88, 95%
CI 0.83–0.93) and regular (aHR 0.84, 95% CI, 0.78–0.92) physical activity
reduced the risk of TB. Male sex, lower income, alcohol consumption,
smoking, diabetes, and asthma/chronic obstructive pulmonary disease
increased the risk of TB. Conclusion: The risk of TB among older adults increased with worsening anemia,
sarcopenia, and physical inactivity. Physicians should be aware of those
modifiable predictors for TB among the older population.
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Affiliation(s)
- Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dahye Kim
- Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Dongjak-gu, Seoul, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seoul, Seongdong-gu 04763, Republic of Korea
| | - Dong Wook Shin
- Shin Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Seoul, Gangnam-gu 06351, Republic of Korea
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10
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Habimana DS, Ngabonziza JCS, Migambi P, Mucyo-Habimana Y, Mutembayire G, Byukusenge F, Habiyambere I, Remera E, Mugwaneza P, Mwikarago IE, Mazarati JB, Turate I, Nsanzimana S, Decroo T, de Jong CB. Predictors of Rifampicin-Resistant Tuberculosis Mortality among HIV-Coinfected Patients in Rwanda. Am J Trop Med Hyg 2021; 105:47-53. [PMID: 33999845 PMCID: PMC8274780 DOI: 10.4269/ajtmh.20-1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis (TB), including multidrug-resistant (MDR; i.e., resistant to at least rifampicin and isoniazid)/rifampicin-resistant (MDR/RR) TB, is the most important opportunistic infection among people living with HIV (PLHIV). In 2005, Rwanda launched the programmatic management of MDR/RR-TB. The shorter MDR/RR-TB treatment regimen (STR) has been implemented since 2014. We analyzed predictors of MDR/RR-TB mortality, including the effect of using the STR overall and among PLHIV. This retrospective study included data from patients diagnosed with RR-TB in Rwanda between July 2005 and December 2018. Multivariable logistic regression was used to assess predictors of mortality. Of 898 registered MDR/RR-TB patients, 861 (95.9%) were included in this analysis, of whom 360 (41.8%) were HIV coinfected. Overall, 86 (10%) patients died during MDR/RR-TB treatment. Mortality was higher among HIV-coinfected compared with HIV-negative TB patients (13.3% versus 7.6%). Among HIV-coinfected patients, patients aged ≥ 55 years (adjusted odds ratio = 5.89) and those with CD4 count ≤ 100 cells/mm3 (adjusted odds ratio = 3.77) had a higher likelihood of dying. Using either the standardized longer MDR/RR-TB treatment regimen or the STR was not correlated with mortality overall or among PLHIV. The STR was as effective as the long MDR/RR-TB regimen. In conclusion, older age and advanced HIV disease were strong predictors of MDR/RR-TB mortality. Therefore, special care for elderly and HIV-coinfected patients with ≤ 100 CD4 cells/mL might further reduce MDR/RR-TB mortality.
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Affiliation(s)
- Dominique Savio Habimana
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Jean Claude Semuto Ngabonziza
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick Migambi
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Yves Mucyo-Habimana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Grace Mutembayire
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Francine Byukusenge
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Innocent Habiyambere
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Eric Remera
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Placidie Mugwaneza
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Ivan Emil Mwikarago
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Innocent Turate
- Department of Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | | | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Catherine Bouke de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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11
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Gopie F, Hassankhan A, Ottevanger S, Krishnadath I, de Lange W, Zijlmans C, Vreden S. Ethnic disparities in tuberculosis incidence and related factors among indigenous and other communities in ethnically diverse Suriname. J Clin Tuberc Other Mycobact Dis 2021; 23:100227. [PMID: 33851035 PMCID: PMC8022245 DOI: 10.1016/j.jctube.2021.100227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background In Suriname, a country home to many ethnic groups, a high incidence of tuberculosis (TB) has been found among Indigenous Trio Amerindians. However, whether wider ethnic disparities in TB incidence and its associated risk factors (e.g., diabetes mellitus and HIV) exist in Suriname, is not known. We sought to investigate disparities in TB incidence and its risk factors on ethnicity in Suriname, as this could give way to targeted TB intervention programs. Methods Anonymized patient data from 2011 to 2015 was extracted from the National TB Registry and analyzed. Differences in the five-year incidence rates of TB for the six largest ethnic groups-Creole, Hindustani, Indigenous, Javanese, Maroon, and Mixed-were assessed using a chi-square goodness-of-fit test, and TB patient differences regarding ethnicity were evaluated for selected factors using a multinomial logistic regression with Creole patients as reference. Results 662 Patients were eligible for analyses with the following ethnic makeup: Creole (36.4%), Hindustani (15.6%), Indigenous (8.6%), Javanese (10.6%), Maroon (15.1%), and Mixed ethnicity (13.7%). Differences in five-year incidence rates for TB were significant, χ 2(5, N = 662) = 244.42, p < .001, and the highest TB rates were found for Indigenous (280 per 100,000) and Creole people (271 per 100,000). HIV coinfection was a TB risk factor for Creoles (38.2% of these patients were HIV positive). Several variables (i.e., those for drug use) had high levels of incomplete or missing data. Conclusions Our study has demonstrated that ethnic disparities in tuberculosis incidence exist in Suriname and that they are associated with specific, known risk factors such as HIV (especially for Creole people). For Indigenous people, risk factors may include diminished access to health care facilities and low socioeconomic status. However, direct data on these factors was unavailable. These findings call for targeted national intervention programs-with special attention given to the vulnerabilities of susceptible ethnic groups-and improved data collection.
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Affiliation(s)
- F.A. Gopie
- Pulmonologist, Academic Hospital Paramaribo, Paramaribo, Suriname
- Anton de Kom University of Suriname, Faculty of Medical Sciences, Paramaribo, Suriname
- Corresponding author at: Academic Hospital Paramaribo, Paramaribo, Suriname.
| | - A. Hassankhan
- MoleMann Mental Health Suriname, Paramaribo, Suriname
| | - S. Ottevanger
- Amsterdam UMC, University of Amsterdam, Medical Microbiology, Amsterdam, The Netherlands
| | - I. Krishnadath
- Anton de Kom University of Suriname, Faculty of Medical Sciences, Paramaribo, Suriname
| | - W. de Lange
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
| | - C.W.R. Zijlmans
- Anton de Kom University of Suriname, Faculty of Medical Sciences, Paramaribo, Suriname
- Department of Paediatrics, Diakonessenhuis Hospital, Paramaribo, Suriname
| | - S. Vreden
- Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
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12
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Di Gennaro F, Vittozzi P, Gualano G, Musso M, Mosti S, Mencarini P, Pareo C, Di Caro A, Schininà V, Girardi E, Palmieri F. Active Pulmonary Tuberculosis in Elderly Patients: A 2016-2019 Retrospective Analysis from an Italian Referral Hospital. Antibiotics (Basel) 2020; 9:antibiotics9080489. [PMID: 32784552 PMCID: PMC7459440 DOI: 10.3390/antibiotics9080489] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) in the elderly (>65 years old) has increasingly become a global health problem. It has long been recognized that older people are vulnerable to developing tuberculosis. We retrospectively evaluated data from patients older than 65 years diagnosed with pulmonary TB admitted to the National Institute for Infectious Diseases L. Spallanzani, Rome, Italy, from 1 January 2016 to 31 December 2019. One hundred and six consecutive patients were diagnosed with pulmonary TB and 68% reported at least one comorbidity and 44% at least one of the TB risk-factors. Out of the 26 elderly patients who reported an adverse event, having risk factors for TB (O.R. (Odds Ratios) = 1.45; 95% CI 1.12-3.65) and the presence of cavities on Chest X-rays (O.R. = 1.42; 95% CI 1.08-2.73) resulted in being more likely to be associated with adverse events in elderly patients. Having weight loss (O.R. = 1.31; 95% CI 1.08-1.55) and dyspnea (O.R. = 1.23; 95% CI 1.13-1.41) resulted in being significant predictors of unsuccessful treatment outcome in elderly patients. Older people with TB represent a vulnerable group, with high mortality rate, with a challenging diagnosis. Hospitalizations in tertiary referral hospital with clinical expertise in TB management can be useful to improve the outcome of these fragile patients.
