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Prommi A, Wongjarit K, Petsong S, Somsukpiroh U, Faksri K, Kawkitinarong K, Payungporn S, Rotcheewaphan S. Co-resistance to isoniazid and second-line anti-tuberculosis drugs in isoniazid-resistant tuberculosis at a tertiary care hospital in Thailand. Microbiol Spectr 2024; 12:e0346223. [PMID: 38323824 PMCID: PMC10913473 DOI: 10.1128/spectrum.03462-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
Isoniazid-resistant tuberculosis (Hr-TB) is an important drug-resistant tuberculosis (TB). In addition to rifampicin, resistance to other medications for Hr-TB can impact the course of treatment; however, there are currently limited data in the literature. In this study, the drug susceptibility profiles of Hr-TB treatment and resistance-conferring mutations were investigated for Hr-TB clinical isolates from Thailand. Phenotypic drug susceptibility testing (pDST) and genotypic drug susceptibility testing (gDST) were retrospectively and prospectively investigated using the Mycobacterium Growth Indicator Tube (MGIT), the broth microdilution (BMD) method, and whole-genome sequencing (WGS)-based gDST. The prevalence of Hr-TB cases was 11.2% among patients with TB. Most Hr-TB cases (89.5%) were newly diagnosed patients with TB. In the pDST analysis, approximately 55.6% (60/108) of the tested Hr-TB clinical isolates exhibited high-level isoniazid resistance. In addition, the Hr-TB clinical isolates presented co-resistance to ethambutol (3/161, 1.9%), levofloxacin (2/96, 2.1%), and pyrazinamide (24/118, 20.3%). In 56 Hr-TB clinical isolates, WGS-based gDST predicted resistance to isoniazid [katG S315T (48.2%) and fabG1 c-15t (26.8%)], rifampicin [rpoB L430P and rpoB L452P (5.4%)], and fluoroquinolones [gyrA D94G (1.8%)], but no mutation for ethambutol was detected. The categorical agreement for the detection of resistance to isoniazid, rifampicin, ethambutol, and levofloxacin between WGS-based gDST and the MGIT or the BMD method ranged from 80.4% to 98.2% or 82.1% to 100%, respectively. pDST and gDST demonstrated a low co-resistance rate between isoniazid and second-line TB drugs in Hr-TB clinical isolates. IMPORTANCE The prevalence of isoniazid-resistant tuberculosis (Hr-TB) is the highest among other types of drug-resistant tuberculosis. Currently, the World Health Organization (WHO) guidelines recommend the treatment of Hr-TB with rifampicin, ethambutol, pyrazinamide, and levofloxacin for 6 months. The susceptibility profiles of Hr-TB clinical isolates, especially when they are co-resistant to second-line drugs, are critical in the selection of the appropriate treatment regimen to prevent treatment failure. This study highlights the susceptibility profiles of the WHO-recommended treatment regimen in Hr-TB clinical isolates from a tertiary care hospital in Thailand and the concordance and importance of using the phenotypic drug susceptibility testing or genotypic drug susceptibility testing for accurate and comprehensive interpretation of results.
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Affiliation(s)
- Ajala Prommi
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kanphai Wongjarit
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suthidee Petsong
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ubonwan Somsukpiroh
- Department of Microbiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kiatichai Faksri
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Kamon Kawkitinarong
- Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunchai Payungporn
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suwatchareeporn Rotcheewaphan
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Chua F, Low S, Chai GT, Inoue Y, Ong V, Wongkarnjana A, Kawkitinarong K, Song JW, Hamid ZA, Aziz AA, Campomanes M, Maher TM, Molyneaux PL, Syakirin S. Knowledge gaps in fibrotic interstitial lung disease in pan-Asian populations: data not missing at random? The Lancet Respiratory Medicine 2023:S2213-2600(23)00125-X. [PMID: 37028437 DOI: 10.1016/s2213-2600(23)00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
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Suwanpimolkul G, Gatechompol S, Kawkitinarong K, Ueaphongsukkit T, Sophonphan J, Siriyakorn N, Jirajariyavej S, Khusuwan S, Panarat P, Wannalerdsakun S, Saetiew N, Chayangsu S, Wiwatrojanagul S, Noopetch P, Danpornprasert P, Mekviwattanawong S, Fujitnirun C, Lertpiriyasuwat C, Han WM, Kerr SJ, Ruxrungtham K, Avihingsanon A. Incidence of active tuberculosis among people living with HIV receiving long-term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy. J Int AIDS Soc 2022; 25:e25900. [PMID: 35384317 PMCID: PMC8982319 DOI: 10.1002/jia2.25900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Among high tuberculosis (TB) and HIV burden countries in Asia, tuberculosis preventive therapy (TPT) in people living with HIV (PLWH) has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Therefore, we determined the incidence of active TB and mortality among 9179 adult PLWH who attended and received ART from 15 tertiary care hospitals across Thailand. Methods A retrospective study was conducted in 2018 using follow‐up data from 1999 to 2018. The primary endpoint was incident TB disease after ART initiation. Factors associated with TB incidence were analysed using competing risk regression. The Kaplan–Meier method was used to estimate mortality after ART initiation. Results During a median of 5.1 years of ART (IQR 2.2–9.5 years), 442 (4.8%) PLWH developed TB (TB/HIV), giving an overall incidence of 750 (95% CI 683–823) per 100,000 persons‐year of follow up (PYFU). In multivariate analysis, lower CD4 at ART initiation (≤100 cells/mm3, adjusted sub‐distribution hazard ratio [aSHR]: 2.08, 95% CI, 1.47–2.92; 101–200 cells/mm3, aSHR: 2.21, 95% CI, 1.54–3.16; 201–350 cells/mm3, aSHR: 1.59, 95% CI, 1.11–2.28 vs. >350 cells/mm3), male sex (aSHR: 1.40, 95% CI, 1.11–1.78), lower body weight (<50 kg, aSHR: 1.52, 95% CI, 1.17–1.95) and prior TB event (aSHR: 3.50, 95% CI, 2.72–4.52) were associated with TB incidence. PLWH with HIV RNA ≥50 copies/ml had 5–9 times higher risk of active TB disease higher than those with HIV RNA <50 copies/ml at the same CD4 level. The risk for developing TB was remarkably high during the initial period of ART (175,511 per 100,000 PYFU at<3 months) and was comparable to the general population after 10 years of ART (151 per 100,000 PYFU). TB/HIV had higher mortality (10% vs. 5%) and poorer HIV treatment outcomes: HIV RNA <50 copies/ml (63.8% vs. 82.8%), CD4 cells count (317 vs. 508 cells/mm3) at the most recent visit. Conclusions In this high TB burden country, TB incidence was remarkably high during the first few years after ART initiation and thereafter decreased significantly. Rapid ART initiation and appropriate TPT can be potential key interventions to tackle the TB epidemic and reduce mortality among PLWH in TB/HIV high burden settings.
