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Helle OMB, Kanthali M, Ishtiaq S, Ambreen A, Purohit MR, Mustafa T. Diagnosing adult and pediatric extrapulmonary tuberculosis by MPT64 antigen detection with immunohistochemistry and immunocytochemistry using reproduced polyclonal antibodies. J Pathol Clin Res 2024; 10:e12373. [PMID: 38572528 PMCID: PMC10993049 DOI: 10.1002/2056-4538.12373] [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: 12/13/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Immunohistochemistry or immunocytochemistry has been used to diagnose tuberculosis (TB) by detection of MPT64 antigen from various extrapulmonary specimens and has shown good diagnostic performance in our previous studies. The test can distinguish between disease caused by Mycobacterium tuberculosis (Mtb) complex and nontuberculous mycobacteria and can be applied on formalin-fixed paraffin-embedded tissue. As the antibodies previously used were in limited supply, a new batch of polyclonal antibodies was developed for scale-up and evaluated for the first time in this study. Our aim was to assess the diagnostic accuracy of the MPT64 test with reproduced antibodies in the high burden settings of Pakistan and India. Patients were enrolled prospectively. Samples from suspected sites of infection were collected and subjected to histopathologic and/or cytologic evaluation, routine TB diagnostics, GeneXpert MTB/RIF (Xpert), and the MPT64 antigen detection test. Patients were followed until the end of treatment. Based on a composite reference standard (CRS), 556 patients were categorized as TB cases and 175 as non-TB cases. The MPT64 test performed well on biopsies with a sensitivity and specificity of 94% and 75%, respectively, against a CRS. For cytology samples, the sensitivity was low (36%), whereas the specificity was 81%. Overall, the MPT64 test showed higher sensitivity (73%) than Xpert (38%) and Mtb culture (33%). The test performed equally well in adults and children. We found an additive diagnostic value of the MPT64 test in conjunction with histology and molecular tests, increasing the yield for EPTB. In conclusion, immunochemical staining with MPT64 antibodies improves the diagnosis of EPTB in high burden settings and could be a valuable addition to routine diagnostics.
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Affiliation(s)
- Ole Magnus Bjørgaas Helle
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
- Centre for International Health, Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Mala Kanthali
- Department of PathologyR.D. Gardi Medical CollegeUjjainIndia
| | - Sheeba Ishtiaq
- Department of HistopathologyGulab Devi HospitalLahorePakistan
| | - Atiqa Ambreen
- Department of MicrobiologyGulab Devi HospitalLahorePakistan
| | - Manju Raj Purohit
- Department of PathologyR.D. Gardi Medical CollegeUjjainIndia
- Department of Public Health SciencesKarolinska InstitutetStockholmSweden
| | - Tehmina Mustafa
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
- Centre for International Health, Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Li M, Deng B, Huang Y, Li Q, Han J, Tang S, Chen L. Trends and risk factors for drug-resistant tuberculosis among children in Sichuan, China: A 10-year retrospective analysis, 2013-2022. Medicine (Baltimore) 2024; 103:e37643. [PMID: 38608104 PMCID: PMC11018228 DOI: 10.1097/md.0000000000037643] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
To investigate the status of the drug-resistant tuberculosis (DR-TB) among children in Sichuan, and to find out the risk factors and high-risk population related to drug resistance among children. The clinical data of tuberculosis patients ≤14 years old with culture-confirmed tuberculosis hospitalized in Chengdu Public Health Clinical Center from January 2013 through December 2022 were collected. Clinical data such as gender, age, ethnicity, history of anti-TB treatment, history of exposure to tuberculosis, nutritional status, and specific drug resistance of the children were collected and recorded. The drug resistance of children in different age groups (0-4 years old, 5-9 years old, 10-14 years old) and different periods (2013-2017 and 2018-2022) were grouped and compared. Logistic regression analysis was to analyze analysis of risk factors of drug resistance in children. A total of 438 children with culture-confirmed tuberculosis were screened. Among them, 26.19% (11/42) were 0 to 4 years old, 33.33% (22/66) were 5 to 9 years old, and 36.67% (121/330) were 10 to 14 years old among the resistant children. There was no statistically significant difference in the resistance rate among the 3 groups (P = .385). The proportions of DR-TB, monoresistant tuberculosis, polydrug-resistant tuberculosis were decreased during 2019 to 2022 compared with 2013 to 2017 (P < .0001). The resistance rates of drug resistant, monoresistant, polydrug-resistant, isoniazid-resistant, and rifampicin resistant during 2018 to 2022 were decreased compared with those from 2013 to 2017 (P < .05), but the multi-drug resistance rate was not decreased (P = .131, without statistical difference). The results of logistic regression analysis showed that male gender OR = 1.566 (95% CI 1.035-2.369), a history of antituberculosis therapy OR = 4.049 (95% CI 1.442-11.367), and pulmonary and extrapulmonary tuberculosis OR = 7.335 (95% CI 1.401-38.392) were risk factors for the development of drug resistance; but fever OR = 0.581 (95% CI 0.355-0.950) was Protective factor. The total drug resistance rate of children in Sichuan showed a downward trend, but the rate of multi-drug-resistant tuberculosis was still at a high level, and the form of drug resistance was still severe. Absence of fever, male, retreatment, and pulmonary concurrent with extrapulmonary tuberculosis are risk factors for DR-TB in children.
