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Molina-Moya B, Guglielmetti L, Bothamley G, van Leth F, Lange C, Dominguez J. Use and impact of molecular methods for detecting drug-resistant TB. Int J Tuberc Lung Dis 2021; 25:157-159. [PMID: 33656431 DOI: 10.5588/ijtld.20.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- B Molina-Moya
- Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Badalona, Spain
| | - L Guglielmetti
- Unité 1135, Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Groupe Hospitalier Universitaire Sorbonne Université, Assistanve Publique-Hôpitaux de Paris, Paris, France
| | - G Bothamley
- Department of Respiratory Medicine, Homerton University Hospital, Queen Mary University, London, London School of Hygiene & Tropical Medicine, London, UK
| | - F van Leth
- Department of Global Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - C Lange
- Divisions of Clinical Infectious Diseases, Research Center Borstel, German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | - J Dominguez
- Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Badalona, Spain
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Lange C, Aarnoutse RE, Alffenaar JWC, Bothamley G, Brinkmann F, Costa J, Chesov D, van Crevel R, Dedicoat M, Dominguez J, Duarte R, Grobbel HP, Günther G, Guglielmetti L, Heyckendorf J, Kay AW, Kirakosyan O, Kirk O, Koczulla RA, Kudriashov GG, Kuksa L, van Leth F, Magis-Escurra C, Mandalakas AM, Molina-Moya B, Peloquin CA, Reimann M, Rumetshofer R, Schaaf HS, Schön T, Tiberi S, Valda J, Yablonskii PK, Dheda K. Management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2019; 23:645-662. [DOI: 10.5588/ijtld.18.0622] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C. Lange
- Please see Supplementary Data for details of all author affiliations
| | - R. E. Aarnoutse
- Please see Supplementary Data for details of all author affiliations
| | | | - G. Bothamley
- Please see Supplementary Data for details of all author affiliations
| | - F. Brinkmann
- Please see Supplementary Data for details of all author affiliations
| | - J. Costa
- Please see Supplementary Data for details of all author affiliations
| | - D. Chesov
- Please see Supplementary Data for details of all author affiliations
| | - R. van Crevel
- Please see Supplementary Data for details of all author affiliations
| | - M. Dedicoat
- Please see Supplementary Data for details of all author affiliations
| | - J. Dominguez
- Please see Supplementary Data for details of all author affiliations
| | - R. Duarte
- Please see Supplementary Data for details of all author affiliations
| | - H. P. Grobbel
- Please see Supplementary Data for details of all author affiliations
| | - G. Günther
- Please see Supplementary Data for details of all author affiliations
| | - L. Guglielmetti
- Please see Supplementary Data for details of all author affiliations
| | - J. Heyckendorf
- Please see Supplementary Data for details of all author affiliations
| | - A. W. Kay
- Please see Supplementary Data for details of all author affiliations
| | - O. Kirakosyan
- Please see Supplementary Data for details of all author affiliations
| | - O. Kirk
- Please see Supplementary Data for details of all author affiliations
| | - R. A. Koczulla
- Please see Supplementary Data for details of all author affiliations
| | - G. G. Kudriashov
- Please see Supplementary Data for details of all author affiliations
| | - L. Kuksa
- Please see Supplementary Data for details of all author affiliations
| | - F. van Leth
- Please see Supplementary Data for details of all author affiliations
| | - C. Magis-Escurra
- Please see Supplementary Data for details of all author affiliations
| | - A. M. Mandalakas
- Please see Supplementary Data for details of all author affiliations
| | - B. Molina-Moya
- Please see Supplementary Data for details of all author affiliations
| | - C. A. Peloquin
- Please see Supplementary Data for details of all author affiliations
| | - M. Reimann
- Please see Supplementary Data for details of all author affiliations
| | - R. Rumetshofer
- Please see Supplementary Data for details of all author affiliations
| | - H. S. Schaaf
- Please see Supplementary Data for details of all author affiliations
| | - T. Schön
- Please see Supplementary Data for details of all author affiliations
| | - S. Tiberi
- Please see Supplementary Data for details of all author affiliations
| | - J. Valda
- Please see Supplementary Data for details of all author affiliations
| | - P. K. Yablonskii
- Please see Supplementary Data for details of all author affiliations
| | - K. Dheda
- Please see Supplementary Data for details of all author affiliations
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Woznitza N, Piper K, Burke S, Ellis S, Bothamley G. Agreement between expert thoracic radiologists and the chest radiograph reports provided by consultant radiologists and reporting radiographers in clinical practice: Review of a single clinical site. Radiography (Lond) 2018; 24:234-239. [DOI: 10.1016/j.radi.2018.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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D'Ambrosio L, Bothamley G, Caminero Luna JA, Duarte R, Guglielmetti L, Muñoz Torrico M, Payen MC, Saavedra Herrera N, Salazar Lezama MA, Skrahina A, Tadolini M, Tiberi S, Veziris N, Migliori GB. Team approach to manage difficult-to-treat TB cases: Experiences in Europe and beyond. Pulmonology 2017; 24:132-141. [PMID: 29229274 DOI: 10.1016/j.rppnen.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 01/17/2023] Open
Abstract
As recommended by the World Health Organization (WHO), optimal management of MDR-TB cases can be ensured by a multi-speciality consultation body known as 'TB Consilium'. This body usually includes different medical specialities, competences and perspectives (e.g., clinical expertise both for adults and children; surgical, radiological and public health expertise; psychological background and nursing experience, among others), thus lowering the risk of making mistakes - or managing the patients inappropriately, in order to improve their clinical outcomes. At present, several high MDR-TB burden countries in the different WHO regions (and beyond) have introduced TB Consilium-like bodies at the national or subnational level to reach consensus on the best treatment approach for their patients affected by TB. In addition, in countries/settings where a formal system of consultation does not exist, specialized staff from MDR-TB reference centres or international organizations usually spend a considerable amount of their working time responding to phone or e-mail clinical queries on how to manage M/XDR-TB cases. The aim of this manuscript is to describe the different experiences with the TB Consilia both at the international level (European Respiratory Society - ERS/WHO TB Consilium) and in some of the countries where this experience operates successfully in Europe and beyond. The Consilium experiences are described around the following topics: (1) history, aims and focus; (2) management and funding; (3) technical functioning and structure; (4) results achieved. In addition a comparative analysis of the TB Consilia in the different countries has been performed.
