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Sacoor C, Vitorino P, Nhacolo A, Munguambe K, Mabunda R, Garrine M, Jamisse E, Magaço A, Xerinda E, Sitoe A, Fernandes F, Carrilho C, Maixenchs M, Chirinda P, Nhampossa T, Nhancale B, Rakislova N, Bramugy J, Nhacolo A, Ajanovic S, Valente M, Massinga A, Varo R, Menéndez C, Ordi J, Mandomando I, Bassat Q. Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique. Gates Open Res 2024; 7:4. [PMID: 39233704 PMCID: PMC11374382 DOI: 10.12688/gatesopenres.13931.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 09/06/2024] Open
Abstract
The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.
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Affiliation(s)
- Charfudin Sacoor
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Pio Vitorino
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Ariel Nhacolo
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Khátia Munguambe
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Maputo, Mozambique
| | - Rita Mabunda
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Marcelino Garrine
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Edgar Jamisse
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Amílcar Magaço
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Elísio Xerinda
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - António Sitoe
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Fabíola Fernandes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Maputo, Mozambique
| | - Carla Carrilho
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Maputo, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo, Maputo, Mozambique
| | - Maria Maixenchs
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Percina Chirinda
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Tacilta Nhampossa
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Bento Nhancale
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Justina Bramugy
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Arsénio Nhacolo
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Sara Ajanovic
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Marta Valente
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Arsénia Massinga
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
| | - Rosauro Varo
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- National Institute of Health, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Quique Bassat
- Manhiça Health Research Center, Municipio da Vila da Manhiça, Maputo Province, 1929, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
- ICREA, Barcelona, Spain
- Pediatric Department, Hospital Sant Joan de Deu- Universitat de Barcelona, Barcelona, Spain
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Naidoo K, Perumal R, Cox H, Mathema B, Loveday M, Ismail N, Omar SV, Georghiou SB, Daftary A, O'Donnell M, Ndjeka N. The epidemiology, transmission, diagnosis, and management of drug-resistant tuberculosis-lessons from the South African experience. THE LANCET. INFECTIOUS DISEASES 2024; 24:e559-e575. [PMID: 38527475 DOI: 10.1016/s1473-3099(24)00144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
Drug-resistant tuberculosis (DR-TB) threatens to derail tuberculosis control efforts, particularly in Africa where the disease remains out of control. The dogma that DR-TB epidemics are fueled by unchecked rates of acquired resistance in inadequately treated or non-adherent individuals is no longer valid in most high DR-TB burden settings, where community transmission is now widespread. A large burden of DR-TB in Africa remains undiagnosed due to inadequate access to diagnostic tools that simultaneously detect tuberculosis and screen for resistance. Furthermore, acquisition of drug resistance to new and repurposed drugs, for which diagnostic solutions are not yet available, presents a major challenge for the implementation of novel, all-oral, shortened (6-9 months) treatment. Structural challenges including poverty, stigma, and social distress disrupt engagement in care, promote poor treatment outcomes, and reduce the quality of life for people with DR-TB. We reflect on the lessons learnt from the South African experience in implementing state-of-the-art advances in diagnostic solutions, deploying recent innovations in pharmacotherapeutic approaches for rapid cure, understanding local transmission dynamics and implementing interventions to curtail DR-TB transmission, and in mitigating the catastrophic socioeconomic costs of DR-TB. We also highlight globally relevant and locally responsive research priorities for achieving DR-TB control in South Africa.
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Affiliation(s)
- Kogieleum Naidoo
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Rubeshan Perumal
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Helen Cox
- Institute of Infectious Diseases and Molecular Medicine, Wellcome Centre for Infectious Disease Research and Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Barun Mathema
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Marian Loveday
- South African Medical Research Council, Durban, South Africa
| | - Nazir Ismail
- School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Shaheed Vally Omar
- Centre for Tuberculosis, National & WHO Supranational TB Reference Laboratory, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | | | - Amrita Daftary
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; School of Global Health and Dahdaleh Institute of Global Health Research, York University, Toronto, ON, Canada
| | - Max O'Donnell
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York City, NY, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York City, NY, USA
| | - Norbert Ndjeka
- TB Control and Management, Republic of South Africa National Department of Health, Pretoria, South Africa
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Basile FW, Sweeney S, Singh MP, Bijker EM, Cohen T, Menzies NA, Vassall A, Indravudh P. Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003429. [PMID: 39042611 PMCID: PMC11265660 DOI: 10.1371/journal.pgph.0003429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/12/2024] [Indexed: 07/25/2024]
Abstract
Tuberculosis is a major infectious disease worldwide, but currently available diagnostics have suboptimal accuracy, particularly in patients unable to expectorate, and are often unavailable at the point-of-care in resource-limited settings. Test/treatment decision are, therefore, often made on clinical grounds. We hypothesized that contextual factors beyond disease probability may influence clinical decisions about when to test and when to treat for tuberculosis. This umbrella review aimed to identify such factors, and to develop a framework for uncertainty in tuberculosis clinical decision-making. Systematic reviews were searched in seven databases (MEDLINE, CINAHL Complete, Embase, Scopus, Cochrane, PROSPERO, Epistemonikos) using predetermined search criteria. Findings were classified as barriers and facilitators for testing or treatment decisions, and thematically analysed based on a multi-level model of uncertainty in health care. We included 27 reviews. Study designs and primary aims were heterogeneous, with seven meta-analyses and three qualitative evidence syntheses. Facilitators for decisions to test included providers' advanced professional qualification and confidence in tests results, availability of automated diagnostics with quick turnaround times. Common barriers for requesting a diagnostic test included: poor provider tuberculosis knowledge, fear of acquiring tuberculosis through respiratory sampling, scarcity of healthcare resources, and complexity of specimen collection. Facilitators for empiric treatment included patients' young age, severe sickness, and test inaccessibility. Main barriers to treatment included communication obstacles, providers' high confidence in negative test results (irrespective of negative predictive value). Multiple sources of uncertainty were identified at the patient, provider, diagnostic test, and healthcare system levels. Complex determinants of uncertainty influenced decision-making. This could result in delayed or missed diagnosis and treatment opportunities. It is important to understand the variability associated with patient-provider clinical encounters and healthcare settings, clinicians' attitudes, and experiences, as well as diagnostic test characteristics, to improve clinical practices, and allow an impactful introduction of novel diagnostics.
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Affiliation(s)
- Francesca Wanda Basile
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maninder Pal Singh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Else Margreet Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, Maastricht University Medical Centre, MosaKids Children’s Hospital, Maastricht, the Netherlands
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nicolas A. Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Molinengo L, Estrin-Serlui T, Hanley B, Osborn M, Goldin R. Infectious diseases and the role of needle biopsy post-mortem. THE LANCET. MICROBE 2024; 5:707-716. [PMID: 38604206 DOI: 10.1016/s2666-5247(24)00044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 04/13/2024]
Abstract
Post-mortem examinations continue to play a crucial role in understanding the epidemiology and pathogenesis of infectious diseases. However, the perceived infection risk can preclude traditional, invasive, complete diagnostic autopsy. Post-mortem examination is especially important in emerging infectious diseases with potentially unknown infection risks, but rapid acquisition of good quality tissue samples is needed as part of the scientific and public health response. Needle biopsy post-mortem is a minimally invasive, rapid, closed-body autopsy technique that was originally developed to minimise the infection risk to practitioners. Since its inception, needle biopsy post-mortem has also been used as a technique to support complete diagnostic autopsy provision in poorly resourced regions and to facilitate post-mortem examinations in communities that might have religious or cultural objections to an invasive autopsy. This Review analyses the evolution and applicability of needle biopsy post-mortem in investigating endemic and emerging infectious diseases.