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Affiliation(s)
- Maoying Li
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Bin Deng
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Yuhong Huang
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Qiong Li
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | - Jing Han
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
| | | | - Lei Chen
- Chengdu Public Health Clinic Center, Chengdu, Sichuan, China
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Sundaram K, Vajravelu LK. Tuberculosis and its clinical consequences on Women's health. Indian J Tuberc 2024; 71:195-203. [PMID: 38589124 DOI: 10.1016/j.ijtb.2023.06.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 04/10/2024]
Abstract
Mycobacterium tuberculosis causes tuberculosis, a fatal infection resulting in widespread illness and death. In 2020, approximately 10 million people were diagnosed with tuberculosis. The top 30 tuberculosis-endemic countries accounted for 86% of all estimated occurrence cases worldwide. In this context, eight of these accounted for two-thirds of the global total, with India having a prevalence of 26%. Aside from lung inflammation, the risk factors for tuberculosis in women include extra-pulmonary infection, particularly genital tuberculosis, tuberculous mastitis, and tuberculous in the peritoneum, intestine, and spine. Depending on the epidemiologic context and screening methods, different tuberculosis symptoms and disease diagnoses are more or less common among expectant mothers. The disease is almost certainly going to have a global impact. The social stigma and anxiety associated with tuberculosis may have a much more significant negative impact on women's health behaviors than men. Notably, the abdominal sites of miliary tuberculosis could mimic tumor likely, carcinoma and lymphoma. Also, the results of the diagnostic accuracy tests for the condition demonstrate that extra-pulmonary tuberculosis can be quickly and accurately diagnosed in various sites using both the T-SPOT assay and the GeneXpert/PCR test. Therefore, this review exemplified the prevalence of extra-pulmonary tuberculosis at various points in women's lives. On the contrary, it also illustrated the symptoms and dangers of TB as they relate to women's health.
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Affiliation(s)
- Karthikeyan Sundaram
- Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattangulathur, Chennai, 603203, Tamilnadu, India.
| | - Leela Kagithakara Vajravelu
- Department of Microbiology, SRM Medical College Hospital and Research Centre, Kattangulathur, Chennai, 603203, Tamilnadu, India
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Hailu S, Hurst C, Cyphers G, Thottunkal S, Harley D, Viney K, Irwin A, Dean J, Nourse C. Prevalence of extra-pulmonary tuberculosis in Africa: A systematic review and meta-analysis. Trop Med Int Health 2024; 29:257-265. [PMID: 38263374 DOI: 10.1111/tmi.13970] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The burden of extra-pulmonary tuberculosis (EPTB) is not well quantified in TB endemic countries such as those in sub-Saharan Africa. This study aimed to quantify that burden via a systematic review of the prevalence of EPTB in African countries. METHODS Studies were retrieved by searching five databases; 105 studies published between 1990 and 2023 were included. The studies described the prevalence of EPTB among the general population (4 studies), TB patients (68) and patients with other conditions, including HIV (15), meningitis (3), renal failure (3) and other comorbidities, some of which are cancer (12). Due to the low number of studies reporting EPTB in patients with conditions other than TB, the meta-analysis was performed on studies reporting on EPTB among TB patients (68 studies). Meta-analysis was performed on the 68 studies (271,073 participants) using a random-effects model to estimate the pooled prevalence of EPTB. Meta-regression was used to explore possible explanations for heterogeneity according to regions and time periods. RESULTS The pooled prevalence of EPTB among TB patients was 26% (95% CI 23-29%). There was substantial heterogeneity of prevalence for the five African regions. The Eastern region had the highest prevalence of 32% (95% CI 28-37%) and the lowest in Western Africa, 16% (95% CI 10-24%). There was no significant difference in the prevalence of EPTB between the 3 eleven-year time periods. CONCLUSIONS Our systematic review and meta-analysis give insight into the burden of EPTB in Africa. This review could inform clinical and programmatic practices-a higher suspicion index for clinicians and more effort for better services. This could contribute to efforts aiming to end TB, which have historically been focused on PTB.Coordinated efforts that target both EPTB and PTB are needed.
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Affiliation(s)
- Semira Hailu
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Cameron Hurst
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Griffin Cyphers
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Stefan Thottunkal
- ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - David Harley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Kerri Viney
- ANU College of Health and Medicine, Australian National University, Canberra, Australia
- School of Public Health, University of Sydney, Camperdown, Australia
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Adam Irwin
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - Judith Dean
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
- UQ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia
| | - Clare Nourse
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
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Zangpo T, Tsheten, Tenzin P, Dorji C, Nima G, Dorjee S, Sultana R. Demographic risk factors for extra-pulmonary tuberculosis: a rising public health threat in Bhutan. Indian J Tuberc 2024; 71:137-146. [PMID: 38589117 DOI: 10.1016/j.ijtb.2023.04.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/16/2023] [Accepted: 04/20/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan. METHODS A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018. RESULTS The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB. CONCLUSION Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.
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Affiliation(s)
- Tandin Zangpo
- Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan.
| | - Tsheten
- Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Bhutan
| | - Phurpa Tenzin
- National Tuberculosis Control Program, Department of Public Health, Ministry of Health, Bhutan
| | - Chencho Dorji
- Gidakom Hospital, Ministry of Health, Thimphu, Bhutan
| | - Gaki Nima
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sithar Dorjee
- Khesar Gyalpo University of Health Sciences of Bhutan, Thimphu, Bhutan
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Jain R, Gupta G, Mitra DK, Guleria R. Diagnosis of extra pulmonary tuberculosis: An update on novel diagnostic approaches. Respir Med 2024; 225:107601. [PMID: 38513873 DOI: 10.1016/j.rmed.2024.107601] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
Tuberculosis (TB) remains a major global public health problem worldwide. Though Pulmonary TB (PTB) is mostly discussed, one in five cases of TB present are extrapulmonary TB (EPTB) that manifests conspicuous diagnostic and management challenges with respect to the site of infection. The diagnosis of EPTB is often delayed or even missed due to insidious clinical presentation, pauci-bacillary nature of the disease, and lack of laboratory facilities in the resource limited settings. Culture, the classical gold standard for the diagnosis of tuberculosis, suffers from increased technical and logistical constraints in EPTB cases. Other than culture, several other tests are available but their feasibility and effciacy for the detection of EPTB is still the matter of interest. We need more specific and precise test/s for the various forms of EPTB diagnosis which can easily be applied in the routine TB control program is required. A test that can contribute remarkably towards improving EPTB case detection reducing the morbidity and mortality is the utmost requirement. In this review we described the scenario of molecular and other noval methods available for laboratory diagnosis of EPTB, and also discussed the challenges linked with each diagnostic method. This review will make the readers aware of new emerging diagnostic techniques in the field of EPTB diagnosis. They can make an informed decision to choose the appropriate one according to the test availability, their clinical settings and financial considerations.
