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Navarro CE, Betancur JE. Cost-Effectiveness Analysis Comparing QuantiFERON-TB Gold Plus Test and Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Immunocompetent Subjects in Colombia. Value Health Reg Issues 2024; 41:54-62. [PMID: 38241885 DOI: 10.1016/j.vhri.2023.11.010] [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: 07/16/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To determine the cost-effectiveness of the QuantiFERON-TB Gold Plus (QFT-Plus) test versus the tuberculin skin test in diagnosing latent tuberculosis infection in immunocompetent subjects in the context of the Colombian healthcare system. METHODS A hypothetical cohort of 2000 immunocompetent adults vaccinated with Bacillus Calmette-Guérin at birth who are asymptomatic for tuberculosis disease was simulated and included in a decision tree over a horizon of <1 year. The direct healthcare costs related to tests, antituberculosis treatment, and medical care were considered, and diagnostic performance was used as a measure of effectiveness. The incremental cost-effectiveness ratio (ICER) was estimated, and univariate deterministic and probabilistic sensitivity analyses were carried out using 5000 simulations. The currency was the US dollar for the year 2022, with a cost-effectiveness threshold of $6666 USD (1 gross domestic product per capita for 2022). RESULTS QFT-Plus was cost-effective with an ICER of $5687 USD for each correctly diagnosed case relative to a threshold of $6666 USD. In the deterministic analysis, QFT-Plus was cost-effective in half of the proposed scenarios. The variable that most affected the ICER was the prevalence of latent tuberculosis and test sensitivities. In the probabilistic analysis, QFT-Plus was cost-effective in 54.74% of the simulated scenarios, and tuberculin skin test was dominant in 13.84%. CONCLUSIONS The study provides evidence of the cost-effectiveness of QFT-Plus compared with the tuberculin skin test in diagnosing latent tuberculosis infection in immunocompetent adults in the Colombian context.
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Affiliation(s)
- Cristian E Navarro
- School of Economic Sciences and School of Medicine, Universidad de Antioquia, Colombia, Medellín; Grupo de Investigación E.S.E Hospital Emiro Quintero Cañizares, Colombia, Ocaña.
| | - John E Betancur
- School of Economic Sciences and School of Medicine, Universidad de Antioquia, Colombia, Medellín
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2
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Meregildo-Rodriguez ED, Yuptón-Chávez V, Asmat-Rubio MG, Vásquez-Tirado GA. Latent tuberculosis infection (LTBI) in health-care workers: a cross-sectional study at a northern Peruvian hospital. Front Med (Lausanne) 2023; 10:1295299. [PMID: 38098842 PMCID: PMC10720426 DOI: 10.3389/fmed.2023.1295299] [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: 09/16/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background Healthcare workers (HCWs) have a higher risk of latent tuberculosis infection (LTBI) and active tuberculosis than the general population. In HCWs, the risk of tuberculosis infection depends on the local tuberculosis prevalence, HCWs' characteristics, the healthcare facility, and prevention and control measures. We aimed to estimate the prevalence and risk factors for LTBI in HCWs at a northern Peruvian hospital. Methods This study had two phases: (1) a cross-sectional phase involving recruitment, history taking, and sampling for the Interferon-Gamma Release Assays (IGRA test), and (2) a prospective follow-up of IGRA-positive participants. We enrolled direct and non-direct patient caregivers among HCWs. We defined an LTBI case if the IGRA test was positive and clinical, laboratory, and radiological evaluations for active tuberculosis were negative. Results We recruited 308 participants between November 2022 and May 2023. The mean age was 38.6 ± 8.3 years. Over 75% of the participants were female. The most common job category was technicians (30.5%), physicians (22.7%), nurses (20.5%), and other HCWs groups (17.5%). Most participants worked in hospital wards (28.2%), diagnostics departments (16.9%), and critical care departments (15.6%). The LTBI prevalence among HCWs was 17.86% (95% CI 13.84-22.70). In multivariate analysis, after adjusting for age, time working in our hospital, and family history of tuberculosis, males had a higher risk of LTBI (aPR 1.69, 95% CI 1.01-2.77) than females. Working for more than 10 years increased the risk of LBTI (aPR 2.4, 95% CI 1.44-3.97) compared to working for ≤10 years. Even further, participants who had worked for more than 20 years had an aPR of 4.31 (95% CI 1.09-13.65) compared to those with ≤10 years. Similarly, occupational exposure increased the risk of LTBI (aPR 2.21, 95% CI 1.27-4.08) compared to those HCWs not occupationally exposed. Conclusion The LTBI prevalence in HCWs at a northern Peruvian hospital was lower compared to other Peruvian cities. Males, more experienced, and occupational exposed HCWs are at higher risk of LTBI. LTBI prevalence in Peruvian HCWs is still high. More studies are needed to address some aspects this study has not examined.