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Affiliation(s)
- L D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
| | - G Bothamley
- Homerton University Hospital, London, United Kingdom.
| | - J A Caminero Luna
- Pneumology Department, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain; MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease The Union, Paris, France.
| | - R Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - L Guglielmetti
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires de l'Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France.
| | - M Muñoz Torrico
- Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
| | - M C Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles ULB, Brussels, Belgium.
| | | | - M A Salazar Lezama
- Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
| | - A Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - M Tadolini
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - S Tiberi
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom.
| | - N Veziris
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires de l'Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France
| | - G B Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.
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Murray J, Repossi A, Ismail S, Bhowmik A, Bothamley G. P183 Endobronchial Ultrasound And Tuberculosis: Beware The Non-caseating Granuloma. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Repossi A, Turner R, Bothamley G. S62 Risk Factors For Igra Positivity In Contacts Of Active Tuberculosis In A Uk High-prevalence Setting. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Tweed C, Bothamley G. S63 Investigation Of Serum Biomarkers In Tuberculosis Diagnosis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Woznitza N, Piper K, Burke S, Patel K, Amin S, Grayson K, Bothamley G. Adult chest radiograph reporting by radiographers: Preliminary data from an in-house audit programme. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Giehl C, Lange C, Duarte R, Bothamley G, Gerlach C, Cirillo DM, Wagner D, Kampmann B, Goletti D, Juers T, Sester M. TBNET - Collaborative research on tuberculosis in Europe. Eur J Microbiol Immunol (Bp) 2012; 2:264-74. [PMID: 24265908 DOI: 10.1556/eujmi.2.2012.4.4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 09/10/2012] [Indexed: 02/04/2023] Open
Abstract
Networking is a key feature of scientific success. The Tuberculosis Network European Trialsgroup (TBNET) was founded in 2006 as a non-profit, non-governmental peer-initiated scientific organization to collaboratively address research priorities in the area of tuberculosis in Europe. Today, TBNET is the largest tuberculosis research organization in Europe with nearly 500 members from 22 EU countries and 49 countries worldwide (www.tb-net.org). Apart from small multicenter basic research studies, a particular strength of TBNET is the performance of large collaborative projects, pan-European multicenter studies and database projects. In recent years, research from TBNET has substantially contributed to the understanding of the management, risk and prognosis of patients with multidrug (MDR) and extensively drug-resistant (XDR) tuberculosis and led to a better understanding of the clinical value of novel tests for the identification of adults and children with tuberculosis and latent infection with Mycobacterium tuberculosis. In 2009, two branches of TBNET were founded to specifically address tuberculosis in the pediatric population (ptbnet) and non-tuberculous mycobacterial diseases (NTM-NET). In addition to the research activities, TBNET is developing expert consensus documents for clinical management and provides training and capacity building especially for members from Eastern European countries, where tuberculosis is still a prevalent health problem.
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Sotgiu G, D'Ambrosio L, Centis R, Bothamley G, Cirillo DM, De Lorenzo S, Guenther G, Kliiman K, Muetterlein R, Spinu V, Villar M, Zellweger JP, Sandgren A, Huitric E, Lange C, Manissero D, Migliori GB. TB and M/XDR-TB infection control in European TB reference centres: the Achilles' heel? Eur Respir J 2012; 38:1221-3. [PMID: 22045789 DOI: 10.1183/09031936.00029311] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Migliori GB, Sotgiu G, D'Ambrosio L, Centis R, Lange C, Bothamley G, Cirillo DM, De Lorenzo S, Guenther G, Kliiman K, Muetterlein R, Spinu V, Villar M, Zellweger JP, Sandgren A, Huitric E, Manissero D. TB and MDR/XDR-TB in European Union and European Economic Area countries: managed or mismanaged? Eur Respir J 2012; 39:619-25. [PMID: 22323578 DOI: 10.1183/09031936.00170411] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In spite of the growing awareness of emerging drug-resistant Mycobacterium tuberculosis, the extent of inappropriate tuberculosis (TB) case management may be underestimated, even in Europe. We evaluated TB case management in the European Union/European Economic Area countries, with special focus on multidrug-resistant (MDR) and extensively drug-resistant (XDR)-TB, using a purposely developed, standardised survey tool. National reference centres in five countries representing different geographical, socioeconomic and epidemiological patterns of TB in Europe were surveyed. 40 consecutive, original clinical TB case records (30 MDR/XDR-TB cases) were reviewed in each of the five countries. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards. Deviations from international standards of TB care were observed in the following areas: surveillance (no information available on patient outcomes); infection control (lack of respiratory isolation rooms/procedures and negative-pressure ventilation rooms); clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration); laboratory support; and diagnostic/treatment algorithms. Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug resistance.
