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Panin F, Orlandini E, Galli L, De Martino M, Chiappini E. Tuberculosis burden in immigrants and natives, adults and children, in Tuscany between 2000-2018. Travel Med Infect Dis 2021; 44:102185. [PMID: 34715364 DOI: 10.1016/j.tmaid.2021.102185] [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: 12/13/2019] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Updated data on epidemiology of tuberculosis are needed in Italy. The aim of this study is to evaluate trends in incidence and associated lethality of tuberculosis in immigrants compared with Italians. METHODS All tuberculosis cases diagnosed from 2000 to 2018 in 31 Tuscan hospitals were retrospectively identified. RESULTS In 10,827 tuberculosis cases 6715 were males (62%), 4312 (60%) were Italian-born. Hospitalization rate was 15.37/100,000 population/year. The most common comorbidity were liver disease (832/10,827; 7.7%), COPD (675/10,827; 6.2%), cancer (614/10,827; 5.7%). HIV was more frequent in the immigrants (p < 0.001). Extra-pulmonary tuberculosis cases (EPTB) were mainly localized in pleura (740/3,894, 19%) and lymph nodes (449/3,894, 11,5%). HIV was associated with an increased risk of EPTB (OR 3.51 95% CI 2.92-4.23, p < 0.0001). EPTB risk was increased in South Asian-born patients (OR 1.77, 95% CI 1.46-2.15, p < 0.0001) as well in African-born patients (OR 1.13, 95% CI 1.03-1.24, p = 0.0091), who were at risk for gastroenteric tuberculosis (OR 3.74, 95% CI 2.69-5.22, p < 0.0001). Overall mortality rate was 0.006 per 1000. Most of death cases (89%) were Italians (p < 0.02) and mainly affected by pulmonary tuberculosis (PTB). CONCLUSIONS In Tuscany, tuberculosis is still a health concern in terms of both morbidity and mortality.
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Affiliation(s)
- Fiorenza Panin
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elisa Orlandini
- Tuscany Regional Government Department of Right to Health and Solidarity Policies, Information Technology Section, Via T. Alderotti 26/n, 50123, Florence, Italy
| | - Luisa Galli
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Maurizio De Martino
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elena Chiappini
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy.
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Tuberculosis-Related Hospitalizations in a Low-Incidence Country: A Retrospective Analysis in Two Italian Infectious Diseases Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010124. [PMID: 31878009 PMCID: PMC6981912 DOI: 10.3390/ijerph17010124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
In recent years, a decrease in the incidence of tuberculosis (TB) has been recorded worldwide. However, an increase in TB cases has been reported in foreign people living in low-incidence countries, with an increase in extrapulmonary TB (EPTB) in the western region of the world. In the present work, a retrospective study was conducted in two Italian infectious diseases wards to evaluate the clinical characteristics of TB admission in the time period 2013-2017. A significant increase in TB was shown in the study period: 166 (71% males) patients with TB were enrolled, with ~70% coming from outside Italy (30% from Africa, 25% from Europe, and 13% from Asia and South America). Compared to foreign people, Italians were significantly older (71.5 (interquartile range, IQR: 44.5-80.0) vs. 30 (IQR: 24-40) years; p < 0.0001) more immunocompromised (48% vs. 17%; p < 0.0001), and affected by comorbidities (44% vs. 14%; p < 0.0001). EPTB represented 37% of all forms of the disease, and it was more incident in subjects coming from Africa than in those coming from Europe (39.3% vs. 20%, respectively). In logistic regression analysis, being European was protective (odd ratio, OR (95% CI): 0.2 (0.1-0.6); p = 0.004) against the development of EPTB forms. In conclusion, an increase in the rate of TB diagnosis was documented in two Italian reference centers in the period 2013-2017, with 39% of EPTB diagnosed in patients from outside Europe.