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Affiliation(s)
- Rashi Jain
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India; Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Gopika Gupta
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D K Mitra
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Randeep Guleria
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India; Institute of Internal Medicine & Respiratory and Sleep Medicine, Medanta-The Medicity, Gurugram, Haryana, 122033, India.
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Nasrin R, Uddin MKM, Kabir SN, Rahman T, Biswas S, Hossain A, Rahman SMM, Ahmed S, Pouzol S, Hoffmann J, Banu S. Xpert MTB/RIF Ultra for the rapid diagnosis of extrapulmonary tuberculosis in a clinical setting of high tuberculosis prevalence country and interpretation of 'trace' results. Tuberculosis (Edinb) 2024; 145:102478. [PMID: 38218133 DOI: 10.1016/j.tube.2024.102478] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/12/2023] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
To evaluate the diagnostic performance of Xpert MTB/RIF Ultra (Ultra) for the diagnosis of extrapulmonary tuberculosis (EPTB) from different types of extrapulmonary specimens in comparison with culture and composite microbiological reference standard (CRS). A total of 240 specimens were prospectively collected from presumptive EPTB patients between July 2021-January 2022 and tested by Ultra, Xpert, culture and acid-fast bacilli (AFB) smear microscopy. Out of 240 specimens, 35.8 %, 20.8 %, 11.3 %, and 7.1 % were detected as Mycobacterium tuberculosis complex by Ultra, Xpert, culture and AFB microscopy, respectively. An additional 15.0 % cases were detected by Ultra compared to Xpert MTB/RIF (Xpert) assay. A total of 28 (11.7 %) cases were identified as 'trace' category by Ultra with indeterminate rifampicin resistance result; of which 36.4 % were clinically confirmed as EPTB. Compared to culture, the sensitivity and specificity of Ultra and Xpert were 100 % and 72.3 %; 92.6 % and 88.3 %, respectively. In comparison with CRS, these were respectively: 98.9 % and 100 %; 57.5 % and 100 %. For individual category of specimens, sensitivity of Ultra was 100 % with varying specificity. We found that Ultra was highly sensitive for the rapid diagnosis of EPTB and has extensive potential over current diagnostics in high TB burden countries, but 'trace' results should be interpreted with caution.
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Affiliation(s)
- Rumana Nasrin
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | | | - Sk Nazmul Kabir
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Tanjina Rahman
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Samanta Biswas
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Aazia Hossain
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | | | - Shahriar Ahmed
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh
| | - Stephane Pouzol
- Scientific and Medical Department, Fondation Mérieux (Lyon), France
| | | | - Sayera Banu
- Infectious Diseases Division, Icddr,b, Dhaka, 1212, Bangladesh.
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Laway BA, Blouria BPS, Jan RA, Bhat MH, Choh NA. Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment. Arch Endocrinol Metab 2024; 68:e210514. [PMID: 38427810 PMCID: PMC10948036 DOI: 10.20945/2359-4292-2021-0514] [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: 12/19/2022] [Accepted: 03/15/2023] [Indexed: 03/03/2024]
Abstract
Objective Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusion Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.
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Affiliation(s)
- Bashir Ahmad Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India,
| | | | - Rafi Ahmad Jan
- General Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Moomin Hussain Bhat
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Naseer Ahmad Choh
- Radio Diagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Gu WF, Shi X, Ma X, Yu JL, Xu JC, Qian CC, Hu ZD, Zhang H. Effectiveness of Histopathological Examination of Ultrasound-guided Puncture Biopsy Samples for Diagnosis of Extrapulmonary Tuberculosis. Biomed Environ Sci 2024; 37:170-177. [PMID: 38582979 DOI: 10.3967/bes2024.017] [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] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/24/2023] [Indexed: 04/08/2024]
Abstract
Objective To evaluate the diagnostic value of histopathological examination of ultrasound-guided puncture biopsy samples in extrapulmonary tuberculosis (EPTB). Methods This study was conducted at the Shanghai Public Health Clinical Center. A total of 115 patients underwent ultrasound-guided puncture biopsy, followed by MGIT 960 culture (culture), smear, GeneXpert MTB/RIF (Xpert), and histopathological examination. These assays were performed to evaluate their effectiveness in diagnosing EPTB in comparison to two different diagnostic criteria: liquid culture and composite reference standard (CRS). Results When CRS was used as the reference standard, the sensitivity and specificity of culture, smear, Xpert, and histopathological examination were (44.83%, 89.29%), (51.72%, 89.29%), (70.11%, 96.43%), and (85.06%, 82.14%), respectively. Based on liquid culture tests, the sensitivity and specificity of smear, Xpert, and pathological examination were (66.67%, 72.60%), (83.33%, 63.01%), and (92.86%, 45.21%), respectively. Histopathological examination showed the highest sensitivity but lowest specificity. Further, we found that the combination of Xpert and histopathological examination showed a sensitivity of 90.80% and a specificity of 89.29%. Conclusion Ultrasound-guided puncture sampling is safe and effective for the diagnosis of EPTB. Compared with culture, smear, and Xpert, histopathological examination showed higher sensitivity but lower specificity. The combination of histopathology with Xpert showed the best performance characteristics.