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Affiliation(s)
- G B Migliori
- WHO Collaborating Centre forTuberculosis and Lung Diseases,Fondazione S. Maugeri, Care andReasearch Institute, Tradate, Italy
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Maguire H, Brailsford S, Carless J, Yates M, Altass L, Yates S, Anaraki S, Charlett A, Lozewicz S, Lipman M, Bothamley G. Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case–control study and recommendations. Euro Surveill 2011. [DOI: 10.2807/ese.16.13.19830-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- H Maguire
- St George’s Hospital Medical School, London, United Kingdom
- Health Protection Agency, London Region Epidemiology Unit, London, United Kingdom
| | - S Brailsford
- Health Protection Agency, London Region Epidemiology Unit, London, United Kingdom
| | - J Carless
- Health Protection Agency, London Region Epidemiology Unit, London, United Kingdom
| | - M Yates
- Health Protection Agency Mycobacterium Reference Unit, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - L Altass
- North Central London TB Network, Haringey Teaching Primary Care Trust and National Health Service London, London, United Kingdom
| | - S Yates
- Her Majesty’s Prison Pentonville, London, United Kingdom
| | - S Anaraki
- Health Protection Agency, North East and Central Health Protection Unit, London, United Kingdom
| | - A Charlett
- Health Protection Agency, Centre for Infections, London, United Kingdom
| | - S Lozewicz
- North Middlesex University Hospital, London, United Kingdom
| | - M Lipman
- Royal Free University Hospital, London, United Kingdom
| | - G Bothamley
- Homerton University Hospital, London, United Kingdom
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Maguire H, Brailsford S, Carless J, Yates M, Altass L, Yates S, Anaraki S, Charlett A, Lozewicz S, Lipman M, Bothamley G. Large outbreak of isoniazid-monoresistant tuberculosis in London, 1995 to 2006: case-control study and recommendations. Euro Surveill 2011; 16:19830. [PMID: 21489373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
We conducted a case–control study to examine risk factors for isoniazid-monoresistant Mycobacterium tuberculosis in an ongoing outbreak in London. Cases were defined as individuals with an isoniazid-monoresistant strain diagnosed from 1995 to the third quarter of 2006 with an indistinguishable restriction fragment length polymorphism (RFLP) or mycobacterial interspersed repetitive unit (MIRU)-variable number tandem repeats (VNTR) pattern who were resident in or had epidemiological links with London. Controls were all other individuals reported with tuberculosis to the Health Protection Agency London regional epidemiology unit or the HPA London TB Register during 2000 to 2005. Of 293 cases, 153 (52%) were sputum smear-positive compared with 3,266 (18%) of controls. Cases were more likely to be young adults (aged between 15 and 34 years), born in the United Kingdom (OR: 2.4; 95% CI: 1.7–3.4) and of white (OR: 2.9; 95% CI: 1.8–4.8) or black Caribbean (OR: 12.5; 95% CI: 7.7–20.4) ethnicity, a prisoner at the time of diagnosis (OR: 20.2; 95% CI: 6.7–60.6), unemployed (OR: 4.1; 95% CI: 3.0–5.6), or a drug dealer or sex worker (OR: 187.1; 95% CI: 28.4–1,232.3). A total of 113 (39%) of cases used drugs and 54 (18%) were homeless. Completion of treatment gradually improved in cases from 55% among those diagnosed up to the end of 2002 compared with 65% by the end of 2006. Treatment completion increased from 79% to 83% in controls from 2000 to 2005. There are complex social challenges facing many cases in this outbreak that need to be addressed if medical interventions are to be successful.
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Affiliation(s)
- H Maguire
- Health Protection Agency, London Region Epidemiology Unit, London, United Kingdom.
