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Weber SF, Ruby LC, Heller T, Hande M, Shastry BA, Acharya RV, Bhat R, Shankar S, Prabhu M, Mohapatra AK, Magazine R, Kadavigere R, Denkinger CM, Gehring S, Bélard S, Saravu K. TB disease patterns by HIV and diabetes status. Int J Tuberc Lung Dis 2022; 26:733-740. [PMID: 35898145 DOI: 10.5588/ijtld.21.0693] [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: 11/10/2022] Open
Abstract
BACKGROUND: TB is commonly categorised as pulmonary (PTB) or extrapulmonary TB (EPTB). Knowledge of TB disease patterns (PTB and/or EPTB) and determining risk factors remains limited.METHODS: This was a prospective cohort study using point-of-care ultrasound (POCUS) in Indian patients with presumed TB. Clinical and imaging data were used to develop refined case definitions for PTB, concurrent PTB and EPTB (PTB + EPTB) and EPTB without PTB (EPTB). These groups were analysed by HIV (HIV+/-) and diabetes mellitus (DM+/-) status.RESULTS: Of 172 HIV-/DM- patients with TB, 48% had PTB, 23% PTB + EPTB and 29% had EPTB, totalling 52% with any EPTB (PTB + EPTB or EPTB). In HIV+/DM- patients with TB (n = 35), 6% had PTB, 40% had PTB + EPTB and 54% had EPTB, accounting for 94% with EPTB. In HIV-/DM+ patients with TB (n = 61), 61% had PTB, 28% had PTB + EPTB and 11% had EPTB, representing 39% with EPTB.CONCLUSION: Refined case definitions revealed high proportions of EPTB even without HIV or DM. HIV further altered the TB disease pattern towards EPTB and DM towards PTB. Therefore, the dichotomy between PTB or EPTB does not represent the actual spectrum of TB disease. EPTB should receive higher priority in research and clinical practice.
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Affiliation(s)
- S F Weber
- University Hospital Heidelberg, Division for Infectious Diseases and Tropical Medicine, Heidelberg, Germany
| | - L C Ruby
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T Heller
- Lighthouse Clinic Lilongwe, Kamuzu Central Hospital, Mzimba, Lilongwe, Malawi
| | - M Hande
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - B A Shastry
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R V Acharya
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R Bhat
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - S Shankar
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - M Prabhu
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - A K Mohapatra
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R Magazine
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - R Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - C M Denkinger
- University Hospital Heidelberg, Division for Infectious Diseases and Tropical Medicine, Heidelberg, Germany, German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany
| | - S Gehring
- University Clinics Mainz, Department of Paediatrics, Mainz, Germany
| | - S Bélard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany, German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - K Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Remppis J, Verheyden A, Bustinduy AL, Heller T, García-Tardón N, Manouana GP, Obiang R, Adegnika AA, Grobusch MP, Ramharter M, Joekes E, Bélard S. Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS)-pilot evaluation of a simple point-of-care ultrasound protocol and short training program for detecting urinary tract morbidity in highly endemic settings. Trans R Soc Trop Med Hyg 2021; 114:38-48. [PMID: 31735956 DOI: 10.1093/trstmh/trz101] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urogenital schistosomiasis (UGS) causes inflammation and fibrosis of the urinary tract. In resource-limited settings, affordable tools for morbidity assessment in clinical care are needed. Point-of-care ultrasound has not yet been validated for UGS-related pathology. METHODS We developed a protocol for Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS), assessing pathology of the bladder wall, ureters and kidneys. Following standardized training, two clinicians performed FASUS on children and adults with hematuria in Lambaréné, Gabon. Recorded ultrasound clips were remotely reviewed by two ultrasound experts as a diagnostic reference. RESULTS In 2015 and 2016, scans were performed in 118 patients. The image quality was sufficient in 90% of bladder views and more than 97% of kidney views. UGS-compatible pathology was detected in 51/118 (43%) by the operator and in 46/107 (43%) by the experts among baseline scans of sufficient quality. Inter-rater agreement between operators and experts was very good (κ > 0.8) for hydronephrosis and good (κ > 0.6) for bladder wall thickening. CONCLUSIONS FASUS is a promising clinical, point-of-care tool for detecting UGS-related urinary tract morbidity in symptomatic patients. Based on larger validation studies, appropriate diagnostic and therapeutic algorithms for the use of FASUS should be established.
