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Take Y, Shirahata M, Sakai J, Kubota Y, Suzuki T, Adachi JI, Maesaki S, Mishima K, Nishikawa R. Miliary Tuberculosis during R-MPV Therapy in an Elderly Patient with Primary Central Nerve System Lymphoma: A Case Report. Case Rep Oncol 2023; 16:1054-1059. [PMID: 37900802 PMCID: PMC10601709 DOI: 10.1159/000530711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 10/31/2023] Open
Abstract
Most elderly patients with tuberculosis (TB) have previously been infected with Mycobacterium tuberculosis, which remains dormant in the body for decades and may reactivate when their immunity declines due to underlying diseases. Elderly cancer patients are at a high risk for TB, and the treatment of TB reactivation in these patients is challenging. Among cancer patients, the incidence of TB reactivation is the highest in lymphoma patients. However, the impact of chemotherapy on TB reactivation in lymphoma patients is unknown. We report the case of an immunocompetent elderly patient with primary central nervous system lymphoma (PCNSL) having no prior history of TB, who developed miliary TB during multiagent chemotherapy consisting of rituximab, high-dose methotrexate, procarbazine, and vincristine (R-MPV therapy). Retrospectively, the chest computed tomography showed calcification of the pleura, suggesting that the patient had a latent tuberculosis infection (LTBI) and developed miliary TB from the reactivation of TB triggered by the R-MPV therapy. Our case emphasizes that when chemotherapy is administered to patients with PCNSL, interferon-gamma release assay (IGRA) should be performed if there are findings on chest examination suggestive of LTBI, such as pleural calcification, and if IGRA is positive, chemotherapy should be given concurrently with LTBI treatment.
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Affiliation(s)
- Yushiro Take
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun Sakai
- Department of Infectious Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun-ichi Adachi
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shigefumi Maesaki
- Department of Infectious Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Lee JY, Oh K, Hong HS, Kim K, Hong SW, Park JH, Hwang SW, Yang DH, Ye BD, Byeon JS, Myung SJ, Yang SK, Lee HS, Jo KW, Park SH. Risk and characteristics of tuberculosis after anti-tumor necrosis factor therapy for inflammatory bowel disease: a hospital-based cohort study from Korea. BMC Gastroenterol 2021; 21:390. [PMID: 34670529 PMCID: PMC8527666 DOI: 10.1186/s12876-021-01973-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Anti-tumor necrosis factor (TNF) treatment for inflammatory bowel disease (IBD) increases the risk of tuberculosis (TB) infection. In the present study, we analyzed the clinical characteristics and risks of TB in Korean patients with IBD who received anti-TNF treatment. METHODS The study included patients with IBD who were treated using anti-TNF agents between January 2001 and June 2018 at the Asan Medical Center. Overall, 1434 patients with ulcerative colitis or Crohn's disease were enrolled. We calculated the incidence of active TB infection after anti-TNF treatment and compared the clinical characteristics of the TB group with those of the non-TB group. RESULTS Twenty-one patients (1.46%) developed active TB infection, and the incidence rate of active TB was 366.73 per 100,000 person-years. In total, 198 patients (14.9%) were positive for latent tuberculosis infection (LTBI), of whom only eight (4%) did not complete LTBI treatment. The age at which the anti-TNF therapy was started was significantly higher in the TB group than in the non-TB group (HR 1.041, 95% CI 1.014-1.069, p = 0.002), and as age increased, so did the incidence rate of active TB infection (linearity p < 0.001). There was no significant difference in the incidence rate of LTBI between the TB and non-TB groups (HR 0.896, 95% CI 0.262-3.066, p = 0.862). CONCLUSIONS In patients with IBD, the incidence rate of TB increased with age at anti-TNF therapy initiation. Active treatment of LTBI may lower the incidence of TB in patients with IBD who are to undergo anti-TNF therapy.
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Affiliation(s)
- Jae Yong Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kyunghwan Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Seung Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kyuwon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jin Hwa Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho-Su Lee
- Department of Biochemistry, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kyung-Wook Jo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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3
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Kwak SH, Choi JS, Lee EH, Lee SH, Leem AY, Lee SH, Kim SY, Chung KS, Jung JY, Park MS, Kim YS, Chang J, Kang YA. Characteristics and risk factors associated with missed diagnosis in patients with smear-negative pulmonary tuberculosis. Korean J Intern Med 2021; 36:S151-S159. [PMID: 32811133 PMCID: PMC8009164 DOI: 10.3904/kjim.2019.435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS Delayed diagnosis and treatment of smear-negative pulmonary tuberculosis (TB) are major concerns for TB control. We evaluated characteristics of patients with smear-negative pulmonary TB who received a delayed diagnosis and identified risk factors that may have contributed to this delay. METHODS We reviewed medical records of patients with smear-negative culture-positive pulmonary TB treated at a tertiary care hospital in South Korea between January 2017 and December 2018. Patients who initiated anti-TB treatment after positive cultures were included in the missed TB group, and those who initiated empirical treatment before positive cultures were included in the control group. RESULTS Of 220 patients included, 117 (53.2%) and 103 (46.8%) were in the missed TB and control groups, respectively. Patients in the missed TB group were older (p = 0.001) and had a higher mean body mass index (BMI) (p = 0.019). Comorbidities (66.9% vs. 46.6%, p = 0.003) and immunocompromised patients (33.1% vs. 20.4%, p = 0.035) were more common in the missed TB group than in the control group. Old age (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.012 to 1.048; p = 0.001), high BMI (OR, 1.114; 95% CI, 1.004 to 1.237; p = 0.042), and negative polymerase chain reaction (PCR) results (OR, 9.551; 95% CI, 4.925 to 18.521; p < 0.001) were associated with delayed diagnosis. CONCLUSION In more than half of patients with smear-negative pulmonary TB, the diagnosis was delayed. Patients with delayed TB diagnosis were older, had higher BMI, and negative PCR results.