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Affiliation(s)
- Lucia Molinengo
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | - Theodore Estrin-Serlui
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Brian Hanley
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK; Department of Metabolism, Digestion and Reproduction, South Kensington Campus, Imperial College, London, UK
| | - Michael Osborn
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Robert Goldin
- Department of Metabolism, Digestion and Reproduction, South Kensington Campus, Imperial College, London, UK
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Sindato EM, Mlwati A, Swai SS, Kajogoo VD. Postmortem for Intensified Missed Tuberculosis Case Finding in High Human Immunodeficiency Virus and Tuberculosis-burdened Settings in Sub-Saharan Africa among Adults' Population: Systematic Review and Meta-analysis. Int J Mycobacteriol 2024; 13:126-132. [PMID: 38916381 DOI: 10.4103/ijmy.ijmy_41_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/18/2024] [Indexed: 06/26/2024] Open
Abstract
Tuberculosis (TB) is the leading infectious cause of mortality in sub-Saharan Africa (SSA); the high prevalence of TB in this region is due to human immunodeficiency virus (HIV)-coinfection. Despite the advent of modalities to diagnose TB, undiagnosed TB-related deaths among HIV-infected patients remain significantly high. This systematic review aims at characterizing missed TB cases from postmortem studies. This review informs on the burden of TB missed diagnosis and highlights the need of improving TB case-finding strategies, especially among the high-risk groups and early TB therapy initiation to keeping in with the World Health Organization's end TB strategy. We searched PubMed, Cochrane, Web of Science, and African journals online for studies that looked into missed TB cases following postmortem using the following key terms: postmortem, TB diagnosis, and HIV; we included cross-sectional and cohorts from 1980 in the English language that were carried out in SSA among adults' population. Authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reporting, the quality of the included studies was assessed using the Newcastle-Ottawa Scale for observational studies, and STATA 17.0 software was used for analysis. This study was registered in the International Prospective Register of Systematic Reviews with registration number CRD42024507515. The combined prevalence of postmortem missed TB diagnosis among the 6025 participants was 27.13% (95% confidence interval [CI] =14.52-41.89), with a high level of heterogeneity at 98.65% (P < 0.001). The prevalence varied significantly across the included studies, ranging from 1.21% (95% CI = 0.93-1.59) in the general population to 66.67% (95% CI = 50.98-79.37) in people living with HIV (PLWHIV). This current literature suggests that SSA is a region with a high prevalence of missed TB cases but with significant variations between countries. In addition, this study confirms a high number of missed TB infections within the PLWHIV. These results highlight the immediate need for targeted screening and diagnosis strategies and relevant policies.
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Affiliation(s)
- Emmanuel M Sindato
- Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
| | - Abdallah Mlwati
- Department of Internal Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
- Department of Chest Diseases, Alexandria University, Egypt
| | - Sylivia Sarah Swai
- Department of Demand Planning, Global Health Supply Chain-Technical Assistance Project, Dar-es-Salaam, Tanzania
| | - Violet Dismas Kajogoo
- Department of Clinical Trials, Tanzania Diabetes Association, Dar-es-Salaam, Tanzania
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Hernanz-Lobo A, Noguera-Julian A, Minguell L, López-Suárez A, Soriano-Arandes A, Espiau M, Colino Gil E, López Medina EM, Bustillo-Alonso M, Aguirre-Pascual E, Baquero-Artigao F, Calavia Garsaball O, Gomez-Pastrana D, Falcón-Neyra L, Santiago-García B. Prevalence and Clinical Characteristics of Children With Nonsevere Tuberculosis in Spain. Pediatr Infect Dis J 2023; 42:837-843. [PMID: 37410579 DOI: 10.1097/inf.0000000000004016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND To assess the prevalence and characteristics of nonsevere TB among children in Spain. It has been recently demonstrated that these children can be treated with a 4-month regimen instead of the classical 6-month treatment regimen, with the same effectivity and outcomes, decreasing toxicity and improving adherence. METHODS We conducted a retrospective cohort study in a cohort of children ≤16 years of age with TB. Nonsevere TB cases included smear-negative children with respiratory TB confined to 1 lobe, with no significant airway obstruction, no complex pleural effusion, no cavities and no signs of miliary disease, or with peripheral lymph-node disease. The remaining children were considered to have severe TB. We estimated the prevalence of nonsevere TB and compared the clinical characteristics and outcomes between children with nonsevere and severe TB. RESULTS A total of 780 patients were included [46.9% males, median age 5.5 years (IQR: 2.6-11.1)], 477 (61.1%) of whom had nonsevere TB. Nonsevere TB was less frequent in children <1 year (33% vs 67%; P < 0.001), and >14 years of age (35% vs 65%; P = 0.002), mostly diagnosed in contact tracing studies (60.4% vs 29.2%; P < 0.001) and more frequently asymptomatic (38.3% vs 17.7%; P < 0.001). TB confirmation in nonsevere disease was less frequent by culture (27.0% vs 57.1%; P < 0.001) and by molecular tests (18.2% vs 48.8%; P < 0.001). Sequelae were less frequent in children with nonsevere disease (1.7 vs 5.4%; P < 0.001). No child with nonsevere disease died. CONCLUSIONS Two-thirds of children had nonsevere TB, mostly with benign clinical presentation and negative microbiologic results. In low-burden countries, most children with TB might benefit from short-course regimens.