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Diel R, Goletti D, Ferrara G, Bothamley G, Cirillo D, Kampmann B, Lange C, Losi M, Markova R, Migliori GB, Nienhaus A, Ruhwald M, Wagner D, Zellweger JP, Huitric E, Sandgren A, Manissero D. Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis. Eur Respir J 2010; 37:88-99. [PMID: 21030451 DOI: 10.1183/09031936.00115110] [Citation(s) in RCA: 355] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a systematic review and meta-analysis to compare the accuracy of the QuantiFERON-TB® Gold In-Tube (QFT-G-IT) and the T-SPOT®.TB assays with the tuberculin skin test (TST) for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). The Medline, Embase and Cochrane databases were explored for relevant articles in November 2009. Specificities, and negative (NPV) and positive (PPV) predictive values of interferon-γ release assays (IGRAs) and the TST, and the exposure gradient influences on test results among bacille Calmette-Guérin (BCG) vaccinees were evaluated. Specificity of IGRAs varied 98-100%. In immunocompetent adults, NPV for progression to tuberculosis within 2 yrs were 97.8% for T-SPOT®.TB and 99.8% for QFT-G-IT. When test performance of an immunodiagnostic test was not restricted to prior positivity of another test, progression rates to tuberculosis among IGRA-positive individuals followed for 19-24 months varied 8-15%, exceeding those reported for the TST (2-3%). In multivariate analyses, the odd ratios for TST positivity following BCG vaccination varied 3-25, whereas IGRA results remained uninfluenced and IGRA positivity was clearly associated with exposure to contagious tuberculosis cases. IGRAs may have a relative advantage over the TST in detecting LTBI and allow the exclusion of M. tuberculosis infection with higher reliability.
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Affiliation(s)
- R Diel
- Dept of Pneumology, Medical School Hanover, Hanover, Germany
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Abubakar I, Story A, Lipman M, Bothamley G, van Hest R, Andrews N, Watson JM, Hayward A. Diagnostic accuracy of digital chest radiography for pulmonary tuberculosis in a UK urban population. Eur Respir J 2010; 35:689-92. [DOI: 10.1183/09031936.00136609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mackay AJ, Burke S, Bothamley G. Trust in the patient's history: cough and eels. Case Reports 2009; 2009:bcr07.2009.2114. [DOI: 10.1136/bcr.07.2009.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mack U, Migliori GB, Sester M, Rieder HL, Ehlers S, Goletti D, Bossink A, Magdorf K, Holscher C, Kampmann B, Arend SM, Detjen A, Bothamley G, Zellweger JP, Milburn H, Diel R, Ravn P, Cobelens F, Cardona PJ, Kan B, Solovic I, Duarte R, Cirillo DM. LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J 2009; 33:956-73. [DOI: 10.1183/09031936.00120908] [Citation(s) in RCA: 365] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ali E, Geddes L, Guha A, Vallayil L, Collier J, Cheng L, Bothamley G. P.236 Unusual presentations of cervical tuberculosis and their treatment. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)72024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Coker R, Bell A, Pitman R, Zellweger JP, Heldal E, Hayward A, Skulberg A, Bothamley G, Whitfield R, de Vries G, Watson JM. Tuberculosis screening in migrants in selected European countries shows wide disparities. Eur Respir J 2006; 27:801-7. [PMID: 16585088 DOI: 10.1183/09031936.06.00104305] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Well-established tuberculosis screening units in Western Europe were selectively sampled. Three screening units in Norway, two in the UK, one in the Netherlands and one in Switzerland were evaluated. The aim of this study was to describe a range of service models used at a number of individual tuberculosis units for the screening of new entrants into Europe. Semi-structured interviews were conducted with clinicians, nurses and administrators from a selected sample of European tuberculosis screening units. An outline of key themes to be addressed was forwarded to units ahead of scheduled interviews. Themes included the history of the unit, structure, processes and outputs involved in screening new entrants for tuberculosis. Considerable variation in screening services exists in the approaches studied. Units are sited in transit camps or as units within hospital facilities. Staff capacity and administration varies from one clinic per week with few dedicated staff to fully dedicated units. Only one site recorded symptoms; tuberculin testing was universal in children, but varied in adults; chest radiograph screening was universal except at one site where a positive tuberculin skin test or symptoms were required in those <35 yrs of age before ordering a radiograph. Few output data are routinely and systematically collected, which hinders comparison and determination of effectiveness and efficiency. Service models for screening new immigrants for tuberculosis appear to vary in Western Europe. The systematic collection of data would make international comparisons between units easier and help draw conclusions that might usefully inform service development.
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Affiliation(s)
- R Coker
- ECOHOST, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, and North East London TB Network, Department of Respiratory Medicine, Homerton University Hospital, London WC1E 7HT, UK.
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Nnoaham KE, Pool R, Bothamley G, Grant AD. Perceptions and experiences of tuberculosis among African patients attending a tuberculosis clinic in London. Int J Tuberc Lung Dis 2006; 10:1013-7. [PMID: 16964793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
SETTING Little is known of the social and cultural issues influencing the uptake of and attitudes to tuberculosis (TB) care by people of African extraction living in the UK. OBJECTIVE To describe the perceptions and experiences of African patients with TB in London, focusing on issues relating to diagnosis, treatment adherence and stigma. DESIGN Qualitative study using in-depth interviews. RESULTS Misinterpretation of early symptoms led to delays in seeking health care. Although half of the respondents reported denial of the diagnosis, they reported good treatment adherence, noting the role of TB specialist nurses in promoting adherence. Respondents felt stigmatised by the diagnosis, although actual experiences of stigma were rare. Experience of TB in a known person mitigated stigma. Human immunodeficiency virus (HIV) disease was perceived to have worsened TB stigma, and most patients offered HIV testing initially declined, fearing stigmatisation and poor illness outcomes if positive. CONCLUSIONS Awareness of TB can be improved among migrants at high risk of developing the disease and among health professionals. Counselling around HIV testing for TB patients must take their beliefs into account if a high uptake of testing is to be achieved.