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Affiliation(s)
- Francesco Di Gennaro
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
- Correspondence: ; Tel.: +39-3924-804-707
| | - Pietro Vittozzi
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Maria Musso
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Silvia Mosti
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Paola Mencarini
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Carlo Pareo
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Antonino Di Caro
- Microbiology and Bio-Repository Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Vincenzo Schininà
- Diagnostic Imaging Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
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Merza MA. A 5-year experience characterizing the demographic and clinical profile and directly observed treatment short-course treatment outcome in National Tuberculosis Center of Duhok province, Iraqi Kurdistan. SAGE Open Med 2020; 8:2050312120921055. [PMID: 32435487 PMCID: PMC7222648 DOI: 10.1177/2050312120921055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/22/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The objectives were to describe the demographic and clinical profile and treatment outcomes in the National Tuberculosis Program Center of Duhok governorate. METHODS This was a descriptive retrospective study of all forms of drug-susceptible tuberculosis cases in the National Tuberculosis Program Center of Duhok. The Electronic Nominal Recording Reporting System data of tuberculosis cases were reviewed during 2014-2018. Information on the demographic, clinical, and laboratory characteristics of the patients were analyzed. Tuberculosis trends and treatment outcomes were determined. RESULTS A total of 1063 tuberculosis patients visited the National Tuberculosis Program Center, of whom 905 were from Duhok. The estimated tuberculosis notification rate per 100,000 people in Duhok governorate was 14.06, 16.16, 10.43, 11.05, and 10.34 for the years 2014, 2015, 2016, 2017, and 2018, respectively. The most affected age group was 15-24 years. The male cases were predominant. Most patients (97.3%) were native Iraqi. There were 718 (67.5%) pulmonary tuberculosis cases and 345 (32.5%) extra-pulmonary tuberculosis cases; tuberculosis lymphadenitis was the most common presentation. The majority of extra-pulmonary tuberculosis patients were females aged 15-24 years (p = 0.019), and patients aged ⩾65 years were associated with pulmonary tuberculosis and extra-pulmonary tuberculosis in males (p ⩽ 0.001). The highest tuberculosis incidence occurred in winter (288 patients). The patient treatment outcomes were as follows: 90.7% successful treatment, 1.6% lost to follow-up, 6.7% death, 0.3 transferred out, and 0.8 treatment failure. CONCLUSION There was a high frequency of extra-pulmonary tuberculosis, which may reflect overestimation in its diagnosis. Therefore, meticulous evaluations should be provided. The treatment outcome was satisfactory in the center. Hence, we should maintain the favorable work to attain tuberculosis control objectives. Performing GeneXpert for all tuberculosis cases and introducing culture and drug susceptibility testing should be an urgent plan to strengthen the diagnosis of susceptible and drug-resistant tuberculosis cases.
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Affiliation(s)
- Muayad Aghali Merza
- Department of Internal Medicine, Azadi Teaching Hospital, College of Pharmacy, University of Duhok, Duhok, Iraq
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14
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Symes MJ, Probyn B, Daneshvar C, Telisinghe L. Diagnosing Pulmonary Tuberculosis in the Elderly. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00319-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Lin SY, Chien JY, Chiang HT, Lu MC, Ko WC, Chen YH, Hsueh PR. Ambulatory independence is associated with higher incidence of latent tuberculosis infection in long-term care facilities in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 54:319-326. [PMID: 31624017 DOI: 10.1016/j.jmii.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Tuberculosis (TB) in the elderly population remains a major challenge in areas with intermediate disease burden like Taiwan. Despite the increasing burden and high risks of TB in the elderly population, particularly those living in long-term care facilities (LTCFs), diagnostic testing for latent tuberculosis infection (LTBI) has not been carefully evaluated in this group. This study aimed to investigate the prevalence and predictors of LTBI in older adults living in LTCFs. METHODS Older adults living in seven LTCFs in Taiwan were prospectively enrolled between January and July 2017. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine presence of LTBI. Predictors for LTBI were analyzed. RESULTS A total of 258 participants were enrolled, including 240 older residents (mean age, 81.6 years; male, 51.2%) and 18 employees (mean age, 64.8 years; male, 22.2%). The proportion of independent status in ambulation assessments significantly declined with aging (p < 0.001). The IGRA-positivity rate in LTCFs was 31.4% (81/258), which consisted of 73 (30.4%) residents and 8 (44.4%) employees. The IGRA results were different with respect to the ambulation status (p = 0.052). In the multivariate logistic regression analysis, the only independent predictor of LTBI among older adults in LTCFs was independent ambulation (odds ratio, 2.16; 95% confidence interval, 1.09-4.28; p = 0.027). CONCLUSIONS There was a high prevalence of LTBI among older adults in LTCFs in Taiwan. Independent ambulation was the only independent predictor of LTBI.
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Affiliation(s)
- Shang-Yi Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Sepsis Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hsiu-Tzy Chiang
- Infection Control Centre, MacKay Memorial Hospital, Taipei, Taiwan
| | - Min-Chi Lu
- Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, Center of Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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16
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Berry KM, Rodriguez CA, Berhanu RH, Ismail N, Mvusi L, Long L, Evans D. Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa. BMC Public Health 2019; 19:973. [PMID: 31331311 PMCID: PMC6647101 DOI: 10.1186/s12889-019-7257-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/28/2019] [Indexed: 11/12/2022] Open
Abstract
Background Gauteng Province has the second lowest tuberculosis (TB) incidence rate in South Africa but the greatest proportion of TB/HIV co-infection, with 68% of TB patients estimated to have HIV. TB treatment outcomes are well documented at the national and provincial level; however, knowledge gaps remain on how outcomes differ across detailed age groups. Methods Using data from South Africa’s National Electronic TB Register (ETR), we assessed all-cause mortality and loss to follow-up (LTFU) among patients initiating treatment for TB between 01/2010 and 12/2015 in the metropolitan municipalities of Ekurhuleni Metropolitan Municipality and the City of Johannesburg in Gauteng Province. We excluded patients who were missing age, had known drug-resistance, or transferred into TB care from sites outside the two metropolitan municipalities. Among patients assigned a treatment outcome, we investigated the association between age group at treatment initiation and mortality or LTFU (treatment interruption of ≥2 months) within 10 months after treatment initiation using Cox proportional hazard models and present hazard ratios and Kaplan-Meier survival curves. Results We identified 182,890 children (<10 years), young adolescent (10–14), older adolescent (15–19), young adult (20–24), adult (25–49), and older adult (≥50) TB cases without known drug-resistance. ART coverage among HIV co-infected patients was highest for young adolescents (64.3%) and lowest for young adults (54.0%) compared to other age groups (all over 60%). Treatment success exceeded 80% in all age groups (n = 170,017). All-cause mortality increased with age. Compared to adults, young adults had an increased hazard of LTFU (20–24 vs 25–49 years; aHR 1.43 95% CI: 1.33, 1.54) while children, young adolescents, and older adults had lower hazard of LTFU. Patients with HIV on ART had a lower risk of LTFU, but greater risk of death when compared to patients without HIV. Conclusions Young adults in urban areas of Gauteng Province experience a disproportionate burden of LTFU and low coverage of ART among co-infected patients. This group should be targeted for interventions aimed at improving clinical outcomes and retention in both TB and HIV care.
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Affiliation(s)
- Kaitlyn M Berry
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Carly A Rodriguez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rebecca H Berhanu
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Faculty of Health Sciences, Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lindiwe Mvusi
- National Department of Health, Tuberculosis Cluster, Pretoria, South Africa
| | - Lawrence Long
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa.
