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Bhargava A, Bhargava M, Velayutham B. Tuberculosis and undernutrition in India - Authors' reply. Lancet Glob Health 2023; 11:e1861. [PMID: 37973335 DOI: 10.1016/s2214-109x(23)00501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Anurag Bhargava
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore 575018, India.
| | - Madhavi Bhargava
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore 575018, India; Department of Community Medicine, Yenepoya Medical College, Mangalore, India
| | - Banurekha Velayutham
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
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Avaliani Z, Gozalov O, Kuchukhidze G, Skrahina A, Soltan V, van den Boom M, Vasilyeva I, Vilc V, Yedilbayev A. What is behind programmatic treatment outcome definitions for tuberculosis? Eur Respir J 2020; 56:56/1/2001751. [PMID: 32703821 DOI: 10.1183/13993003.01751-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/22/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | | | - Alena Skrahina
- Republican Research and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | | | - Irina Vasilyeva
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russian Federation
| | - Valentina Vilc
- Institute of Phthisiopneumology, Chisinau, Republic of Moldova
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3
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Holden IK, Andersen PH, Wejse C, Lillebaek T, Johansen IS. Review of tuberculosis treatment outcome reporting system in Denmark, a retrospective study cohort study from 2009 through 2014. BMC Health Serv Res 2020; 20:83. [PMID: 32013962 PMCID: PMC6998178 DOI: 10.1186/s12913-020-4927-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Denmark, reporting of tuberculosis (TB) treatment outcome is voluntary and data incomplete. In the European Centre for Disease Prevention and Control most recent report presenting data from 2017, only 53.9% of Danish pulmonary TB cases had a reported outcome. Monitoring of TB treatment outcome is not feasible based on such limited results. In this retrospective study from 2009 to 2014, we present complete treatment outcome data and describe characteristics of cases lost to follow up. METHODS All cases notified from 2009 through 2014 were reviewed. Hospital records were examined, and TB treatment outcome was categorized according to the World Health Organization's (WHO) definitions. RESULTS A total of 2131 TB cases were included. Treatment outcome was reported to the Surveillance Unit in 1803 (84.6%) cases, of which 468 (26.0%) were reclassified. For pulmonary TB, 339 (28.9%) cases were reclassified between cured and treatment completed. Overall, the proportion of cases who achieved successful treatment outcome increased from 1488 (70.4%) to 1748 (81.8%). CONCLUSION A high number of cases were reclassified during the review process. Increased focus on correct treatment outcome reporting is necessary in Denmark. A more comprehensive and exhaustive categorization of TB treatment outcome could be beneficial, especially for cases where collection of sputum or tissue towards the end of treatment is challenging.
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Affiliation(s)
- Inge K Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, 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.,GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
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Evenden P, Roche A, Karo B, Balasegaram S, Anderson CS. Presentation and healthcare delays among people with tuberculosis in London, and the impact on treatment outcome. BMJ Open Respir Res 2019; 6:e000468. [PMID: 31673368 PMCID: PMC6797301 DOI: 10.1136/bmjresp-2019-000468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background A quarter of London’s pulmonary tuberculosis (TB) patients have over 4 months of delay. Late diagnosis increases disease severity and the risk of transmission. We aim to classify delays, identify associated risk factors and assess treatment outcome. Methods We conducted a retrospective cohort study using London surveillance data, 2012–2018 on adults aged ≥18 years with pulmonary TB. We defined presentation delay (days from symptom onset to first healthcare visit) and healthcare delay (first healthcare visit to treatment commencement) as dichotomous variables; positive delay being days equal or greater than the third quartile. We applied logistic regression models to identify risk factors associated with delays and treatment outcome at 12 months. Results Of 7216 people, 4539 reported presentation and 5193 healthcare delays. The third quartiles for presentation and healthcare delay were 84 and 61 days, respectively. Presentation delay was associated with female sex (adjusted OR (aOR)=1.21; 95% CI 1.04 to 1.39), increasing age (aOR=1.004; 95% CI 1.001 to 1.008), white compared to Asian ethnicity (aOR=1.35; 95% CI 1.12 to 1.62), previous imprisonment (aOR=1.66; 95% CI 1.22 to 2.26) and alcohol misuse (aOR=1.44; 95% CI 1.04 to 1.89). Healthcare delay was associated with female sex (aOR=1.39; 95% CI 1.21 to 1.59), increasing age (aOR=1.014; 95% CI 1.009 to 1.018) and white ethnicity (aOR=1.41; 95% CI 1.19 to 1.68). 16% of 5678 people with known outcome did not complete treatment. Neither delay was associated with non-completion (p value <0.05). Conclusions Female, white and older people with TB were more likely to experience both presentation and healthcare delays. Social risk factors were also associated with delay in presentation. Early diagnosis and treatment remain critical to reduce transmission, regardless of whether delay affected completion.