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Affiliation(s)
- K E Nnoaham
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Maguire H, Ruddy M, Bothamley G, Patel B, Lipman M, Drobniewski F, Yates M, Brown T. Multidrug resistance emerging in North London outbreak. Thorax 2006; 61:547-8. [PMID: 16738048 PMCID: PMC2111212 DOI: 10.1136/thx.2005.052423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brewin P, Jones A, Kelly M, McDonald M, Beasley E, Sturdy P, Bothamley G, Griffiths C. Is screening for tuberculosis acceptable to immigrants? A qualitative study. J Public Health (Oxf) 2006; 28:253-60. [PMID: 16820434 DOI: 10.1093/pubmed/fdl031] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Screening of immigrants has been a widespread response to the global resurgence of tuberculosis but has been criticized as discriminatory and stigmatising. Acceptability is an essential but neglected ethical prerequisite of screening programmes, particularly those targeting vulnerable groups such as refugees. No data exist concerning acceptability of tuberculosis screening. We therefore examined the responses of immigrants to screening for tuberculosis in a range of settings. METHODS We carried out a qualitative interview study of a maximum diversity sample of 53 immigrants offered screening for tuberculosis in east London. We recruited people screened in three settings: a social service centre for asylum seekers, a hospital clinic for new entrants and primary care. We confirmed validity of our findings at a focus group of asylum seekers. RESULTS The opportunity to be screened for tuberculosis was valued highly by recipients. Moreover, many saw being screened as a socially responsible activity. Of the minority raising concerns, few mentioned the possibility of discrimination. Acceptability was high irrespective of setting, with respondents expressing preference for their chosen place of screening. CONCLUSION Screening for tuberculosis was highly acceptable to recipients in these settings. Screening should be offered in a range of settings.
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Affiliation(s)
- P Brewin
- Department of Respiratory Medicine, Homerton University Hospital, Homerton Row, London E9 6SR, UK
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25
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Brahmbhatt S, Hussain R, Zafar S, Dawood G, Ottenhoff THM, Drijfhout JW, Bothamley G, Smith S, Lopez FV, Dockrell HM. Human T cell responses to peptides of the Mycobacterium leprae 45-kD serine-rich antigen. Clin Exp Immunol 2002; 128:140-8. [PMID: 11982601 PMCID: PMC1906361 DOI: 10.1046/j.1365-2249.2002.01796.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In order to identify T cell epitopes within the Mycobacterium leprae 45-kD serine-rich antigen, we analysed responses to overlapping 17-mer peptides encompassing the whole antigen in non-exposed UK controls, Pakistani leprosy patients and tuberculosis patients in both the United Kingdom and Pakistan. This antigen has been described as M. leprae-specific, although it has a hypothetical homologue in M. tuberculosis. Human peripheral blood mononuclear cells were stimulated with peptide for 5 days and IFN-gamma measured in supernatants by ELISA. Some peptides were recognized more frequently by T cells from tuberculoid leprosy patients than those from UK controls, suggesting that such T cell epitopes might have diagnostic potential, while other peptides induced greater responses among UK control subjects. Short-term cell lines confirmed that these assays detected specific T cell recognition of these peptides. However, many tuberculosis patients also recognized these potentially specific peptides suggesting that there could be a true homologue present in M. tuberculosis.
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Affiliation(s)
- S Brahmbhatt
- Immunology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Untreated tuberculosis in pregnancy poses a significant threat to the mother, fetus and family. Adherence to treatment is especially difficult in pregnancy because of the general fear of any medication and pregnancy-related nausea. Supervised treatment is especially helpful in encouraging adherence. All 4 first line drugs [isoniazid, rifampicin (rifampin), ethambutol and pyrazinamide] have an excellent safety record in pregnancy and are not associated with human fetal malformations. Drug-induced hepatitis, especially with isoniazid, is a significant problem in treating tuberculosis, not peculiar to pregnancy; close monitoring of liver function is recommended. Liver enzyme induction by rifampicin alters the metabolism of other drugs, e.g. methadone doses will need to be increased. Streptomycin should not be used in pregnancy, as perhaps 1 in 6 babies will have problems with hearing and/or balance. Ciprofloxacin has the best safety profile of second line drugs in the treatment of drug-resistant tuberculosis. Preventive treatment with isoniazid can be undertaken safely during pregnancy. Pyridoxine (vitamin B6) should be added to the drug treatment of tuberculosis in all pregnant women taking isoniazid. Neither tuberculin nor the bacille Calmette Guérin (BCG) vaccine are treatments for tuberculosis, but they play an important role in the management of the disease. Tuberculin testing is safe, but BCG vaccination should be avoided in pregnancy and instead given earlier in life.