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Affiliation(s)
- Wen Fei Gu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China;School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Xia Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xin Ma
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jun Lei Yu
- Department of Laboratory Medicine, Zhejiang Putuo Hospital, Zhoushan 316100, Zhejiang, China
| | - Jin Chuan Xu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Cheng Cheng Qian
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Zhi Dong Hu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Hui Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China;Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Bouzouita I, Ghariani A, Dhaou KB, Jemaeil S, Essaalah L, Bejaoui S, Draoui H, El Marzouk N, Mehiri E, Slim-Saidi L. Usefulness of Xpert MTB/RIF Ultra for rapid diagnosis of extrapulmonary tuberculosis in Tunisia. Sci Rep 2024; 14:2217. [PMID: 38278853 PMCID: PMC10817909 DOI: 10.1038/s41598-024-52130-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024] Open
Abstract
Extrapulmonary tuberculosis (EPTB) remains a challenging diagnosis. The purpose of this study was to assess the accuracy of Xpert MTB/RIF Ultra (Cepheid, USA) for rapid diagnosis of EPTB in Tunisia. Eight hundred and forty-seven extrapulmonary samples collected from 2017 to 2021, were subjected to Xpert MTB/RIF Ultra. Microscopy and culture were performed for all the specimens. The accuracy of Xpert Ultra was evaluated in comparison to the culture. Xpert Ultra diagnosed EPTB with a global sensitivity of 80.66% (74.3-85.75) and specificity of 70.87% (67.31-74.20). The molecular test was most accurate when performed in cerebrospinal fluids, bones and joints and cutaneous specimens showing a sensitivity of 100% and a specificity ranging from 70.60 to 91.11%. In lymph node samples comprising aspirates and biopsies, the sensitivity of Xpert Ultra was high 87.50% (77.23-93.53), however, the specificity was 51.08% (44.67-57.46). For pleural samples, the Xpert Ultra sensitivity was 77.50% (68.34-84.68) ranging from 71.43 to 80% in pleural biopsies and fluids respectively. The specificity in all pleural specimens was 79.56% (74.40-83.91). Xpert Ultra showed promise in the diagnosis of EPTB. The performances varied according to the site of the disease. The test may be more valuable if used in combination with other diagnostic modalities.
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Affiliation(s)
- Imen Bouzouita
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia.
- Faculty of Mathematical, Physical and Natural Sciences of Tunis, University of Tunis El Manar, Campus Universitaire El Manar, 1068, Tunis, Tunisia.
| | - Asma Ghariani
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
- Faculty of Pharmacy, University of Monastir, Rue Ibn Sina 5000, Monastir, Tunisia
| | - Khouloud Ben Dhaou
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
- Faculty of Pharmacy, University of Monastir, Rue Ibn Sina 5000, Monastir, Tunisia
| | - Sabrine Jemaeil
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
| | - Leila Essaalah
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
| | - Sana Bejaoui
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
| | - Henda Draoui
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
| | - Naceur El Marzouk
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
| | - Emna Mehiri
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
- Faculty of Pharmacy, University of Monastir, Rue Ibn Sina 5000, Monastir, Tunisia
| | - Leila Slim-Saidi
- National Reference Laboratory for Mycobacteria, LR19SP02, Abderahmane Mami pneumology hospital, Rue de l'hôpital, 2080, Ariana, Tunisia
- Faculty of Pharmacy, University of Monastir, Rue Ibn Sina 5000, Monastir, Tunisia
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11
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Ravikumar DB, Sivasubramanian BP, Singla A, Venu R, Shekar SP. Shorter antitubercular therapy for extrapulmonary tuberculosis - a case report. BMC Infect Dis 2024; 24:86. [PMID: 38225554 PMCID: PMC10788989 DOI: 10.1186/s12879-023-08941-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Extrapulmonary tuberculosis (EPTB) adds to India's significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries. PRESENTATION This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy. CONCLUSION This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
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Affiliation(s)
| | | | - Ankur Singla
- Internal Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, India
| | - Rakshaya Venu
- Internal Medicine, Saveetha Medical College and Hospital, Chennai, Tamilnadu, India.
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12
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Bergh A, Wilcke JT, From G, Carstensen AN. Extrapulmonary tuberculosis as a cause of complex perianal fistula disease. Ugeskr Laeger 2024; 186:V09230551. [PMID: 38305264 DOI: 10.61409/v09230551] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Extrapulmonary tuberculosis (TB) in the gastrointestinal tract is a rare, but yet an essential differential diagnosis to patients with complex fistula disease, since the initiation of immunosuppressive therapy for presumed Crohn's disease can lead to a fulminant course of TB. This case report presents a young Danish woman with a progressive complex fistula disease, where cause and treatment were uncovered by interprofessional collaboration between pulmonologists, gastroenterologists and surgeons including a screening test for TB as well as multiple biopsies from the anal fistula tissue.
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Affiliation(s)
- Amanda Bergh
- Abdominalcenter K, Københavns Universitetshospital - Bispebjerg Hospital
| | - Jon Torgny Wilcke
- Lungemedicinsk Afdeling, Københavns Universitetshospital - Gentofte Hospital
| | - Gustav From
- Abdominalcenter K, Københavns Universitetshospital - Bispebjerg Hospital
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13
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Mamishi S, Pourakbari B, Hosseinpour Sadeghi R, Marjani M, Mahmoudi S. Diagnostic accuracy of the IFN-γ release assay using RD1 immunodominant T-cell antigens for diagnosis of extrapulmonary tuberculosis. FEMS Microbiol Lett 2024; 371:fnae023. [PMID: 38533666 DOI: 10.1093/femsle/fnae023] [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: 01/08/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
The diagnosis of extrapulmonary tuberculosis (EPTB) poses a significant challenge, with controversies surrounding the accuracy of IFN-γ release assays (IGRAs). This study aimed to assess the diagnostic accuracy of RD1 immunodominant T-cell antigens, including ESAT-6, CFP-10, PE35, and PPE68 proteins, for immunodiagnosis of EPTB. Twenty-nine patients with EPTB were enrolled, and recombinant PE35, PPE68, ESAT-6, and CFP-10 proteins were evaluated in a 3-day Whole Blood Assay. IFN-γ levels were measured using a Human IFN-γ ELISA kit, and the QuantiFERON-TB Gold Plus (QFT-Plus) test was performed. Predominantly, the patients were of Afghan (62%, n = 18) and Iranian (38%, n = 11) nationalities. Eighteen individuals tested positive for QFT-Plus, accounting for 62% of the cases. The positivity rate for IGRA, using each distinct recombinant protein (ESAT-6, PPE68, PE35, and CFP-10), was 72% (n = 21) for every protein tested. Specifically, among Afghan patients, the positivity rates for QFT-Plus and IGRA using ESAT-6, PPE68, PE35, and CFP-10 were 66.7%, 83.3%, 83.3%, 77.8%, and 88.9%, respectively. In contrast, among Iranian patients, the positivity rates for the same antigens were 54.5%, 54.5%, 54.5%, 63.6%, and 45.5%, respectively. In conclusion, our study highlights the potential of IGRA testing utilizing various proteins as a valuable diagnostic tool for EPTB. Further research is needed to elucidate the underlying factors contributing to these disparities and to optimize diagnostic strategies for EPTB in diverse populations.