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Affiliation(s)
- Poppy Evenden
- ANTICPE, INSERM U1086, Caen, France.,Field Service, South East and London, Public Health England, London, UK
| | - Anita Roche
- South London Health Protection Team, Public Health England, London, UK
| | - Basel Karo
- Field Service, South East and London, Public Health England, London, UK.,ECDC, European Centre for Disease Prevention and Control, Solna, Sweden
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5
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Holden IK, Lillebaek T, Seersholm N, Andersen PH, Wejse C, Johansen IS. Predictors for Pulmonary Tuberculosis Treatment Outcome in Denmark 2009-2014. Sci Rep 2019; 9:12995. [PMID: 31506499 PMCID: PMC6736960 DOI: 10.1038/s41598-019-49439-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/20/2019] [Indexed: 11/24/2022] Open
Abstract
Monitoring of tuberculosis (TB) treatment outcome is essential to ensure an effective TB control program. In this nationwide retrospective cohort study from Denmark we present TB treatment outcome rates and risk factors associated with an unfavourable outcome. All patients notified with pulmonary TB from 2009 through 2014 were included. Logistic regression analyses were used to identify risk factors for unfavourable outcome. In total, 1681 pulmonary TB cases were included. TB treatment success rates increased during the study period. In 2014, the treatment success rate reached 85% for new culture positive cases whereas 7% cases interrupted treatment. The mortality decreased during the study period from 12.3% to 4.1%. Several risk factors associated with unfavourable outcome were identified in a multivariable model: male (OR: 2.56), Greenlandic origin (OR: 1.80), abuse of alcohol (OR: 2.90), history of mental disorder (OR: 2.46), and anaemia at time of treatment initiation (OR: 1.92). In a TB low incidence setting such as the Danish, it is important to maintain focus on preventing an unfavourable TB outcome. Patient management and treatment can be optimized by taking into consideration risk factors such as those identified in the present study.
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Affiliation(s)
- Inge K Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark.
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, 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
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
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6
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Holden IK, Lillebaek T, Andersen PH, Bjerrum S, Wejse C, Johansen IS. Extrapulmonary Tuberculosis in Denmark From 2009 to 2014; Characteristics and Predictors for Treatment Outcome. Open Forum Infect Dis 2019; 6:ofz388. [PMID: 31660351 PMCID: PMC6786510 DOI: 10.1093/ofid/ofz388] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/30/2019] [Indexed: 12/27/2022] Open
Abstract
Background Extrapulmonary tuberculosis (EPTB) represents an increasing percentage of tuberculosis (TB) cases in Europe. However, strategies on TB prevention and successful treatment outcomes primarily target pulmonary TB. In this nationwide study, we present characteristics of EPTB, treatment outcomes, and predictors for unfavorable treatment outcomes. Methods All patients diagnosed with EPTB from 2009 to 2014 were included. Logistic regression analyses were used to identify risk factors for unfavorable outcome. The following definitions were used: unfavorable outcome: the sum of treatment failed, lost to follow-up, and not evaluated; patient delay: time from TB-related symptom onset until first hospital contact related to TB; doctor delay: time from first TB-related contact in the health care system to start of TB treatment. Results A total of 450 EPTB cases were notified, which represented 21.1% of all TB cases in Denmark. Immigrants accounted for 82.9%. Lymph nodes were the most common site of EPTB (55.4%) followed by pleural TB (13.4%). Patient delay was significantly longer among immigrants than Danes (60 vs 30 days; P < .01), whereas doctor delay was significantly longer among Danes (38.5 vs 28 days; P < .01). Treatment completion rates were high and reached 90.9% in 2014. Male gender (odds ratio [OR], 5.18; 95% confidence interval [CI], 1.79–15.04) and age 0–24 years (OR, 16.39; 95% CI, 2.02–132.64) were significantly associated with unfavorable outcome. Conclusions EPTB represented a significant number of all TB cases and was predominantly seen among younger immigrants in Denmark. To maintain high treatment completion rates, increased focus on male gender and young age is needed.