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Affiliation(s)
- G Bothamley
- East London Tuberculosis Service, Homerton Hospital, England.
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al Jarad N, Strickland B, Bothamley G, Lock S, Logan-Sinclair R, Rudd RM. Diagnosis of asbestosis by a time expanded wave form analysis, auscultation and high resolution computed tomography: a comparative study. Thorax 1993; 48:347-53. [PMID: 8511731 PMCID: PMC464431 DOI: 10.1136/thx.48.4.347] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Crackles are a prominent clinical feature of asbestosis and may be an early sign of the condition. Auscultation, however, is subjective and interexaminer disagreement is a problem. Computerised lung sound analysis can visualise, store, and analyse lung sounds and disagreement on the presence of crackles is minimal. High resolution computed tomography (HRCT) is superior to chest radiography in detecting early signs of asbestosis. The aim of this study was to compare clinical auscultation, time expanded wave form analysis (TEW), chest radiography, and HRCT in detecting signs of asbestosis in asbestos workers. METHODS Fifty three asbestos workers (51 men and two women) were investigated. Chest radiography and HRCT were assessed by two independent readers for detection of interstitial opacities. HRCT was performed in the supine position with additional sections at the bases in the prone position. Auscultation for persistent fine inspiratory crackles was performed by two independent examiners unacquainted with the diagnosis. TEW analysis was obtained from a 33 second recording of lung sounds over the lung bases. TEW and auscultation were performed in a control group of 13 subjects who had a normal chest radiograph. There were 10 current smokers and three previous smokers. In asbestos workers the extent of pulmonary opacities on the chest radiograph was scored according to the International Labour Office (ILO) scale. Patients were divided into two groups: 21 patients in whom the chest radiograph was > 1/0 (group 1) and 32 patients in whom the chest radiograph was scored < or = 1/0 (group 2) on the ILO scale. RESULTS In patients with an ILO score of < or = 1/0 repetitive mid to late inspiratory crackles were detected by auscultation in seven (22%) patients and by TEW in 14 (44%). HRCT detected definite interstitial opacities in 11 (34%) and gravity dependent subpleural lines in two (6%) patients. All but two patients with evidence of interstitial disease or gravity dependent subpleural lines on HRCT had crackles detected by TEW. In patients with an ILO score of > 1/0 auscultation and TEW revealed mid to late inspiratory crackles in all patients, whereas HRCT revealed gravity dependent subpleural lines in one patient and signs of definite interstitial fibrosis in the rest. In normal subjects crackles different from those detected in asbestosis were detected by TEW in three subjects but only in one subject by auscultation. These were early, fine inspiratory crackles. CONCLUSION Mid to late inspiratory crackles in asbestos workers are detected by TEW more frequently than by auscultation. Signs of early asbestosis not apparent on the plain radiograph are detected by TEW and HRCT with similar frequency. off
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Bothamley G, Batra H, Ramesh V, Chandramui A, Ivanyi J. Serodiagnostic value of the 19 kilodalton antigen of Mycobacterium tuberculosis in Indian patients. Eur J Clin Microbiol Infect Dis 1992; 11:912-5. [PMID: 1283126 DOI: 10.1007/bf01962372] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Previous studies in UK subjects suggested that the 19 kDa protein antigen of Mycobacterium tuberculosis might be valuable in the serodiagnosis of paucibacillary tuberculosis. In this study, antibody titres for the 19 kDa antigen were higher in healthy controls in India than in the UK. Consequently, the diagnostic sensitivity of this antigen and its TB23 epitope was negligible in Indian patients with tuberculosis. However, a diagnostic sensitivity of 50% was achieved in patients with skin tuberculosis on the basis of a high ratio between antibody titres for the whole antigen and its TB23 epitope.
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MESH Headings
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/immunology
- Antibodies, Monoclonal
- Antigens, Bacterial/immunology
- Chi-Square Distribution
- Epitopes/immunology
- Humans
- India
- Mycobacterium tuberculosis/immunology
- Sensitivity and Specificity
- Serologic Tests
- Tuberculosis/diagnosis
- Tuberculosis/immunology
- Tuberculosis, Cutaneous/diagnosis
- Tuberculosis, Cutaneous/immunology
- Tuberculosis, Meningeal/diagnosis
- Tuberculosis, Meningeal/immunology
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/immunology
- United Kingdom
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Affiliation(s)
- G Bothamley
- MRC Tuberculosis and Related Infections Unit, Hammersmith Hospital, London, UK
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31
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Elsaghier A, Prantera C, Bothamley G, Wilkins E, Jindal S, Ivanyi J. Disease association of antibodies to human and mycobacterial hsp70 and hsp60 stress proteins. Clin Exp Immunol 1992; 89:305-9. [PMID: 1638774 PMCID: PMC1554437 DOI: 10.1111/j.1365-2249.1992.tb06950.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Structural homology between microbial and human stress proteins has been postulated to be a basis for autoimmunization in chronic inflammatory diseases. Therefore, we estimated by ELISA titration the antibody levels to mycobacterial (M) and human (H) recombinant hsp70 and M-hsp65 heat-shock proteins in sera of patients with Crohn's disease (n = 29), ulcerative colitis (n = 20) and nontuberculous mycobacterial disease of the lungs (n = 20). Antibodies to H-hsp60, separated by two-dimensional gel electrophoresis, were tested in six sera of each group of patients. In Crohn's disease, antibody titres to the M-hsp65 antigen without detectable H-hsp60 binding were significantly elevated in 52% of the patients. In contrast titres to both M-hsp70 and H-hsp70 were demonstrable and correlated, but increased over control values only in four (14%) patients. The antibody pattern in ulcerative colitis was found to be quite different: anti-H-hsp60 binding was demonstrable in most patients, although anti-M-hsp65 titres were not elevated. Furthermore, 25% of patients had significantly elevated titres to M-hsp70, but not to H-hsp70. In non-tuberculous mycobacterial pulmonary disease, about 50% of patients had elevated titres to both hsp65 and hsp71 mycobacterial antigens but not to the corresponding human proteins; patients with Mycobacterium xenopi infection had the highest titres in this group. These results demonstrate the existence of distinct disease-associated patterns in the human antibody response to stress protein antigens. However, these data are not sufficient to imply sensitization with mycobacteria in patients with inflammatory bowel diseases, since certain epitopes of heat-shock proteins are shared by several bacterial genera.