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Affiliation(s)
- Se Hyun Kwak
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hye Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Leem
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Soo Chung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Young Ae Kang, M.D. Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1954 Fax: +82-2-393-6884 E-mail:
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4
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Weerasuriya CK, Harris RC, McQuaid CF, Bozzani F, Ruan Y, Li R, Li T, Rade K, Rao R, Ginsberg AM, Gomez GB, White RG. The epidemiologic impact and cost-effectiveness of new tuberculosis vaccines on multidrug-resistant tuberculosis in India and China. BMC Med 2021; 19:60. [PMID: 33632218 PMCID: PMC7908776 DOI: 10.1186/s12916-021-01932-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Despite recent advances through the development pipeline, how novel tuberculosis (TB) vaccines might affect rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is unknown. We investigated the epidemiologic impact, cost-effectiveness, and budget impact of hypothetical novel prophylactic prevention of disease TB vaccines on RR/MDR-TB in China and India. METHODS We constructed a deterministic, compartmental, age-, drug-resistance- and treatment history-stratified dynamic transmission model of tuberculosis. We introduced novel vaccines from 2027, with post- (PSI) or both pre- and post-infection (P&PI) efficacy, conferring 10 years of protection, with 50% efficacy. We measured vaccine cost-effectiveness over 2027-2050 as USD/DALY averted-against 1-times GDP/capita, and two healthcare opportunity cost-based (HCOC), thresholds. We carried out scenario analyses. RESULTS By 2050, the P&PI vaccine reduced RR/MDR-TB incidence rate by 71% (UI: 69-72) and 72% (UI: 70-74), and the PSI vaccine by 31% (UI: 30-32) and 44% (UI: 42-47) in China and India, respectively. In India, we found both USD 10 P&PI and PSI vaccines cost-effective at the 1-times GDP and upper HCOC thresholds and P&PI vaccines cost-effective at the lower HCOC threshold. In China, both vaccines were cost-effective at the 1-times GDP threshold. P&PI vaccine remained cost-effective at the lower HCOC threshold with 49% probability and PSI vaccines at the upper HCOC threshold with 21% probability. The P&PI vaccine was predicted to avert 0.9 million (UI: 0.8-1.1) and 1.1 million (UI: 0.9-1.4) second-line therapy regimens in China and India between 2027 and 2050, respectively. CONCLUSIONS Novel TB vaccination is likely to substantially reduce the future burden of RR/MDR-TB, while averting the need for second-line therapy. Vaccination may be cost-effective depending on vaccine characteristics and setting.
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Affiliation(s)
- Chathika K Weerasuriya
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Rebecca C Harris
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Currently employed at Sanofi Pasteur, Singapore, Singapore
| | - C Finn McQuaid
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiammetta Bozzani
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Yunzhou Ruan
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Renzhong Li
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Tao Li
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | | | - Raghuram Rao
- National Tuberculosis Elimination Programme, New Delhi, India
| | - Ann M Ginsberg
- International AIDS Vaccine Initiative, New York, USA.,Current Affiliation: Bill and Melinda Gates Foundation, Washington DC, USA
| | - Gabriela B Gomez
- Department of Global Health and Development, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK.,Currently employed at Sanofi Pasteur, Lyon, France
| | - Richard G White
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
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5
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Wickramasinghe D, Wickramasinghe N, Kamburugamuwa SA, Arambepola C, Samarasekera DN. Correlation between immunity from BCG and the morbidity and mortality of COVID-19. Trop Dis Travel Med Vaccines 2020; 6:17. [PMID: 32868985 PMCID: PMC7453689 DOI: 10.1186/s40794-020-00117-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To investigate the association between parameters indicating immunity from BCG at country level (presence of BCG vaccination policy, BCG coverage, age-specific incidence of tuberculosis (TB)) and the morbidity and mortality of COVID-19. METHODS Country-specific data for COVID-19 cases and deaths, demographic details, BCG coverage and policy, age-specific TB incidence and income level were obtained. The crude COVID-19 cases and deaths per 100,000 population were calculated and assessed against the parameters indicating immunity from BCG using linear regression analysis. RESULTS Univariate analysis identified higher income level of a country to be significantly associated with COVID-19 cases (p < 0.0001) and deaths (p < 0.0001) but not with its case fatality rate. The association between COVID-19 and TB was strongest for TB incidence in patients > 65-years (Cases (rs = - 0.785,p = 0.0001)) and deaths (rs = - 0.647,p = 0.0001).Multivariate analysis identified the higher income level of a country and not having a universal BCG vaccination policy to affect the COVID-19 cases. The deaths were inversely affected by the presence of BCG vaccination policy and coverage; and positively by the TB incidence in patients > 65-years. CONCLUSION Significant inverse correlations observed between cases and deaths of COVID-19 and BCG related parameters highlights immunity from BCG as a likely explanation for the variation in COVID-19 across countries.
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Affiliation(s)
| | - Nilanka Wickramasinghe
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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6
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Holden IK, Lillebaek T, Andersen PH, Wejse C, Johansen IS. Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study. PLoS One 2020; 15:e0231821. [PMID: 32497102 PMCID: PMC7272085 DOI: 10.1371/journal.pone.0231821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Mortality from tuberculosis (TB) has been declining since 2000, nevertheless there is still a significant number of patients who die before or during TB treatment. The aims were to examine and describe predictors associated with TB related mortality. Methods Patients notified with TB from 2009 though 2014 in Denmark were included. Data were extracted from national registers and patient records were examined for clinical information and treatment outcome. Cox proportional hazards regression was used to examine TB related mortality. Results A total of 2131 cases were identified, 141 (6.6%) patients died before or during TB treatment. TB related mortality accounted for 104 cases (73.8%) and decreased significantly from 6.7% to 3.2% (p = .04) during the study period. Within 1 months of diagnosis, 49% of TB related deaths had occurred. The strongest risk factors present at time of diagnosis, associated with TB related mortality, were: age > 70 years, Charlson comorbidity index > 1, alcohol abuse, weight loss, anemia, and C-reactive protein > 100 mg/L (p < .05). Conclusion The majority of TB related deaths occurred soon after diagnosis, emphasizing that TB patients identified to have a high risk of mortality should be closely monitored before and during the intensive treatment period to improve their outcomes.