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Affiliation(s)
- J Remppis
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Department of Haematology and Oncology, Children's University Hospital, Hoppe-Seyler-Straße 1, 72076 Tübingen, Germany.,Institute of Tropical Medicine, University of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - A Verheyden
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon
| | - A L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - T Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33 Mzimba Street. P.O. Box 106, Lilongwe, Malawi
| | - N García-Tardón
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Clinical Chemistry Laboratory, Isala, Dr. van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - G P Manouana
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - R Obiang
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon
| | - A A Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.,German Center for Infection Research, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - M P Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.,Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - M Ramharter
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine University Medical Center Hamburg-Eppendorf, Bernhard-Nocht-Straße 74, 20359 Hamburg, Germany
| | - E Joekes
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK.,Department of Radiology, Royal Liverpool University Hospital NHS Trust, Prescot St, Liverpool L7 8XP, UK
| | - S Bélard
- Centre de Recherches Médicales de Lambaréné (CERMEL), B.P: 242 Lambaréné, Gabon.,Department of Paediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 10117 Berlin, Germany.,Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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Weber SF, Bélard S, Rai S, Reddy R, Belurkar S, Saravu K. Immune thrombocytopenia secondary to tuberculosis: a case and review of literature. Int J Tuberc Lung Dis 2018; 21:466-470. [PMID: 28284263 DOI: 10.5588/ijtld.16.0515] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an auto-immune condition that results in isolated thrombocytopenia associated with possibly lethal haemorrhage. In its secondary form, ITP can be triggered by many infectious and non-infectious conditions. Secondary ITP associated with tuberculosis (TB) has rarely been described in the literature. We report on a 22-year-old patient presenting with hypermenorrhoea and petechiae due to ITP secondary to tuberculous lymphadenitis. Normalisation of thrombocytopenia was only achieved after initiation of anti-tuberculosis treatment following failure of thrombocyte substitution and immune-modulatory treatment. A search of the literature available on TB-associated ITP identified 50 cases published between 1964 and 2016. We reviewed all cases using suggested case definitions on the likelihood of association between ITP and TB. A broad spectrum of TB sites was reported to be associated with ITP, and anti-tuberculosis treatment was the most effective therapy for platelet count normalisation. Time from initiation of anti-tuberculosis treatment to platelet count recovery ranged from 2 days to 3 months. In endemic regions, TB should be considered as an underlying cause of ITP. Early diagnosis of TB and initiation of anti-tuberculosis treatment appears crucial for rapid platelet count recovery, and can reduce the risks associated with long-term immunosuppression, transfusions and the time at risk for haemorrhage.
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Affiliation(s)
- S F Weber
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | - S Bélard
- Department of Paediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Berlin Institute of Health, Berlin, Germany
| | - S Rai
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | - R Reddy
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | - S Belurkar
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal
| | - K Saravu
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India, Manipal McGill Center for Infectious Diseases, Manipal, India
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Grobusch MP, Schaumburg F, Altpeter E, Bélard S. [Drug-resistant tuberculosis. Epidemiology, diagnostics and therapy]. Internist (Berl) 2016; 57:126-35. [PMID: 26795948 DOI: 10.1007/s00108-015-0010-x] [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] [Indexed: 11/30/2022]
Abstract
Drug-resistant tuberculosis (DR-TB) is one of the serious problems in the fight against tuberculosis on a global scale. This review article describes in brief the global epidemiology, diagnostics and treatment of DR-TB. The situation in Germany, Switzerland and Austria is addressed in detail. The article concludes with a presentation of current research topics in the field of resistant TB.