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Innes AL, Nguyen ST, Lebrun V, Nguyen TTH, Huynh TP, Quach VL, Hoang GL, Nguyen TB, Nguyen TBP, Pham HM, Martinez A, Dinh N, Dinh VL, Nguyen BH, Truong TTH, Nguyen VC, Nguyen VN, Mai TH. Tuberculin skin testing and QuantiFERON™-TB Gold Plus positivity among household contacts in Vietnam. Public Health Action 2023; 13:83-89. [PMID: 37736581 PMCID: PMC10446657 DOI: 10.5588/pha.23.0020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/31/2023] [Indexed: 09/23/2023] Open
Abstract
SETTING TB infection (TBI) is diagnosed using the technique-dependent tuberculin skin test (TST) or costly, more accurate interferon-gamma release assays. The TST (⩾10 mm) threshold was indicated by previous research among household contacts in Vietnam, but routine implementation with a different tuberculin reagent showed unexpectedly low TST positivity. OBJECTIVE TST (⩾5 mm and ⩾10 mm) results were compared to QuantiFERON™-TB Gold Plus (QFT) results in household contacts during community campaigns in 2020 and 2021. DESIGN This was a cross-sectional multi-center implementation study. RESULTS Among 1,330 household contacts in 2020, we found a TBI prevalence of 38.6% (QFT), similar to TST ⩾5 mm (37.4%) and higher than TST ⩾10 mm (13.1%). QFT+/TST+ was higher for TST ⩾5 mm (20.7%) than TST ⩾10 mm (9.4%). QFT was not discordant with TST ⩾5 mm (McNemar's test = 0.6, P = 0.5) but was discordant with TST ⩾10 mm (McNemar's test = 263.9, P < 0.01). Older age and Southern region increased odds for positive TST ⩾5 mm and QFT with weaker associations for TST ⩾10 mm. Agreement and discordance were similar in 2021 for 1,158 household contacts. CONCLUSION Tuberculin reagents affect TST positivity rates. High TB burden countries should monitor reliability of TBI diagnosis, including tuberculin potency, cold chain, and TST technique to optimize eligibility for TB preventive treatment.