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Affiliation(s)
- Inge K. Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark–MyCRESD, Odense, Denmark
- * E-mail:
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Peter H. Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark–MyCRESD, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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7
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Survival of patients with multidrug-resistant tuberculosis in Central China: a retrospective cohort study. Epidemiol Infect 2020; 148:e50. [PMID: 32070443 PMCID: PMC7078509 DOI: 10.1017/s0950268820000485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to evaluate long-term survival and risk factors associated with multidrug-resistant tuberculosis (MDR-TB) patient survival in Central China. Between December 2006 and June 2011, incident and retreatment adult MDR-TB patients were enrolled in the present study. Cox proportional hazard regression analysis was used to evaluate the risk factors affecting survival. The total follow-up period was 270 person-years (PY) for 356 MDR-TB cases in Wuhan. Of the 356 cases, 103 patients died, yielding an average case fatality rate of 381.2 per 1000 TB patients per year. Using adjusted Cox regression analysis, older age (adjusted hazard ratio (aHR) >3.0 starting from 30 years) and low education level (primary and middle school; aHR 1.67 (95% CI 1.01–2.77)) were independently associated with lower survival. Diabetes mellitus profoundly affected the survival of MDR-TB patients (aHR 1.95 (95% CI 1.30–2.93)). Our data demonstrate that coexistent diabetes significantly and negatively impacted MDR-TB patient survival. In addition, MDR-TB patients aged 60 years or older exhibited a greater risk of mortality during follow-up. Our findings emphasise that MDR-TB patients with comorbidities that increase their risk of death require additional medical interventions to reduce mortality.
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8
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Abbara A, Collin SM, Kon OM, Buell K, Sullivan A, Barrett J, Corrah T, McGregor A, Hansel T, John L, Davidson RN. Time to diagnosis of tuberculosis is greater in older patients: a retrospective cohort review. ERJ Open Res 2019; 5:00228-2018. [PMID: 31720296 PMCID: PMC6826249 DOI: 10.1183/23120541.00228-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/29/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Age-related immunosenescence influences the presentation of tuberculosis (TB) in older patients. Here, we explore the clinical and radiological presentation of TB in the elderly and the factors associated with time to treatment for TB. Methods This is a retrospective cohort study comparing the clinical, radiological and demographic characteristics of TB patients aged ≥65 years with TB patients aged 18–64 years in a large cohort of TB patients in the UK. Factors associated with the time to presentation and time to treatment were identified using a multivariable analysis model. Results 1023 patients were included in the analyses: 679 patients aged 18–64 years and 344 patients aged ≥65 years. “Classical” symptoms of TB (cough, haemoptysis, fever, nights sweats and weight loss) were less common among older patients with pulmonary TB (PTB) (p<0.05), but dyspnoea was more common among older patients (p=0.001). Time from presenting in secondary care to starting treatment was shorter in younger compared with older patients: 3 versus 15 days (p=0.001). When adjusted for age, factors associated with shorter time to treatment from symptom onset include sex (male versus female) (hazard ratio (HR) 1.23 (95% CI 1.05–1.46)), UK born (HR 1.23 (95% CI 1.05–1.46)) and HIV (HR 2.07 (95% CI 1.30–3.29)). Only age remained an independent predictor of time to treatment in a multivariable model (HR 0.98 (95% CI 0.98–0.99)). For those with PTB, chest radiography findings showed that cavitation and lymphadenopathy were more common among younger patients (p=0.001). Conclusions Older patients aged ≥65 years with TB had fewer “classical” clinical and radiological presentations of TB, which may explain longer times to starting treatment from symptom onset compared with younger patients aged <65 years. A retrospective UK study in patients with TB shows only age remains an independent predictor of time to treatment in a multivariable model. Older patients have fewer of the “classical” clinical and radiological features of TB compared with younger patients.http://bit.ly/2yHc0OL
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Affiliation(s)
- Aula Abbara
- London North West University Healthcare NHS Trust, London, UK.,Dept of Infection, Imperial College London, London, UK
| | | | - Onn M Kon
- Dept of Infection, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Kevin Buell
- Dept of Infection, Imperial College London, London, UK
| | - Adam Sullivan
- Dept of Infection, Imperial College London, London, UK
| | - Jessica Barrett
- London North West University Healthcare NHS Trust, London, UK
| | - Tumena Corrah
- London North West University Healthcare NHS Trust, London, UK
| | | | - Trevor Hansel
- Dept of Infection, Imperial College London, London, UK
| | - Laurence John
- London North West University Healthcare NHS Trust, London, UK
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9
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Tao NN, Li YF, Wang SS, Liu YX, Liu JY, Song WM, Liu Y, Geng H, Li HC. Epidemiological characteristics of pulmonary tuberculosis in Shandong, China, 2005-2017: A retrospective study. Medicine (Baltimore) 2019; 98:e15778. [PMID: 31124969 PMCID: PMC6571395 DOI: 10.1097/md.0000000000015778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aimed to analyze the epidemiology of pulmonary tuberculosis (PTB) and gained insight into the future TB control plan in China.We extracted epidemiological, clinical, and geographic data from TB prevention and control institutions in 6 cities of Shandong province, China, during 2005 to 2017.Among 224,480 diagnosed PTB, rural residents accounted for 93%, smear-positive PTB 52%, and new cases 92%. The incidence rate of overall PTB declined from 40.8 to 26.25 per 100,000 during 2005 to 2017. Except smear-negative PTB (7.57-19.87 per 100,000), the incidence of smear-positive PTB and all that stratified by age, sex, and treatment history decreased. With 80% reduction, the incidence of smear-positive PTB (6.38 per 100,000) and relapse cases (1.01 per 100,000) were already very low in 2017.With persistent efforts to combat TB, the disease burden had shifted from smear-positive PTB to smear-negative PTB. While new cases need continuous attention, further reducing the incidence of smear-negative PTB and elderly patients may have a greater impact on future TB control.