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17
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Incidence and Risk Factors Associated With Tuberculosis Treatment Outcomes Among Prisoners. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Hemmersbach-Miller M, Wolfe CR, Schmader KE. Solid organ transplantation in older adults. Infectious and other age-related considerations. ACTA ACUST UNITED AC 2019; 3. [PMID: 34113803 PMCID: PMC8189398 DOI: 10.21926/obm.transplant.1901046] [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] [Indexed: 12/11/2022]
Abstract
In the U.S., older adults aged 65 or above comprise nearly one quarter of the solid organ transplant (SOT) waitlists, and the number of transplants performed in this age group continues to increase. There are no specific guidelines for the assessment and follow up of the older SOT candidate or recipient. Older adults are at increased risk of infectious complications after SOT. Despite these complications and even with the use of suboptimal donors, overall outcomes are favorable. We provide an overview to specific consideration as they relate to the older SOT candidate and recipient.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Division of Infectious Diseases, Duke University Medical Center, Durham NC, USA.,Duke Clinical Research Institute, Durham NC, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham NC, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center, Durham NC, USA.,GRECC, Durham VA, Durham NC. USA
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19
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Nguyen DT, Teeter LD, Graves J, Graviss EA. Characteristics Associated with Negative Interferon-γ Release Assay Results in Culture-Confirmed Tuberculosis Patients, Texas, USA, 2013-2015. Emerg Infect Dis 2019; 24:534-540. [PMID: 29460756 PMCID: PMC5823348 DOI: 10.3201/eid2403.171633] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Interferon-γ release assays (IGRAs) are the preferred diagnostic test for tuberculosis (TB) infection in at-risk populations in developed countries. However, IGRAs have high false-negative rates in patients with TB disease. Population-based studies assessing the factors associated with negative IGRA results in TB patients have not been performed. Using statewide TB surveillance data of culture-confirmed TB patients in Texas, USA, during 2013–2015, we describe the patient characteristics and treatment outcomes associated with false-negative IGRA results. Among 2,854 TB patients, 1,527 (53.5%) had an IGRA result; 97.4% (1,487/1,527) of those had a positive (87.7%) or negative (12.3%) result. Older age, HIV co-infection, non-Hispanic white race/ethnicity, and being tested with T-SPOT.TB were associated with negative IGRA results. TB patients with negative IGRA results had a higher mortality, potentially due to delayed treatment. Healthcare providers should consider these risk factors when making decisions for patients with suspected TB and negative IGRA results and potentially provide treatment.
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20
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Nguyen DT, Graviss EA. Development and validation of a risk score to predict mortality during TB treatment in patients with TB-diabetes comorbidity. BMC Infect Dis 2019; 19:10. [PMID: 30611208 PMCID: PMC6321653 DOI: 10.1186/s12879-018-3632-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Making an accurate prognosis for mortality during tuberculosis (TB) treatment in TB-diabetes (TB-DM) comorbid patients remains a challenge for health professionals, especially in low TB prevalent populations, due to the lack of a standardized prognostic model. METHODS Using de-identified data from TB-DM patients from Texas, who received TB treatment had a treatment outcome of completed treatment or died before completion, reported to the National TB Surveillance System from January 2010-December 2016, we developed and internally validated a mortality scoring system, based on the regression coefficients. RESULTS Of 1227 included TB-DM patients, 112 (9.1%) died during treatment. The score used nine characteristics routinely collected by most TB programs. Patients were divided into three groups based on their score: low-risk (< 12 points), medium-risk (12-21 points) and high-risk (≥22 points). The model had good performance (with an area under the receiver operating characteristic (ROC) curve of 0.83 in development and 0.82 in validation), and good calibration. A practical mobile calculator app was also created ( https://oaa.app.link/Isqia5rN6K ). CONCLUSION Using demographic and clinical characteristics which are available from most TB programs at the patient's initial visits, our simple scoring system had good performance and may be a practical clinical tool for TB health professionals in identifying TB-DM comorbid patients with a high mortality risk.
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Affiliation(s)
- Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Mail Station: R6-414, 6670 Bertner Ave, Houston, TX 77030 USA
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Mail Station: R6-414, 6670 Bertner Ave, Houston, TX 77030 USA
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Kirirabwa NS, Kimuli D, DeJene S, Nanziri C, Birabwa E, Okello DA, Suarez PG, Kasozi S, Byaruhanga R, Lukoye D. Response to anti-tuberculosis treatment by people over age 60 in Kampala, Uganda. PLoS One 2018; 13:e0208390. [PMID: 30566486 PMCID: PMC6300205 DOI: 10.1371/journal.pone.0208390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 11/18/2018] [Indexed: 12/13/2022] Open
Abstract
While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young (AOR 0.39; 95% CI 0.33-0.48, p<0.001), they had a two-fold higher risk of unfavorable treatment outcomes (AOR 2.14; CI 1.84-2.72, p<0.001) and were more likely to die while on treatment (AOR 1.86; CI 1.27-2.73; p = 0.001). However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.
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Affiliation(s)
| | - Derrick Kimuli
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Seyoum DeJene
- United States Agency for International Development, Kampala, Uganda
| | - Carol Nanziri
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Estella Birabwa
- United States Agency for International Development, Kampala, Uganda
| | - Daniel Ayen Okello
- Kampala Capital City Authority, Directorate of Public Health and Environment, Kampala, Uganda
| | | | - Samuel Kasozi
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Raymond Byaruhanga
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
| | - Deus Lukoye
- TRACK TB Project, Management Sciences for Health, Bugolobi, Kampala, Uganda
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Wachinou AP, Agodokpessi G, Agbodande A, Affolabi D, Esse M, Adjibode O, Anagonou S. [Tuberculosis in older persons in African setting: Epidemiological, diagnostic and evolutive features]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:444-451. [PMID: 30279016 DOI: 10.1016/j.pneumo.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/21/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the epidemiological, diagnostic and evolutives features of tuberculosis (TB) in older subjects in Benin. PATIENTS AND METHODS This was a retrospective cohort study of adults TB patients (age≥15 years) who were notified at all the Basic Management Units (BMU) in Benin from January 1st, 2013 to December 31st. Older subjects (age≥60 years) were compared to those less than 60 years named young subjects. The threshold of significance was set at 5%. RESULTS The analysis was carried out on 6531 cases adults cases notified during the period. 601 (9.2%) were 60 years old or above. The case notification rate (CNR) in elders was more than twice the CNR in young people (68 cases vs. 31 cases per 100,000 population). Older subjects were less often infected with HIV (9.3%) than young's (16.7%), P<0.0001. In new bacteriologically confirmed pulmonary TB negative for HIV, unfavorable treatment outcomes were more frequent in older subjects than in young subjects with more deaths (7.5% vs. 3.0%). On the other hand, in bacteriological confirmed TB seropositive for HIV and all the other cases, treatment outcomes were comparable between the two groups. CONCLUSION The high CNR and the high death rate in older subjects should plead for a specific care for an adapted management of TB case in this group.
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Affiliation(s)
- A P Wachinou
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin.
| | - G Agodokpessi
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
| | - A Agbodande
- Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin; Service de médecine interne, Centre national hospitalier universitaire Hubert K. Maga (CNHU-HKM), Cotonou, Bénin
| | - D Affolabi
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
| | - M Esse
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin
| | - O Adjibode
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin
| | - S Anagonou
- Centre national hospitalier universitaire de pneumo-phtisiologie, Cotonou, Bénin; Faculté des sciences de la santé, université d'Abomey-Calavi, Cotonou, Bénin
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23
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Zellweger JP, Sousa P, Heyckendorf J. Clinical diagnosis of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Repossi A, Bothamley G. Tuberculosis in pregnancy and the elderly. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kalam H, Singh K, Chauhan K, Fontana MF, Kumar D. Alternate splicing of transcripts upon Mycobacterium tuberculosis infection impacts the expression of functional protein domains. IUBMB Life 2018; 70:845-854. [PMID: 30120868 PMCID: PMC7115969 DOI: 10.1002/iub.1887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 12/17/2022]
Abstract
Previously, we reported that infection of human macrophages with Mycobacterium tuberculosis (Mtb) results in massive alterations in the pattern of RNA splicing in the host. The finding gained significance since alternate spliced variants of a same gene may have substantially different structure, function, stability, interaction partners, localization, and so forth, owing to inclusion or exclusion of specific exons. To establish a proof-of-concept; on how infection-induced RNA splicing could impact protein functions, here we used RNA-seq data from THP-1 macrophages that were infected with clinical isolate of Mtb. In addition to re-establishing the fact that Mtb infection may cause strain specific alterations in RNA splicing, we also developed a new analysis pipeline resulting in characterization of domain maps of the transcriptome postinfection. For the sake of simplicity, we restricted our analysis to all the kinases in the human genome and considered only pfam classified protein domains and checked their frequency of inclusion or exclusion due to alternate splicing across the conditions and time points. We report massive alterations in the domain architecture of most regulated proteins across the entire kinases highlighting the physiological importance of such an understanding. This study paves way for more detailed analysis of different functional classes of proteins and perturbations to their domain architecture as a consequence of mycobacterial infections. Such analysis would yield unprecedented depth to our understanding of host-pathogen interaction and allow in a more systematic manner targeting of host pathways for controlling the infections.