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Affiliation(s)
- Alicia Hernanz-Lobo
- From the Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain
- Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- RITIP Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
| | - Antoni Noguera-Julian
- RITIP Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Hospital Sant Joan de Déu
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
- Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Laura Minguell
- Department of Paediatrics, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Andrea López-Suárez
- Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Soriano-Arandes
- RITIP Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
- Pediatrics Department, Drassanes-Vall d'Hebron Center for International Health and Communicable Diseases, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Complejo Hospitalario Insular Materno Infantil Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Maria Espiau
- Pediatrics Department, Drassanes-Vall d'Hebron Center for International Health and Communicable Diseases, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Complejo Hospitalario Insular Materno Infantil Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Elena Colino Gil
- Pediatrics Department, Drassanes-Vall d'Hebron Center for International Health and Communicable Diseases, Barcelona, Spain
| | | | - Matilde Bustillo-Alonso
- Pediatrics Infectious Diseases Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Fernando Baquero-Artigao
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- RITIP Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
- Department of Infectious Diseases and Tropical Pediatrics, La Paz Hospital, Madrid, Spain
| | | | - David Gomez-Pastrana
- Unidad de Neumología Infantil, Servicio de Pediatría, Hospital Universitario Materno-Infantil de Jerez, Jerez de la Frontera, Spain
- Grupo de investigación UNAIR, Jerez de la Frontera, Cádiz, Spain
| | - Lola Falcón-Neyra
- RITIP Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Institute of Biomedicine, Seville, Spain
| | - Begoña Santiago-García
- From the Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain
- Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- RITIP Translational Research Network in Pediatric Infectious Diseases, Madrid, Spain
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7
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Aguiar Soares K, Ehrlich J, Camará M, Chaloub S, Emeka E, Gando HG, Ismail F, Mvusi L, Jele T, José B, Kgwaadira B, Kisonga R, Letta T, Liega AO, Lungu PS, Maama L, Mahoumbou J, Mbendera K, Ogoro J, Tollo DAD, Sandy C, Saye RG, Sheehama J, Musala S, Tugumisirize D, Carratala L, Cossa M, Garcia-Basteiro AL. Implementation of WHO guidelines on urine lateral flow LAM testing in high TB/HIV burden African countries. Eur Respir J 2023; 62:2300556. [PMID: 37802630 DOI: 10.1183/13993003.00556-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/26/2023] [Indexed: 10/10/2023]
Affiliation(s)
| | - Joanna Ehrlich
- ISGlobal - Barcelona Institute for Global Health, Barcelona, Spain
| | - Miguel Camará
- Programa Nacional de Luta Contra Lepra e Tuberculose, Bissau, Guinea-Bissau
| | | | - Elom Emeka
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Hervé Gildas Gando
- Service de Lutte Contre la Tuberculose, Bangui, Central African Republic
| | - Farzana Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases/National Health Laboratory Services, Johannesburg, South Africa
| | - Lindiwe Mvusi
- TB Control and Management, National Department of Health, Pretoria, South Africa
| | - Thulani Jele
- National Tuberculosis Control Programme, Manzini, Eswatini
| | - Benedita José
- Programa Nacional de Controlo da Tuberculose, Maputo, Mozambique
| | | | - Riziki Kisonga
- National Tuberculosis and Leprosy Programme, Dar Es Salaam, United Republic of Tanzania
| | - Taye Letta
- National Tuberculosis and Leprosy Programme, Addis Ababa, Ethiopia
| | | | | | - Llang Maama
- National Tuberculosis and Leprosy Programme, Maseru, Lesotho
| | - Jocelyn Mahoumbou
- Programme National de Lutte Contre la Tuberculose, Libreville, Gabon
| | | | - Jeremiah Ogoro
- National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya
| | | | | | - Rufus G Saye
- National Leprosy and Tuberculosis Control Programme, Monrovia, Liberia
| | | | - Sissy Musala
- Programme National de Lutte Contre la Tuberculose, Kinshasa, Democratic Republic of the Congo
| | - Didas Tugumisirize
- Ministry of Health - National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Lucia Carratala
- ISGlobal - Barcelona Institute for Global Health, Barcelona, Spain
| | - Marta Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Alberto L Garcia-Basteiro
- ISGlobal - Barcelona Institute for Global Health, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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8
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Montoya I de Manuel-Rimbau A, Nguenha D, Mambuque E, Ehrlich J, Munguambe S, Saavedra B, Matsena T, Chiconela H, Casellas A, López-Varela E, Acacio S, Garcia-Basteiro AL. Initiation and adherence to isoniazid preventive therapy in children under 5 years of age in Manhiça, Southern Mozambique. J Trop Pediatr 2022; 69:7010560. [PMID: 36718019 DOI: 10.1093/tropej/fmad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The WHO recommends preventive treatment for all pediatric contacts of a confirmed TB case, but coverage remains low in many high TB burden countries. We aimed to assess the coverage and adherence of the isoniazid preventive therapy (IPT) program among children under 5 years of age with household exposure to an adult pulmonary TB case in a rural district of Southern Mozambique. The estimated IPT coverage was 11.7%. A longer distance to the health center and lower age of the children hindered IPT initiation. Among patients who started IPT, 12/18 (69.9%) were adherent to the 6-month treatment.
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Affiliation(s)
| | - Dinis Nguenha
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Edson Mambuque
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Joanna Ehrlich
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Shilzia Munguambe
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Belén Saavedra
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Teodimiro Matsena
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Hélio Chiconela
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique.,National Tuberculosis Control Programme, District of Manhiça, Mozambique
| | - Aina Casellas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elisa López-Varela
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Sozinho Acacio
- Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique
| | - Alberto L Garcia-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saude de Manhiça, Manhiça, Maputo, Mozambique.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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9
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Shah HD, Yasobant S, Narkhede KM, Patel J, Bhavsar P, Saha S, Sinha AK, Saxena D, Puwar T, Nimavat PD, Kapadia D, Makwana S. A step up to end tuberculosis: Lessons from a community-based death review of patients with tuberculosis from western India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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10
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Vonasek BJ, Rabie H, Hesseling AC, Garcia-Prats AJ. Tuberculosis in Children Living With HIV: Ongoing Progress and Challenges. J Pediatric Infect Dis Soc 2022; 11:S72-S78. [PMID: 36314545 DOI: 10.1093/jpids/piac060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There has been much recent progress on control of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics globally. However, advances in children have lagged behind, and TB-HIV coinfection continues to be a major driver of pediatric mortality in many settings. This review highlights recent research findings in the areas of prevention, diagnosis, and treatment of HIV-associated childhood TB. Key areas for future research are defined. Current prevention efforts such as vaccination, TB symptom screening, and TB preventive treatment are demonstrated as beneficial but need to be optimized for children living with HIV (CLHIV). Diagnosis of HIV-associated TB in children remains a major challenge, depending heavily on clinicians' ability to judge an array of signs, symptoms, and imaging findings, but there are a growing number of promising diagnostic tools with improved accuracy and feasibility. Treatment of TB-HIV coinfection has also seen recent progress with more evidence demonstrating the safety and effectiveness of shorter regimens for treatment of TB infection and disease and improved understanding of interactions between antiretrovirals and TB medications. However, several evidence gaps on drug-drug interactions persist, especially for young children and those with drug-resistant TB. Accelerated efforts are needed in these areas to build upon current progress and reduce the burden of TB on CLHIV.
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Affiliation(s)
- Bryan J Vonasek
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Helena Rabie
- FAMCRU, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anthony J Garcia-Prats
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Saavedra Cervera B, López MG, Chiner-Oms Á, García AM, Cancino-Muñoz I, Torres-Puente M, Villamayor L, Madrazo-Moya C, Mambuque E, Sequera GV, Respeito D, Blanco S, Augusto O, López-Varela E, García-Basteiro AL, Comas I. Fine-grain population structure and transmission patterns of Mycobacterium tuberculosis in southern Mozambique, a high TB/HIV burden area. Microb Genom 2022; 8. [PMID: 35787782 PMCID: PMC9455694 DOI: 10.1099/mgen.0.000844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Genomic studies of the Mycobacterium tuberculosis complex (MTBC) might shed light on the dynamics of its transmission, especially in high-burden settings, where recent outbreaks are embedded in the complex natural history of the disease. To this end, we conducted a 1 year prospective surveillance-based study in Mozambique. We applied whole-genome sequencing (WGS) to 295 positive cultures. We fully characterized MTBC isolates by phylogenetics and dating evaluation, and carried out a molecular epidemiology analysis to investigate further associations with pre-defined transmission risk factors. The majority of strains (49.5%, 136/275) belonged to lineage (L) 4; 57.8 % of them (159/275) were in genomic transmission clusters (cut-off 5 SNPs), and a strikingly high proportion (45.5%) shared an identical genotype (0 SNP pairwise distance). We found two ‘likely endemic’ clades, comprising 67 strains, belonging to L1.2, which dated back to the late 19th century and were associated with recent spread among people living with human immunodeficiency virus (PLHIV). We describe for the first time the population structure of MTBC in our region, a high tuberculosis (TB)/HIV burden area. Clustering analysis revealed an unforeseen pattern of spread and high rates of progression to active TB, suggesting weaknesses in TB control activities. The long-term presence of local strains in Mozambique, which were responsible for large transmission among HIV/TB-coinfected patients, calls into question the role of HIV in TB transmission.