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Affiliation(s)
- Inge K Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, Aarhus, Denmark.,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
| | - 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
| | - Stephanie Bjerrum
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, Aarhus, Denmark.,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, Aarhus, Denmark.,Mycobacterial Centre for Research Southern Denmark - MyCRESD, Odense, Denmark
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Yunusbaeva M, Borodina L, Alekseev P, Davydov R, Yunusbaev U, Sharipov R, Bilalov F, Yunusbayev B. Treatment efficacy of drug-resistant tuberculosis in Bashkortostan, Russia: A retrospective cohort study. Int J Infect Dis 2019; 81:203-209. [PMID: 30794942 DOI: 10.1016/j.ijid.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Russia, together with other former Soviet Union countries, is characterized by one of the highest burdens of drug-resistant tuberculosis. Published data on the drug-resistant tuberculosis for these countries are limited, and it is not clear whether current treatment regimens remain effective against constantly evolving drug-resistant strains. OBJECTIVES The aim of the study was to evaluate treatment efficacy of patients with multidrug-resistant (MDR), extensively drug-resistant (XDR) and drug-susceptible (DSTB) tuberculosis in the most populous region of Russia (Bashkortostan) that borders with Central Asia. METHODS A retrospective cohort study was performed on 436 patients with pulmonary tuberculosis who were enrolled between January 1, 2016, and February 28, 2018, and received treatment according to WHO recommendations. Altogether, 369 patients completed the full course of chemotherapy. Clinical characteristics and treatment outcomes of DSTB, MDR, and XDR-TB patients were analyzed. RESULTS Of 436 patients, 169 (39%) had XDR-TB, 94 (22%) had MDR-TB and 173 (40%) had DSTB. Half of the MDR-TB patients (44%) and 82% of XDR-TB patients failed treatment. Patients with DSTB had unexpectedly poor treatment efficacy: only 67% had treatment success. We found that most of the MDR isolates from our patients were resistant to all first-line drugs, and a majority of the XDR isolates were resistant to more than 6-7 anti-TB drugs. While this can explain poor treatment efficacy in drug-resistant cases, causes of poor treatment efficacy in DSTB patients remain unclear. Finally, a considerable fraction (46%) of newly diagnosed patients had MDR-TB (27%) and XDR-TB (19%), suggesting that drug-resistant Mtb is being transmitted in the general population. To our best knowledge, this study is the first one to report XDR-TB prevalence in Russia in recent years (2016-2018). CONCLUSIONS MDR and XDR-TB became more common in recent years and treatment efficacy is declining at the face of more extensive drug resistance. There is evidence for the transmission of resistant strains in the general population, which calls for urgent changes not only in clinical practice but also in measures to prevent spread in the general population.
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Affiliation(s)
- Milyausha Yunusbaeva
- Institute of Biochemistry and Genetics, Ufa Federal Research Centre of the Russian Academy of Sciences, Ufa, Bashkortostan, Pr. Oktyabrya, 71, Russia; Bashkir State Pedagogical University M. Akmullah, Ufa, October Revolution, 3a, Russia
| | - Liliya Borodina
- Republican Clinical Antituberculous Dispensary, Ufa, Pr. Oktyabrya, 155, Russia
| | - Pavel Alekseev
- Bashkir State Medical University, Ufa, Lenina, 3, Bashkortostan, Russia
| | - Rostislav Davydov
- Bashkir State Medical University, Ufa, Lenina, 3, Bashkortostan, Russia
| | - Ural Yunusbaev
- Institute of Biochemistry and Genetics, Ufa Federal Research Centre of the Russian Academy of Sciences, Ufa, Bashkortostan, Pr. Oktyabrya, 71, Russia; Incheon National University, Incheon, Academy-ro, 119, South Korea
| | - Raul Sharipov
- Republican Clinical Antituberculous Dispensary, Ufa, Pr. Oktyabrya, 155, Russia
| | - Fanil Bilalov
- Bashkir State Medical University, Ufa, Lenina, 3, Bashkortostan, Russia
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van Leth F, Brinkmann F, Cirillo DM, Dheda K, Duarte R, Guglielmetti L, Kuksa L, Lange C, Mitnick C, Skrahina A, Zaman K, Bothamley G. The Tuberculosis Network European Trials group (TBnet) ERS Clinical Research Collaboration: addressing drug-resistant tuberculosis through European cooperation. Eur Respir J 2019; 53:53/1/1802089. [PMID: 30606765 DOI: 10.1183/13993003.02089-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Frank van Leth
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,Amsterdam University Medical Centers, Location Meibergdreef, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Folke Brinkmann
- Universitaetskinderklinik fuer Kinder- und Jugendmedizin, Ruhr University, Bochum, Germany
| | - Daniela M Cirillo
- Emerging Bacterial Pathogens, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, UCT Lung Institute and Dept of Medicine, University of Cape Town, Cape Town, South Africa.,University College London, London, UK
| | - Raquel Duarte
- Pneumology Dept, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal.,ISPUP-EP unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lorenzo Guglielmetti
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France.,Sorbonne Université, Université Pierre et Marie Curie 06, Unité 1135, Team E13 (Bactériologie), CR7 INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Liga Kuksa
- Riga East University Hospital, and WHO Collaborating Centre, Riga, Latvia
| | - Christoph Lange
- German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany.,Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - Carole Mitnick
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Alena Skrahina
- The Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Khalequ Zaman
- ICDDRB Infectious Disease Division, Dhaka, Bangladesh
| | - Graham Bothamley
- Homerton University Hospital, London, UK.,Blizard Institute, Barts and The Royal London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
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