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Affiliation(s)
- A L Innes
- FHI 360 Asia Pacific Regional Office, Bangkok, Thailand
| | - S T Nguyen
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | | - H M Pham
- United States Agency for International Development Vietnam, Hanoi, Vietnam
| | | | | | - V L Dinh
- Vietnam National Lung Hospital/National Tuberculosis Programme Hanoi, Vietnam
| | - B H Nguyen
- Vietnam National Lung Hospital/National Tuberculosis Programme Hanoi, Vietnam
| | - T T H Truong
- Vietnam National Lung Hospital/National Tuberculosis Programme Hanoi, Vietnam
| | - V C Nguyen
- Vietnam National Lung Hospital/National Tuberculosis Programme Hanoi, Vietnam
| | - V N Nguyen
- Vietnam National Lung Hospital/National Tuberculosis Programme Hanoi, Vietnam
| | - T H Mai
- FHI 360 Vietnam, Hanoi, Vietnam
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Baca R, Vivancos-Gallego MJ. Interferon-gamma release assay for the diagnosis of latent tuberculosis infection in the prison population with a positive tuberculin test: a descriptive study in a prison (Burgos, Spain). Rev Esp Sanid Penit 2023; 25:104-111. [PMID: 38289165 PMCID: PMC10910322 DOI: 10.18176/resp.00076] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/19/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES A high prevalence of prison inmates have a positive tuberculin skin test (TST) and sometimes unnecessary treatment for latent tuberculosis infection (LTBI) is prescribed. The prison tuberculosis prevention and control program has not generalized the use of QuantiFERON (QFT) in prisons. We set out to describe the implementation and usefulness of QFT in a population of inmates with positive TST, and to detect false positives and avoid unnecessary treatments. We also analysed the sociodemographic variables of the inmate population. MATERIAL AND METHODS All the positive TST tests between December 2020 and December 2021 from an average population of 300 inmates in Burgos prison were analysed. The QFT value was measured in all the positive cases. Sociodemographic variables were analysed and finally the number of inmates with positive TST, but with a negative QFT result and therefore not requiring LTBI treatment, was evaluated. RESULTS A total of 41 inmates were included in the study, with a mean age of 44 years. The proportion between Spanish inmates and foreigners was similar. Of all the positive TST, 48.8% were QFT negative. DISCUSSION It was observed that QFT is a safe method for the diagnosis of LTBI in prisons and that its use would contribute to a more specific selection of inmates who actually need chemoprophylactic treatment for LTBI.
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Affiliation(s)
- Roberto Baca
- Departmental Physician at Burgos Primary Care Management. Medical Doctor at Burgos Prison.Departmental PhysicianBurgos Primary Care ManagementSpain
- Burgos PrisonSpain
| | - María J. Vivancos-Gallego
- HIV Unit. Infectious Diseases Service. Ramón y Cajal University Hospital. Ramón y Cajal Health Research Institute (IRYCIS). Online Infectious Disease Biomedical Research Centre (CIBERINFEC). Madrid.HIV Unit. Infectious Diseases ServiceRamón y Cajal University HospitalMadridSpain
- Ramón y Cajal Health Research Institute (IRYCIS)MadridSpain
- Online Infectious Disease Biomedical Research Centre (CIBERINFEC)MadridSpain
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Zavala Del Ángel AE, Morales-Romero J, Zenteno-Cuevas R, Enciso Moreno JA, Mata Miranda MDP, Martínez Zapata JL, Sampieri Ramírez CL, Nachón García MG, Blázquez Morales MSL, Álvarez-Bañuelos MT, Cruz López JA, Demeneghi-Marini VP, González-López L, Gámez-Nava JI. Prevalence of Latent Tuberculosis Infection (LTBI) in Mexican Patients With Rheumatoid Arthritis (RA). Cureus 2023; 15:e39743. [PMID: 37398734 PMCID: PMC10310548 DOI: 10.7759/cureus.39743] [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] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) are at increased risk of developing tuberculosis, and