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Affiliation(s)
- Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Dr. Gharib Street, Keshavarz Boulevard, Tehran, Iran
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Ghaet, Keshavarz Boulevard, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Dr. Gharib Street, Keshavarz Boulevard, Tehran, Iran
| | - Reihaneh Hosseinpour Sadeghi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Dr. Gharib Street, Keshavarz Boulevard, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran 1956944413, Iran
| | - Shima Mahmoudi
- Biotechnology Centre, Silesian University of Technology, 44-100 Gliwice, Poland
- Tehran University of Medical Sciences, Tehran, Iran
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Hagen F, Bachmann O, Berg C, Bedke J, Göpel S, Kaufmann S. [Pictorial Essay: Extrapulmonary Tuberculosis]. ROFO-FORTSCHR RONTG 2024; 196:5-11. [PMID: 36863359 DOI: 10.1055/a-2007-9450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Florian Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Department of Radiology, Tübingen, Germany
| | - Oliver Bachmann
- Department of Internal Medicine 1, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Christoph Berg
- Department of Internal Medicine I: Hepatology, Gastroenterology, Infectiology, University Hospital of Tuebingen, Tübingen, Germany
| | - Jens Bedke
- Department of Urology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Siri Göpel
- Department of Internal Medicine I: Hepatology, Gastroenterology, Infectiology, University Hospital of Tuebingen, Tübingen, Germany
| | - Sascha Kaufmann
- Department of Diagnostic and Interventional Radiology, Siloah St. Trudpert Hospital, Pforzheim, Germany
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15
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Kodjo AD, Lohanimpo D, Abou-Bakari T, Toyi T, Abago B, Mohaman AD. [EXTRAPULMONARY TUBERCULOSIS AT SYLVANUS OLYMPIO UNIVERSITY HOSPITAL]. West Afr J Med 2023; 40:S41. [PMID: 38071484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Agbeko Djagadou Kodjo
- Service de Médecine Interne, Faculté des sciences de la santé, Université de Lomé, Togo
| | - Djalogue Lohanimpo
- Service de Médecine Interne, Faculté des sciences de la santé, Université de Kara, Togo
| | - Tchala Abou-Bakari
- Service de Médecine Interne, Faculté des sciences de la santé, Université de Lomé, Togo
| | - Tchamdja Toyi
- Service de Médecine Interne, Faculté des sciences de la santé, Université de Lomé, Togo
| | - Balaka Abago
- Service de Médecine Interne, Faculté des sciences de la santé, Université de Lomé, Togo
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Kamponda M, Bickton FM, Mategula D, Nliwasa M, Kreuels B, Kumwenda J. The diagnostic performance of Xpert MTB/RIF Ultra on Pericardial, Pleural and Ascitic cohort study fluids for diagnosis of extra-pulmonary Tuberculosis at a referral hospital in Malawi. Malawi Med J 2023; 35:201-207. [PMID: 38362570 PMCID: PMC10865050 DOI: 10.4314/mmj.v35i4.1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Background Extra-pulmonary tuberculosis (EPTB) accounts for 15% of the 1.4 million patients with TB notified in 2019. EPTB carries a high risk of mortality and so early diagnosis and treatment are important to reduce this risk. Diagnosis of EPTB in low- and middle-income countries is challenging. This study investigated the diagnostic performance of Xpert MTB Ultra for the diagnosis of EPTB (pericardial, pleural, and ascitic fluid) in adults at a referral hospital in Malawi. Methods Adults with suspected extra-pulmonary TB were screened for evidence of extra-pulmonary fluid and tested for TB using Xpert MTB Ultra, mycobacterial culture, and a Focused Abdominal Sonography in HIV-associated TB (FASH scan). The diagnostic performance of the Xpert MTB Ultra was compared to mycobacterial culture and a composite reference standard defined as a positive FASH scan or a positive mycobacterial culture or a clinical TB diagnosis (constitutional symptoms not otherwise explained with response to empirical TB treatment). Results There were 174 patients recruited: 99/174 (57%) pleural, 70/174 (40%) ascitic and 5/174 (3%) pericardial. Overall, 10/174 (6%) had bacteriologically confirmed TB and 30/174 (17%) were started on TB treatment based on a positive FASH scan or a clinical TB diagnosis. The sensitivity and specificity of Xpert ultra compared to culture was 83% (95%CI:36%-100%) and 98% (95%CI:94%-99%), respectively. Compared to the composite reference standard, the sensitivity of Xpert Ultra was 17% (95%CI:7%-34%) and specificity was 98% (95%CI:94%-100%). Conclusion Xpert MTB Ultra provides good diagnostic performance on pleural, pericardial and ascitic fluid with reference to mycobacterial culture. Improved EPTB diagnostic tests are required to improve patient outcomes. We recommend larger multi-centre studies to corroborate our findings.