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Affiliation(s)
- Gompol Suwanpimolkul
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Centre of Excellence in Tuberculosis, Division of Pulmonary Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Emerging Infectious Diseases Clinical Center, Bangkok, Thailand
| | - Sivaporn Gatechompol
- Centre of Excellence in Tuberculosis, Division of Pulmonary Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Kamon Kawkitinarong
- Centre of Excellence in Tuberculosis, Division of Pulmonary Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Pulmonary Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thornthun Ueaphongsukkit
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Centre of Excellence in Tuberculosis, Division of Pulmonary Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Emerging Infectious Diseases Clinical Center, Bangkok, Thailand
| | | | - Nirada Siriyakorn
- Infectious Disease Unit, Medicine Department, Rajavithi Hospital, Bangkok, Thailand
| | | | - Suwimon Khusuwan
- Medicine Department, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Palakorn Panarat
- Medicine Department, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Surat Wannalerdsakun
- Division of Infectious Disease, Department of Medicine, Naresuan University Hospital Phitsanulok, Phitsanulok, Thailand
| | - Natcha Saetiew
- Medicine Department, Sisaket Hospital, Sisaket, Thailand
| | | | | | | | | | | | - Chris Fujitnirun
- Medicine Department, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Cheewanan Lertpiriyasuwat
- Division of AIDS and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Win Min Han
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Anchalee Avihingsanon
- Centre of Excellence in Tuberculosis, Division of Pulmonary Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Chumpa N, Kawkitinarong K, Wongpiyabovorn J, Paitoonpong L, Suwanpimolkul G. Prevalence of Latent Tuberculosis Infection among Pre-clinical and Clinical Medical Students Using QuantiFERON-TB Gold Plus and Tuberculin Skin Test at a Teaching Hospital in Thailand: A Cross-sectional Study. J Infect Public Health 2022; 15:400-405. [DOI: 10.1016/j.jiph.2022.02.010] [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] [Received: 11/29/2021] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022] Open
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Sodsai P, Sengprasert P, Sae-Jung T, Kawkitinarong K, Udomsantisuk N, Palaga T, Reantragoon R. Notch 2 receptor expression and reduced cytotoxicity in MAIT cells of active pulmonary TB patients. Asian Pac J Allergy Immunol 2021. [PMID: 34717526 DOI: 10.12932/ap-230621-1166] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Knowledge of the prevalence of common sensitizing allergens may aid in overall management of allergic disease in a specified area. OBJECTIVE The aim of this study was to identify and analyse the prevalence of common inhaled and food sensitizing allergens in Beijing. METHODS This was a retrospective study, analysing demographic data and serum sIgE antibody test results from 59057 outpatients who presented to Beijing TongRen Hospital, from January 2013 to December 2019. RESULTS 28879 patients (48.9%) showed positive sIgE test results; with significantly more males aged under 16 years sensitized to at least one allergen than females, and most patients (53.62%) were sensitized to multiple allergens. The first inhaled sensitizing allergens was Artemisia grass (11910 (41.24%)); and the first food allergens was crab (3547 (12.28%)). For Artemisia sensitized patients, sIgE levels were mostly at level 5. The number of patients with ragweed allergy is increasing year by year. The detection rates for sIgE to Artemisia, common ragweed, and Humulus grass allergens were significantly higher in August and September. R package ggplot2 analysis, demonstrated strong correlations between tree allergens and common ragweed and Humulus grass allergens (phi coefficients = 0.50 and 0.46, respectively; both P < 0.01). CONCLUSIONS The prevalence of sensitization to different allergens in Beijing showed Artemisia grass was the most commonly inhaled sensitizing allergen, and the number of patients with ragweed grass allergy was increasing by year.
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Affiliation(s)
- Pimpayao Sodsai
- Immunology Division, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Panjana Sengprasert
- Immunology Division, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thitiya Sae-Jung
- Medical Microbiology Interdisciplinary Program, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Kamon Kawkitinarong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nibondh Udomsantisuk
- Bacteriology Division, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanapat Palaga
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Rangsima Reantragoon
- Immunology Division, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Immunology and Immune-mediated Diseases, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Laohapojanart N, Ratanajamit C, Kawkitinarong K, Srichana T. Efficacy and safety of combined isoniazid-rifampicin-pyrazinamide-levofloxacin dry powder inhaler in treatment of pulmonary tuberculosis: A randomized controlled trial. Pulm Pharmacol Ther 2021; 70:102056. [PMID: 34273498 DOI: 10.1016/j.pupt.2021.102056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/23/2020] [Accepted: 07/12/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of add-on dry powder for inhalation (DPI) of combined anti-TB agents prepared as a particulate system (study group) compared with placebo DPI (control group) in patients diagnosed with pulmonary TB. METHODS This study was a randomized, placebo-controlled, double-blinded parallel design. Subjects were pulmonary TB patients, new or re-treatment, aged 18 years or older. The eligible patients were randomly allocated (1:1) to either the study group or the control group using stratified blocked randomization. The add-on DPI of combined anti-TB therapy (each capsule contained isoniazid 5 mg, rifampicin 2 mg, pyrazinamide 16 mg, and levofloxacin 2 mg) was used throughout the course of the standard oral anti-TB treatment. The primary outcome was Mycobacterium tuberculosis (MTB) sputum culture conversion measured after receiving treatment for eight weeks. Secondary outcomes were clinical signs and symptoms of pulmonary TB and adverse drug reactions (ADRs) related to anti-TB agents. The percentages of patients who achieved the primary outcome were compared (95% confidence interval). All analyses were performed using the modified intention-to-treat principle. RESULTS 91 patients were randomly allocated: 44 to the study group and 47 to the control group. Important baseline data (%peak expiratory flow rate, chest X-ray findings, resistance to anti-TB agents, renal and liver function tests) were similar between the two groups. Although the percentages of patients who achieved the primary outcome were similar in both groups (34/44 [77.3%] in the study group and (34/47 [72.3%] in the control group; relative risk [RR] 1.07, 95% CI 0.84-1.36; p = 0.589), the study group patients seemed to achieve the primary outcome earlier than the control group (22/44 [50.0%] vs 15/47 [31.9%]; RR 1.57, 95% CI 0.94-2.61; p = 0.079) at the end of week 4. Cough was significantly lower in the study group than in the control group (23/44 [52.3%] vs 43/47 [91.5%]; RR 0.57, 95% CI 0.43-0.77; p < 0.001) at week 4 of treatment. Hemoptysis was found in approximately half of each group at baseline. The percentage of patients having hemoptysis was substantially reduced at week 2 of treatment (5 [11.4%] in the study group and 11 [23.0%] in the control group, p = 0.132). Regarding safety outcomes, no dyspnea or severe ADRs were reported. Adverse events (AEs) related to oral anti-TB agents, (e.g. liver function tests) were in normal ranges in most patients in both groups during the treatment. The incidences of common AEs reported (e.g. anorexia, dizziness, numbness, arthralgia, rash, and itching) were similar between the two groups, while the incidences of nausea and vomiting were significantly lower in the study group than the control group (38.6% vs 74.5%, p = 0.001, and 43.2% vs 66.0%, p = 0.029, respectively). CONCLUSIONS Add-on combined anti-TB DPI therapy to the standard oral anti-TB treatment did not increase MTB sputum culture conversion at two months of treatment. However, the percentage of patients having cough in the study group was significantly lower than in the control group at two months after treatment. A reduction in cough might represent adequate response to treatment, and result in a decreased risk of spread of infection. Combined anti-TB DPI therapy was safe. Further study investigated in a larger sample using higher strengths of DPI therapy is required.