even more so if they receive biological agents. In Mexico, the prevalence of latent tuberculosis infection (LTBI) in RA diagnosed by interferon-gamma release assay (IGRA) is largely unknown. The objective was to determine LTBI prevalence and the associated risk factors in rheumatoid arthritis patients. METHODS A cross-sectional study was performed comprising 82 patients with RA who attended the rheumatology service at a second-level hospital. Demographic characteristics, comorbidity, Bacillus Calmette-Guerin (BCG) vaccination and smoking history, type of treatment, disease activity and functional capacity were investigated. The Disease Activity Score 28 and the Health Assessment Questionnaire-Disability Index were applied for the estimate of RA activity and functional capacity. Further information was compiled from the electronic medical records and personal interviews. LTBI was determined by QuantiFERON TB Gold Plus (QIAGEN, Germantown, USA). RESULTS Prevalence of LTBI was 14% (95% confidence interval (CI): 8.6% to 23.9%). Factors associated with LTBI were history of smoking (odds ratio (OR) = 6.63 95% CI 1.01 to 43.3) and disability score (OR = 7.19 95%CI 1.41 to 36.6). CONCLUSIONS The prevalence of LTBI in Mexican patients with RA was 14%. Our results suggest prevention of smoking and functional incapacity could reduce the risk of LTBI. Further research could endorse our results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - José Artemio Cruz López
- Public Health Coordination, Regional Decentralized Administrative Operation Organ Veracruz-Norte, Instituto Mexicano del Seguro Social, Xalapa, MEX
| | | | - Laura González-López
- University Center of Health Sciences, Universidad de Guadalajara, Guadalajara, MEX
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Santos JA, Duarte R, Nunes C. Tuberculin skin test and interferon-γ release assays: Can they agree? Clin Respir J 2022; 17:109-114. [PMID: 36526296 PMCID: PMC9892696 DOI: 10.1111/crj.13569] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The diagnosis of latent tuberculosis infection (LTBI) relies largely on the tuberculin skin test (TST) or, more recently, on interferon-gamma release assays (IGRA). Knowledge regarding these tests is essential to improve their usefulness in combating the tuberculosis epidemic. OBJECTIVES To characterize the agreement between the IGRA and TST tests by determining the kappa coefficient (K) and agreement rate between these two tests in patients with active tuberculosis (TB). METHODS Retrospective cohort study conducted with data from active TB patients notified in the Portuguese Tuberculosis Surveillance System (SVIG-TB), from 2008 to 2015. TST results were interpreted using a 5 mm (TST-5 mm) and 10 mm (TST-10 mm) cutoff. Kappa coefficient and agreement rate were calculated in order to evaluate the agreement between IGRA and TST (both cutoffs) test results. RESULTS A total of 727 patients with results for both tests were included in the study, of which 3.4% (n = 25) had HIV infection, 5.6% (n = 41) diabetes, 5.0% (n = 36) oncological diseases and 4.4% (n = 32) inflammatory diseases. Of the 727 patients, 16.5% (n = 120) presented different outcomes between IGRA and TST-5 mm, and 20.5% (n = 149) presented different outcomes between IGRA and TST-10 mm. Kappa coefficient between IGRA and TST-5 mm was 0.402 (p < 0.001) with an agreement rate of 83.5%. Between IGRA and TST-10 mm, the kappa coefficient was 0.351 (p < 0.001), with an agreement rate of 79.5%. Patients with HIV infection, diabetes, oncologic diseases and inflammatory diseases presented a substantial agreement between IGRA and TST-5 mm, while inflammatory diseases was the only variable that presented a substantial agreement between IGRA and TST-10 mm. CONCLUSION As both tests can present false-negative results, the low level of agreement between the tests can potentially help identify more cases of LTBI if the two tests are used in parallel, with infections not detected by IGRA possibly being detected by the TST and vice versa.