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Glasauer S, Altmann D, Hauer B, Brodhun B, Haas W, Perumal N. First-line tuberculosis drug resistance patterns and associated risk factors in Germany, 2008-2017. PLoS One 2019; 14:e0217597. [PMID: 31188848 PMCID: PMC6561568 DOI: 10.1371/journal.pone.0217597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background Drug-resistant tuberculosis (TB), especially multidrug-resistant TB (MDR-TB), poses a threat to public health. While standard surveillance focuses on Rifampicin and/or Isoniazid resistance, little is known about other resistance patterns. This study aims to identify predominant drug resistance (DR) patterns in Germany and risk factors associated with them in order to inform diagnostic and treatment strategies. Methods Case-based TB surveillance data notified in Germany from 2008–2017 were utilized to investigate DR and MDR-TB patterns for Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S). Predominant patterns were further analyzed stratified by sex, age, country of birth, prior TB, and disease site. Multivariable logistic regression was conducted to determine risk factors associated with any resistance, MDR-TB, and complete HRZES resistance. Results 26,228 cases with complete DST results were included in the study, among which 3,324 cases had any DR (12.7%). Four patterns were predominant, representing about ¾ of all cases with any resistance (S: 814 [3.1%]; H: 768 [2.9%]; HS: 552 [2.1%]; Z: 412 [1.6%]). High proportions of S and H resistances were found among both German and foreign-born populations, especially those born in Eastern Europe, and were unexpectedly high among children (H: 4.3%; S: 4.6%). Foreign-born cases had significantly higher proportion of any resistance (16.0%) and MDR-TB (3.3%) compared to German-born cases (8.3% and 0.6%). Of 556 MDR-TB cases, 39.2% showed complete HRZES resistance. Logistic regression revealed having prior TB and being foreign-born as consistently strong risk factors for any DR, MDR-TB, and complete HRZES resistance. Conclusions DR patterns observed in Germany, particularly for MDR-TB were more complex than expected, highlighting the fact that detailed drug-testing results are crucial before incorporating HRZES drugs in MDR-TB treatment. Furthermore, the relatively high rate of H-resistance in Germany provides strong rationale against the use of only H-based preventive therapy for LTBI.
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Affiliation(s)
- Saskia Glasauer
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, LMU Munich, Munich, Germany
- * E-mail:
| | - Doris Altmann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Lombardi G, Di Gregori V, Girometti N, Tadolini M, Bisognin F, Dal Monte P. Diagnosis of smear-negative tuberculosis is greatly improved by Xpert MTB/RIF. PLoS One 2017; 12:e0176186. [PMID: 28430807 PMCID: PMC5400262 DOI: 10.1371/journal.pone.0176186] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/06/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diagnosis of pulmonary (PTB) and extra-pulmonary tuberculosis (EPTB) in smear-negative patients can be difficult. We assessed retrospectively the performance of Xpert MTB/RIF system (Xpert, Cepheid) in diagnosing smear-negative tuberculosis (TB), which represents the most common form of TB in a low incidence setting. METHODS Performance of Xpert was compared to acid-fast microscopic examination using Ziehl-Neelsen (ZN) stain in patients with culture-confirmed TB. RESULTS 386 Mycobacterium tuberculosis (MTB) culture-positive samples were detected out of 5170 specimens tested with smear microscopy, Xpert and culture: 323 were both culture- and Xpert-positive, and 63 culture-positive only. Of these, 234 (60.6%) were smear-negative. In addition Xpert detected 40 probable TB cases, based on clinical findings, which were culture-negative. Compared to culture, Xpert showed an overall sensitivity of 83.7% and a specificity of 99.1%; sensitivity was higher for respiratory samples (86.5%) than for non-respiratory samples (76.8%). Xpert sensitivity for smear-negative culture-confirmed TB was 73.1% and was not influenced by TB localization. As sensitivity of microscopy alone was poor (39.4%), Xpert improved both diagnosis of pulmonary TB (Δ = 36.5%) and extra-pulmonary TB (Δ = 63.4%). CONCLUSIONS Xpert MTB/RIF is a sensitive method for rapid diagnosis of TB compared to the conventional ZN staining. Xpert can serve as a sensitive and time-saving diagnostic method for microbiological diagnosis of smear-negative TB in countries with a low TB prevalence.