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Affiliation(s)
- Martin Kamponda
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Fanuel Meckson Bickton
- Department of Rehabilitation Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
- Lung Health Group, Malawi-Liverpool-Welcome Programme, Blantyre, Malawi
| | - Donnie Mategula
- Lung Health Group, Malawi-Liverpool-Welcome Programme, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Benno Kreuels
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Johnstone Kumwenda
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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17
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Araújo RM, Montenegro RDA, Peixoto ADS, Silva LLDS, da Costa RMPJ, Carvalho-Silva WHV, Mello DCD, Diniz GTN, Silva MALD, Melo FLD, Montenegro LML, Schindler HC. Performance of IS6110-LAMP assay for detection of Mycobacterium tuberculosis complex in blood and urine samples from patients with extrapulmonary tuberculosis. Tuberculosis (Edinb) 2023; 143:102423. [PMID: 38180027 DOI: 10.1016/j.tube.2023.102423] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The diagnosis of extrapulmonary tuberculosis (EPTB) shows numerous difficulties because of non-specific symptomatology and low sensitivity of conventional methods. Loop-mediated isothermal amplification (LAMP) is a fast and low-cost technique, which can amplify under isothermal conditions an amount of target DNA copies into approximately a billion copies. OBJECTIVE The present study aimed to evaluate a IS6110-LAMP system for Mycobacterium tuberculosis detection in blood and urine samples from patients with EPTB. METHODS The collected samples (n = 122) were stratified in two groups: Group EPTB - patient samples with confirmed EPTB (n = 61); Group non-TB - patient samples without TB (n = 61). The urine samples underwent decontamination, and the components of blood samples were separated (plasma and PBMC). DNA extractions were performed in all biological samples followed by IS6110-LAMP assay technique. The detection limit was evaluated through dilution curves (1:10) using Mtb reference strain (H37Rv) genomic DNA. FINDINGS The detection limit of IS6110-LAMP was 10 fg/μL (∼10-20 bacilli/μL). The IS6110-LAMP technique sensitivity and specificity were 95.65 % and 79.25 %, respectively, with a general kappa agreement index of 0.762. MAIN CONCLUSIONS Based on these results, IS6110-LAMP test showed considerable diagnostic parameters, being able to aid in the speed and accuracy of the final EPTB diagnosis.
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18
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Slail MJ, Booq RY, Al-Ahmad IH, Alharbi AA, Alharbi SF, Alotaibi MZ, Aljubran AM, Aldossary AM, Memish ZA, Alyamani EJ, Tawfik EA, Binjomah AZ. Evaluation of Xpert MTB/RIF Ultra for the Diagnosis of Extrapulmonary Tuberculosis: A Retrospective Analysis in Saudi Arabia. J Epidemiol Glob Health 2023; 13:782-793. [PMID: 37707714 PMCID: PMC10686912 DOI: 10.1007/s44197-023-00150-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023] Open
Abstract
The incidence of extrapulmonary tuberculosis (EPTB) in low- and middle-income countries, as well as, high-income countries has increased over the last two decades. The acid-fast bacillus (AFB) smear test is easy to perform and cost-effective with a quick turnaround time but the test has low sensitivity. Culture remains the gold standard for detecting TB; however, it has low sensitivity and slow bacterial growth patterns, as it may take up to 6 to 8 weeks to grow. Therefore, a rapid detection tool is crucial for the early initiation of treatment and ensuring an improved therapeutic outcome. Here, the Xpert Ultra system was developed as a nucleic acid amplification technique to accelerate the detection of MTB in paucibacillary clinical samples and endorsed by the World Health Organization. From March 2020 to August 2021, Xpert Ultra was evaluated for its sensitivity and specificity against EPTB and compared with those of the routinely used Xpert, culture, and AFB tests in 845 clinical samples in Saudi Arabia. The results indicate the overall sensitivity and specificity of Xpert Ultra to be 91% and 95%, respectively, compared with the Xpert (82% and 99%, respectively) and AFB smear (18% and 100%, respectively) tests. The results also indicated that despite the low microbial loads that were categorized as trace, very low, or low on Xpert Ultra, yet, complete detection was achieved with some sample types (i.e., 100% detection). Consequently, Xpert Ultra has great potential to replace conventional diagnostic approaches as a standard detection method for EPTB.
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Affiliation(s)
- Mousa J Slail
- Tuberculosis Department, Dammam Regional Laboratory, Ministry of Health, Dammam, Saudi Arabia
| | - Rayan Y Booq
- Wellness and Preventive Medicine Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), 11442, Riyadh, Saudi Arabia
| | - Ibrahim H Al-Ahmad
- Tuberculosis Department, Dammam Regional Laboratory, Ministry of Health, Dammam, Saudi Arabia
| | - Arwa A Alharbi
- Mycobacteriology Unit, Riyadh Regional Laboratory, Ministry of Health, 12746, Riyadh, Saudi Arabia
| | - Shafi F Alharbi
- Mycobacteriology Unit, Riyadh Regional Laboratory, Ministry of Health, 12746, Riyadh, Saudi Arabia
| | - Mutlaq Z Alotaibi
- Mycobacteriology Unit, Riyadh Regional Laboratory, Ministry of Health, 12746, Riyadh, Saudi Arabia
| | - Abdulaziz M Aljubran
- Mycobacteriology Unit, Riyadh Regional Laboratory, Ministry of Health, 12746, Riyadh, Saudi Arabia
| | - Ahmad M Aldossary
- Wellness and Preventive Medicine Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), 11442, Riyadh, Saudi Arabia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, 11533, Riyadh, Saudi Arabia
- Research & Innovation Center, King Saud Medical City, Riyadh, Saudi Arabia
- Hubert Department School of Public Health, Emory University, Atlanta, USA
- Division of Infectious Diseases, Kyung Hee University, Seoul, Korea
| | - Essam J Alyamani
- Wellness and Preventive Medicine Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), 11442, Riyadh, Saudi Arabia
| | - Essam A Tawfik
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), 11442, Riyadh, Saudi Arabia.
| | - Abdulwahab Z Binjomah
- Mycobacteriology Unit, Riyadh Regional Laboratory, Ministry of Health, 12746, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, 11533, Riyadh, Saudi Arabia.