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Affiliation(s)
- Belén Saavedra Cervera
- PhD Programin Medicine and Translational Research, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Mariana G López
- Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain
| | | | - Ana María García
- Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain.,Universidad de Valencia, Valencia, Spain
| | | | | | | | | | - Edson Mambuque
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Durval Respeito
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Silvia Blanco
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Iñaki Comas
- Instituto de Biomedicina de Valencia (IBV), CSIC, Valencia, Spain.,CIBER in Epidemiology and Public Health, Madrid, Spain
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12
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Dheda K, Perumal T, Moultrie H, Perumal R, Esmail A, Scott AJ, Udwadia Z, Chang KC, Peter J, Pooran A, von Delft A, von Delft D, Martinson N, Loveday M, Charalambous S, Kachingwe E, Jassat W, Cohen C, Tempia S, Fennelly K, Pai M. The intersecting pandemics of tuberculosis and COVID-19: population-level and patient-level impact, clinical presentation, and corrective interventions. THE LANCET. RESPIRATORY MEDICINE 2022; 10:603-622. [PMID: 35338841 PMCID: PMC8942481 DOI: 10.1016/s2213-2600(22)00092-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 01/19/2023]
Abstract
The global tuberculosis burden remains substantial, with more than 10 million people newly ill per year. Nevertheless, tuberculosis incidence has slowly declined over the past decade, and mortality has decreased by almost a third in tandem. This positive trend was abruptly reversed by the COVID-19 pandemic, which in many parts of the world has resulted in a substantial reduction in tuberculosis testing and case notifications, with an associated increase in mortality, taking global tuberculosis control back by roughly 10 years. Here, we consider points of intersection between the tuberculosis and COVID-19 pandemics, identifying wide-ranging approaches that could be taken to reverse the devastating effects of COVID-19 on tuberculosis control. We review the impact of COVID-19 at the population level on tuberculosis case detection, morbidity and mortality, and the patient-level impact, including susceptibility to disease, clinical presentation, diagnosis, management, and prognosis. We propose strategies to reverse or mitigate the deleterious effects of COVID-19 and restore tuberculosis services. Finally, we highlight research priorities and major challenges and controversies that need to be addressed to restore and advance the global response to tuberculosis.
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Affiliation(s)
- Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa; Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tahlia Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Harry Moultrie
- Centre for TB, National Institute for Communicable Diseases, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rubeshan Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Alex J Scott
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Zarir Udwadia
- Department of Pulmonology, P D Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Kwok Chiu Chang
- Tuberculosis and Chest Service, Department of Health, Hong Kong Special Administrative Region, China
| | - Jonathan Peter
- Allergy and Immunology unit, Division of Allergy and Clinical Immunology, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Anil Pooran
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council (SAMRC) Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Arne von Delft
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; TB Proof, Cape Town, South Africa
| | | | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Salome Charalambous
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The Aurum Institute, Johannesburg, South Africa
| | - Elizabeth Kachingwe
- Centre for TB, National Institute for Communicable Diseases, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kevin Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, QC, Canada
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13
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Cobelens F, Suri RK, Helinski M, Makanga M, Weinberg AL, Schaffmeister B, Deege F, Hatherill M. Accelerating research and development of new vaccines against tuberculosis: a global roadmap. THE LANCET. INFECTIOUS DISEASES 2022; 22:e108-e120. [PMID: 35240041 PMCID: PMC8884775 DOI: 10.1016/s1473-3099(21)00810-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022]
Abstract
To eliminate tuberculosis globally, a new, effective, and affordable vaccine is urgently needed, particularly for use in adults and adolescents in low-income and middle-income countries. We have created a roadmap that lists the actions needed to accelerate tuberculosis vaccine research and development using a participatory process. The vaccine pipeline needs more diverse immunological approaches, antigens, and platforms. Clinical development can be accelerated by validated preclinical models, agreed laboratory correlates of protection, efficient trial designs, and validated endpoints. Determining the public health impact of new tuberculosis vaccines requires understanding of a country's demand for a new tuberculosis vaccine, how to integrate vaccine implementation with ongoing tuberculosis prevention efforts, cost, and national and global demand to stimulate vaccine production. Investments in tuberculosis vaccine research and development need to be increased, with more diversity of funding sources and coordination between these funders. Open science is important to enhance the efficiency of tuberculosis vaccine research and development including early and freely available publication of study findings and effective mechanisms for sharing datasets and specimens. There is a need for increased engagement of industry vaccine developers, for increased political commitment for new tuberculosis vaccines, and to address stigma and vaccine hesitancy. The unprecedented speed by which COVID-19 vaccines have been developed and introduced provides important insight for tuberculosis vaccine research and development.
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Affiliation(s)
- Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands.
| | - Rajinder Kumar Suri
- Department of Governance and Strategy, Developing Countries Vaccine Manufacturers' Network International, Nyon, Switzerland
| | - Michelle Helinski
- European & Developing Countries Clinical Trials Partnership, The Hague, Netherlands
| | - Michael Makanga
- European & Developing Countries Clinical Trials Partnership, The Hague, Netherlands
| | - Ana Lúcia Weinberg
- European & Developing Countries Clinical Trials Partnership, The Hague, Netherlands
| | | | | | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
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14
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Costales C, Crump JA, Mremi AR, Amsi PT, Kalengo NH, Kilonzo KG, Kinabo G, Lwezaula BF, Lyamuya F, Marandu A, Mbwasi R, Mmbaga BT, Mosha C, Carugati M, Madut DB, Nelson AM, Maze MJ, Matkovic E, Zaki SR, Maro VP, Rubach MP. Performance of Xpert Ultra nasopharyngeal swab for identification of tuberculosis deaths in northern Tanzania. Clin Microbiol Infect 2022; 28:1150.e1-1150.e6. [DOI: 10.1016/j.cmi.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
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15
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Onyango DO, Akelo V, van der Sande MAB, Ridzon R, Were JA, Agaya JA, Oele EA, Wandiga S, Igunza AK, Young PW, Blau DM, Joseph RH, Yuen CM, Zielinski-Gutierrez E, Tippett-Barr BA. Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya. AIDS 2022; 36:59-68. [PMID: 34586084 DOI: 10.1097/qad.0000000000003086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Describe the causes of death among infants and children less than 5 years stratified by HIV status. DESIGN Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. METHODS We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status. RESULTS Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) = 9349-2 670 143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (P value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (P value = 0.04). CONCLUSION Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.
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Affiliation(s)
- Dickens O Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Victor Akelo
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Renee Ridzon
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Joyce A Were
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Janet A Agaya
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Steve Wandiga
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Peter W Young
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Dianna M Blau
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachael H Joseph
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | | | | | - Beth A Tippett-Barr
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
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16
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du Preez K, Jenkins HE, Donald PR, Solomons RS, Graham SM, Schaaf HS, Starke JR, Hesseling AC, Seddon JA. Tuberculous Meningitis in Children: A Forgotten Public Health Emergency. Front Neurol 2022; 13:751133. [PMID: 35370901 PMCID: PMC8970690 DOI: 10.3389/fneur.2022.751133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Tuberculous meningitis (TBM) remains a major cause of morbidity and mortality in children with tuberculosis (TB), yet there are currently no estimates of the global burden of pediatric TBM. Due to frequent non-specific clinical presentation and limited and inadequate diagnostic tests, children with TBM are often diagnosed late or die undiagnosed. Even when diagnosed and treated, 20% of children with TBM die. Of survivors, the majority have substantial neurological disability with significant negative impact on children and their families. Surveillance data on this devastating form of TB can help to quantify the contribution of TBM to the overall burden, morbidity and mortality of TB in children and the epidemiology of TB more broadly. Pediatric TBM usually occurs shortly after primary infection with Mycobacterium tuberculosis and reflects ongoing TB transmission to children. In this article we explain the public health importance of pediatric TBM, discuss the epidemiology within the context of overall TB control and health system functioning and the limitations of current surveillance strategies. We provide a clear rationale for the benefit of improved surveillance of pediatric TBM using a TB care cascade framework to support monitoring and evaluation of pediatric TB, and TB control more broadly. Considering the public health implications of a diagnosis of TBM in children, we provide recommendations to strengthen pediatric TBM surveillance and outline how improved surveillance can help us identify opportunities for prevention, earlier diagnosis and improved care to minimize the impact of TBM on children globally.