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Affiliation(s)
- João Almeida Santos
- NOVA National School of Public Health, Public Health Research CentreUniversidade NOVA de LisboaLisbonPortugal,National Health Institute Dr. Ricardo JorgeLisbonPortugal,Comprehensive Health Research Center (CHRC)Universidade NOVA de LisboaLisbonPortugal
| | - Raquel Duarte
- Centro Hospitalar de Vila Nova de GaiaVila Nova de GaiaPortugal,Faculdade de Medicina da Universidade do PortoPortoPortugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research CentreUniversidade NOVA de LisboaLisbonPortugal,Comprehensive Health Research Center (CHRC)Universidade NOVA de LisboaLisbonPortugal
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7
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Zalewska M, Fus W, Konka A, Wystyrk K, Bochenek A, Botor H, Fronczek M, Zembala-John J, Adamek B. An Immune Response to Heterologous ChAdOx1/BNT162b2 Vaccination against COVID-19: Evaluation of the anti-RBD Specific IgG Antibodies Titers and Interferon Gamma Release Assay (IGRA) Test Results. Vaccines (Basel) 2022; 10:vaccines10091546. [PMID: 36146624 PMCID: PMC9506411 DOI: 10.3390/vaccines10091546] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
This study aimed to assess the magnitude of anti-SARS-CoV-2 immunoglobulin G (IgG) titers and Interferon-Gamma Release Assay (IGRA) test results following administration of booster BNT162b2 in 48 ChAd-primed participants (vaccination schedule: ChAd/ChAd/BNT). Whole blood samples were collected: first, before and second, 21 days after the booster dose. The IgG level was measured using chemiluminescent immunoassay; the intensity of the T-cell response—IFNγ concentration—was assessed using IGRA test. At 21 days after the booster, all subjects achieved reactive/positive anti-SARS-CoV-2 IgG, and IGRA test results showed a significant increase compared to the results before booster administration. We compared the results before and after the booster between participants with and without prior history of COVID-19. The IFNγ concentrations in both cohorts were higher in convalescents (both before booster and 21 days after). The IgG titers were subtly lower in COVID-19 convalescents than in naïve but without statistical significance. Data on cell-mediated immunity are scarce, especially with regard to the general population. A better understanding of the complexity of the immune response to SARS-CoV-2 could contribute to developing more effective vaccination strategies.
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Affiliation(s)
- Marzena Zalewska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, H. Jordana 19, 41-808 Zabrze, Poland
- Correspondence:
| | - Wiktoria Fus
- Silesian Park of Medical Technology Kardio-Med Silesia, M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
| | - Adam Konka
- Silesian Park of Medical Technology Kardio-Med Silesia, M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
| | - Karolina Wystyrk
- Silesian Park of Medical Technology Kardio-Med Silesia, M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
| | - Aneta Bochenek
- Silesian Park of Medical Technology Kardio-Med Silesia, M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
| | - Hanna Botor
- Acellmed Ltd., M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
| | - Martyna Fronczek
- Silesian Park of Medical Technology Kardio-Med Silesia, M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, H. Jordana 38, 41-808 Zabrze, Poland
| | - Joanna Zembala-John
- Silesian Park of Medical Technology Kardio-Med Silesia, M. Curie-Skłodowskiej 10C, 41-800 Zabrze, Poland
- Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, H. Jordana 19, 41-808 Zabrze, Poland
- Silesian Center for Heart Diseases in Zabrze, M. Curie—Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Brygida Adamek
- Department of Basic Medical Sciences, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 41-902 Bytom, Poland
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8
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Yang QY, Liu YJ, Xu Y, Zhang L, Wang CD. Monitoring frequency of interferon gamma release assay for tuberculosis surveillance following infliximab therapy in patients with Crohn's disease. J Dig Dis 2021; 22:473-480. [PMID: 34240823 DOI: 10.1111/1751-2980.13032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterize the pattern of positive conversion of interferon gamma release assay (IGRA) in patients with Crohn's disease (CD) during infliximab therapy in China, which has a high burden of tuberculosis. METHODS Eligible patients with CD who received serial IGRA screening during infliximab therapy from January 2015 to March 2020 were retrospectively included. The positive conversion rate of IGRA and the risk of subsequent tuberculosis of the patients were analyzed. RESULTS A total of 128 patients with CD were included, and the median time from the initiation of IFX treatment to positive conversion or the last follow-up test of IGRA was 43.6 weeks. At baseline 3.9% of the patients were positive for IGRA and received prophylactic anti-tuberculosis treatment. In the other 123 patients with negative IGRA at baseline, 6.5% had IGRA positive conversion during infliximab treatment, and one (12.5%) who was exposed to Mycobacterium tuberculosis was diagnosed as having active tuberculosis. The conversion rate at 40 weeks, 2 years and 3 years after treatment were 10.0% (6/60), 2.2% (1/46) and 5.9% (1/17), respectively. Age, sex, history of smoking and alcohol consumption, disease severity (Crohn's disease activity index score) and immunosuppressive therapy were not significantly associated with latent tuberculosis test conversion. CONCLUSIONS Positive conversion of IGRA occurs early during treatment with infliximab for CD and the monitoring frequency of IGRA should be appropriately increased at the early stage of treatment. Physicians should pay attention to patient's history of tuberculosis exposure and carry out surveillance in a timely fashion.