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Shen Y, Fang L, Ye B, Yu G. Meta-analysis of diagnostic accuracy of nucleic acid amplification tests for abdominal tuberculosis. PLoS One 2023; 18:e0289336. [PMID: 38011098 PMCID: PMC10681219 DOI: 10.1371/journal.pone.0289336] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Abdominal tuberculosis (TB) is a severe extrapulmonary TB, which can lead to serious complications. Early diagnosis and treatment are very important for the prognosis and the diagnosis of abdominal TB is still difficult. METHODS We searched PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, and the Wanfang database for studies evaluating the diagnostic accuracy of NAATs for abdominal TB until August 2020. Any types of study design with full text were sought and included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Subgroup analysis, meta-regression analysis and sensitivity analysis were used to explore the sources of heterogeneity. Stata version 15.0 with the midas command packages was used to carry out meta-analyses. RESULTS We included a total of 78 independent studies from 53 articles; 64 with CRS as the reference standard, and 14 with culture as the reference standard. The pooled sensitivity, specificity, and the areas under summary receiver operating characteristic (SROC) curves (AUC) were 58% (51%-64%; I2 = 87%), 99% (97%-99%; I2 = 81%), and 0.92 (0.89-0.94) compared with CRS, respectively. The pooled sensitivity, specificity, and the AUC values of the SROC were 80% (66%-90%; I2 = 56%), 96% (92%-98%; I2 = 84%), and 0.97 (0.95-0.98) compared with culture, respectively. The heterogeneity of sensitivity and specificity was significant. CONCLUSIONS NAATs had excellent efficacy in the diagnosis of abdominal TB regardless of the reference standard and regardless of the subtype of abdominal TB. Multiplex PCR with multiple target genes may improve diagnostic sensitivity, and stool specimens may also be used for the diagnosis of abdominal TB in addition to tissue and ascites.
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Affiliation(s)
- Yanqin Shen
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Likui Fang
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bo Ye
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guocan Yu
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
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Shi T, Shou F, He Y, Zhou K, Gao W, Nie X, Han M, Liao C, Li T. Whole genome sequencing of drug resistance Mycobacterium tuberculosis from extra-pulmonary sites. Life Sci Alliance 2023; 6:e202302076. [PMID: 37591723 PMCID: PMC10435967 DOI: 10.26508/lsa.202302076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
This study aimed to determinate characteristics of drug resistance Mycobacterium tuberculosis from patients with extra-pulmonary tuberculosis (EPTB). Patients were retrospectively studied from January 2020 to December 2021. All the isolates were cultured, tested drug susceptibility, and detected the gene mutation using whole genome sequencing. The correlations of whole genome sequencing, pattern of DR, patients' distribution, and transmission were analyzed. 111 DR-EPTB isolates included pre-XDR-TB (53.2%), MDR-TB (29.7%), and poly-DR-TB (12.6%). The resistant drugs were INH followed by RFP and SM. The genotypes of 111 strains were lineage 2 and lineage 4. KatG_p.Ser315Thr was main gene mutation for resistance to INH; rpsL_p.Lys43Arg for SM, rpoB_p.Ser450Leu for rifampicin, embB_p.Met306Val for ethambutol, gyrA_p.Asp94Gly for FQs, and pncA_p.Thr76Pro for PZA. The residence was a significant risk factor for cluster transmission by patients and phenotypic DR types of strains for lineage 2 transmission. In the local area of southwest China INH, rifampicin and SM were main drugs in patients with DR-EPTB. KatG_p.Ser315, rpoB_p.Ser450Leu, and rpsL_p.Lys43Arg were main gene mutations. Phenotypic DR types and residence were main risk of transmission.
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Affiliation(s)
- Tao Shi
- Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China
| | - Fenyong Shou
- Department of Orthopedics, Tianjin First Central Hospital, Tianjin, China
| | - Ying He
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Kan Zhou
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Wenwan Gao
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiaoping Nie
- Medical Department, Chongqing Public Health Medical Center, Chongqing, China
| | - Mei Han
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Chuanyu Liao
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
| | - Tongxin Li
- Central Laboratory, Chongqing Public Health Medical Center, Chongqing, China
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Losev Y, Rubinstein M, Nissan I, Haviv P, Barsky Y, Volinsky M, Bar-Giora G, Zouher T, Hamawi M, Valenci GZ, Kutikov I, Shwartz HK, Dveyrin Z, Chemtob D, Rorman E. Genomic, phenotypic and demographic characterization of Mycobacterium tuberculosis in Israel in 2021. Front Cell Infect Microbiol 2023; 13:1196904. [PMID: 37928179 PMCID: PMC10622789 DOI: 10.3389/fcimb.2023.1196904] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
According to World Health Organization WHO, Tuberculosis (TB) is the second cause of death from infectious disease worldwide. During 2021, 10.6 million people were infected with TB, and 1.6 million people died. TB is caused by pathogens belonging to the Mycobacterium tuberculosis complex (MTBC), mainly by Mycobacterium tuberculosis (M.tb). Members of this complex are acid-fast bacilli, which can cause intrapulmonary and extra pulmonary TB, and can be divided into various lineages, based on genomic markers. The main public health threat comes from drug resistant M.tb strains, which are responsible for about 25% of TB death and treatment failure worldwide. Treating drug resistant TB patients significantly raises the costs of TB treatment. This study provides an overview of the demographic and drug susceptibility characteristics of newly diagnosed TB patients in Israel in 2021. The State of Israel has a very low level of TB endemicity and is at a pre-elimination phase. Notably, only 11.7% of the newly diagnosed TB patients were born in Israel. In this report, of the 154 new laboratory-confirmed TB patients, 66.7% had pulmonary TB, while 16% had extrapulmonary TB. Males accounted for 52% of the patients, with the most prevalent age group being 21-40. Most patients were citizens of Israel (53.9%), while 37.7% had no Israeli citizenship. Among non-citizens, there was a predominance of males and patients aged 21-40. The susceptibility profile showed a high resistance rate to streptomycin (18.2%) and to a lower extent to isoniazid (13.6%), pyrazinamide (8.4%), rifampicin (7.8%), and ethambutol (3.2%). Only 2 cases of XDR-TB and 10 MDR-TB strains were detected in Israel in 2021, with both XDR strains and 5 out of 10 MDR strains belonging to the Beijing lineage. Most of Beijing isolates were resistant to at least one tested drug. Genomic sequencing of 134 out of 156 strains and bioinformatics analysis using the MTBseq program and WHO mutation catalogue shows a good match with only 9 discrepancies between phenotypic and genotypic susceptibility profiles in first line drugs. The most common lineage is Delhi-Cas (23%) followed by the Beijing lineage (17%). Most patients from the Delhi-Cas lineage were born in Africa, while patients with Beijing isolates were born in different countries. Minimum spanning tree analysis identified 15 clusters. The study highlights the need for ongoing surveillance of TB using molecular and phenotypic tools to further decreasing the spreading level of the disease and develop effective treatment strategies.