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Affiliation(s)
- Karen du Preez
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- *Correspondence: Karen du Preez
| | - Helen E. Jenkins
- 2Department of Biostatistics, School of Public Health, Boston University, Boston, MA, United States
| | - Peter R. Donald
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan S. Solomons
- 3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M. Graham
- 4Department of Paediatrics and Murdoch Children's Research Institute, Centre for International Child Health, University of Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- 5International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H. Simon Schaaf
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- 3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jeffrey R. Starke
- 6Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Anneke C. Hesseling
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A. Seddon
- 1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- 7Department of Infectious Diseases, Imperial College London, London, United Kingdom
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17
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Bassat Q, Varo R, Hurtado JC, Marimon L, Ferrando M, Ismail MR, Carrilho C, Fernandes F, Castro P, Maixenchs M, Rodrigo-Calvo MT, Guerrero J, Martínez A, Lacerda MVG, Mandomando I, Menéndez C, Martinez MJ, Ordi J, Rakislova N. Minimally Invasive Tissue Sampling as an Alternative to Complete Diagnostic Autopsies in the Context of Epidemic Outbreaks and Pandemics: The Example of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2021; 73:S472-S479. [PMID: 34910176 PMCID: PMC8672745 DOI: 10.1093/cid/ciab760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Infectious diseases’ outbreak investigation requires, by definition, conducting a thorough epidemiological assessment while simultaneously obtaining biological samples for an adequate screening of potential responsible pathogens. Complete autopsies remain the gold-standard approach for cause-of-death evaluation and characterization of emerging diseases. However, for highly transmissible infections with a significant associated lethality, such as COVID-19, complete autopsies are seldom performed due to biosafety challenges, especially in low-resource settings. Minimally invasive tissue sampling (MITS) is a validated new approach based on obtaining postmortem samples from key organs and body fluids, a procedure that does not require advanced biosafety measures or a special autopsy room. Methods We aimed to review the use of MITS or similar procedures for outbreak investigation up to 27 March 2021 and their performance for evaluating COVID-19 deaths. Results After a literature review, we analyzed in detail the results of 20 studies conducted at international sites, whereby 216 COVID-19–related deaths were investigated. MITS provided a general and more granular understanding of the pathophysiological changes secondary to the infection and high-quality samples where the extent and degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related damage could be evaluated. Conclusions MITS is a useful addition in the investigation and surveillance of infections occurring in outbreaks or epidemics. Its less invasive nature makes the tool more acceptable and feasible and reduces the risk of procedure-associated contagion, using basic biosafety measures. Standardized approaches protocolizing which samples should be collected—and under which exact biosafety measures—are necessary to facilitate and expand its use globally.
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Affiliation(s)
- Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institut D'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - José Guerrero
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane-ILMD, Manaus, Brazil
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miguel J Martinez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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18
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Rakislova N, Rodrigo-Calvo MT, Marimon L, Ribera-Cortada I, Ismail MR, Carrilho C, Fernandes F, Ferrando M, Sanfeliu E, Castillo P, Guerrero J, Ramírez-Ruz J, Saez de Gordoa K, López Del Campo R, Bishop R, Ortiz E, Muñoz-Beatove A, Vila J, Hurtado JC, Navarro M, Maixenchs M, Delgado V, Aldecoa I, Martinez-Pozo A, Castro P, Menéndez C, Bassat Q, Martinez MJ, Ordi J. Minimally Invasive Tissue Sampling Findings in 12 Patients With Coronavirus Disease 2019. Clin Infect Dis 2021; 73:S454-S464. [PMID: 34910166 PMCID: PMC8672758 DOI: 10.1093/cid/ciab812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS), a postmortem procedure that uses core needle biopsy samples and does not require opening the body, may be a valid alternative to complete autopsy (CA) in highly infectious diseases such as coronavirus disease-19 (COVID-19). This study aimed to (1) compare the performance of MITS and CA in a series of COVID-19 deaths and (2) evaluate the safety of the procedure. METHODS From October 2020 to February 2021, MITS was conducted in 12 adults who tested positive before death for COVID-19, in a standard, well-ventilated autopsy room, where personnel used reinforced personal protective equipment. In 9 cases, a CA was performed after MITS. A thorough histological evaluation was conducted, and the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated by real-time reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry. RESULTS The diagnoses provided by MITS and CA matched almost perfectly. In 9 patients, COVID-19 was in the chain of events leading to death, being responsible for diffuse alveolar damage and mononuclear T-cell inflammatory response in the lungs. No specific COVID-19 features were identified. Three deaths were not related to COVID-19. All personnel involved in MITS repeatedly tested negative for COVID-19. SARS-CoV-2 was identified by RT-PCR and immunohistochemistry in the MITS samples, particularly in the lungs. CONCLUSIONS MITS is useful for evaluating COVID-19-related deaths in settings where a CA is not feasible. The results of this simplified and safer technique are comparable to those of CA.
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Affiliation(s)
- Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | | | - Lorena Marimon
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | | | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Melania Ferrando
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | - Esther Sanfeliu
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - José Guerrero
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - José Ramírez-Ruz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | | | | | - Rosanna Bishop
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Estrella Ortiz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Abel Muñoz-Beatove
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Mireia Navarro
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | - Vima Delgado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain.,Neurological Tissue Bank of the Biobank, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain
| | | | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Miguel J Martinez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
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19
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Saavedra B, Mambuque E, Gomes N, Nguenha D, Mabunda R, Faife L, Langa R, Munguambe S, Manjate F, Cossa A, Scott L, García-Basteiro AL. Diagnostic performance of the Abbott RealTime MTB assay for tuberculosis diagnosis in people living with HIV. Sci Rep 2021; 11:19271. [PMID: 34588508 PMCID: PMC8481474 DOI: 10.1038/s41598-021-96922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/02/2021] [Indexed: 11/09/2022] Open
Abstract
Strengthening tuberculosis diagnosis is an international priority and the advocacy for multi-disease testing devices raises the possibility of improving laboratory efficiency. However, the advantages of centralized platforms might not translate into real improvements under operational conditions. This study aimed to evaluate the field use of the Abbott RealTime MTB (RT-MTB) and Xpert MTB/RIF assays, in a large cohort of HIV-positive and TB presumptive cases in Southern Mozambique. Over a 6-month period, 255 HIV-positive TB presumptive cases were consecutively recruited in the high TB/HIV burden district of Manhiça. The diagnostic performance of both assays was evaluated against two different reference standards: a microbiological gold standard (MGS) and a composite reference standard (CRS). Results from the primary analysis (MGS) showed improved sensitivity (Se) and reduced specificity (Sp) for the Abbott RT-MTB assay compared to the Xpert MTB/RIF (RT-MTB Se: 0.92 (95% CI: 0.75;0.99) vs Xpert Se: 0.73 (95% CI: 0.52;0.88) p value = 0.06; RT-MTB Sp: 0.80 (0.72;0.86) vs Xpert Sp: 0.96 (0.92;0.99) p value < 0.001). The lower specificity may be due to cross-reactivity with non-tuberculous mycobacteria (NTMs), the detection of non-viable MTBC, or the identification of true TB cases missed by the gold standard.
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Affiliation(s)
- Belén Saavedra
- PhD Program in Medicine and Translational Research, Universitat de Barcelona, Barcelona, Spain.
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique.