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Affiliation(s)
- Qin Yu Yang
- Department of Gastroenterology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yi Juan Liu
- Department of Gastroenterology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ye Xu
- Department of Gastroenterology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Lin Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Cheng Dang Wang
- Department of Gastroenterology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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9
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Albasanz-Puig A, Suanzes P, Esperalba J, Fernández C, Sellarès-Nadal J, Torrella A, Planas B, Segura A, Burgos J, Ribera E, Cañas-Ruano E, García JN, Navarro J, Curran A, Len Ó, Falcó V. Low frequency of cytomegalovirus (CMV) disease despite high prevalence of CMV viraemia in patients with advanced HIV infection: a clinical and immunological 48-week follow-up study. HIV Med 2021; 22:682-689. [PMID: 33998115 DOI: 10.1111/hiv.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the dynamics of cytomegalovirus (CMV) replication and CMV-specific immune response recovery after antiretroviral treatment (ART) initiation in patients with advanced HIV infection. METHODS A prospective observational study of patients with HIV infection and CD4 counts of < 100 cells/µL was carried out (September 2015 to July 2018). HIV viral load (VL), CD4 count and CMV VL were determined by quantitative polymerase chain reaction (PCR) at baseline and at 4, 12, 24 and 48 weeks, and CMV-specific immune response was determined by QuantiFERON-CMV assay at baseline and 48 weeks. All patients were started on ART but only those with CMV end-organ disease (EOD) received anti-CMV treatment. RESULTS Fifty-three patients with a median age of 43.6 [interquartile range (IQR) 36.7-52.4] years were included in the study. At baseline, the median CD4 count was 30 cells/µL (IQR 20-60 cells/µL) and the median HIV VL was 462 000 HIV-1 RNA copies/mL (IQR 186 000-1 300 000 copies/mL). At baseline, 32% patients had detectable CMV viraemia but none had detectable CMV viraemia at 48 weeks. Only one of 53 (1.9%) patients developed EOD during follow-up. Seven (13.2%) patients were lost to follow-up and six (11.3%) died; none of the deaths was related to CMV. Similar percentages of patients had a CMV-specific immune response at baseline (71.7%) and at 48 weeks (70.0%). The magnitude of this response tended to increase over time [median 1.63 (IQR 0.15-5.77) IU/mL at baseline vs. median 2.5 (IQR 0.1-8.325) IU/mL at 48 weeks; P = 0.11]. We did not find any risk factors associated with 48-week mortality. CONCLUSIONS Although the prevalence of CMV viraemia in patients with advanced HIV infection remains high, achieving a good immunological recovery through ART is enough to suppress CMV viraemia, without an increased risk of CMV EOD. The prevalence of a CMV-specific immune response was high and endured over time.
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Affiliation(s)
- A Albasanz-Puig
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Suanzes
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - J Esperalba
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Fernández
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Sellarès-Nadal
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Torrella
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - B Planas
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Segura
- Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - E Ribera
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Cañas-Ruano
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J N García
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ó Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - V Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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10
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Lee YS, Lee JH, Choi JE, Kim JY, Han TY. Erythema induratum of Bazin in a 10-year-old boy. Pediatr Dermatol 2021; 38:290-291. [PMID: 33006145 DOI: 10.1111/pde.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/08/2020] [Revised: 08/11/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022]
Abstract
Erythema induratum of Bazin (EIB) is a form of tuberculid resulting from hypersensitivity to tuberculosis antigen. EIB occurs most commonly in middle-aged women and is not typically seen in children. Here, we present a rare case of EIB, presenting as a chronic nodular panniculitis, in a 10-year-old Korean boy.