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Affiliation(s)
- Haroon Kalam
- Cellular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India
| | - Kartikeya Singh
- Cellular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India
| | - Komal Chauhan
- Cellular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India
| | - Mary F Fontana
- Cellular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India
| | - Dhiraj Kumar
- Cellular Immunology Group, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India
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[Tuberculosis and comorbidities in urban areas in Argentina. A gender and age perspective]. BIOMEDICA 2018; 38:180-188. [PMID: 30184347 DOI: 10.7705/biomedica.v38i0.3904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tuberculosis continues to be a major health problem in the world with an incidence of more than 10 million cases in 2015. There are factors that change the risk of developing the disease after infection, as well as the presentation of the disease. OBJECTIVE To determine the main comorbidities and demographic, clinical and microbiological characteristics of tuberculosis adult patients in Argentina from a gender and age perspective. MATERIALS AND METHODS We conducted a cross-sectional study in urban referral hospitals for patients with tuberculosis. We included tuberculosis patients of 15 years or more of age who were hospitalized or treated in outpatient clinics with bacteriologically confirmed pulmonary or extrapulmonary forms of the disease, as well as those who, although not bacteriologically confirmed, had clinical and radiological characteristics consistent with tuberculosis. The study period was from August 1st, 2015 to August 31st, 2016. RESULTS We included 378 patients. The median age was 37 years. Male gender was associated with extrapulmonary tuberculosis, hospitalization, smoking, drug addiction and alcoholism. Tuberculosis and aids (22.6%) was related to drug use, admission into hospital, extrapulmonary tuberculosis, nonaddiction to tobacco, non-pathological radiology, absence of cavitation, and negative sputum smear microscopy. Patients less than 40 years of age had a higher rate of drug addiction and low weight, while those aged 40 or over had a higher proportion of diabetes, alcoholism and chronic obstructive pulmonary disease (COPD). CONCLUSIONS This study will help recognize tuberculosis patients' characteristics and comorbidities influencing the development and evolution of the disease from an age and gender perspective to enable the development of social and community-based strategies.
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Nguyen DT, Jenkins HE, Graviss EA. Prognostic score to predict mortality during TB treatment in TB/HIV co-infected patients. PLoS One 2018; 13:e0196022. [PMID: 29659636 PMCID: PMC5901929 DOI: 10.1371/journal.pone.0196022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
Background Estimating mortality risk during TB treatment in HIV co-infected patients is challenging for health professionals, especially in a low TB prevalence population, due to the lack of a standardized prognostic system. The current study aimed to develop and validate a simple mortality prognostic scoring system for TB/HIV co-infected patients. Methods Using data from the CDC’s Tuberculosis Genotyping Information Management System of TB patients in Texas reported from 01/2010 through 12/2016, age ≥15 years, HIV(+), and outcome being “completed” or “died”, we developed and internally validated a mortality prognostic score using multiple logistic regression. Model discrimination was determined by the area under the receiver operating characteristic (ROC) curve (AUC). The model’s good calibration was determined by a non-significant Hosmer-Lemeshow’s goodness of fit test. Results Among the 450 patients included in the analysis, 57 (12.7%) died during TB treatment. The final prognostic score used six characteristics (age, residence in long-term care facility, meningeal TB, chest x-ray, culture positive, and culture not converted/unknown), which are routinely collected by TB programs. Prognostic scores were categorized into three groups that predicted mortality: low-risk (<20 points), medium-risk (20–25 points) and high-risk (>25 points). The model had good discrimination and calibration (AUC = 0.82; 0.80 in bootstrap validation), and a non-significant Hosmer-Lemeshow test p = 0.71. Conclusion Our simple validated mortality prognostic scoring system can be a practical tool for health professionals in identifying TB/HIV co-infected patients with high mortality risk.
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Affiliation(s)
- Duc T. Nguyen
- Houston Methodist Hospital Institute, Houston, Texas, United States of America
| | - Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Edward A. Graviss
- Houston Methodist Hospital Institute, Houston, Texas, United States of America
- * E-mail:
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Nguyen DT, Graviss EA. Development and validation of a prognostic score to predict tuberculosis mortality. J Infect 2018; 77:283-290. [PMID: 29649520 DOI: 10.1016/j.jinf.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop and validate a simple prognostic scoring system to predict the mortality risk during treatment in tuberculosis patients. METHODS Using data from the CDC's Tuberculosis Genotyping Information Management System of TB patients in Texas reported from 01/2010 to 12/2016, age ≥ 15 years and having an outcome as "completed" or "died", we developed and validated a prognostic mortality scoring system-based logistic regression beta-coefficients. RESULTS The developmental and validation cohorts consisted of 3378 and 3377 patients, respectively. The score used 9 demographic and clinical characteristics, which are usually available at the patient's initial visits to a healthcare facility. Prognostic scores were categorized into three groups that predicted mortality: low-risk (<15 points), medium-risk (15-18 points), and high-risk (>18 points). The model had excellent discrimination and calibration with an area under the receiver operating characteristic curve of 0.82 and 0.80, and a non-significant Hosmer-Lemeshow test P = 0.514 and P = 0.613 in the developmental and validation cohorts, respectively. CONCLUSION Our validated TB prognostic scoring system, which used demographic and clinical characteristics available at the patient's initial visits, can be a practical tool for health care providers to identify TB patients with high mortality risk so that appropriate treatment, medical supports and follow-up resources could be appropriately allocated.
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Affiliation(s)
- Duc T Nguyen
- Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Edward A Graviss
- Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030, USA.
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30
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Yew WW, Yoshiyama T, Leung CC, Chan DP. Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people. Respirology 2018; 23:567-575. [PMID: 29607596 DOI: 10.1111/resp.13303] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/25/2018] [Accepted: 03/14/2018] [Indexed: 12/18/2022]
Abstract
With the ageing population globally, tuberculosis (TB) in older people becomes a major clinical and public health challenge. In many Asian countries, especially those located in the eastern and southeastern parts of the continent, geriatric TB is a significant problem. TB in the older patients is more difficult to diagnose in the early course of disease, and has poorer treatment outcomes, largely as increased failure and death. More drug-induced adverse reactions are also experienced by this population during TB therapy. Oxidative stress and mitochondrial dysfunction are now well recognized to be associated with the ageing process, and it is likely that the cellular and molecular perturbations interact inextricably with the immunological dysfunction biophysiologically inherent to ageing. These underlying mechanistic bases putatively contribute to the development of TB in the geriatric population and worsen the disease outcomes, especially when the TB is compounded by co-morbid conditions such as smoking and diabetes mellitus. Unravelling these mechanisms further would yield knowledge that might potentially help to prevent reactivated TB in older people, and also to better manage the established disease with drug regimens and other new therapeutic strategies. In addition, addressing the social elements associated with geriatric TB is also imperative in the relief of individual patient suffering and improvement of overall disease control.