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Edson Mambuque
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Neide Gomes
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Dinis Nguenha
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Rita Mabunda
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Luis Faife
- Manhiça Health Research Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Ruben Langa
- Manhiça Health Research Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Shilzia Munguambe
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Filomena Manjate
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Anelsio Cossa
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, and iLEAD, Faculty of Health Sciences, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Alberto L García-Basteiro
- Centro de Investigação Em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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20
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Saavedra B, Mambuque E, Nguenha D, Gomes N, Munguane S, García JI, Izco S, Acacio S, Murias-Closas A, Cossa M, Losada I, Pernas H, Oliveras L, Theron G, García-Basteiro AL. Performance of Xpert MTB/RIF Ultra for tuberculosis diagnosis in the context of passive and active case finding. Eur Respir J 2021; 58:13993003.00257-2021. [PMID: 34140293 DOI: 10.1183/13993003.00257-2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/11/2021] [Indexed: 11/05/2022]
Abstract
We present a field evaluation of the diagnostic accuracy of Xpert MTB/RIF (Xpert) and Xpert MTB/RIF Ultra (Ultra), using two cohorts in a high TB/HIV burden setting in Southern Mozambique. Single respiratory specimens from symptomatic adults accessing health care services (passive case finding (PCF) cohort), and from household and community close contacts (active case finding (ACF) cohort), were tested by smear microscopy, culture, Xpert and Ultra. Liquid and solid culture served as a composite reference standard. We explored trace results' impact on specificity via their recategorisation to negative (in all and just among those previously treated individuals) A total of 1419 and 252 participants were enrolled in the PCF and ACF cohorts, respectively. For the PCF cohort, Ultra showed higher sensitivity than Xpert overall (0.95 (95% CI: 0.90, 0.98) versus 0.88 (0.82, 0.93); p<0.001) and among smear negative patients (0.63 (0.48, 0.76) and 0.84 (0.71, 0.93). Ultra's specificity was lower than Xpert's (0.98 (0.97, 0.99) versus 0.96 (0.95, 0.97); p=0.008). For ACF, sensitivities were the same (0.67 (95% CI: 0.22,0.96) for both tests), although Ultra detected a higher number of microbiologically confirmed samples than Xpert (4.7% (12/252) versus 2.7% (7/252)). Conditional recategorisation of trace results among previously treated participants maintained differences in specificity in the PCF cohort. These results add evidence on the improved sensitivity of Ultra and support its use in different case finding scenarios.
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Affiliation(s)
- Belén Saavedra
- Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Edson Mambuque
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
| | - Dinis Nguenha
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
| | - Neide Gomes
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
| | - Shilzia Munguane
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
| | - Juan Ignacio García
- TB Group, Population Health Programme, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Santiago Izco
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Sozinho Acacio
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
| | | | - Marta Cossa
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique
| | - Irene Losada
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Hadrián Pernas
- MD Internal Medicine - Infectious Diseases Complexo Hospitalario Universitario de Santiago
| | - Laura Oliveras
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Grant Theron
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, and SAMRC Centre for Tuberculosis Research, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Alberto L García-Basteiro
- Centro de Investigação em Sade de Manhiça (CISM), Maputo, Mozambique .,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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21
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Rodríguez-Grande C, Hurtado JC, Rodríguez-Maus S, Casas I, Castillo P, Navarro M, Rakislova N, García-Basteiro A, Carrilho C, Fernandes F, Lovane L, Jordao D, Ismail MR, Lorenzoni C, Cossa A, Mandomando I, Bassat Q, Menéndez C, Ordi J, Muñoz P, Pérez-Lago L, García de Viedma D, Martínez MJ. High within-host diversity found from direct genotyping on post-mortem tuberculosis specimens in a high-burden setting. Clin Microbiol Infect 2021; 27:1518.e5-1518.e9. [PMID: 34119641 DOI: 10.1016/j.cmi.2021.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To characterize the clonal complexity in Mycobacterium tuberculosis (MTB) infections considering factors that help maximize the detection of coexisting strains/variants. METHODS Genotypic analysis by Mycobacterial Interspersed Repetitive-Unit-Variable-Number Tandem-Repeats (MIRU-VNTR) was performed directly on 70 biopsy specimens from two or more different tissues involving 28 tuberculosis cases diagnosed post-mortem in Mozambique, a country with a high tuberculosis burden. RESULTS Genotypic data from isolates collected from two or more tissues were obtained for 23 of the 28 cases (82.1%), allowing the analysis of within-patient diversity. MIRU-VNTR analysis revealed clonal diversity in ten cases (35.7%). Five cases showed allelic differences in three or more loci, suggesting mixed infection with two different strains. In half of the cases showing within-host diversity, one of the specimens associated with clonal heterogeneity was brain tissue. CONCLUSIONS Direct MTB genotyping from post-mortem tissue samples revealed a frequent within-host Mycobacterium tuberculosis diversity, including mixed and polyclonal infections. Most of this diversity would have been overlooked if only standard analysis of respiratory specimens had been performed.
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Affiliation(s)
- Cristina Rodríguez-Grande
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juan Carlos Hurtado
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sandra Rodríguez-Maus
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Isaac Casas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mireia Navarro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alberto García-Basteiro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Anélsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jaume Ordi
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Laura Pérez-Lago
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Darío García de Viedma
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Miguel J Martínez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain.
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22
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Zifodya JS, Kreniske JS, Schiller I, Kohli M, Dendukuri N, Schumacher SG, Ochodo EA, Haraka F, Zwerling AA, Pai M, Steingart KR, Horne DJ. Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis. Cochrane Database Syst Rev 2021; 2:CD009593. [PMID: 33616229 DOI: 10.1002/14651858.cd009593.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Xpert MTB/RIF and Xpert MTB/RIF Ultra (Xpert Ultra) are World Health Organization (WHO)-recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in people with signs and symptoms of tuberculosis. This review builds on our recent extensive Cochrane Review of Xpert MTB/RIF accuracy. OBJECTIVES To compare the diagnostic accuracy of Xpert Ultra and Xpert MTB/RIF for the detection of pulmonary tuberculosis and detection of rifampicin resistance in adults with presumptive pulmonary tuberculosis. For pulmonary tuberculosis and rifampicin resistance, we also investigated potential sources of heterogeneity. We also summarized the frequency of Xpert Ultra trace-positive results, and estimated the accuracy of Xpert Ultra after repeat testing in those with trace-positive results. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, LILACS, Scopus, the WHO ICTRP, the ISRCTN registry, and ProQuest to 28 January 2020 with no language restriction. SELECTION CRITERIA We included diagnostic accuracy studies using respiratory specimens in adults with presumptive pulmonary tuberculosis that directly compared the index tests. For pulmonary tuberculosis detection, the reference standards were culture and a composite reference standard. For rifampicin resistance, the reference standards were culture-based drug susceptibility testing and line probe assays. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a standardized form, including data by smear and HIV status. We assessed risk of bias using QUADAS-2 and QUADAS-C. We performed meta-analyses comparing pooled sensitivities and specificities, separately for pulmonary tuberculosis detection and rifampicin resistance detection, and separately by reference standard. Most analyses used a bivariate random-effects model. For tuberculosis detection, we estimated accuracy in studies in participants who were not selected based on prior microscopy testing or history of tuberculosis. We performed subgroup analyses by smear status, HIV status, and history of tuberculosis. We summarized Xpert Ultra trace results. MAIN RESULTS We identified nine studies (3500 participants): seven had unselected participants (2834 participants). All compared Xpert Ultra and Xpert MTB/RIF for pulmonary tuberculosis detection; seven studies used a paired comparative accuracy design, and two studies used a randomized design. Five studies compared Xpert Ultra and Xpert MTB/RIF for rifampicin resistance detection; four studies used a paired design, and one study used a randomized design. Of the nine included studies, seven (78%) were mainly or exclusively in high tuberculosis burden countries. For pulmonary tuberculosis detection, most studies had low risk of bias in all domains. Pulmonary tuberculosis detection Xpert Ultra pooled sensitivity and specificity (95% credible interval) against culture were 90.9% (86.2 to 94.7) and 95.6% (93.0 to 97.4) (7 studies, 2834 participants; high-certainty evidence) versus Xpert MTB/RIF pooled sensitivity and specificity of 84.7% (78.6 to 89.9) and 98.4% (97.0 to 99.3) (7 studies, 2835 participants; high-certainty evidence). The difference in the accuracy of Xpert Ultra minus Xpert MTB/RIF was estimated at 6.3% (0.1 to 12.8) for sensitivity and -2.7% (-5.7 to -0.5) for specificity. If the point estimates for Xpert Ultra and Xpert MTB/RIF are applied to a hypothetical cohort of 1000 patients, where 10% of those presenting with symptoms have pulmonary tuberculosis, Xpert Ultra will miss 9 cases, and Xpert MTB/RIF will miss 15 cases. The number of people wrongly diagnosed with pulmonary tuberculosis would be 40 with Xpert Ultra and 14 with Xpert MTB/RIF. In smear-negative, culture-positive participants, pooled sensitivity was 77.5% (67.6 to 85.6) for Xpert Ultra versus 60.6% (48.4 to 71.7) for Xpert MTB/RIF; pooled specificity was 95.8% (92.9 to 97.7) for Xpert Ultra versus 98.8% (97.7 to 99.5) for Xpert MTB/RIF (6 studies). In people living with HIV, pooled sensitivity was 87.6% (75.4 to 94.1) for Xpert Ultra versus 74.9% (58.7 to 86.2) for Xpert MTB/RIF; pooled specificity was 92.8% (82.3 to 97.0) for Xpert Ultra versus 99.7% (98.6 to 100.0) for Xpert MTB/RIF (3 studies). In participants with a history of tuberculosis, pooled sensitivity was 84.2% (72.5 to 91.7) for Xpert Ultra versus 81.8% (68.7 to 90.0) for Xpert MTB/RIF; pooled specificity was 88.2% (70.5 to 96.6) for Xpert Ultra versus 97.4% (91.7 to 99.5) for Xpert MTB/RIF (4 studies). The proportion of Ultra trace-positive results ranged from 3.0% to 30.4%. Data were insufficient to estimate the accuracy of Xpert Ultra repeat testing in individuals with initial trace-positive results. Rifampicin resistance detection Pooled sensitivity and specificity were 94.9% (88.9 to 97.9) and 99.1% (97.7 to 99.8) (5 studies, 921 participants; high-certainty evidence) for Xpert Ultra versus 95.3% (90.0 to 98.1) and 98.8% (97.2 to 99.6) (5 studies, 930 participants; high-certainty evidence) for Xpert MTB/RIF. The difference in the accuracy of Xpert Ultra minus Xpert MTB/RIF was estimated at -0.3% (-6.9 to 5.7) for sensitivity and 0.3% (-1.2 to 2.0) for specificity. If the point estimates for Xpert Ultra and Xpert MTB/RIF are applied to a hypothetical cohort of 1000 patients, where 10% of those presenting with symptoms have rifampicin resistance, Xpert Ultra will miss 5 cases, and Xpert MTB/RIF will miss 5 cases. The number of people wrongly diagnosed with rifampicin resistance would be 8 with Xpert Ultra and 11 with Xpert MTB/RIF. We identified a higher number of rifampicin resistance indeterminate results with Xpert Ultra, pooled proportion 7.6% (2.4 to 21.0) compared to Xpert MTB/RIF pooled proportion 0.8% (0.2 to 2.4). The estimated difference in the pooled proportion of indeterminate rifampicin resistance results for Xpert Ultra versus Xpert MTB/RIF was 6.7% (1.4 to 20.1). AUTHORS' CONCLUSIONS Xpert Ultra has higher sensitivity and lower specificity than Xpert MTB/RIF for pulmonary tuberculosis, especially in smear-negative participants and people living with HIV. Xpert Ultra specificity was lower than that of Xpert MTB/RIF in participants with a history of tuberculosis. The sensitivity and specificity trade-off would be expected to vary by setting. For detection of rifampicin resistance, Xpert Ultra and Xpert MTB/RIF had similar sensitivity and specificity. Ultra trace-positive results were common. Xpert Ultra and Xpert MTB/RIF provide accurate results and can allow rapid initiation of treatment for rifampicin-resistant and multidrug-resistant tuberculosis.
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Affiliation(s)
- Jerry S Zifodya
- Department of Medicine, Section of Pulmonary, Critical Care, & Environmental Medicine , Tulane University, New Orleans, LA, USA
| | - Jonah S Kreniske
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, Canada
| | | | - Eleanor A Ochodo
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Frederick Haraka
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Alice A Zwerling
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David J Horne
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, and Firland Northwest TB Center, University of Washington, Seattle, WA, USA
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23
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García JI, Mambuque E, Nguenha D, Vilanculo F, Sacoor C, Sequera VG, Fernández-Quevedo M, Pierre MLL, Chiconela H, Faife LA, Respeito D, Saavedra B, Nhampossa T, López-Varela E, Garcia-Basteiro AL. Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out. Sci Rep 2020; 10:15442. [PMID: 32963296 PMCID: PMC7509810 DOI: 10.1038/s41598-020-71784-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022] Open
Abstract
Tuberculosis (TB) misdiagnosis remains a public health concern, especially among people living with HIV (PLHIV), given the high mortality associated with missed TB diagnoses. The main objective of this study was to describe the all-cause mortality, TB incidence rates and their associated risk factors in a cohort of PLHIV with presumptive TB in whom TB was initially ruled out. We retrospectively followed a cohort of PLHIV with presumptive TB over a 2 year-period in a rural district in Southern Mozambique. During the study period 382 PLHIV were followed-up. Mortality rate was 6.8/100 person-years (PYs) (95% CI 5.2-9.2) and TB incidence rate was 5.4/100 PYs (95% CI 3.9-7.5). Thirty-six percent of deaths and 43% of TB incident cases occurred in the first 12 months of the follow up. Mortality and TB incidence rates in the 2-year period after TB was initially ruled out was very high. The TB diagnostic work-up and linkage to HIV care should be strengthened to decrease TB burden and all-cause mortality among PLHIV with presumptive TB.
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Affiliation(s)
- Juan Ignacio García
- TB Group, Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Edson Mambuque
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Dinis Nguenha
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | | | - Charfudin Sacoor
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | | | | | | | - Helio Chiconela
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- Manhiça District Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Luis A Faife
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- Manhiça District Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Durval Respeito
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- Manhiça District Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique
| | - Belén Saavedra
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Tacilta Nhampossa
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Elisa López-Varela
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Desmond Tutu TB center, Stellenbosch University, Cape Town, South Africa
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique.