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Affiliation(s)
- Yeon Seok Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - June Hyunkyung Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Eun Choi
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Joo Young Kim
- Department of Pathology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Tae Young Han
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Merli P, Gentile L, Quagliarella F, Cefalo MG, Strocchio L, Locatelli F, Russo C, Gaspari S. QuantiFERON-TB Gold can help clinicians in the diagnosis of haemophagocytic lymphohistiocytosis. Br J Haematol 2020; 191:e64-e67. [PMID: 32712963 DOI: 10.1111/bjh.17001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Leonarda Gentile
- Mycobacteria Unit, Laboratory Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Quagliarella
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Giuseppina Cefalo
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luisa Strocchio
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy.,Sapienza University of Rome, Rome, Italy
| | - Cristina Russo
- Mycobacteria Unit, Laboratory Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefania Gaspari
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
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Lambert LA, Katz D, Feng PJ, Djojonegoro BM, Fair E, Jasuja S, Marantz S, Horsburgh CR, Ho C. Impact of Choice of Test for Latent Tuberculosis Infection on Treatment Acceptance and Completion. Microbiol Insights 2018; 11:1178636118811311. [PMID: 30505150 PMCID: PMC6259069 DOI: 10.1177/1178636118811311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 10/05/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess whether choice of test for tuberculosis (TB) infection affects decisions to accept and complete treatment among contacts to TB cases. METHODS Retrospective study is conducted in which TB contacts, ⩾15 years old during 2005 and 2009, were tested for infection with either a tuberculin skin test (TST) or an interferon-gamma release assay test, the QuantiFERON-TB Gold In-Tube (QFT-GIT). RESULTS Of 658 persons with valid test results, 185 (28%) had positive results, including 128 of 406 (32%) who had TST and 57 of 252 (23%) who received QFT-GIT. Treatment acceptance was 43 of 57 (75%) among QFT-GIT-positive and 97 of 128 (76%) among TST-positive persons (risk ratio [RR] = 1.0, 95% confidence interval [CI], 0.83-1.2). Treatment completion was 56% among QFT-GIT-positive (32 of 57) and 59% (75 of 128) among TST-positive persons (RR = 0.96, 95% CI, 0.73-1.26). DISCUSSION Our study showed no difference in proportions of TB contacts ⩾15 years old with positive TST results who accepted or completed LTBI treatment compared with those with positive QFT-GIT results. Future studies should include high-risk persons with no known TB exposure, who constitute the main reservoir for TB cases in the United States.
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Affiliation(s)
- Lauren A Lambert
- Centers for Disease Control and Prevention, Division of TB Elimination Atlanta, GA, USA
| | - Dolly Katz
- Centers for Disease Control and Prevention, Division of TB Elimination Atlanta, GA, USA
| | - Pei-Jean Feng
- Centers for Disease Control and Prevention, Division of TB Elimination Atlanta, GA, USA
| | | | - Elizabeth Fair
- Francis J. Curry National TB Center, San Francisco, CA, USA
| | - Supriya Jasuja
- Respiratory Health Association, Cook County Department of Public Health, Chicago, IL, USA
| | - Susan Marantz
- Respiratory Health Association, Cook County Department of Public Health, Chicago, IL, USA
| | | | - Christine Ho
- Centers for Disease Control and Prevention, Division of TB Elimination Atlanta, GA, USA
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Chen Y, Jiang J, Jiang H, Chen J, Wang X, Liu W, Chen Z, Shi Y, Zhang W, Wang H. Mycobacterium gordonae in Patient with Facial Ulcers, Nosebleeds, and Positive T-SPOT.TB Test, China. Emerg Infect Dis 2018. [PMID: 28628445 PMCID: PMC5512493 DOI: 10.3201/eid2307.162033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium gordonae is often regarded as a weak pathogen that only occasionally causes overt disease. We report a case of M. gordonae infection in the facial skin, nasal mucosa, and paranasal sinus in an immunocompetent patient and review previous cases. The T-SPOT.TB test might be useful in diagnosing such cases.