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Affiliation(s)
- Nisa Laohapojanart
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand.
| | - Chaveewan Ratanajamit
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand.
| | - Kamon Kawkitinarong
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Teerapol Srichana
- Drug Delivery System Excellence Center and Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand.
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Gatechompol S, Harnpariphan W, Supanan R, Suwanpimolkul G, Sophonphan J, Ubolyam S, Kerr SJ, Avihingsanon A, Kawkitinarong K. Prevalence of latent tuberculosis infection and feasibility of TB preventive therapy among Thai prisoners: a cross-sectional study. BMC Public Health 2021; 21:1206. [PMID: 34162348 PMCID: PMC8223292 DOI: 10.1186/s12889-021-11271-0] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prisons are considered as major reservoirs for tuberculosis. Preventive therapy for latent TB infection (LTBI) is an adjunctive strategy to control TB. However, LTBI data in Thai prisoners is limited. This study assessed the prevalence of LTBI and feasibility of isoniazid preventive therapy (IPT). METHODS A cross-sectional study was conducted among prisoners in Klong Prem Central Prison, Bangkok. Participants were screened for active TB by questionnaire and chest X-ray. LTBI was evaluated by Tuberculin skin test (TST) and QuantiFERON-TB Gold Plus (QFTP) among subgroup. Participants with positive TST or QFTP were considered to have LTBI. Participants with LTBI were offered IPT. RESULTS From August 2018-November 2019, 1002 participants were analyzed. All participants were male with a median age of 38 (IQR 32-50) years. LTBI identified by either TST/QFTP was present in 466 (46.5%) participants. TST was positive in 359 (36%) participants. In the subgroup of 294 participants who had both TST and QFTP results, 181/294 (61.6%) tested positive by QFTP. Agreement between TST and QFTP was 55.1% (Kappa = 0.17). The risk factors associated with LTBI were previous incarceration (aOR 1.53, 95%CI, 1.16-2.01, p = 0.002), history of prior active TB (aOR 3.02, 95%CI, 1.74-5.24, p < 0.001) and duration of incarceration ≥10 years (aOR 1.86, 95%CI, 1.24-2.79, p = 0.003). Majority of LTBI participants (82%) agreed to take IPT. Three hundred and 56 (93%) participants completed treatment whereas 27 (7%) participants discontinued IPT due to the side effects of INH. CONCLUSION This is the first study to evaluate the prevalence of LTBI and feasibility of IPT among Thai prisoners. LTBI prevalence in male prisoners in Thailand is high. LTBI screening and treatment should be implemented together with other preventive components.
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Affiliation(s)
- Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand. .,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Weerakit Harnpariphan
- Medical Correctional Institution, Bangkok and Klong Prem Central Prison, Bangkok, Thailand
| | - Ruamthip Supanan
- Medical Correctional Institution, Bangkok and Klong Prem Central Prison, Bangkok, Thailand
| | - Gompol Suwanpimolkul
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiratchaya Sophonphan
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Sasiwimol Ubolyam
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamon Kawkitinarong
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Leelayuwatanakul N, Kongpolprom N, Sriprasart T, Phoophiboon V, Thanthitaweewat V, Thawanaphong S, Sirichana W, Chirakalwasan N, Kawkitinarong K, Sittipunt C, Putcharoen O, Paitoonpong L, Suwanpimolkul G, Jantarabenjakul W, Srisawat N, Pachinburavan M. Multimodality treatment in immunocompromised patients with severe COVID-19: the role of IL-6 inhibitor, intravenous immunoglobulin, and haemoperfusion. Respirol Case Rep 2021; 9:e0733. [PMID: 33732466 PMCID: PMC7938208 DOI: 10.1002/rcr2.733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023] Open
Abstract
Cytokine release syndrome (CRS) is known to be associated with severe coronavirus disease 2019 (COVID-19). Multiple anti-inflammatory therapies such as tocilizumab, corticosteroids, intravenous immunoglobulin (IVIG), and haemoadsorption or haemoperfusion have been used to combat this life-threatening condition. However, immunocompromised hosts are often omitted from research studies, and knowledge on the clinical efficacy of these therapies in immunocompromised patients is therefore limited. We report two cases of immunocompromised patients with severe COVID-19-related CRS requiring mechanical ventilation who were treated with multimodality treatment consisting of tocilizumab, IVIG, and haemoperfusion. Within 48 h, both patients showed clinical improvement with PaO2:FiO2 ratio and haemodynamic stability. Both survived to discharge. There were no adverse events following these therapies. In conclusion, combined therapeutic modalities, possibly tailored to individual inflammatory profiles, are promising treatment for severe COVID-19 infection in the immunocompromised host. Timely administration of adjunctive therapies that alleviate overwhelming inflammation may provide the best outcome.
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Affiliation(s)
- Nophol Leelayuwatanakul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Napplika Kongpolprom
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Thitiwat Sriprasart
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Vorakamol Phoophiboon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Vorawut Thanthitaweewat
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Sarita Thawanaphong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Worawan Sirichana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Kamon Kawkitinarong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Chanchai Sittipunt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Opass Putcharoen
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Leilani Paitoonpong
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Gompol Suwanpimolkul
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Watsamon Jantarabenjakul
- Thai Red Cross Emerging Infectious Diseases Clinical CenterKing Chulalongkorn Memorial HospitalBangkokThailand
- Department of Paediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Monvasi Pachinburavan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
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Ubolyam S, Iampornsin T, Sophonphan J, Avihingsanon A, Suwanpimolkul G, Kawkitinarong K, Manosuthi W, Gatechompol S, Ananworanich J, Ruxrungtham K, Phanuphak P, Kelleher AD. Performance of a simple flow cytometric assay in diagnosing active tuberculosis. Tuberculosis (Edinb) 2020; 126:102017. [PMID: 33254010 DOI: 10.1016/j.tube.2020.102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/23/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
A flow cytometric assay measuring Mycobacterium tuberculosis-specific CD4 T-cell responses using co-expression of CD25/CD134 (OX40 assay) was explored as a diagnostic tool for active tuberculosis (TB) in a Thai population with and without HIV infection. Peripheral blood mononuclear cells (PBMC) obtained from 133 participants at TB diagnosis were cryopreserved. Seventy-six participants had a clinical diagnosis of TB which were confirmed by a positive culture. CD4 T-cell responses were measured after stimulation with a pool of overlapping peptides covering RD-1 antigens: CFP-10 + ESAT-6. The performance of the assay was also compared to the Xpert MTB/RIF assay. The overall sensitivity of the OX40 assay was 94.7% (95%CI 87.1-98.5); its specificity was 71.9% (95%CI, 58.5-83). The sensitivity of the OX40 assay among HIV-infected participants was 100% (95%CI, 88.8-100) with a specificity of 92.9% (95%CI, 66.1-99.8). OX40 assay performed particularly well in those with active TB and HIV infection.