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
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24
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Low mortality rates at two years in HIV-infected individuals undergoing systematic tuberculosis testing with rapid assays at initiation of antiretroviral treatment in Mozambique. Int J Infect Dis 2020; 99:386-392. [PMID: 32791208 DOI: 10.1016/j.ijid.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Few studies have evaluated the mortality rate in individuals with HIV initiating antiretroviral therapy (ART), undergoing screening with combined or repeated rapid tests for tuberculosis (TB). METHODS All individuals with HIV starting ART, irrespective of the presence of TB-related symptoms, received two consecutive Xpert tests plus a rapid test for the detection of mycobacterial lipoarabinomannan in urine (LAM). Mortality was evaluated by Kaplan-Meier analysis using the log-rank test in univariate analyses and Cox regression models with time-dependent covariates in multivariate analyses. RESULTS Among 972 individuals screened with combined tests, 98 (10.1%) tested positive for TB with Xpert, LAM, or both. At the end of the study, 780 (80.2%) had completed 2 years of follow-up, 39 (4.0%) had died, and 153 (15.7%) were lost to follow-up. In the multivariate analyses, the factors significantly associated with mortality were missed ART (hazard ratio (HR) 7.05, 95% confidence interval (CI) 2.33-21.35), symptomatic HIV disease (WHO-HIV stage >1) (HR 3.31, 95% CI 1.28-8.54), and low CD4 count (<200/mm3) (HR 2.72, 95% CI 1.21-6.13), with no significant effect of TB status. In the subgroup of the 98 TB-positive individuals, only missed ART (HR 4.12, 95% CI 1.03-16.46) and missed anti-TB treatment (HR 9.25, 95% CI 2.65-32.28) were significantly associated with mortality. CONCLUSIONS A low mortality rate was observed among individuals with HIV undergoing systematic testing for TB at initiation of ART. After adjusting for confounders, mortality was significantly associated with missed ART, advanced disease, and missed anti-TB treatment. These findings reinforce the need to promote early diagnosis of HIV and the adoption of screening strategies for TB that prevent presentation with severe disease.
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25
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José B, Manhiça I, Jones J, Mutaquiha C, Zindoga P, Eduardo I, Creswell J, Qin ZZ, Ramis O, Ramiro I, Chidacua M, Cowan J. Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique. PLoS One 2020; 15:e0236262. [PMID: 32702073 PMCID: PMC7377411 DOI: 10.1371/journal.pone.0236262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mozambique has one of the highest incidence rates of both TB and HIV in the world and an estimated tuberculosis (TB) treatment coverage of only 57% in 2018. Numerous approaches are being tested to reduce existing gaps in coverage and the estimated number of missing cases. METHODS Thirty Community Healthcare Workers (CHWs) were tasked with increasing TB notifications by performing verbal facility-based TB screening of all people presenting for care and TB contact tracing in the community. Using routine National TB Program data, we analyzed trends in TB notifications in five intervention districts and seven control districts in Manica province the year before this project and during a one-year intervention period. RESULTS In the four quarters before the study, the intervention districts notified 5,219 individuals with all forms of TB, and the control districts notified 2,248 TB cases. During the study 5,982 all forms of people with TB were notified in the intervention area, an increase of 763 (14.6%) over the baseline, whereas the control districts notified 1,877 persons with TB, a decrease of -371 (-16.5%). The CHW screening activities yielded 1,502 notified and treated individuals with TB. CONCLUSIONS Employing CHWs to promote facility-based TB screening and household contact tracing may lead to an overall increase in TB notification.
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Affiliation(s)
- B. José
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - I. Manhiça
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - J. Jones
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - C. Mutaquiha
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - P. Zindoga
- National TB Program, Mozambique Ministry of Health, Maputo, Mozambique
| | - I. Eduardo
- Provincial TB Program, Mozambique Ministry of Health, Manica, Mozambique
| | - J. Creswell
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - Z. Z. Qin
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - O. Ramis
- TB REACH, Stop TB Partnership, Geneva, Switzerland
| | - I. Ramiro
- Health Alliance International, Beira, Mozambique
| | - M. Chidacua
- Health Alliance International, Beira, Mozambique
| | - J. Cowan
- Health Alliance International, Beira, Mozambique
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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26
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Garcia-Basteiro AL, Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, Quintó L, Jordao D, Ismail MR, Lorenzoni C, Carrilho C, Sanz A, Rakislova N, Mira A, Alvarez-Martínez MJ, Cossa A, Cobelens F, Mandomando I, Vila J, Bassat Q, Menendez C, Ordi J, Martínez MJ. Performance of the Xpert MTB/RIF Ultra Assay for Determining Cause of Death by TB in Tissue Samples Obtained by Minimally Invasive Autopsies. Chest 2020; 159:103-107. [PMID: 32663500 PMCID: PMC7803937 DOI: 10.1016/j.chest.2020.06.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/29/2020] [Accepted: 06/25/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alberto L Garcia-Basteiro
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Isaac Casas
- Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Aurea Mira
- Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain, Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Moçambique
| | - Miriam J Alvarez-Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Anélsio Cossa
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Inácio Mandomando
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain, Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Moçambique
| | - Jordi Vila
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu,University of Barcelona, Barcelona, Spain
| | - Clara Menendez
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
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27
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Gebhardt S. New (or not so new?) lessons from maternal autopsy in Mozambique. Lancet Glob Health 2020; 8:e875-e876. [PMID: 32562644 DOI: 10.1016/s2214-109x(20)30258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Stefan Gebhardt
- Stellenbosch University and Tygerberg Hospital, Tygerberg 7530, South Africa.
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28
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Bomanji J, Sharma R, Mittal BR, Gambhir S, Qureshy A, Begum SM, Paez D, Sathekge M, Vorster M, Sobic Saranovic D, Pusuwan P, Mann V, Vinjamuri S, Zumla A, Pascual TN. PET/CT features of extrapulmonary tuberculosis at first clinical presentation: a cross-sectional observational 18F-FDG imaging study across six countries. Eur Respir J 2019; 55:13993003.01959-2019. [DOI: 10.1183/13993003.01959-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022]
Abstract
BackgroundA large proportion of the huge global burden of extrapulmonary tuberculosis (EPTB) cases are treated empirically without accurate definition of disease sites and extent of multi-organ disease involvement. Positron emission tomography (PET) imaging using 2-deoxy-2-(fluorine-18) fluoro-d-glucose (18F-FDG) in tuberculosis could be a useful imaging technique for localising disease sites and extent of disease.MethodsWe conducted a study of HIV-negative adult patients with a new clinical diagnosis of EPTB across eight centres located in six countries: India, Pakistan, Thailand, South Africa, Serbia and Bangladesh, to assess the extent of disease and common sites involved at first presentation. 18F-FDG PET/computed tomography (CT) scans were performed within 2 weeks of presentation.Findings358 patients with EPTB (189 females; 169 males) were recruited over 45 months, with an age range of 18–83 years (females median 30 years; males median 38 years). 350 (98%) out of 358 patients (183 female, 167 male) had positive scans. 118 (33.7%) out of 350 had a single extrapulmonary site and 232 (66.3%) out of 350 had more than one site (organ) affected. Lymph nodes, skeleton, pleura and brain were common sites. 100 (28%) out of 358 EPTB patients had 18F-FDG PET/CT-positive sites in the lung. 110 patients were 18F-FDG PET/CT-positive in more body sites than were noted clinically at first presentation and 160 patients had the same number of positive body sites.Interpretation18F-FDG PET/CT scan has potential for further elucidating the spectrum of disease, pathogenesis of EPTB and monitoring the effects of treatment on active lesions over time, and requires longitudinal cohort studies, twinned with biopsy and molecular studies.
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29
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Reeve BWP, Centis R, Theron G. Still dying in plain sight: missed and misclassified deaths due to tuberculosis in hospitals. Eur Respir J 2019; 54:54/3/1901578. [PMID: 31575725 DOI: 10.1183/13993003.01578-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/10/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Byron William Patrick Reeve
- NRF/DST Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Grant Theron
- NRF/DST Centre of Excellence for Biomedical Tuberculosis Research; South African Medical Research Council Centre for Tuberculosis Research; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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