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Affiliation(s)
- Ning-Ning Tao
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yi-Fan Li
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Shan-Shan Wang
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yun-Xia Liu
- Department of Biostatistics, School of Public Health, Shandong University
| | - Jin-Yue Liu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
| | - Wan-Mei Song
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yao Liu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Hong Geng
- Centers for Tuberculosis Control in Shandong Province, Jinan, China
| | - Huai-Chen Li
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University
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Results from a roving, active case finding initiative to improve tuberculosis detection among older people in rural cambodia using the Xpert MTB/RIF assay and chest X-ray. J Clin Tuberc Other Mycobact Dis 2018; 13:22-27. [PMID: 31720408 PMCID: PMC6830163 DOI: 10.1016/j.jctube.2018.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/22/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Cambodia has one of the highest tuberculosis (TB) prevalence rates in the world. People aged 55 years and over account for an estimated 50% of the country's TB burden, yet this group has a low notification rate owing to specific barriers in accessing health services. One-off active case finding (ACF) days with mobile GeneXpert and X-ray systems were organized at 75 government health facilities in four operational districts. Symptomatic community members with an abnormal chest X-ray were tested using the Xpert MTB/RIF assay. People with TB were then treated at health facilities after screening services moved onto the next site. Methods De-identified project data were analysed to produce descriptive statistics about the people tested on Xpert and those diagnosed with TB. A linear regression was fit through the 12 quarters of National TB Program (NTP) TB case notification data immediately prior to ACF. The regression was used to calculate trend-expected notifications during and after the ACF quarters. Notifications from the ACF quarters were then compared to actual notifications from the previous year and to the trend-expected notifications during the ACF quarter by age group and type of TB. Finally, NTP TB treatment outcomes for the patients started on treatment during the ACF quarter were compared to those from a year prior. Results 2068 individuals submitted sputum for Xpert MTB/RIF testing, resulting in the identification of 319 (15.4%) bacteriologically-positive TB patients and an additional 574 people who were clinically diagnosed with TB. In the ACF quarters, new bacteriologically-positive notifications increased +119.2% for all ages and +262.7% for people aged 55 and over compared with trend-expected notifications. Treatment initiation figures remained above trend-expected notifications for three full quarters after ACF. The treatment success rate across all operational districts was significantly higher for patients detected in the ACF quarters (88.8% vs 94.5%, p = 0.012). Conclusion A series of roving, one-off ACF days at government health facilities were able to increase TB diagnosis, treatment initiation and treatment outcomes in a key population with high TB prevalence. Targeted ACF interventions such as this could be used to reduce a backlog of untreated, prevalent TB.
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Nishiguchi S, Tomiyama S, Kitagawa I, Tokuda Y. Delayed isolation of smear-positive pulmonary tuberculosis patients in a Japanese acute care hospital. BMC Pulm Med 2018; 18:94. [PMID: 29855359 PMCID: PMC5984307 DOI: 10.1186/s12890-018-0653-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Active pulmonary tuberculosis (TB) is associated with intra-hospital spread of the disease. Expeditious diagnosis and isolation are critical for infection control. However, factors that lead to delayed isolation of smear-positive pulmonary TB patients, especially among the elderly, have not been reported. The purpose of this study is to investigate factors associated with delay in the isolation of smear-positive TB patients. METHODS All patients with smear-positive pulmonary TB admitted between January 2008 and December 2016 were included. The setting was a Japanese acute care teaching hospital. Following univariate analysis, significant factors in the model were analyzed using the multivariate Cox proportional hazard model. RESULTS Sixty-nine patients with mean age of 81 years were included. The median day to the isolation of pulmonary TB was 1 day with interquartile range, 1-4 days. On univariate analysis, the time to isolation was significantly delayed in male patients (p = 0.009), in patient who had prior treatment with newer quinolone antibiotics (p = 0.027), in patients who did not have chronic cough (p = 0.023), in patients who did not have appetite loss (p = 0.037), and in patients with non-cavitary lesion (p = 0.005), lesion located other than in the upper zone (p = 0.015), and non-disseminated lesion on the chest radiograph (p = 0.028). On multivariate analysis, the time to isolation was significantly delayed in male patients (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.25 to 0.89; P = 0.02), in patients who did not have chronic chough (HR, 0.52; 95% CI, 0.28 to 0.95; P = 0.033), and in patients with non-cavitary lesion on the chest radiograph (HR, 0.46; 95% CI, 0.23 to 0.92; P = 0.028). CONCLUSIONS In acute care hospitals of an aging society, prompt diagnosis and isolation of TB patients are important for the protection of other patients and healthcare providers. Delay in isolation is associated with male gender, absence of chronic cough, and presence of non-cavitary lesions on the chest radiograph.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan. .,Department of Internal Medicine, Hayama Heart Center, Hayama, Kanagawa, Japan. .,Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
| | | | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Project for Teaching Hospitals, Okinawa, Okinawa Prefecture, Japan
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Coffman J, Chanda-Kapata P, Marais BJ, Kapata N, Zumla A, Negin J. Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group. BMC Public Health 2017; 17:804. [PMID: 29025403 PMCID: PMC5639764 DOI: 10.1186/s12889-017-4836-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/06/2017] [Indexed: 01/14/2023] Open
Abstract
Background The 2010 Global Burden of Disease estimates show that 57% of all TB deaths globally occurred among adults older than 50 years of age. Few studies document the TB burden among older adults in Southern Africa. We focused on adults older than 55 years to assess the relative TB burden and associated demographic factors. Methods A cross sectional nationally representative TB prevalence survey conducted of Zambian residents aged 15 years and above from 66 clusters across all the 10 provinces of Zambia. Evaluation included testing for TB as well as an in-depth questionnaire. We compared survey data for those aged 55 and older to those aged 15–54 years. Survey results were also compared with 2013 routinely collected programmatic notification data to generate future hypotheses regarding active and passive case finding. Results Among older adults with TB, 30/ 54 (55.6%) were male, 3/27 (11.1%) were HIV infected and 35/54 (64.8%) lived in rural areas. TB prevalence was higher in those aged ≥55 (0.7%) than in the 15–54 age group (0.5%). Males had higher rates of TB across both age groups with 0.7% (15–54) and 1.0% (≥55) compared with females 0.4% (15–54) and 0.6% (≥55). In rural areas, the prevalence of TB was significantly higher among older than younger adults (0.7% vs 0.3%), while the HIV infection rate was among TB patients was lower (11.1% vs 30.8%). The prevalence survey detected TB in 54/7484 (0.7%) of older adults compared to 3619/723,000 (0.5%) reported in 2013 programmatic data. Conclusion High TB rates among older adults in TB endemic areas justify consideration of active TB case finding and prevention strategies.