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Affiliation(s)
- Sasiwimol Ubolyam
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
| | - Thatri Iampornsin
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jiratchaya Sophonphan
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Gompol Suwanpimolkul
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamon Kawkitinarong
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sivaporn Gatechompol
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand
| | - Jintanat Ananworanich
- Department of Global Health, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
| | - Kiat Ruxrungtham
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Praphan Phanuphak
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Anthony D Kelleher
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
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Chumpa N, Kawkitinarong K, Rotcheewaphan S, Sawatpanich A, Petsong S, Tumwasorn S, Suwanpimolkul G. Evaluation of Anyplex™ II MTB/MDR kit's performance to rapidly detect isoniazid and rifampicin resistant Mycobacterium tuberculosis from various clinical specimens. Mol Biol Rep 2020; 47:2501-2508. [PMID: 32124172 DOI: 10.1007/s11033-020-05331-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 10/24/2019] [Accepted: 02/15/2020] [Indexed: 12/30/2022]
Abstract
To determine the accuracy of multiplex real-time PCR (Anyplex™ II MTB/MDR kit) in detecting Isoniazid (INH)- and Rifampin (RIF)-resistant Mycobacterium tuberculosis strains from various clinical specimens. The performance of Anyplex™ II MTB/MDR kit in detecting INH- and RIF-resistant M. tuberculosis compared to the conventional drug susceptibility tests by Mycobacterial Growth Indicator Tube (MGIT). A total of 430 clinical samples had positive results for M. tuberculosis from both Anyplex™ II MTB/MDR kit assay and mycobacterial cultures by MGIT method. When compared to MGITs, the sensitivity and specificity of Anyplex™ II MTB/MDR kit in detecting INH-resistant TB were 85.71% and 99.75%, respectively. For the detection of MDR-TB, the sensitivity and specificity of the test were 82.35% and 99.76%, respectively. The positive predictive values and negative predictive values to detect INH-resistant TB were 96.77% and 98.75%, respectively. Anyplex™ II MTB/MDR kit can be used to rapidly detect isoniazid and rifampicin resistances. It has a high sensitivity, specificity and PPV in detecting INH-resistant TB and MDR-TB. This test can be used as an alternative test to Xpert MTB/RIF because it can rapidly detect both INH-resistant TB and RIF-resistant TB.
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Affiliation(s)
- Nuntana Chumpa
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kamon Kawkitinarong
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Chulalongkorn Hospital, Thai Red Cross Society, Bangkok, Thailand
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suwatchareeporn Rotcheewaphan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ajcharaporn Sawatpanich
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Suthidee Petsong
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Somying Tumwasorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Gompol Suwanpimolkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- Department of Medicine, Faculty of Medicine, Thai Red Cross Emerging Infectious Diseases Clinical Center, Chulalongkorn University, Bangkok, Thailand.
- Division of Infectious Diseases, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
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Chaikajornwat J, Rattanajiajaroen P, Srisawat N, Kawkitinarong K. Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation. BMJ Case Rep 2020; 13:13/1/e230075. [PMID: 31915183 PMCID: PMC6954809 DOI: 10.1136/bcr-2019-230075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Leptospirosis, one of the most important of neglected tropical diseases, is a common zoonosis in the tropics. Recent reports have demonstrated that pulmonary haemorrhage is one of the fatal complications of severe leptospirosis. In this report, we present a case of leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). A 39-year-old man who lives in Bangkok presented with fever, severe myalgia and haemoptysis. With rapid progression of acute respiratory failure in 6 hours, he was intubated and a litre of fresh blood was suctioned. Chest x-ray showed diffuse alveolar infiltrates compatible with ARDS, then mechanical ventilator with lung protective strategy was used. Diagnosis of leptospirosis with diffuse alveolar haemorrhage was made. Refractory hypoxaemia was not responsive to positive end-expiratory pressure (PEEP); thus, VV-ECMO was initiated on the first day. Other treatments included plasmapheresis, intravenous pulse methylprednisolone and intravenous antibiotics. The outcome of treatment was successful, and this patient was discharged to home on day 14 after admission.
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Affiliation(s)
- Jukkaphop Chaikajornwat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Pornpan Rattanajiajaroen
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattachai Srisawat
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamon Kawkitinarong
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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12
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Gatechompol S, Kawkitinarong K, Suwanpimolkul G, Kateruttanakul P, Manosuthi W, Sophonphan J, Ubolyam S, Kerr SJ, Avihingsanon A, Ruxrungtham K. Treatment outcomes and factors associated with mortality among individuals with both TB and HIV in the antiretroviral era in Thailand. J Virus Erad 2019; 5:225-230. [PMID: 31754446 PMCID: PMC6844402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to compare treatment outcomes and factors associated with mortality in HIV-1-positive and HIV-1-negative individuals. METHODS We conducted a cohort study between July 2008 and December 2016. Logistic regression was used to determine factors associated with outcomes and death after tuberculosis (TB) treatment. RESULTS A total of 996 individuals with TB, 228 (22.9%) with HIV-1 co-infection and 770 (77.1%) who were HIV-1 negative were reviewed. The overall treatment success rate was 74.3%. The HIV-1-negative individuals with TB had significantly higher treatment success rates (77.2% vs 64.5%, P < 0.001). Using logistic regression analysis, age >50 years (adjusted odds ratio [aOR] 3.89, 95% confidence interval [CI] 2.24-6.76; P < 0.001), body weight ≤45 kg (aOR 2.19, 95% CI 1.14-4.19; P = 0.02) and HIV-1-positive status (aOR 3.31, 95% CI 1.84-5.91; P < 0.001) were independently associated with death during TB treatment. Among HIV-1-positive individuals, not undergoing antiretroviral therapy (ART), having diabetes and a CD4 T cell count of <50 cells/mm3 were significantly associated with death. CONCLUSION Individuals who had both TB and HIV-1 in Thailand had lower TB treatment success and higher mortality rates compared with individuals with TB without HIV-1. Strategies to improve ART uptake and to reduce risk of developing active TB among individuals with advanced HIV-1 infection should be scaled up.