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Affiliation(s)
- A Elsaghier
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, UK
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Abstract
Sera from patients with leprosy or tuberculosis and healthy subjects have been analysed for the presence of antibodies to four species-specific mycobacterial epitopes, four different viruses and five autoantigens. Antibodies to the Mycobacterium leprae-specific 35-kD protein and phenolic glycolipid I epitopes were not present in patients with active pulmonary tuberculosis. In contrast, antibody levels to species-specific epitopes of the 38-kD and 14-kD antigens M. tuberculosis were significantly elevated in patients with lepromatous leprosy. Neither of the two antigens is cross-reactive with M. leprae at the B cell level. However, it was considered that cross-reactive helper T cells could recall the response of M. tuberculosis-specific memory B cells, which had been primed through prior self-healing tuberculous infection. As an alternative explanation, the possible role of polyclonal B cell stimulation was considered. This seemed unlikely, however, since: (i) antibody levels to autoantigens, except anti-smooth muscle, were not elevated, and (ii) antibody levels to four distinct viruses, unlike those to all mycobacterial epitopes, showed no correlation with titres, to M. tuberculosis-specific epitopes.
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Affiliation(s)
- G Bothamley
- Infections Unit, Hammersmith Hospital, London, England
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33
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Wilkins E, Bothamley G, Jackett P. A rapid, simple enzyme immunoassay for detection of antibody to individual epitopes in the serodiagnosis of tuberculosis. Eur J Clin Microbiol Infect Dis 1991; 10:559-63. [PMID: 1717268 DOI: 10.1007/bf01967273] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The antibody response to individual epitopes has previously been analysed by competition assay using 125I- or enzyme labelled monoclonal antibodies. A modification of the test is described in which competition of human sera with unlabelled mouse monoclonal antibodies at the limiting dilution is revealed by peroxidase labelled antimouse IgG conjugate. Analysis of 54 sera from patients with pulmonary (36) and extra-pulmonary (18) tuberculosis and 31 controls indicated that the modified test compares favourably with the test based upon directly labelled antibodies. Diagnostic sensitivity for five monoclonal antibodies evaluated was 11.1% (TB78), 35.2% (TB23 and TB68), 37.0% (TB71) and 61.1% (TB72) at 97.5% specificity. For TB72, sensitivity was highest for pulmonary disease (69.7%). The modified assay is also easier to standardise for screening new monoclonal antibodies using a single enzyme-labelled conjugate.
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Affiliation(s)
- E Wilkins
- Department of Infectious Diseases, Lister Unit, Northwick Park Hospital, Middlesex, UK
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34
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Mendez-Samperio P, Lamb J, Bothamley G, Stanley P, Ellis C, Ivanyi J. Molecular study of the T cell repertoire in family contacts and patients with leprosy. J Immunol 1989; 142:3599-604. [PMID: 2497176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The specificity of lymphocyte proliferative responses of 22 family contacts and 7 patients with leprosy were analyzed using Ag fractions from soluble extracts of Mycobacterium leprae and Mycobacterium tuberculosis. Fractions 10-100 kDa m.w. from each extract were separated by SDS-polyacrylamide gel electrophoresis, electroblotted to nitrocellulose membrane and solubilized for use in lymphocyte culture. The main immunogenic fractions for both contacts and patients had m.w. of 12,000 to 22,000, 35,000 to 40,000, and 65,000. Determinants which were either distinct or shared by the two extracts were active in each of the immunogenic fractions. Lymphocyte proliferation following stimulation with separated Ag was found also in five subjects who failed to respond to the whole soluble extracts. Stimulatory synthetic peptides were identified for the 65 kDa protein Ag. This technique has permitted the screening of the T cell immune repertoire for the identification of the immunodominant Ag which merit further purification and molecular characterization.