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Affiliation(s)
- Jenna Coffman
- School of Public Health, University of Sydney, Sydney, Australia.
| | - Pascalina Chanda-Kapata
- Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.,Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Nathan Kapata
- National TB and Leprosy Control Program, Lusaka, Zambia
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, University College London, London, UK
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
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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: 24] [Impact Index Per Article: 3.4] [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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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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Abstract
Tuberculosis (TB) remains one of the world's most lethal infectious diseases. Preventive and control strategies among other high-risk groups, such as the elderly population, continues to be a challenge. Clinical features of TB in older adults may be atypical and confused with age-related diseases. Diagnosis and management of TB in the elderly person can be difficult; treatment can be associated with adverse drug reactions. This article reviews the current global epidemiology, pathogenesis, clinical characteristics, diagnosis, management, and prevention of Mycobacterium tuberculosis infection in community-dwelling and institutionalized aging adults.
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Affiliation(s)
- Shobita Rajagopalan
- Los Angeles County Department of Public Health, 123 West Manchester Boulevard, Inglewood, CA 90301, USA; Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
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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: 103] [Impact Index Per Article: 12.9] [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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Three-dimensional in vitro models of granuloma to study bacteria-host interactions, drug-susceptibility, and resuscitation of dormant mycobacteria. BIOMED RESEARCH INTERNATIONAL 2014; 2014:623856. [PMID: 24967387 PMCID: PMC4055484 DOI: 10.1155/2014/623856] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 04/16/2014] [Indexed: 12/02/2022]
Abstract
Mycobacterium tuberculosis, Mycobacterium leprae, Mycobacterium bovis, and Mycobacterium avium subsp. paratuberculosis can survive within host macrophages in a dormant state, encased within an organized aggregate of immune host cells called granuloma. Granulomas consist of uninfected macrophages, foamy macrophages, epithelioid cells, and T lymphocytes accumulated around infected macrophages. Within granulomas, activated macrophages can fuse to form multinucleated giant cells, also called giant Langhans cells. A rim of T lymphocytes surrounds the core, and a tight coat of fibroblast closes the structure. Several in vivo models have been used to study granuloma's structure and function, but recently developed in vitro models of granuloma show potential for closer observation of the early stages of host's responses to live mycobacteria. This paper reviews culture conditions that resulted in three-dimensional granulomas, formed by the adhesion of cell populations in peripheral blood mononuclear cells infected with mycobacteria. The similarities of these models to granulomas encountered in clinical specimens include cellular composition, granulomas' cytokine production, and cell surface antigens. A reliable in vitro dormancy model may serve as a useful platform to test whether drug candidates can kill dormant mycobacteria. Novel drugs that target dormancy-specific pathways may shorten the current long, difficult treatments necessary to cure mycobacterial diseases.
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Liu Q, Zhu L, Shao Y, Song H, Li G, Zhou Y, Shi J, Zhong C, Chen C, Lu W. Rates and risk factors for drug resistance tuberculosis in Northeastern China. BMC Public Health 2013; 13:1171. [PMID: 24330553 PMCID: PMC3878749 DOI: 10.1186/1471-2458-13-1171] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 12/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (TB) has emerged as a major challenge toward TB control and prevention. In Lianyungang city, the extent and trend of drug resistant TB is not well known. The objective of the survey was to assess drug resistance pattern of MTB and risk factors for drug resistant TB, including multidrug resistance tuberculosis (MDR-TB) in this area. METHODS We performed drug susceptibility testing on Mycobacterium tuberculosis (MTB) isolates with first- and second-line anti-tuberculosis drugs of 1012 culture positive TB cases by using the proportion method, who were consecutively enrolled from January 2011 to December 2012 in Lianyungang city, China. The patterns of drug resistance in MTB were investigated and multiple logistic regression analysis was performed to assess the risk factors for drug resistant TB. RESULTS Among the 1012 strains tested, 308 (30.4%) strains were resistant to at least one first-line drug; the prevalence of MDR-TB was 88 (8.7%), 5 (0.5%) strains were found to be extensively drug-resistant tuberculosis (XDR-TB). Female gender was a risk factor for MDR-TB (adjusted odds ratio (aOR) 1.763, 95% CI (1.060-2.934). The aged 28-54 years was significantly associated with the risk of MDR-TB with an aOR: 2.224, 95% CI (1.158-4.273) when compared with those 65 years or older. Patients with previous treatment history had a more than 7-fold increased risk of MDR-TB, compared with those never previously treated. CONCLUSIONS The burden of drug resistant TB cases is sizeable, which highlights an urgent need to reinforce control, detection and treatment strategies for drug resistant TB.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, 172 Jiangsu Rd, Nanjing 210009, PR China.