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Affiliation(s)
| | | | | | | | - Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute,
Ministry of Public Health,
Nonthaburi,
Thailand
| | | | | | - Stephen J Kerr
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- Department of Medicine,
Faculty of Medicine,
Chulalongkorn University,
Bangkok,
Thailand
| | - Anchalee Avihingsanon
- Corresponding author: Anchalee Avihingsanon
HIV-NAT,
Thai Red Cross AIDS Research Centre,
104 Ratchadamri Rd., Pathumwan,
Bangkok,
10330,
Thailand
| | - Kiat Ruxrungtham
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- Department of Medicine,
Faculty of Medicine,
Chulalongkorn University,
Bangkok,
Thailand
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13
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Gatechompol S, Kawkitinarong K, Suwanpimolkul G, Kateruttanakul P, Manosuthi W, Sophonphan J, Ubolyam S, Kerr SJ, Avihingsanon A, Ruxrungtham K. Treatment outcomes and factors associated with mortality among individuals with both TB and HIV in the antiretroviral era in Thailand. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30032-7] [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: 10/23/2022] Open
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14
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Luekitinun N, Mahasirimongkol S, Satproedprai N, Miyahara R, Kawkitinarong K. The Pleural and blood gene expression level of GBP5 and STAT1 were associated with pleural tuberculosis: TB pleura diagnostic biomarkers. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa550] [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: 11/05/2022]
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15
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Zürcher K, Ballif M, Fenner L, Borrell S, Keller PM, Gnokoro J, Marcy O, Yotebieng M, Diero L, Carter EJ, Rockwood N, Wilkinson RJ, Cox H, Ezati N, Abimiku AG, Collantes J, Avihingsanon A, Kawkitinarong K, Reinhard M, Hömke R, Huebner R, Gagneux S, Böttger EC, Egger M. Drug susceptibility testing and mortality in patients treated for tuberculosis in high-burden countries: a multicentre cohort study. Lancet Infect Dis 2019; 19:298-307. [PMID: 30744962 DOI: 10.1016/s1473-3099(18)30673-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/07/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Drug resistance is a challenge for the global control of tuberculosis. We examined mortality in patients with tuberculosis from high-burden countries, according to concordance or discordance of results from drug susceptibility testing done locally and in a reference laboratory. METHODS This multicentre cohort study was done in Côte d'Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand. We collected Mycobacterium tuberculosis isolates and clinical data from adult patients aged 16 years or older. Patients were stratified by HIV status and tuberculosis drug resistance. Molecular or phenotypic drug susceptibility testing was done locally and at the Swiss National Center for Mycobacteria, Zurich, Switzerland. We examined mortality during treatment according to drug susceptibility test results and treatment adequacy in multivariable logistic regression models adjusting for sex, age, sputum microscopy, and HIV status. FINDINGS We obtained M tuberculosis isolates from 871 patients diagnosed between 2013 and 2016. After exclusion of 237 patients, 634 patients with tuberculosis were included in this analysis; the median age was 33·2 years (IQR 26·9-42·5), 239 (38%) were women, 272 (43%) were HIV-positive, and 69 (11%) patients died. Based on the reference laboratory drug susceptibility test, 394 (62%) strains were pan-susceptible, 45 (7%) monoresistant, 163 (26%) multidrug-resistant (MDR), and 30 (5%) had pre-extensively or extensively drug resistant (pre-XDR or XDR) tuberculosis. Results of reference and local laboratories were concordant for 513 (81%) of 634 patients and discordant for 121 (19%) of 634. Overall, sensitivity to detect any resistance was 90·8% (95% CI 86·5-94·2) and specificity 84·3% (80·3-87·7). Mortality ranged from 6% (20 of 336) in patients with pan-susceptible tuberculosis treated according to WHO guidelines to 57% (eight of 14) in patients with resistant strains who were under-treated. In logistic regression models, compared with concordant drug susceptibility test results, the adjusted odds ratio of death was 7·33 (95% CI 2·70-19·95) for patients with discordant results potentially leading to under-treatment. INTERPRETATION Inaccurate drug susceptibility testing by comparison with a reference standard leads to under-treatment of drug-resistant tuberculosis and increased mortality. Rapid molecular drug susceptibility test of first-line and second-line drugs at diagnosis is required to improve outcomes in patients with MDR tuberculosis and pre-XDR or XDR tuberculosis. FUNDING National Institutes of Allergy and Infectious Diseases, Swiss National Science Foundation, Swiss National Center for Mycobacteria.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Marie Ballif
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sonia Borrell
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Peter M Keller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Joachim Gnokoro
- Centre de Prise en Charge de Recherche et de Formation, Yopougon, Abidjan, Côte d'Ivoire
| | - Olivier Marcy
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Marcel Yotebieng
- Ohio State University, College of Public Health, Columbus, OH, USA
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, and Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - E Jane Carter
- Department of Medicine, Moi University School of Medicine, and Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Neesha Rockwood
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College London, London, UK
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College London, London, UK; Francis Crick Institute, London, UK
| | - Helen Cox
- Division of Medical Microbiology and the Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicholas Ezati
- Institute of Human Virology, Abuja, Nigeria; National Tuberculosis and Leprosy Training Center, Saye, Zaria, Kaduna State, Nigeria
| | | | - Jimena Collantes
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Kamon Kawkitinarong
- HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Miriam Reinhard
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rico Hömke
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Robin Huebner
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Erik C Böttger
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
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Kawkitinarong K, Suwanpimolkul G, Kateruttanakul P, Manosuthi W, Ubolyam S, Sophonphan J, Avihingsanon A, Ruxrungtham K. Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand. Clin Infect Dis 2018; 64:S171-S178. [PMID: 28475796 DOI: 10.1093/cid/cix151] [Citation(s) in RCA: 10] [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] [Indexed: 11/13/2022] Open
Abstract
Background Delayed diagnosis of tuberculosis (TB) and drug-resistant TB are major challenges of TB control in Thailand. This study assessed the practicality of the Xpert MTB/RIF assay in a real-life setting with high prevalence of human immunodeficiency virus (HIV) infection and pulmonary tuberculosis (PTB). Methods This prospective study was conducted at 3 large tertiary care hospitals. Patients who had suspected PTB were enrolled into the study. Expectorated sputum samples were sent for staining, mycobacterial culture, and Xpert MTB/RIF. Results Four hundred ninety-four patients were enrolled. From 355 cases with final diagnosis of PTB, 263 (71.8%) had definite diagnosis and 92 cases had probable diagnosis. Among TB culture-positive cases, Xpert MTB/RIF had 100% and 81% sensitivity in sputum smear-positive and smear-negative groups, respectively. The specificity was 95.7%. The sensitivity and positive predictive value of Xpert MTB/RIF in culture-negative but clinically diagnosed PTB was 37.8% and 83.8%, respectively. Centrifugation was required in 59% cases with scanty sputum. Five cases were false-positive by Xpert MTB/RIF in patients with nontuberculous mycobacteria, old PTB scar, and immune reconstitution syndrome. Discordant rifampicin susceptibility results of Xpert MTB/RIF and mycobacteria growth indicator tube (MGIT) were confirmed by using rpoB gene sequencing, which raised the sensitivity of Xpert MTB/RIF in detecting rifampicin resistance to 93.8%. Conclusions Xpert MTB/RIF is an effective tool in diagnosing PTB but will be more cost-effective for sputum-negative patients and in settings with high prevalence of rifampicin resistance. Early diagnosis of TB results in early treatment and implementation of strategies to limit spreading of TB. Sputum centrifugation may increase the yield of Xpert MTB/RIF.