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Affiliation(s)
- P Mendez-Samperio
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
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35
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Mendez-Samperio P, Lamb J, Bothamley G, Stanley P, Ellis C, Ivanyi J. Molecular study of the T cell repertoire in family contacts and patients with leprosy. The Journal of Immunology 1989. [DOI: 10.4049/jimmunol.142.10.3599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
The specificity of lymphocyte proliferative responses of 22 family contacts and 7 patients with leprosy were analyzed using Ag fractions from soluble extracts of Mycobacterium leprae and Mycobacterium tuberculosis. Fractions 10-100 kDa m.w. from each extract were separated by SDS-polyacrylamide gel electrophoresis, electroblotted to nitrocellulose membrane and solubilized for use in lymphocyte culture. The main immunogenic fractions for both contacts and patients had m.w. of 12,000 to 22,000, 35,000 to 40,000, and 65,000. Determinants which were either distinct or shared by the two extracts were active in each of the immunogenic fractions. Lymphocyte proliferation following stimulation with separated Ag was found also in five subjects who failed to respond to the whole soluble extracts. Stimulatory synthetic peptides were identified for the 65 kDa protein Ag. This technique has permitted the screening of the T cell immune repertoire for the identification of the immunodominant Ag which merit further purification and molecular characterization.
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Affiliation(s)
- P Mendez-Samperio
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
| | - J Lamb
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
| | - G Bothamley
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
| | - P Stanley
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
| | - C Ellis
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
| | - J Ivanyi
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, London, United Kingdom
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Prantera C, Bothamley G, Levenstein S, Mangiarotti R, Argentieri R. Crohn's disease and mycobacteria: two cases of Crohn's disease with high anti-mycobacterial antibody levels cured by dapsone therapy. Biomed Pharmacother 1989; 43:295-9. [PMID: 2676002 DOI: 10.1016/0753-3322(89)90011-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Five patients with Crohn's colitis or ileocolitis (CD) refractory to conventional therapy were enrolled in an open trial with dapsone (100 mg/day). This therapy was apparently effective in two out of five patients. In these patients we observed a clinical improvement after one month of therapy and, in the first patient, a complete healing of all the cutaneous and rectal ulcers. In the two responders antibody levels to a soluble extract of M. paratuberculosis (MPSE) were significantly greater than in the three non-responders (P = 0.03); in the first patient, moreover, there was a rise of 39% in antibody titres following the treatment. This rise in antibody levels, that might be expected following death of the pathogen and release of antigen, is similar to that observed after treatment of tuberculosis. Our data suggest that a mycobacterial species or another pathogen that cross-react with those of MPSE, sensitive to dapsone, may in a subset of cases be responsible for the development of CD. This is the first report of clinical cure with an agent active against specific bacterial species, associated with immunologic confirmation of a response.
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Affiliation(s)
- C Prantera
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
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Ivanyi J, Sharp K, Jackett P, Bothamley G. Immunological study of the defined constituents of mycobacteria. Springer Semin Immunopathol 1988; 10:279-300. [PMID: 3065951 DOI: 10.1007/bf02053841] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J Ivanyi
- MRC Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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Bothamley G, Udani P, Rudd R, Festenstein F, Ivanyi J. Humoral response to defined epitopes of tubercle bacilli in adult pulmonary and child tuberculosis. Eur J Clin Microbiol Infect Dis 1988; 7:639-45. [PMID: 2461861 DOI: 10.1007/bf01964242] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In order to investigate the humoral response to tuberculosis in different categories of patients, serum antibody levels to six epitopes of Mycobacterium tuberculosis in adult pulmonary and child tuberculosis were determined. Serum antibody titres were determined by competitive inhibition with radio-labelled murine monoclonal antibodies in 67 adults and 85 children with tuberculosis and in 79 age-matched controls. BCG vaccination (n = 39) and self-healed tuberculosis (n = 11) in adults gave rise to higher antibody titres to TB68, TB23 and TB72 epitopes (all p less than 0.003) when compared to non-vaccinated controls (n = 18). TB68 titres were higher (p = 0.006) in self-healed than in vaccinated adults. Adult sputum-negative patients (n = 15) had higher titres to TB71 (p = 0.015) and ML34 (p = 0.02) epitopes compared to BCG-vaccinated healthy controls, while sputum-positive patients (n = 41) had higher titres to all epitopes tested (all p less than 10(-4]. The diagnostic sensitivity, with a 95% specificity, was best with the combination of probes TB23, TB68, TB72 for sputum-positive (85%) and TB78, ML34 (53%) for sputum-negative patients. Antibody titres in children with tuberculosis were lower than in adult patients; diagnostic sensitivity in histologically or microbiologically proven cases (n = 18) was only 44%, while that in mediastinal lymph-adenitis (n = 67) was 13.5%. This study suggests that the magnitude and specificity of the humoral response to tubercle bacilli varies with site and severity of infection; the implications for pathogenesis or protective immunity are discussed.
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Affiliation(s)
- G Bothamley
- Medical Research Council Tuberculosis and Related Infections Unit, Royal Postgraduate Medical School Hammersmith Hospital, London, UK
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