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Affiliation(s)
- Giulia Lombardi
- Department of Experimental, Diagnostic and Specialty Medicine - Unit of Microbiology, Alma Mater Studiorum University of Bologna - S. Orsola-Malpighi University Hospital, Bologna, Italy
- * E-mail:
| | - Valentina Di Gregori
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Public Health, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nicolò Girometti
- Department of Medical and Surgical Sciences - Unit of Infectious Diseases, Alma Mater Studiorum University of Bologna - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marina Tadolini
- Department of Medical and Surgical Sciences - Unit of Infectious Diseases, Alma Mater Studiorum University of Bologna - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Bisognin
- Department of Experimental, Diagnostic and Specialty Medicine - Unit of Microbiology, Alma Mater Studiorum University of Bologna - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Dal Monte
- Department of Experimental, Diagnostic and Specialty Medicine - Unit of Microbiology, Alma Mater Studiorum University of Bologna - S. Orsola-Malpighi University Hospital, Bologna, Italy
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Hermosilla S, You P, Aifah A, Abildayev T, Akilzhanova A, Kozhamkulov U, Muminov T, Darisheva M, Zhussupov B, Terlikbayeva A, El-Bassel N, Schluger N. Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan. PLoS One 2017; 12:e0172942. [PMID: 28249005 PMCID: PMC5332099 DOI: 10.1371/journal.pone.0172942] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 02/13/2017] [Indexed: 01/27/2023] Open
Abstract
Background Sputum smear-positive tuberculosis (TB) patients have a high risk of transmission and are of great epidemiological and infection control significance. Little is known about the smear-positive populations in high TB burden regions, such as Kazakhstan. The objective of this study is to characterize the smear-positive population in Kazakhstan and identify associated modifiable risk factors. Methods Data on incident TB cases’ (identified between April 2012 and March 2014) socio-demographic, risk behavior, and comorbidity characteristics were collected in four regions of Kazakhstan through structured survey and medical record review. We used multivariable logistic regression to determine factors associated with smear positivity. Results Of the total sample, 193 (34.3%) of the 562 study participants tested smear-positive. In the final adjusted multivariable logistic regression model, sex (adjusted odds ratio (aOR) = 2.0, 95% CI:1.3–3.1, p < 0.01), incarceration (aOR = 3.6, 95% CI:1.2–11.1, p = 0.03), alcohol dependence (aOR = 2.6, 95% CI:1.2–5.7, p = 0.02), diabetes (aOR = 5.0, 95% CI:2.4–10.7, p < 0.01), and physician access (aOR = 2.7, 95% CI:1.3–5.5p < 0.01) were associated with smear-positivity. Conclusions Incarceration, alcohol dependence, diabetes, and physician access are associated with smear positivity among incident TB cases in Kazakhstan. To stem the TB epidemic, screening, treatment and prevention policies should address these factors.
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Affiliation(s)
- Sabrina Hermosilla
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America
- * E-mail:
| | - Paul You
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America
| | - Angela Aifah
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, United States of America
| | | | - Ainur Akilzhanova
- Center for Life Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, Republic of Kazakhstan
| | - Ulan Kozhamkulov
- Center for Life Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana, Republic of Kazakhstan
| | - Talgat Muminov
- National Association for TB Specialists, Almaty, Kazakhstan
| | - Meruert Darisheva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Baurzhan Zhussupov
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, United States of America
| | - Neil Schluger
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, United States of America
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Martinez Lacasa X, Canals Font R, Jaen Manzanera A, Cuchi Burgos E, Lite Lite J. [Comparative study of concordance and costs between tuberculin skin test and QuantiFERON(®)-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis]. Med Clin (Barc) 2015; 145:427-32. [PMID: 25794770 DOI: 10.1016/j.medcli.2014.11.027] [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: 06/10/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. METHODS This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. RESULTS The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. CONCLUSION We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT.
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Affiliation(s)
- Xavier Martinez Lacasa
- Unitat de Control de Tuberculosis, Servei de Medicina Interna, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España.
| | - Roser Canals Font
- Unitat de Control de Tuberculosis, Servei de Medicina Interna, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
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Gisondi P, Cazzaniga S, Chimenti S, Maccarone M, Picardo M, Girolomoni G, Naldi L. Latent tuberculosis infection in patients with chronic plaque psoriasis: evidence from the Italian Psocare Registry. Br J Dermatol 2015; 172:1613-1620. [DOI: 10.1111/bjd.13539] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- P. Gisondi
- Department of Medicine; Section of Dermatology and Venereology; University of Verona; Piazzale A. Stefani 1 I-37126 Verona Italy
| | - S. Cazzaniga
- GISED Study Centre; Ospedali Riuniti; Bergamo Italy
| | - S. Chimenti
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - M. Maccarone
- Italian Psoriatic Patient Association (ADIPSO); Rome Italy
| | - M. Picardo
- Laboratory of Cutaneous Physiopathology; San Gallicano Dermatological Institute; Rome Italy
| | - G. Girolomoni
- Department of Medicine; Section of Dermatology and Venereology; University of Verona; Piazzale A. Stefani 1 I-37126 Verona Italy
| | - L. Naldi
- GISED Study Centre; Ospedali Riuniti; Bergamo Italy
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Gisondi P, Pezzolo E, Lo Cascio G, Girolomoni G. Latent tuberculosis infection in patients with chronic plaque psoriasis who are candidates for biological therapy. Br J Dermatol 2014; 171:884-90. [DOI: 10.1111/bjd.13130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 01/02/2023]
Affiliation(s)
- P. Gisondi
- Department of Medicine Section of Dermatology and Venereology University of Verona I‐37126 Verona Italy
| | - E. Pezzolo
- Department of Medicine Section of Dermatology and Venereology University of Verona I‐37126 Verona Italy
| | - G. Lo Cascio
- Department of Pathology and Diagnostics Section of Microbiology University of Verona I‐37126 Verona Italy
| | - G. Girolomoni
- Department of Medicine Section of Dermatology and Venereology University of Verona I‐37126 Verona Italy
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