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Affiliation(s)
- Kamon Kawkitinarong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and
| | - Gompol Suwanpimolkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and
| | | | - Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi; and
| | - Sasiwimol Ubolyam
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jiratchaya Sophonphan
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Anchalee Avihingsanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and.,HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Kiat Ruxrungtham
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and.,HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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17
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Suwanpimolkul G, Kawkitinarong K, Manosuthi W, Sophonphan J, Gatechompol S, Ohata PJ, Ubolyam S, Iampornsin T, Katerattanakul P, Avihingsanon A, Ruxrungtham K. Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network. Int J Infect Dis 2017; 59:96-102. [PMID: 28457751 DOI: 10.1016/j.ijid.2017.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Received: 02/11/2017] [Revised: 04/06/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the applicability and accuracy of the urine lipoarabinomannan (LAM) test in tuberculosis (TB)/HIV co-infected patients and HIV-negative patients with disseminated TB. METHODS Frozen urine samples obtained at baseline from patients in the TB research cohort with proven culture-positive TB were selected for blinded urine LAM testing. One hundred and nine patients were categorized into four groups: (1) HIV-positive patients with TB; (2) HIV-negative patients with disseminated TB; (3) HIV-negative immunocompromised patients with TB; and (4) patients with diseases other than TB. The sensitivity of urine LAM testing for culture-positive TB, specificity of urine LAM testing for patients without TB, positive predictive value (PPV), and negative predictive value (NPV) were assessed. RESULTS The sensitivity of the urine LAM test in group 1 patients with a CD4 T-cell count of >100, ≤100, and ≤50 cells/mm3 was 38.5%, 40.6%, and 45%, respectively. The specificity and PPV of the urine LAM test were >80%. The sensitivity of the test was 20% in group 2 and 12.5% in group 3, and the specificity and PPV were 100% for both groups. A positive urine LAM test result was significantly associated with death. CONCLUSIONS This promising diagnostic tool could increase the yield of TB diagnosis and may predict the mortality rate of TB infection, particularly in TB/HIV co-infected patients.
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Affiliation(s)
- Gompol Suwanpimolkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand.
| | - Kamon Kawkitinarong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand
| | - Weerawat Manosuthi
- Department of Medicine, Bamrasnaradura Infectious Diseases Institute (BIDI), 26, Mueang Nonthaburi District, Nonthaburi 11000, Thailand
| | - Jiratchaya Sophonphan
- HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Sivaporn Gatechompol
- HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Pirapon June Ohata
- HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Sasiwimol Ubolyam
- HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Thatri Iampornsin
- HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Pairaj Katerattanakul
- Rajavithi Hospital, 2, Phayathai Road, Ratchathewi District, Bangkok 10400, Thailand
| | - Anchalee Avihingsanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand; HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Kiat Ruxrungtham
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand; HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
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18
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Manosuthi W, Kawkitinarong K, Suwanpimolkul G, Chokbumrungsuk C, Jirawattanapisal T, Ruxrungtham K, Akksilp S. Clinical characteristics and treatment outcomes among patients with tuberculosis in Bangkok and Nonthaburi, Thailand. Southeast Asian J Trop Med Public Health 2012; 43:1426-1436. [PMID: 23413706] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Tuberculosis (TB) is a public health problem in many large cities. We retrospectively studied the clinical characteristics and treatment outcomes of patients with active TB at 6 hospitals in Bangkok and Nonthaburi, Thailand during 2008-2009. Eight hundred thirteen patients were included in the study. The mean age of subjects +/- SD was 41 +/- 14 years and mean body weight +/- SD was 53 +/- 11 kilograms. The three leading co-morbid conditions were HIV infection (40%), diabetes (6%) and chronic liver disease (2%). Two-thirds of subjects had isolated pulmonary TB. Isoniazid, rifampicin and multi-drug resistance were seen in 13, 7 and 5%, respectively. After 1 year, 52% were cured or completed treatment, 19% transferred out, 12% defaulted, 9% were still on-going TB treatment, 7% had died and 1% had failed treatment. Survival rates at 2, 6 and 12 months were 93, 85 and 81% among HIV seropositive subjects; 96, 94 and 92% among HIV seronegative subjects and 98, 97 and 97% among subjects with unknown HIV status (p < 0.001). On multivariate analysis, death was associated with: TB/HIV co-infection (HR 2.8; 95% CI 1.6-5.0), low body weight (HR 1.6; 95% CI 1.2-2.3), being elderly (HR 1.4; 95% CI 1.1-1.8) and having extrapulmonary/disseminated TB (HR 2.2; 95% CI 1.1-4.2). HIV infection and diabetes were the most common co-morbidities among TB subjects in our study. The percent of patients with unfavorable outcomes was relatively high, particularly among HIV co-infected and elderly subjects. Further effort needs to be made to improve these unfavorable TB outcomes in Nonthaburi and Bangkok, Thailand.
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Affiliation(s)
- Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand.
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19
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Tia T, Putaporntip C, Kosuwin R, Kongpolprom N, Kawkitinarong K, Jongwutiwes S. A highly sensitive novel PCR assay for detection of Pneumocystis jirovecii DNA in bronchoalveloar lavage specimens from immunocompromised patients. Clin Microbiol Infect 2012; 18:598-603. [DOI: 10.1111/j.1469-0691.2011.03656.x] [Citation(s) in RCA: 25] [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: 01/04/2023]
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20
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Kawkitinarong K, Dumrongpiwat S, Sittipunt C. Clinical Score for the Diagnosis of Tuberculous Pleural Effusion. Chest 2011. [DOI: 10.1378/chest.1117762] [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: 11/01/2022] Open
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21
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Jaimchariyatam N, Wongtim S, Udompanich V, Sittipunt C, Kawkitinarong K, Chaiyakul S, Gonlachanvit S. Prevalence of gastroesophageal reflux in Thai asthmatic patients. J Med Assoc Thai 2011; 94:671-678. [PMID: 21696074] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Asthma is a chronic inflammatory disorder of airways and associated with airway hyperresponsiveness and reversible bronchoconstriction. Gastroesophageal reflux disease (GERD) is a disorder caused by the reflux of gastric content up into the esophagus. It has been proposed that GERD is one of the exacerbating factors in the patients with poor controlled asthma. OBJECTIVE Determine the prevalence of GERD in asthmatic patients and the association between GERD and the level of asthma control in Thailand. MATERIAL AND METHOD A cross-sectional descriptive study was conducted in 56 asthmatic patients at the King Chulalongkorn Memorial Hospital. They were performed twenty-four-hour esophageal pH monitoring. RESULTS The prevalence of GERD in Thai asthmatic patients was 37.50%. Fifteen of 21 patients (71.43%) with GERD experienced reflux symptoms. The sensitivity specificity, positive predictive value and negative predictive value of reflux symptoms for diagnosis GERD were 71.43%, 77.14%, 65.22% and 81.82%, respectively. The prevalence of GERD was higher in uncontrolled asthmatic patients than partly controlled and controlled subjects. Among uncontrolled asthma, the prevalence of GERD was higher than those without GERD (57.17% and 25.72%, respectively, p = 0.028). Asthma Control Test (ACT) score of less than twenty (poor controlled asthma) was higher in the asthmatic patients with GERD than those without GERD (80.95% and 48.57%, respectively, p = 0.024). CONCLUSION The authors concluded that the prevalence of GERD in Thai asthmatic patients was 37.50%. There was significant association between GERD and the level of asthma control.