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Affiliation(s)
- Wing W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Takashi Yoshiyama
- Japan Anti Tuberculosis Association, The Research Institute of Tuberculosis and Fukujuji Hospital, Tokyo, Japan
| | - Chi C Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong
| | - Denise P Chan
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Lee CH, Wang JY, Lin HC, Lin PY, Chang JH, Suk CW, Lee LN, Lan CC, Bai KJ. Treatment delay and fatal outcomes of pulmonary tuberculosis in advanced age: a retrospective nationwide cohort study. BMC Infect Dis 2017; 17:449. [PMID: 28646854 PMCID: PMC5483299 DOI: 10.1186/s12879-017-2554-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/16/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Studies focusing on pulmonary tuberculosis in advanced age (≥80 years) are lacking. This study aimed to explore treatment delay, outcomes and their predictors in this group. METHODS Adult (≥20 years) patients with pulmonary tuberculosis were identified from the National Health Insurance Research Database of Taiwan from 2004 to 2009. Treatment completion and mortality rates were noted at one year after treatment. RESULTS Among the 81,081 patients with pulmonary tuberculosis identified, 13,923 (17.2%) were aged ≥80 years, and 26,897 (33.2%) were aged 65-79 years. The treatment completion, mortality rates and treatment delay were 54.8%, 34.7% and 61 (12-128) [median, (1st-3rd quartiles)] days in patients aged ≥80 years, 68.3%, 18.5% and 53 (8-122) days in patients aged 65-79 years, and 78.9%, 6.5% and 21 (1-84) days in patients aged <65 years, respectively. The elder patients were more likely to receive second-line anti-tuberculosis agents. The treatment completion rate decreased with older age, female sex, comorbidities, low income, requiring second-line anti-tuberculosis agents, severity of pulmonary tuberculosis and longer treatment delay. Older age, female sex, comorbidities, low income, and not undergoing rapid molecular diagnostic tests were independently associated with longer treatment delays. CONCLUSIONS Pulmonary tuberculosis in advanced age has a longer treatment delay and a higher mortality rate. Applying rapid molecular diagnostic tools may reduce treatment delay and should be integrated into the diagnostic algorithm for pulmonary tuberculosis, particularly in elderly patients.
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Affiliation(s)
- Chih-Hsin Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Hsing-Long Rd., Taipei, 116 Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Taipei, 110 Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 100 Taiwan
| | - Hsien-Chun Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Hsing-Long Rd., Taipei, 116 Taiwan
| | - Pai-Yang Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Hsing-Long Rd., Taipei, 116 Taiwan
| | - Jer-Hwa Chang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Hsing-Long Rd., Taipei, 116 Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Taipei, 110 Taiwan
| | - Chi-Won Suk
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Hsing-Long Rd., Taipei, 116 Taiwan
| | - Li-Na Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei, 100 Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist, New Taipei, 231 Taiwan
- School of Medicine, Tzu Chi University, No.701, Sec. 3, Zhongyang Rd., Hualien, 970 Taiwan
| | - Kuan-Jen Bai
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Hsing-Long Rd., Taipei, 116 Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Taipei, 110 Taiwan
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González-García A, Fortún J, Elorza Navas E, Martín-Dávila P, Tato M, Gómez-Mampaso E, Moreno S. The changing epidemiology of tuberculosis in a Spanish tertiary hospital (1995-2013). Medicine (Baltimore) 2017; 96:e7219. [PMID: 28658113 PMCID: PMC5500035 DOI: 10.1097/md.0000000000007219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Important epidemiological changes and improvement of new diagnostic approaches, mainly molecular tools, might have impacted the management and outcome of tuberculosis (TB) in the last years in industrialized countries. In order to describe the epidemiological trends, and changes in clinical, diagnostic, and therapeutic aspects in patients with TB, an observational study was performed in a tertiary hospital in Western Europe (Madrid, Spain).All adult patients (>16 years) with a diagnosis of TB in the period 1995 to 2013 were included in the study.TB was diagnosed in 1284 patients, including 304 (24%) foreign-born and 298 (23.2%) human immunodeficiency virus (HIV)-infected patients. The proportion of foreign-born patients increased significantly, from 7.4% (1995) to 40.3% (2013), P < .001, while the proportion of patients with HIV infection decreased (from 41% to 15%, P < .001). Extrapulmonary locations of TB increased (from 23.9% to 37.1%, P < .001), although the miliary forms were less frequent (from 16% to 5.6%, P < .001). Pulmonary involvement remained constant during the period of study (from 50% to 46%, P = .18). The yield of microbiological diagnostic methods in different clinical specimens has remained very similar. Only molecular techniques have improved the diagnosis in respiratory, urinary, and peritoneal samples. The global cure rate was 64.8% and mortality rate was 9.1% (6.5% directly attributable to TB). Mortality has decreased significantly during the years of study (from 11% to 2%, P < .001).There has been a significant decline in the number of patients with TB. Changes in HIV coinfection and immigration have conditioned other epidemiological and clinical aspects of the disease, including the clinical presentation, treatment response, and mortality. Only the use of molecular tests has provided an improvement in the diagnosis of pulmonary and extrapulmonary TB.
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Affiliation(s)
| | | | | | | | - Marta Tato
- Department of Microbiology, University Hospital Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain
| | - Enrique Gómez-Mampaso
- Department of Microbiology, University Hospital Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain
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Determinants of mortality in elderly patients with tuberculosis: a population-based follow-up study. Epidemiol Infect 2017; 145:1374-1381. [PMID: 28190404 DOI: 10.1017/s0950268817000152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Elderly individuals with tuberculosis (TB) are more likely to have a non-specific clinical presentation of TB and high mortality. However, factors associated with mortality in elderly TB patients have not been extensively studied. This retrospective cohort study aimed to identify factors associated with death among elderly Taiwanese with TB. All elderly patients with TB from 2006 to 2014 in Taipei, Taiwan, were included in a study. Multiple logistic regression was used to identify the factors associated with death in elderly TB patients. The mean age of the 5011 patients was 79·7 years; 74·1% were men; 32·7% had mortality during the study follow-up period. After controlling for potential confounders, age ⩾75 years (reference: 65-74 years), male sex, end-stage renal disease (ESRD), malignancy, acid-fast bacilli-smear positivity, TB-culture positivity, pleural effusion on chest radiograph and notification by an ordinary ward or intensive care unit were associated with a higher risk of all-cause death; while high school, and university or higher education, cavity on chest radiograph and directly observed therapy were associated with a lower risk of all-cause death. This study found that the proportion of death among elderly patients with TB in Taipei, Taiwan, was high. To improve TB treatment outcomes, future control programmes should particularly target individuals with comorbidities (e.g. ESRD and malignancy) and those with a lower socio-economic status (e.g. not educated).
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Báez-Saldaña R, Delgado-Sánchez G, García-García L, Cruz-Hervert LP, Montesinos-Castillo M, Ferreyra-Reyes L, Bobadilla-del-Valle M, Canizales-Quintero S, Ferreira-Guerrero E, Téllez-Vázquez N, Montero-Campos R, Yanes-Lane M, Mongua-Rodriguez N, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A. Isoniazid Mono-Resistant Tuberculosis: Impact on Treatment Outcome and Survival of Pulmonary Tuberculosis Patients in Southern Mexico 1995-2010. PLoS One 2016; 11:e0168955. [PMID: 28030600 PMCID: PMC5193431 DOI: 10.1371/journal.pone.0168955] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
Abstract
Background Isoniazid mono-resistance (IMR) is the most common form of mono-resistance; its world prevalence is estimated to range between 0.0 to 9.5% globally. There is no consensus on how these patients should be treated. Objective To describe the impact of IMR tuberculosis (TB) on treatment outcome and survival among pulmonary TB patients treated under programmatic conditions in Orizaba, Veracruz, Mexico. Materials and Methods We conducted a prospective cohort study of pulmonary TB patients in Southern Mexico. From 1995 to 2010 patients with acid-fast bacilli or culture proven Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. We included patients who harbored isoniazid mono-resistant (IMR) strains and patients with strains susceptible to isoniazid, rifampicin, ethambutol and streptomycin. All patients were treated following Mexican TB Program guidelines. We performed annual follow-up to ascertain treatment outcome, recurrence, relapse and mortality. Results Between 1995 and 2010 1,243 patients with pulmonary TB were recruited; 902/1,243 (72.57%) had drug susceptibility testing; 716 (79.38%) harbored pan-susceptible and 88 (9.75%) IMR strains. Having any contact with a person with TB (adjusted odds ratio (aOR)) 1.85, 95% Confidence interval (CI) 1.15–2.96) and homelessness (adjusted odds ratio (aOR) 2.76, 95% CI 1.08–6.99) were associated with IMR. IMR patients had a higher probability of failure (adjusted hazard ratio (HR) 12.35, 95% CI 3.38–45.15) and death due to TB among HIV negative patients (aHR 3.30. 95% CI 1.00–10.84). All the models were adjusted for socio-demographic and clinical variables. Conclusions The results from our study provide evidence that the standardized treatment schedule with first line drugs in new and previously treated cases with pulmonary TB and IMR produces a high frequency of treatment failure and death due to tuberculosis. We recommend re-evaluating the optimal schedule for patients harboring IMR. It is necessary to strengthen scientific research for the evaluation of alternative treatment schedules in similar settings.