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Affiliation(s)
- M P Grobusch
- Zentrum für Tropen- und Reisemedizin, Abteilung Infektiologie, Akademisch-Medizinisches Zentrum, Universität von Amsterdam, 22660, 1100 DD, Amsterdam, Niederlande. .,Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
| | - F Schaumburg
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - E Altpeter
- Abteilung Übertragbare Krankheiten, Bundesamt für Gesundheit, Bern, Schweiz
| | - S Bélard
- Zentrum für Tropen- und Reisemedizin, Abteilung Infektiologie, Akademisch-Medizinisches Zentrum, Universität von Amsterdam, 22660, 1100 DD, Amsterdam, Niederlande.,Pädiatrische Pneumologie und Immunologie, Charité - Universitätsmedizin, Berlin, Deutschland
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Hunter L, Bélard S, Janssen S, van Hoving DJ, Heller T. Miliary tuberculosis: sonographic pattern in chest ultrasound. Infection 2015; 44:243-6. [PMID: 26661658 DOI: 10.1007/s15010-015-0865-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/03/2015] [Accepted: 11/28/2015] [Indexed: 12/16/2022]
Abstract
Miliary tuberculosis (TB) is characterized by a multitude of small nodular opacities on chest radiography. Despite ultrasound of the chest gaining wider acceptance as a diagnostic tool of lung infections, sonographic changes of pulmonary miliary TB have not yet been reported. Here, we describe B-lines and comet-tail artifacts disseminated throughout multiple lung areas and a pattern of sub-pleural granularity as consistent changes seen in lung ultrasound of ten patients with pulmonary miliary TB diagnosed by chest radiography.
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Affiliation(s)
- L Hunter
- Khayelitsha District Hospital, Cape Town, South Africa
| | - S Bélard
- Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - S Janssen
- Clinical Infectious Disease Research Initiative (CIDRI), Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
| | - D J van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - T Heller
- Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany
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Cremers AL, Janssen S, Huson MAM, Bikene G, Bélard S, Gerrets RPM, Grobusch MP. Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon. Public Health Action 2015; 3:328-32. [PMID: 26393056 DOI: 10.5588/pha.13.0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 05/27/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Lambaréné, Gabon. OBJECTIVES To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. DESIGN Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic. RESULTS Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts. CONCLUSION There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities.
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Affiliation(s)
- A L Cremers
- Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon ; Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - S Janssen
- Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - M A M Huson
- Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - G Bikene
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - S Bélard
- Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - R P M Gerrets
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Grobusch
- Center of Tropical and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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Cremers A, Janssen S, Huson M, Bikene G, Bélard S, Gerrets R, Grobusch M. Perceptions, health care seeking behaviour and the implementation of a tuberculosis control program in Lambaréné, Gabon. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.893] [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: 10/25/2022] Open
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Flamen A, Bélard S, Kokou C, Janssen S, Grobusch MP. Childhood tuberculosis in Lambaréné, Gabon: tuberculosis control in its infancy? Infection 2013; 42:161-4. [PMID: 24037689 DOI: 10.1007/s15010-013-0529-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/24/2013] [Indexed: 11/26/2022]
Abstract
Central Africa is a region highly affected by the tuberculosis (TB) pandemic; however, data on local epidemiology are scarce. In the quest for gearing up towards tailored interventions, assessment of local baseline situations is mandatory. We conducted a retrospective study of 62 children registered in the TB register of a hospital in Lambaréné, Gabon. The evaluation revealed a discrepancy between the TB burden and the commitment to control TB. Extrapolation of the incidence suggests an unexpectedly high childhood TB burden, assuming that the official overall TB incidence is an underestimate of the true TB burden in Gabon.
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Affiliation(s)
- A Flamen
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, BP 13901, Libreville, Gabon
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Berner R, Müller C, Bélard S. Epidemiologie und Therapie invasiver Meningokokken-Infektionen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261341] [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] [Indexed: 10/19/2022]
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