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Affiliation(s)
- Nattapong Jaimchariyatam
- Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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22
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Thitithanyanont A, Engering A, Uiprasertkul M, Ekchariyawat P, Wiboon-ut S, Kraivong R, Limsalakpetch A, Kum-Arb U, Yongvanitchit K, Sa-Ard-Iam N, Rukyen P, Mahanonda R, Kawkitinarong K, Auewarakul P, Utaisincharoen P, Sirisinha S, Mason CJ, Fukuda MM, Pichyangkul S. Antiviral immune responses in H5N1-infected human lung tissue and possible mechanisms underlying the hyperproduction of interferon-inducible protein IP-10. Biochem Biophys Res Commun 2010; 398:752-8. [PMID: 20627090 PMCID: PMC2940995 DOI: 10.1016/j.bbrc.2010.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 11/30/2022]
Abstract
Information on the immune response against H5N1 within the lung is lacking. Here we describe the sustained antiviral immune responses, as indicated by the expression of MxA protein and IFN-alpha mRNA, in autopsy lung tissue from an H5N1-infected patient. H5N1 infection of primary bronchial/tracheal epithelial cells and lung microvascular endothelial cells induced IP-10, and also up-regulated the retinoic acid-inducible gene-I (RIG-I). Down-regulation of RIG-I gene expression decreased IP-10 response. Co-culturing of H5N1-infected pulmonary cells with TNF-alpha led to synergistically enhanced production of IP-10. In the absence of viral infection, TNF-alpha and IFN-alpha also synergistically enhanced IP-10 response. Methylprednisolone showed only a partial inhibitory effect on this chemokine response. Our findings strongly suggest that both the H5N1 virus and the locally produced antiviral cytokines; IFN-alpha and TNF-alpha may have an important role in inducing IP-10 hyperresponse, leading to inflammatory damage in infected lung.
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Affiliation(s)
| | - Anneke Engering
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Monkol Uiprasertkul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Amporn Limsalakpetch
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Utaiwan Kum-Arb
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Kosol Yongvanitchit
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | | | - Pimprapa Rukyen
- Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Prasert Auewarakul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Carl J Mason
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Mark M Fukuda
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Sathit Pichyangkul
- U.S. Army Medical Component of the Armed Forces Research Institute of Medical Science, Bangkok, Thailand
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Birukova AA, Chatchavalvanich S, Rios A, Kawkitinarong K, Garcia JGN, Birukov KG. Differential regulation of pulmonary endothelial monolayer integrity by varying degrees of cyclic stretch. Am J Pathol 2006; 168:1749-61. [PMID: 16651639 PMCID: PMC1606576 DOI: 10.2353/ajpath.2006.050431] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ventilator-induced lung injury is a life-threatening complication of mechanical ventilation at high-tidal volumes. Besides activation of proinflammatory cytokine production, excessive lung distension directly affects blood-gas barrier and lung vascular permeability. To investigate whether restoration of pulmonary endothelial cell (EC) monolayer integrity after agonist challenge is dependent on the magnitude of applied cyclic stretch (CS) and how these effects are linked to differential activation of small GTPases Rac and Rho, pulmonary ECs were subjected to physiologically (5% elongation) or pathologically (18% elongation) relevant levels of CS. Pathological CS enhanced thrombin-induced gap formation and delayed monolayer recovery, whereas physiological CS induced nearly complete EC recovery accompanied by peripheral redistribution of focal adhesions and cortactin after 50 minutes of thrombin. Consistent with differential effects on monolayer integrity, 18% CS enhanced thrombin-induced Rho activation, whereas 5% CS promoted Rac activation during the EC recovery phase. Rac inhibition dramatically attenuated restoration of monolayer integrity after thrombin challenge. Physiological CS preconditioning (5% CS, 24 hours) enhanced EC paracellular gap resolution after step-wise increase to 18% CS (30 minutes) and thrombin challenge. These results suggest a critical role for the CS amplitude and the balance between Rac and Rho in mechanochemical regulation of lung EC barrier.
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Affiliation(s)
- Anna A Birukova
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois 60637, USA
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Nonas S, Miller I, Kawkitinarong K, Chatchavalvanich S, Gorshkova I, Bochkov VN, Leitinger N, Natarajan V, Garcia JGN, Birukov KG. Oxidized phospholipids reduce vascular leak and inflammation in rat model of acute lung injury. Am J Respir Crit Care Med 2006; 173:1130-8. [PMID: 16514111 PMCID: PMC2662943 DOI: 10.1164/rccm.200511-1737oc] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Acute inflammation and vascular leak are cardinal features of acute lung injury and the acute respiratory distress syndrome. Nonspecific tissue inflammation and injury in response to infectious and noninfectious insults lead to oxidative stress and the generation of lipid oxidation products, which may inhibit the acute inflammatory response to bacterial components. OBJECTIVE To test the hypothesis that oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine (OxPAPC) may attenuate the acute lung inflammatory response to lipopolysaccharide (LPS) and enhance lung vascular barrier recovery, we used in vivo and in vitro models of LPS-induced lung injury. METHODS Rats received intratracheal aerosolized LPS (5 mg/kg) or sterile water with concurrent intravenous injection of OxPAPC (0.5-6.0 mg/kg) or saline alone. Nonoxidized PAPC was used as a control. At 18 h, bronchoalveolar lavage was performed and the lungs were removed for histologic analysis. Measurements of endothelial transmonolayer electrical resistance and immunofluorescent analysis of monolayer integrity were used in an in vitro model of LPS-induced lung vascular barrier dysfunction. MEASUREMENTS AND MAIN RESULTS In vivo, aerosolized intratracheal LPS induced lung injury with profound increases in bronchoalveolar lavage neutrophils, protein content, and the inflammatory cytokines interleukin 6 and interleukin 1beta, as well as tissue neutrophils. OxPAPC, but not nonoxidized PAPC, markedly attenuated the LPS-induced tissue inflammation, barrier disruption, and cytokine production over a range of doses. In vitro, oxidized phospholipids attenuated LPS-induced endothelial barrier disruption and reversed LPS-induced cytoskeletal remodeling and disruption of monolayer integrity. CONCLUSIONS These studies demonstrate in vivo and in vitro protective effects of oxidized phospholipids on LPS-induced lung dysfunction.