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Affiliation(s)
- Renata Báez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
| | - Luis Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Marlene Montesinos-Castillo
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México, México
| | - Sergio Canizales-Quintero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Téllez-Vázquez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Norma Mongua-Rodriguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México. México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México, México
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Gil A, Mateos I, Zurita A, Ramos J. Tuberculosis diseminada en anciano de edad avanzada. Semergen 2016; 42:e76-8. [DOI: 10.1016/j.semerg.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/12/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
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Lee CT, Gollamudi SPK, Myint KS, Peh WM, Merchant RA. Not Just Atypical Presentation, but Also Atypical Site: Tuberculosis in Elderly Adults. J Am Geriatr Soc 2016; 64:e51-2. [PMID: 27550801 DOI: 10.1111/jgs.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chun-Tsu Lee
- Department of Medicine, National University Singapore, Singapore
| | | | - Khin Saw Myint
- Department of Medicine, National University Singapore, Singapore
| | - Wee Ming Peh
- Department of Diagnostic Imaging, National University Singapore, Singapore
| | - Reshma A Merchant
- Yong Loo Ling School of Medicine, National University Singapore, Singapore
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Menon S, Rossi R, Nshimyumukiza L, Wusiman A, Zdraveska N, Eldin MS. Convergence of a diabetes mellitus, protein energy malnutrition, and TB epidemic: the neglected elderly population. BMC Infect Dis 2016; 16:361. [PMID: 27456231 PMCID: PMC4960905 DOI: 10.1186/s12879-016-1718-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 07/15/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND On a global scale, nearly two billion persons are infected with Mycobacterium tuberculosis. From this vast reservoir of latent tuberculosis (TB) infection, a substantial number will develop active TB during their lifetime, with some being able to transmit TB or Multi-drug- resistant (MDR) TB to others. There is clinical evidence pointing to a higher prevalence of infectious diseases including TB among individuals with Diabetes Mellitus (DM). Furthermore, ageing and diabetes mellitus may further aggravate protein-energy malnutrition (PEM), which in turn impairs T-lymphocyte mediated immunologic defenses, thereby increasing the risk of developing active TB and compromising TB treatment. This article aims to a) highlight synergistic mechanisms associated with immunosenescence, DM and PEM in relation to the development of active TB and b) identify nutritional, clinical and epidemiological research gaps. METHODS To explore the synergistic relationship between ageing, DM, tuberculosis and PEM, a comprehensive review was undertaken. The MEDLINE and the Google Scholar databases were searched for articles published from 1990 to March 2015, using different MESH keywords in various combinations. RESULTS Ageing and DM act synergistically to reduce levels of interferon gamma (IFN- γ), thereby increasing susceptibility to TB, for which cell mediated immunity (CMI) plays an instrumental role. These processes can set in motion a vicious nutritional cycle which can predispose to PEM, further impairing the CMI and consequently limiting host defenses. This ultimately transforms the latent TB infection into active disease. A clinical diagnostic algorithm and clinical guidelines need to be established for this population. CONCLUSION Given the increase in ageing population with DM and PEM, especially in resource-poor settings, these synergistic tripartite interactions must be examined if a burgeoning TB epidemic is to be averted. Implementation of a comprehensive, all-encompassing approach to curb transmission is clearly indicated. To this end, clinical, nutritional and epidemiological research gaps must be addressed without a delay.
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Affiliation(s)
- Sonia Menon
- International Centre for Reproductive health, Ghent University, LSHTM Alumni, Ghent, Belgium
- CDC Foundation, Atlanta, USA
| | | | - Leon Nshimyumukiza
- Department of Social and Preventive Medicine, Laval University-Faculty of Medicine, Quebec, Canada
| | - Aibibula Wusiman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Natasha Zdraveska
- Department of Clinical Pharmacy, Saints Cyril and Methodius University of Skopje (Alumni), Skopje, Republic of Macedonia
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Jappar SB, Low SY. Tuberculosis trends over a five-year period at a tertiary care university-affiliated hospital in Singapore. Singapore Med J 2016; 56:502-5. [PMID: 26451052 DOI: 10.11622/smedj.2015134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tuberculosis (TB), a potentially fatal infectious disease, poses significant health problems. The objective of this study was to analyse trends among newly diagnosed TB patients seen at the Singapore General Hospital (SGH). METHODS This study was a retrospective case record review of notified TB patients at SGH between 2006 and 2010 (inclusive). RESULTS A total of 1,979 cases of TB were notified over the five years. The number increased from 368 in 2006 to 407 in 2010 (p = 0.51), in tandem with the increasing number of patients seen at the hospital and the rising population in Singapore. Singaporean residents accounted for 82.8% of the cases, while non-Singaporean residents and non-residents made up the remainder. The year-to-year percentage of non-Singaporean residents and non-residents notified remained stable throughout the five years (p = 0.783). The number of male Singaporean residents (70.7%) notified was more than twice that of female Singaporean residents (29.3%). The majority of patients infected with TB (31.9%) were elderly patients aged > 65 years. Although testing for the human immunodeficiency virus increased from 43.8% (2006) to 64.2% (2010), the number detected with coinfection remained stable (14 and 12 patients in 2006 and 2010, respectively). Mortality rates also remained stable at 12.0%. CONCLUSION We cannot afford complacency, as there was no downward trend in the number of notified TB cases at SGH from 2006 to 2010. As the elderly contribute significantly to the TB burden, increased efforts are required to manage this vulnerable population.
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Affiliation(s)
- Suzanna Binte Jappar
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Su Ying Low
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Negin J, Abimbola S, Marais BJ. Tuberculosis among older adults--time to take notice. Int J Infect Dis 2016; 32:135-7. [PMID: 25809769 DOI: 10.1016/j.ijid.2014.11.018] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 11/16/2022] Open
Abstract
Knowledge that older people are vulnerable to develop tuberculosis is rarely considered in developing country settings. According to 2010 Global Burden of Disease estimates, the majority of tuberculosis-related deaths occurred among people older than 50; most in those aged 65 and above. Older people also contribute a large proportion of Disability-Adjusted Life Years (DALYs); 51% of tuberculosis DALYs occurred in patients aged 50 years and older in East Asia. Tuberculosis age distributions in Africa have been severely skewed by the human immunodeficiency virus (HIV) epidemic, but emerging data suggest increasing disease burdens among older people. Older adults are more likely to develop extra-pulmonary and atypical forms of disease that are often harder to diagnose than conventional sputum smear-positive pulmonary tuberculosis. Their care is complicated by more frequent drug-related adverse events and increased co-morbidity, which may prove difficult to manage in regions where health resources are already constrained. Health systems will have to confront the challenge of an ageing global population and the integrated services required to address their health needs.