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Guirado E, Schlesinger LS. Modeling the Mycobacterium tuberculosis Granuloma - the Critical Battlefield in Host Immunity and Disease. Front Immunol 2013; 4:98. [PMID: 23626591 PMCID: PMC3631743 DOI: 10.3389/fimmu.2013.00098] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/11/2013] [Indexed: 12/19/2022] Open
Abstract
Granulomas are the hallmark of Mycobacterium tuberculosis (M.tb) infection and thus sit at the center of tuberculosis (TB) immunopathogenesis. TB can result from either early progression of a primary granuloma during the infection process or reactivation of an established granuloma in a latently infected person. Granulomas are compact, organized aggregates of immune cells consisting of blood-derived infected and uninfected macrophages, foamy macrophages, epithelioid cells (uniquely differentiated macrophages), and multinucleated giant cells (Langerhans cells) surrounded by a ring of lymphocytes. The granuloma's main function is to localize and contain M.tb while concentrating the immune response to a limited area. However, complete eradication does not occur since M.tb has its own strategies to persist within the granuloma and to reactivate and escape under certain conditions. Thus M.tb-containing granulomas represent a unique battlefield for dictating both the host immune and bacterial response. The architecture, composition, function, and maintenance of granulomas are key aspects to study since they are expected to have a profound influence on M.tb physiology in this niche. Granulomas are not only present in mycobacterial infections; they can be found in many other infectious and non-infectious diseases and play a crucial role in immunity and disease. Here we review the models currently available to study the granulomatous response to M.tb.
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Affiliation(s)
- Evelyn Guirado
- Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, The Ohio State University Columbus, OH, USA
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Salvadó M, Garcia-Vidal C, Vázquez P, Riera M, Rodríguez-Carballeira M, Martínez-Lacasa J, Cuchi E, Garau J. Mortality of tuberculosis in very old people. J Am Geriatr Soc 2010; 58:18-22. [PMID: 20122037 DOI: 10.1111/j.1532-5415.2009.02619.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the clinical characteristics and outcomes of tuberculosis (TB) in elderly people. DESIGN Observational analysis of a prospective cohort of adults with TB (1995-2004). A case-control study to determine attributable mortality to TB in very old people was done. RESULTS Of 319 patients with TB, 109 (34.2%) were aged 65 and older. The older group was more likely to have comorbidities (1.4% vs 0.4%; P<.001), extrapulmonary and disseminated TB (50.4% vs 26.1%; P<.001), toxicity (22% vs 9.8%; P=.006), and 30-day mortality (18.3% vs 1.6%; P<.001). When patients aged 65 to 79 were compared with those aged 80 and older, only differences in TB-related mortality were detected (9.8% vs 44.4%; P=.01). In the attributable mortality analysis, 30-day and 6-month mortality were higher in very old patients with TB than in controls without TB (41.7% vs 11.1%, P=.005; 45.8% and 19.4%, P=.01, respectively). No differences in mortality were shown when excluding patients with postmortem TB diagnosis or those who died within the first 72 hours of diagnosis. CONCLUSION Older people with TB had a higher frequency of atypical features, more adverse drug reactions, and greater TB-related mortality than younger people. Data suggest that very old patients with TB have higher mortality, but if diagnosed early and adequately treated, very old patients with TB do not have greater mortality than those without.
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Affiliation(s)
- Meritxell Salvadó
- Department of Internal Medicine, Hospital Universitari Mútua de Terrassa and Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
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Cervical tuberculous lymphadenitis in the elderly: comparative diagnostic findings. The Journal of Laryngology & Otology 2009; 123:1343-7. [PMID: 19958562 DOI: 10.1017/s0022215109990880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients suspected of having cervical tuberculous lymphadenitis are diagnosed using investigations such as fine needle aspiration cytology and the polymerase chain reaction for Mycobacterium tuberculosis. However, these investigations are intended for primary tuberculosis infection. The majority of cervical tuberculous lymphadenitis cases in the elderly are thought to be caused by reactivation. OBJECTIVE The aims of this study were (1) to examine the efficacy of fine needle aspiration cytology, polymerase chain reaction and blood tests in the diagnosis of cervical tuberculous lymphadenitis caused by reactivation, and (2) to clarify any differences when compared with primarily infected cervical tuberculous lymphadenitis cases. MATERIALS AND METHODS Thirty-three elderly patients with neck lumps underwent excisional biopsy from 2003 to 2008. The efficacy of fine needle aspiration cytology was examined by comparing the results of excisional biopsy with those of fine needle aspiration cytology performed at the initial medical examination for cases of suspected tuberculous disease. Furthermore, the leucocyte count and C-reactive protein concentration were compared for cases of cervical tuberculous lymphadenitis versus cases of malignant lymphoma. RESULTS Although nine cases were diagnosed with cervical tuberculous lymphadenitis using excisional biopsy, only one of these had been suspected based on fine needle aspiration cytology results. Three cases with tuberculous lymphadenitis were suspected of having malignant lymphoma on initial examination. There was no significant difference in the leucocyte count and C-reactive protein concentration, comparing cases of tuberculous lymphadenitis versus malignant lymphoma. CONCLUSION Unlike the primary infection often seen in endemic areas, the diagnosis of early stage tuberculous lymphadenitis of the swelling type caused by reactivation in elderly people is difficult to confirm unless excisional biopsy is performed. In elderly patients with neck lumps, cervical tuberculous lymphadenitis should be included in the differential diagnosis.