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14
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Kwon Y, Kim SJ, Kim J, Kim SY, Song EM, Lee EJ, Choi Y, Kim Y, Lim BO, Kim DS, Choi D, Kim HS, Park JE, Yun JE, Park JA, Jung JR, Kim JK, Kang SH, Hong SY, Lee SJ, Park SJ, Park SH, Yoon S, Kim Y, Choi Y, Seo YJ, Seo YA, Park J, Sung M, Shin M, Son H, Lee Y, Go U, Kwon GY. Results of tuberculosis contact investigation in congregate settings in Korea, 2013. Osong Public Health Res Perspect 2014; 5:S30-6. [PMID: 25861578 PMCID: PMC4301638 DOI: 10.1016/j.phrp.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/15/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aimed to check the status of the contact investigation in congregate settings to eradicate tuberculosis (TB) in the Republic of Korea. Methods The “Integrated System for Disease and Public Health Management” is used for care and follow-up for patients and contacts of TB. We downloaded data for contact investigations conducted from January to December 2013. Results A total of 1,200 contact investigations in congregate settings were carried out by 25 field investigators in 2013. We performed the status of contact investigation, TB, and LTBI rate by age, accept rate of LTBI treatment, and complete rate of LTBI treatment during 2013. A total of 1,547 index TB patients, 149,166 contacts, and 259 additional TB patients were found through the investigation. Kindergartens showed the highest LTBI rate, 19.8%, among educational facilities. The second highest was in elementary schools and the subtotal LTBI rate of educational facilities was 7.8%. Social welfare/correctional facilities and workplaces showed relatively high LTBI rates of 23.8% and 23.6%, respectively. By age, individuals >35 years showed the highest LTBI rate, followed by those aged 0–4 years, 30–34 years, and 5–9 years, with rates of 18.1%, 16.4%, and 15.4% respectively. When comparing the tuberculin skin test (TST) positive conversion ratio by facility, middle school and high school were relatively high compared to the others. The accept rate of LTBI treatment in the workplace was lowest at 63% and the complete rate in elementary schools was lowest at 76.5%. Conclusion TB contact investigation is considered as a meaningful strategy for preventing TB outbreaks in congregate settings and decreasing the prevalence of TB in young people. Results of this study could be used to establish the LTBI management policy.
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Affiliation(s)
- Yunhyung Kwon
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - So Jung Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Jieun Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Seol-Yi Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Eun Mi Song
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Eun Jung Lee
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Yun Choi
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Yejin Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Byoung Ok Lim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Da Sul Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Duksun Choi
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Hye Sung Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Ji Eun Park
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Ji-Eun Yun
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Jin A Park
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Jong Rak Jung
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Joo-Kyoung Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Sang Hee Kang
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Seo Yean Hong
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Seung Jae Lee
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Soo Jin Park
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Sun Hwa Park
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Sunhye Yoon
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Yoonsun Kim
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Yunjeong Choi
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Yun Jeong Seo
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Yul A Seo
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Jiseon Park
- KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Minhee Sung
- KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Minjang Shin
- KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
| | - Hyunjin Son
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Yeonkyeng Lee
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Unyeong Go
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Geun-Yong Kwon
- Division of HIV/AIDS and TB Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea ; KTEIS (Korea Tuberculosis Epidemic Intelligence Service) Team, Cheongju, Korea
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