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Affiliation(s)
- Joel Negin
- School of Public Health, University of Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia.
| | - Seye Abimbola
- School of Public Health, University of Sydney, Australia; National Primary Health Care Development Agency, Abuja, Nigeria
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Australia; Children's Hospital at Westmead, University of Sydney, Australia
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Hasanain AFA, Zayed AAAH, Mahdy RE, Nafee AMA, Attia RAMH, Mohamed AO. Hookworm infection among patients with pulmonary tuberculosis: Impact of co-infection on the therapeutic failure of pulmonary tuberculosis. Int J Mycobacteriol 2015; 4:318-22. [PMID: 26964815 DOI: 10.1016/j.ijmyco.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE/BACKGROUND The aim of this study is to determine the rate of hookworm infection among patients with pulmonary tuberculosis (TB) and to find out if there is a relation between hookworm infection and the therapeutic failure of pulmonary TB. METHODS We carried out a prospective, hospital-based study. The study included 231 naïve patients with pulmonary TB, consecutively. Patients were evaluated at the 4th month of therapy for persistence of Mycobacterium tuberculosis infection. All patients had clinical evaluation, laboratory investigations (including sputum culture and stool microscopic examination), and imaging studies (abdominal ultrasonography and chest radiography). RESULTS The study population mean age was 42.7±13.9 years old with 26.8% of them 40 years old or more. Out of 231 patients, 133 (57.6%) were men. Therapeutic failure rate of pulmonary TB was 29.4%. Hookworm infection was diagnosed among 16.5% of patients and 27.7% had diabetes mellitus (DM). Using multivariate analysis, it was found that age of 40 years or more (odds ratio [OR] 8.4; 95% confidence interval [CI] 1.7-41.3; p=.009), hookworm infection (OR 7.6; 95% CI 1.2-49.9; p=.034), and DM (OR 5.9; 1.2-28; p=.027) were independently associated with therapeutic failure of pulmonary TB among the study population with pulmonary TB. CONCLUSION In conclusion, the rate of therapeutic failure of pulmonary TB is high. Besides older age and DM, hookworm infection can reduce the therapeutic response of pulmonary TB. Screening for and control of DM and hookworm infection among patients with pulmonary TB may improve their therapeutic response.
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Affiliation(s)
| | | | - Reem Ezzat Mahdy
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Asmaa Omar Mohamed
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Shahrezaei M, Maracy MR, Farid F. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011. Int J Prev Med 2015; 6:91. [PMID: 26445638 PMCID: PMC4593239 DOI: 10.4103/2008-7802.165157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/21/2015] [Indexed: 11/08/2022] Open
Abstract
Background: Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients. Methods: This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used. Results: The result showed that imprisonment (hazard ratio [HR] = 4.76, P = 0.019), age (HR = 4.44, P = 0.001) and the TB case (HR = 2.73, P = 0.037) of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case (HR = 0.34, P < 0.001) proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion. Conclusions: We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients.
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Affiliation(s)
- Marzieh Shahrezaei
- Department of Epidemiology, Faculty of Health and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Farid
- General Practitioner, Group Fighting Against Diseases, Isfahan Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Lin YS, Yen YF. Determinants of mortality before start of and during tuberculosis treatment among elderly patients: a population-based retrospective cohort study. Age Ageing 2015; 44:490-6. [PMID: 25670782 DOI: 10.1093/ageing/afv002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 11/17/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND people with weakened immunity because of age or co-morbidities comprised the fastest growing portion of tuberculosis (TB). Higher mortality before or during TB treatment was observed. In spite of the increasing longevity worldwide, surveys focussing specifically on elderly TB are scarce. OBJECTIVE to identify prognostic factors of mortality before and during TB treatment among the elderly. METHODS we provided a retrospective cohort study of patients aged 65 and above with pulmonary TB in an Asian city with ageing population. A total of 2,546 patients were enrolled, including 743 (29.2%) cases aged 85 or beyond. Study subjects were categorised by treatment outcomes: treatment success, death prior to TB treatment or death during TB treatment. Demographics and laboratory findings were compared between the three groups. RESULTS after controlling for potential confounders, advanced age was the leading determinant of mortality. Adjusted odds ratios (AORs) of death during treatment were 1.79 (aged 75-84) and 3.43 (aged 85 and above) while comparing with patients aged 65-74. AORs of death prior to treatment were 2.95 and 5.66. Other prognostic factors included malignancy, end-stage renal disease receiving dialysis, need of intensive or long-term care, result of sputum acid-fast bacilli examination, findings of pleural effusion on chest X-ray and educational level. CONCLUSION this research manifested significant determinants of mortality in elderly patients prior to or during TB treatment. High awareness, timely intervention and close monitoring of treatment are recommended to older TB patients, especially with the properties mentioned in this study.
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Affiliation(s)
- Yu-Shiuan Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Infectious Disease, Taipei City Hospital Yang-Ming Branch, Taipei City Government, Taipei, Taiwan
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Oshi DC, Oshi SN, Alobu I, Ukwaja KN. Profile and treatment outcomes of tuberculosis in the elderly in southeastern Nigeria, 2011-2012. PLoS One 2014; 9:e111910. [PMID: 25369001 PMCID: PMC4219797 DOI: 10.1371/journal.pone.0111910] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/02/2014] [Indexed: 12/14/2022] Open
Abstract
Background The demographic transition and increasing life expectancy in Africa has lead to a rising elderly population. In Nigeria, little is known about the profile of and treatment outcomes of tuberculosis (TB) in the elderly. Methods Retrospective cohort study of adult TB patients treated between January 2011 and December 2012 in two large health facilities in Nigeria. The demographic, clinical and treatment outcomes of patients aged 60 and older were compared with those aged 15 to 59 years. Results Elderly (≥60 years) TB patients accounted for 12.7% of all (1668) adult TB enrolled. Elderly patients had a higher proportion of men compared to non-elderly (64.2% vs 56.8%; p = 0.043); but a lower proportion of smear-positive TB at baseline (40.7% vs 65.8%; p<0.001). A higher proportion of elderly patients failed to smear convert after the intensive phase of treatment (23.7% vs 19.8%; p = 0.06), and overall elderly patients had lower treatment success rates (68.9% vs 77.1%; p = 0.009). Unsuccessful outcomes were mainly due to higher default and deaths in the elderly. The risk factors for unsuccessful outcomes in the elderly were: extrapulmonary TB case (adjusted odds ratio (aOR) 10.9; 95% confidence interval (CI) 1.1–108), and HIV co-infection (aOR 3.6; CI 1.1–11.7). Conclusions Treatment outcomes of elderly TB patients were inferior to non-elderly adults with higher death and default rates being implicated. With the rising elderly population, specific strategies are needed to quickly address TB management in the elderly in resource-limited settings.
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Affiliation(s)
- Daniel C. Oshi
- Centre for Development and Reproductive Health, Enugu, Enugu State, Nigeria
| | - Sarah N. Oshi
- Centre for Development and Reproductive Health, Enugu, Enugu State, Nigeria
| | - Isaac Alobu
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Abakaliki, Ebonyi State, Nigeria
| | - Kingsley N. Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- * E-mail:
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Moliva JI, Rajaram MVS, Sidiki S, Sasindran SJ, Guirado E, Pan XJ, Wang SH, Ross P, Lafuse WP, Schlesinger LS, Turner J, Torrelles JB. Molecular composition of the alveolar lining fluid in the aging lung. AGE (DORDRECHT, NETHERLANDS) 2014; 36:9633. [PMID: 24584696 PMCID: PMC4082594 DOI: 10.1007/s11357-014-9633-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/14/2014] [Indexed: 06/01/2023]
Abstract
As we age, there is an increased risk for the development of pulmonary diseases, including infections, but few studies have considered changes in lung surfactant and components of the innate immune system as contributing factors to the increased susceptibility of the elderly to succumb to infections. We and others have demonstrated that human alveolar lining fluid (ALF) components, such as surfactant protein (SP)-A, SP-D, complement protein C3, and alveolar hydrolases, play a significant innate immune role in controlling microbial infections. However, there is a lack of information regarding the effect of increasing age on the level and function of ALF components in the lung. Here we addressed this gap in knowledge by determining the levels of ALF components in the aging lung that are important in controlling infection. Our findings demonstrate that pro-inflammatory cytokines, surfactant proteins and lipids, and complement components are significantly altered in the aged lung in both mice and humans. Further, we show that the aging lung is a relatively oxidized environment. Our study provides new information on how the pulmonary environment in old age can potentially modify mucosal immune responses, thereby impacting pulmonary infections and other pulmonary diseases in the elderly population.