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Schwanninger A, Weinberger B, Weiskopf D, Herndler-Brandstetter D, Reitinger S, Gassner C, Schennach H, Parson W, Würzner R, Grubeck-Loebenstein B. Age-related appearance of a CMV-specific high-avidity CD8+ T cell clonotype which does not occur in young adults. IMMUNITY & AGEING 2008; 5:14. [PMID: 19014475 PMCID: PMC2596076 DOI: 10.1186/1742-4933-5-14] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 11/12/2008] [Indexed: 11/15/2022]
Abstract
Old age is associated with characteristic changes of the immune system contributing to higher incidence and severity of many infectious diseases. Particularly within the T cell compartment latent infection with human Cytomegalovirus (CMV) is contributing to and accelerating immunosenescence. However, latent CMV infection and reactivation usually does not cause overt symptoms in immunocompetent elderly persons indicating immunological control of disease. Little is still known about the clonal composition of CMV-specific T cell responses in donors of different age. We therefore analyzed CD8+ T cells specific for an immunodominant pp65-derived nonamer-peptide (NLVPMVATV; CMVNLV) in different age-groups. Independent of donor age CMVNLV-specific CD8+ T cells preferentially use the V beta family 8. This family has monoclonal expansions in the majority of donors after stimulation of CD8+ T cells with the peptide. By sequencing the CDR3 region of the T cell receptor we demonstrated that CMVNLV-specific, BV8+ CD8+ T cells share the conserved CDR3-sequence motif SANYGYT in donors of all age groups. Interestingly, a second conserved clonotype with the CDR3-sequence motif SVNEAF appears in middle-aged and elderly donors. This clonotype is absent in young individuals. The age-related clonotype SVNEAF binds to the pMHC-complex with higher avidity than the clonotype SANYGYT, which is predominant in young adults. The dominance of this high avidity clonotype may explain the lack of overt CMV-disease in old age.
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Affiliation(s)
- Angelika Schwanninger
- Institute for Biomedical Aging Research, Austrian Academy of Sciences, Rennweg 10, 6020 Innsbruck, Austria
| | - Birgit Weinberger
- Institute for Biomedical Aging Research, Austrian Academy of Sciences, Rennweg 10, 6020 Innsbruck, Austria
| | - Daniela Weiskopf
- Institute for Biomedical Aging Research, Austrian Academy of Sciences, Rennweg 10, 6020 Innsbruck, Austria
| | | | - Stephan Reitinger
- Institute for Biomedical Aging Research, Austrian Academy of Sciences, Rennweg 10, 6020 Innsbruck, Austria
| | - Christoph Gassner
- Central Institute for Blood Transfusion and Division for Immunology, University Hospital, 6020 Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion and Division for Immunology, University Hospital, 6020 Innsbruck, Austria
| | - Walther Parson
- Institute of Legal Medicine, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Reinhard Würzner
- Department of Hygiene, Microbiology and Social Medicine, Innsbruck Medical University, 6020 Innsbruck, Austria
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23
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Schluger NW. Tuberculosis and nontuberculous mycobacterial infections in older adults. Clin Chest Med 2008; 28:773-81, vi. [PMID: 17967293 DOI: 10.1016/j.ccm.2007.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tuberculosis is one of the world's great public health crises. It is estimated by the World Health Organization that roughly one third of the world's populations, or some 2 billion people, are infected with Mycobacterium tuberculosis, the causative agent. More than 8 million people every year develop active tuberculosis disease, and 2 million die as a result. This article reviews tuberculosis and nontuberculous mycobacterial infections in older adults.
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Affiliation(s)
- Neil W Schluger
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, Epidemiology and Environmental Health Sciences, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.
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24
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Cavalcanti ZDR, de Albuquerque MDFPM, Campello ARL, Ximenes R, Montarroyos U, Verçosa MKA. Characteristics of elderly tuberculosis patients in Recife, Brazil: a contribution to the tuberculosis control program. J Bras Pneumol 2007; 32:535-43. [PMID: 17435904 DOI: 10.1590/s1806-37132006000600011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Accepted: 02/20/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the demographic characteristics, everyday habits, socio-economic conditions, clinico-epidemiological profiles and access to health care services among the elderly patients with tuberculosis diagnosed and treated in the city of Recife, Brazil, comparing them to those observed in young adults with tuberculosis. METHODS A case-control type strategy was used to evaluate a cohort of patients with tuberculosis, all of whom were treated in public health care facilities in Recife between May of 2001 and July of 2003. RESULTS The final cohort consisted of 1127 patients: 136 elderly patients (cases) and 991 young adults (controls). In both groups, males predominated, and the most common form of tuberculosis was the pulmonary form. Alcoholism was more common in the control group, whereas illiteracy was more common in the case group. There were fewer complaints of cough, sweats and chest pain among the patients in the case group than among those in the control group. Serological testing for the human immunodeficiency virus was performed in only 29 patients (2.6%). The percentage of positive sputum smear microscopy results, as well as that of positive cultures, was higher in the controls. Prior to being diagnosed with the disease, patients in both groups had sought treatment at more than two health care facilities and had waited more than two months (after first seeking treatment). The elderly patients presented higher indices of cure and were more often compliant with the treatment regimen, yet presented higher mortality rates. CONCLUSION In the population studied, the elderly presented less cough, fewer episodes of night sweats and less chest pain, as well as less often presenting positivity on complementary exams. Nevertheless, the mortality rate was higher among the elderly patients than among the young adult patients. Elderly patients with tuberculosis constitute a population that should be given special attention in public health care facilities.
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25
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Thrupp L, Bradley S, Smith P, Simor A, Gantz N, Crossley K, Loeb M, Strausbaugh L, Nicolle L. Tuberculosis prevention and control in long-term-care facilities for older adults. Infect Control Hosp Epidemiol 2005; 25:1097-108. [PMID: 15636299 DOI: 10.1086/502350] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In the United States, older adults comprise 22% of cases of tuberculous disease but only 12% of the population. Most cases of tuberculosis (TB) occur in community dwellers, but attack rates are highest among frail residents of long-term-care facilities. The detection and treatment of latent TB infection and TB disease can pose special challenges in older adults. Rapid recognition of possible disease, diagnosis, and implementation of airborne precautions are essential to prevent spread. It is the intent of this evidence-based guideline to assist healthcare providers in the prevention and control of TB, specifically in skilled nursing facilities for the elderly.