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Affiliation(s)
- Stephanie Nonas
- Division of Pulmonary and Critical Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Chatchavalvanich S, Nonas S, Miller I, Kawkitinarong K, Gorshkova I, Bochkov V, Leitinger N, Natarajan V, Garcia J, Birukov K. Oxidized Phospholipids Reduce Vascular Leak and Inflammation in a Rat Model of Acute Lung Injury. J Investig Med 2006. [DOI: 10.1177/108155890605402s18] [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: 01/09/2023]
Affiliation(s)
| | - S. Nonas
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - I. Miller
- Johns Hopkins University School of Medicine, Baltimore, MD
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Chatchavalvanich S, Nonas S, Miller I, Kawkitinarong K, Gorshkova I, Bochkov VN, Leitinger N, Natarajan V, Garcia JG, Birukov KG. 18 OXIDIZED PHOSPHOLIPIDS REDUCE VASCULAR LEAK AND INFLAMMATION IN A RAT MODEL OF ACUTE LUNG INJURY. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0015.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kawkitinarong K, Sittipunt C, Wongtim S, Udompanich V. Pulmonary alveolar proteinosis: a report of seven patients from King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2005; 88 Suppl 4:S312-6. [PMID: 16623047] [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] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
From 1983 to 2001, 7 patients with pulmonary alveolar proteinosis were admitted to the King Chulalongkorn Memorial Hospital. Presenting symptoms varied from asymptomatic (1 patient), progressive dyspnea on exertion (4 patients) to respiratory failure (2 patients). Other symptoms included dry cough and weight loss. Gradual onset of dyspnea could be observed by average time to hospital (7 months). Early worsening of dyspnea and high-grade fever suggested a possibility of superimposed infection. Chest radiographs revealed symmetrical infiltration without lobar predominance. 4 of 7 patients were misdiagnosed as pulmonary tuberculosis before diagnosis of PAP was made. Diagnosis was made by bronchoscopic examination with typical lavage fluid or pathological results; only one case need open lung biopsy. 6 of 7 patients required lung lavage to relieve dyspneic symptoms. Coinfection with Nocardia and Mycobacterium tuberculosis was found in one patient. Prognosis was good but recurrence was common.
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Affiliation(s)
- Kamon Kawkitinarong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Shikata Y, Rios A, Kawkitinarong K, DePaola N, Garcia JGN, Birukov KG. Differential effects of shear stress and cyclic stretch on focal adhesion remodeling, site-specific FAK phosphorylation, and small GTPases in human lung endothelial cells. Exp Cell Res 2004; 304:40-9. [PMID: 15707572 DOI: 10.1016/j.yexcr.2004.11.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 11/01/2004] [Accepted: 11/01/2004] [Indexed: 11/22/2022]
Abstract
Regulation of endothelial cell (EC) permeability by bioactive molecules is associated with specific patterns of cytoskeletal and cell contact remodeling. A role for mechanical factors such as shear stress (SS) and cyclic stretch (CS) in cytoskeletal rearrangements and regulation of EC permeability becomes increasingly recognized. This paper examined redistribution of focal adhesion (FA) proteins, site-specific focal adhesion kinase (FAK) phosphorylation, small GTPase activation and barrier regulation in human pulmonary EC exposed to laminar shear stress (15 dyn/cm2) or cyclic stretch (18% elongation) in vitro. SS caused peripheral accumulation of FAs, whereas CS induced randomly distributed FAs attached to the ends of newly formed stress fibers. SS activated small GTPase Rac without effects on Rho, whereas 18% CS activated without effect on Rac. SS increased transendothelial electrical resistance (TER) in EC monolayers, which was further elevated by barrier-protective phospholipid sphingosine 1-phosphate. Finally, SS induced FAK phosphorylation at Y576, whereas CS induced FAK phosphorylation at Y397 and Y576. These results demonstrate for the first time differential effects of SS and CS on Rho and Rac activation, FA redistribution, site-specific FAK phosphorylation, and link them with SS-mediated barrier enhancement. Thus, our results suggest common signaling and cytoskeletal mechanisms shared by mechanical and chemical factors involved in EC barrier regulation.
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Affiliation(s)
- Yasushi Shikata
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Room 677, Baltimore, MD 21224, USA
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Kawkitinarong K, Linz-McGillem L, Birukov KG, Garcia JGN. Differential Regulation of Human Lung Epithelial and Endothelial Barrier Function by Thrombin. Am J Respir Cell Mol Biol 2004; 31:517-27. [PMID: 15284075 DOI: 10.1165/rcmb.2003-0432oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Lung epithelial and endothelial barrier dysfunction is critical to the physiologic derangement observed in acute lung injury, but remains poorly understood. We utilized human alveolar epithelial (A549) and endothelial cells (EC) to study cytoskeletal remodeling, myosin light chain (MLC) phosphorylation and barrier regulation evoked by the edemagenic agent, thrombin. Thrombin-challenged human EC monolayers demonstrated increased MLC phosphorylation, actin stress fiber formation and loss of barrier integrity reflected by decreased transmonolayer electrical resistance (TER). In contrast, thrombin produced prominent circumferential localization of actin fibers, increased MLC phosphorylation and increased TER across epithelial monolayers, consistent with barrier protection. Reductions in MLC phosphorylation induced by cell pretreatment with pharmacological inhibitors of MLC kinase (ML-7) and Rho kinase (Y-27632) significantly attenuated thrombin-mediated TER changes and MLC phosphorylation in both lung cell types. Thrombin-produced, time-dependent activation of Rho GTPase in both epithelial and EC, whereas Rac GTPase activation was observed only in A549 cells. Molecular inhibition of Rac activity by adenoviral transfer of dominant-negative Rac mutant abolished thrombin-induced TER increases in alveolar epithelial cells. Finally, A549 cells, but not endothelium, demonstrated increased levels of tight junction proteins (ZO-1 and occludin) after thrombin at the cell-cell interface areas linked to thrombin-elicited barrier protection. These results demonstrate differential pulmonary endothelial and alveolar epithelial barrier regulation via unique actomyosin remodeling and cytoskeletal interactions with tight junction complexes, which confer selective barrier responses to edemagenic stimuli.
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Affiliation(s)
- Kamon Kawkitinarong
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Birukov KG, Bochkov VN, Birukova AA, Kawkitinarong K, Rios A, Leitner A, Verin AD, Bokoch GM, Leitinger N, Garcia JGN. Epoxycyclopentenone-Containing Oxidized Phospholipids Restore Endothelial Barrier Function via Cdc42 and Rac. Circ Res 2004; 95:892-901. [PMID: 15472119 DOI: 10.1161/01.res.0000147310.18962.06] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After an acute phase of inflammation or injury, restoration of the endothelial barrier is important to regain vascular integrity and to prevent edema formation. However, little is known about mediators that control restoration of endothelial barrier function. We show here that oxidized phospholipids that accumulate at sites of inflammation and tissue damage are potent regulators of endothelial barrier function. Oxygenated epoxyisoprostane-containing phospholipids, but not fragmented oxidized phospholipids, exhibited barrier-protective effects mediated by small GTPases Cdc42 and Rac and their cytoskeletal, focal adhesion, and adherens junction effector proteins. Oxidized phospholipid-induced cytoskeletal rearrangements resulted in a unique peripheral actin rim formation, which was mimicked by coexpression of constitutively active Cdc42 and Rac, and abolished by coexpression of dominant-negative Rac and Cdc42. Thus, oxidative modification of phospholipids during inflammation leads to the formation of novel regulators that may be critically involved in restoration of vascular barrier function.
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Affiliation(s)
- Konstantin G Birukov
- Division of Pulmonary and Critical Care Medicine, Center for Translational Respiratory Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
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