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Affiliation(s)
- Juan I. Moliva
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
| | - Murugesan V. S. Rajaram
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
- />Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH USA
| | - Sabeen Sidiki
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
| | - Smitha J. Sasindran
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
| | - Evelyn Guirado
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
| | - Xueliang Jeff Pan
- />Center for Biostatistics, The Ohio State University, Columbus, OH USA
| | - Shu-Hua Wang
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
- />Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH USA
| | - Patrick Ross
- />Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, OH USA
| | - William P. Lafuse
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
- />Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH USA
| | - Larry S. Schlesinger
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
- />Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH USA
| | - Joanne Turner
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
- />Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH USA
| | - Jordi B. Torrelles
- />Center for Microbial Interface Biology, The Ohio State University, Columbus, OH USA
- />Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH USA
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Nobre A, Alarico S, Maranha A, Mendes V, Empadinhas N. The molecular biology of mycobacterial trehalose in the quest for advanced tuberculosis therapies. MICROBIOLOGY-SGM 2014; 160:1547-1570. [PMID: 24858083 DOI: 10.1099/mic.0.075895-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Trehalose is a natural glucose disaccharide identified in the 19th century in fungi and insect cocoons, and later across the three domains of life. In members of the genus Mycobacterium, which includes the tuberculosis (TB) pathogen and over 160 species of nontuberculous mycobacteria (NTM), many of which are opportunistic pathogens, trehalose has been an important focus of research over the last 60 years. It is a crucial player in the assembly and architecture of the remarkable mycobacterial cell envelope as an element of unique highly antigenic glycolipids, namely trehalose dimycolate ('cord factor'). Free trehalose has been detected in the mycobacterial cytoplasm and occasionally in oligosaccharides with unknown function. TB and NTM infection statistics and death toll, the decline in immune responses in the aging population, human immunodeficiency virus/AIDS or other debilitating conditions, and the proliferation of strains with different levels of resistance to the dated drugs in use, all merge into a serious public-health threat urging more effective vaccines, efficient diagnostic tools and new drugs. This review deals with the latest findings on mycobacterial trehalose biosynthesis, catabolism, processing and recycling, as well with the ongoing quest for novel trehalose-related mechanisms to be targeted by novel TB therapeutics. In this context, the drug-discovery pipeline has recently included new lead compounds directed toward trehalose-related targets highlighting the potential of these pathways to stem the tide of rising drug resistance.
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Affiliation(s)
- Ana Nobre
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Susana Alarico
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Ana Maranha
- Biosciences PhD Program, Department of Life Sciences, University of Coimbra, Coimbra, Portugal.,CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Vitor Mendes
- Department of Biochemistry, University of Cambridge, Cambridge, UK.,CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Nuno Empadinhas
- III/UC-Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal.,CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
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Terrazzini N, Bajwa M, Vita S, Thomas D, Smith H, Vescovini R, Sansoni P, Kern F. Cytomegalovirus infection modulates the phenotype and functional profile of the T-cell immune response to mycobacterial antigens in older life. Exp Gerontol 2013; 54:94-100. [PMID: 24370373 PMCID: PMC4003347 DOI: 10.1016/j.exger.2013.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/13/2013] [Accepted: 12/18/2013] [Indexed: 01/10/2023]
Abstract
Infection with Cytomegalovirus is associated with accelerated immunosenescence. Expansions of CMV-specific T cell responses have previously been demonstrated to affect the ability of T cells to respond to other infections. Most people above 60 years of age display M. tuberculosis-specific immunity because of vaccination, exposure, or both. T-cell responses can be assessed by measuring intracellular IFN-γ in vitro after tuberculin stimulation. Here we investigated tuberculin-specific CD4 T-cell responses in independently living healthy older people in the South of England using flow-cytometry. Individuals were investigated for tuberculin and CMV-specific T-cell immunity using in vitro antigen stimulation followed by intracellular staining for IFN-γ, TNF-α, IL2, as well as degranulation and CD154 upregulation. We also examined a control group of younger individuals (20–35 years of age). There was no significant difference between older and young people in regards to tuberculin responsiveness of CD4 T-cells; however, older people seemed to show more outliers. Increased responsiveness to tuberculin was significantly correlated to CMV responsiveness but not age. In older donors, the memory phenotype of tuberculin-induced T-cells was significantly skewed towards a more terminal differentiation phenotype in CMV-infected compared to uninfected individuals and the degree of skewing correlated quantitatively with the size of the CMV-specific CD4 T-cell response. This is a fundamental advance over previous reports of changes of the tuberculin-specific CD4 T-cell response with CMV serostatus. Our results show that how the immune system responds to CMV has a fundamental impact on the phenotype and function of the immune response to mycobacterial antigens in older life. We examine the CD4 T-cell response to tuberculosis antigens in older people. The CD4 T-cell response to Cytomegalovirus is explored in parallel. CMV infection changes the profile of the tuberculin-specific-response. The size of the CMV T-cell response is linked to these changes in a quantitative way. The way we respond to CMV (‘mode’) affects our T-cell immunity to other pathogens.
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Affiliation(s)
- Nadia Terrazzini
- Division of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom; School of Health, Sport and Bioscience, University of East London, London, United Kingdom
| | - Martha Bajwa
- Division of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Serena Vita
- Institute Pasteur, Cenci-Bolognetti Foundation, Department of Public Health and Infectious Diseases, University Sapienza of Rome, Rome, Italy
| | - David Thomas
- Division of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Helen Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Rosanna Vescovini
- Dipartimento di Medicina Interna e Scienze Biomediche, Università di Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Paolo Sansoni
- Dipartimento di Medicina Interna e Scienze Biomediche, Università di Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Florian Kern
- Division of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.
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Martinez L, Arman A, Haveman N, Lundgren A, Cabrera L, Evans CA, Pelly TF, Saito M, Callacondo D, Oberhelman R, Collazo G, Carnero AM, Gilman RH. Changes in tuberculin skin test positivity over 20 years in periurban shantytowns in Lima, Peru. Am J Trop Med Hyg 2013; 89:507-15. [PMID: 23878185 PMCID: PMC3771290 DOI: 10.4269/ajtmh.13-0005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 06/20/2013] [Indexed: 11/07/2022] Open
Abstract
A cross-sectional, community-based study was performed in 2012 with 428 residents of periurban shantytowns in Lima, Peru to study risk factors for and changes in latent tuberculosis infection in age-stratified groups compared with our data from the same region in 1990 (N = 219) and 2005 (N = 103). Tuberculin skin test positivity in these communities was highly prevalent at 52% overall, increased with age (P < 0.01) and was similar to 2005 (53%) and 1990 (48%). From 1990 to 2012, the prevalence of tuberculin positivity decreased in 5-14 and 15-24 year old groups (to 17% and 34%, respectively, both P < 0.05). However, this may be explained by cessation of Bacille Calmette-Guérin revaccination during this period, because Bacille Calmette-Guérin revaccination doubled tuberculin positivity. Over the same 22-year period, tuberculin positivity in the ≥ 25 year old group remained high (71%, P = 0.3), suggesting that prevalent latent tuberculosis infection persists in the adult population despite improving medical care and socioeconomic development in this region.
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Affiliation(s)
- Leonardo Martinez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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48
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Review on Epidemiology, Diagnosis, Occupational Hazards and Management of Pulmonary Tuberculosis in Elderly: A Guide for General Physicians Working in the Health Network Setting, Khuzestan, Iran. Jundishapur J Microbiol 2013. [DOI: 10.5812/jjm.6677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hussein MT, Yousef LM, Abusedera MA. Pattern of pulmonary tuberculosis in elderly patients in Sohag Governorate: Hospital based study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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