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Affiliation(s)
- Lauri Thrupp
- Infection Control Department, University of California Irvine Medical Center, Orange, California, USA
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26
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Rajagopalan S. The elusive great masquerader: the efficient spread of tuberculosis from a nursing home into the community. J Am Geriatr Soc 2002; 50:1304-5. [PMID: 12133031 DOI: 10.1046/j.1532-5415.2002.50323.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Viloria Jiménez A, Ribera Casado JM. [Clinical suspicion criteria of tuberculosis among elderly patients]. Rev Clin Esp 2002; 202:388-90. [PMID: 12139823 DOI: 10.1016/s0014-2565(02)71087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Rajagopalan S. Tuberculosis and aging: a global health problem. Clin Infect Dis 2001; 33:1034-9. [PMID: 11528577 DOI: 10.1086/322671] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2000] [Revised: 03/14/2001] [Indexed: 11/03/2022] Open
Abstract
Despite the World Health Organization's declaration that the spread of tuberculosis is a global emergency and despite the implementation of strong tuberculosis-control initiatives, this highly infectious disease continues to affect all vulnerable populations, including the elderly population (age > or =65 years). Tuberculosis in aging adults remains a clinical and epidemiological challenge. Atypical clinical manifestations of tuberculosis in older persons can result in delay in diagnosis and initiation of treatment; thus, unfortunately, higher rates of morbidity and mortality from this treatable infection can occur. Underlying illnesses, age-related diminution in immune function, the increased frequency of adverse drug reactions, and institutionalization can complicate the overall clinical approach to tuberculosis in elderly patients; maintenance of a high index of suspicion for tuberculosis in this vulnerable population is, thus, undoubtedly justifiable.
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Affiliation(s)
- S Rajagopalan
- Department of Internal Medicine, Division of Infectious Disease, Charles R. Drew University of Medicine and Science, Martin Luther King, Jr./Drew Medical Center, Los Angeles, CA 90059, USA.
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29
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Rajagopalan S, Yoshikawa TT. Tuberculosis in long-term-care facilities. Infect Control Hosp Epidemiol 2000; 21:611-5. [PMID: 11001270 DOI: 10.1086/501816] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The geriatric population represents the largest reservoir of Mycobacterium tuberculosis infection in developed nations, including the United States. Tuberculosis (TB) case rates in the United States are highest for this age group compared with other age categories. The subtle clinical manifestations of TB in the elderly often can pose potential diagnostic dilemmas and therapeutic challenges, resulting in increased morbidity and mortality in this age group; this treatable infection unfortunately often is detected only at autopsy. Compared with their community-dwelling counterparts, the institutionalized elderly are at a greater risk both for reactivation of latent TB and for the acquisition of new TB infection. Prevention and control of TB in facilities providing long-term care to the elderly thus cannot be overemphasized.
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Affiliation(s)
- S Rajagopalan
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, King-Drew Medical Center, Los Angeles, California 90059, USA
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30
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Affiliation(s)
- N Kumar
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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31
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Harper JR. An old infection: the importance of pulmonary tuberculosis in elderly people in Scotland. Scott Med J 1999; 44:134-6. [PMID: 10629907 DOI: 10.1177/003693309904400503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J R Harper
- Department of Medicine, Ninewells Hospital & Medical School, Dundee
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32
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Affiliation(s)
- E D Chan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, National Jewish Medical and Research Center, Denver 80206, USA.
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33
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Abstract
Tuberculosis is an ancient disease which has had a resurgence in the United States. Many elderly clients were exposed to tuberculosis as children and young adults and are still carrying the infection today. This article describes tuberculosis as it affects the elderly client in community and nursing home settings. The history, etiology, clinical manifestations, treatment, and prevention of tuberculosis infection and disease are presented. Because nurses can be very instrumental in controlling tuberculosis in the elderly, gerontological nursing implications are discussed.
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Affiliation(s)
- V L Gubser
- Fairfax County Public Health Department, Virginia, USA
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34
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Albrand G, Corvaisier S, Bissardon I, Bleyzac N, Maire P. Metabolic complications in tuberculosis patients: the disease or the treatment? J Am Geriatr Soc 1997; 45:658-9. [PMID: 9158602 DOI: 10.1111/j.1532-5415.1997.tb03114.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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35
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Abter EIM, Schaening O, Barbour RL, Lutwick LI. Tuberculosis in the adult. Tuberculosis (Edinb) 1995. [DOI: 10.1007/978-1-4899-2869-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Shuman SK, McCusker ML, Owen MK. Enhancing infection control for elderly and medically compromised patients. J Am Dent Assoc 1993; 124:76-84. [PMID: 8409031 DOI: 10.14219/jada.archive.1993.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Some patients may be at risk for complications from relatively common infectious diseases. Influenza, tuberculosis and methicillin-resistant Staphylococcus aureus infection can lead to illness and even death in elderly, medically compromised and institutionalized individuals. Dental personnel caring for these individuals should adopt preventive strategies that are simple and inexpensive in addition to standard infection control guidelines.
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Affiliation(s)
- S K Shuman
- Department of Preventive Sciences, University of Minnesota School of Dentistry, Minneapolis 55455-0348
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37
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38
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Abstract
Dentists are increasingly treating patients who have significant medically compromising conditions, a number of which predispose individuals to tuberculosis. Three case reports describe patients with histories of tuberculosis exposure. The authors also discuss risk assessment and offer practical guidelines for dental management of these patients.
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Affiliation(s)
- R S Faecher
- Department of Community Dentistry, University of Florida College of Dentistry, Gainesville
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39
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40
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