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Affiliation(s)
- Yelena Losev
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Mor Rubinstein
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Israel Nissan
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Paz Haviv
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Yohi Barsky
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Martha Volinsky
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Gefen Bar-Giora
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Tamara Zouher
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Mazal Hamawi
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Gal Zizelski Valenci
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Ina Kutikov
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Hasia Kaidar Shwartz
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Zeev Dveyrin
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
| | - Daniel Chemtob
- Department of Tuberculosis (TB) and AIDS and National TB Program Manager, Ministry of Health, Jerusalem, Israel
- Hebrew University-Hadassah Faculty of Medicine, School of Public Health and Community Medicine, Jerusalem, Israel
| | - Efrat Rorman
- National Public Health Laboratory, Public Health Directorate, Ministry of Health, Tel Aviv, Israel
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Singh UB, Angitha KP, Bhatnagar A, Sharma S, Bir R, Singh K, Nabeta P, Ruhwald M, Kabra SK, Lodha R. GeneXpert Ultra in Urine Samples for Diagnosis of Extra-Pulmonary Tuberculosis. Curr Microbiol 2023; 80:361. [PMID: 37796343 DOI: 10.1007/s00284-023-03503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Extra-pulmonary tuberculosis (EPTB) continues to be difficult to diagnose. Novel biomarkers in biological specimens offer promise. Detection of Mycobacterium tuberculosis (Mtb) DNA in urine could prove useful in diagnosis of EPTB, possibly due to disseminated disease or micro-abscesses reported in kidneys. The current study was designed to detect Mtb DNA in stored urine samples from patients with EPTB. Diagnosis of EPTB was reached using Microbiological Reference Standards (MRS) on samples from the disease site using WHO Recommended Diagnostics (WRD), [smear microscopy, liquid culture (MGIT-960)] and GX (molecular WRD, mWRD) and Comprehensive reference standards [CRS, clinical presentation, microbiological reference standards, radiology, histopathology]. GX-Ultra was performed on urine samples stored in -80oC deep freezer, retrospectively. Of 70 patients, 51 (72.9%) were classified as confirmed TB, 11 (15.7%) unconfirmed TB, and 8 (11.4%) unlikely TB. GX-Ultra in urine samples demonstrated sensitivity of 52.9% and specificity of 57.9% against MRS, and higher sensitivity of 56.5% and specificity of 100% against CRS. The sensitivity and specificity of GX-Ultra in urine was 53.6% and 75% for pus sample subset and 52.2% and 53.3% for fluid sample subset. Urine being non-invasive and easy to collect, detection of Mtb DNA using mWRD in urine samples is promising for diagnosis of EPTB.
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Affiliation(s)
- Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - K P Angitha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anuj Bhatnagar
- Department of Tuberculosis and Chest Diseases, Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, New Delhi, India
| | - Sangeeta Sharma
- Department of Pediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Raunak Bir
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kiran Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pamela Nabeta
- The global alliance for diagnostics, FIND, Geneva, Switzerland
| | - Morten Ruhwald
- The global alliance for diagnostics, FIND, Geneva, Switzerland
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Bal HB, Kar S, Otta S, Kumar S, Samal S, Pattnaik A, Rout SS, Turuk J, Das D, Pati S, Giri S. Impact of cartridge-based nucleic acid amplification test (CBNAAT) introduction on the detection of pulmonary and extra-pulmonary tuberculosis in Bhubaneswar, Odisha. INDIAN J PATHOL MICR 2023; 66:764-769. [PMID: 38084529 DOI: 10.4103/ijpm.ijpm_666_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Compared to conventional microscopy, the cartridge-based nucleic acid amplification test (CBNAAT, Xpert MTB/RIF, Cepheid, USA) has the dual advantage of higher sensitivity to detect Mycobacterium tuberculosis (M. tb), and the ability to detect rifampicin resistance. Aim To evaluate the impact of the CBNAAT on the detection of pulmonary and extra-pulmonary tuberculosis from private and public healthcare facilities in Bhubaneswar, Odisha. Materials and Methods The study included specimens received between June 2015 to February 2017 from public and private health sectors for tuberculosis diagnosis at a national reference laboratory for tuberculosis in Bhubaneswar, where the CBNAAT was initiated in February 2016. We retrospectively collected the patients' socio-demographic characteristics from their test request form, CBNAAT results from the CBNAAT register and PMDT culture and drug susceptibility testing (DST) register and validated the data by comparing the patient details and test results from the CBNAAT software. Results From June 2015 to January 2016, 106 samples were received from Bhubaneswar at the reference laboratory, of which there were zero referrals from the private sector and zero referrals of extra-pulmonary tuberculosis (TB) samples. After initiation of the CBNAAT, from February 2016 to February 2017, 1262 specimens were received, of which 55.2% (696/1262), 17.8% (225/1262), 17.2% (217/1262), and 9.8% (124/1262) were from government hospitals and medical colleges, private hospitals, private practitioners, and district TB centers, respectively. Conclusion The availability of TB diagnostics at public sector facilities to patients from private sectors and the rollout of the CBNAAT increased the referral of patients from private health facilities and the referral of paucibacillary non-sputum samples.
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Affiliation(s)
| | - Sarita Kar
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sarita Otta
- Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sujeet Kumar
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Suryakanta Samal
- Department of Health and Family Welfare, Government of Odisha Microbiologist, Rayagada, Odisha, India
| | - Archana Pattnaik
- Biofuels and Bioprocessing Research Center, ITER, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Sunil Swick Rout
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jyotirmayee Turuk
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Dasarathi Das
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sidhartha Giri
- National Reference Laboratory (NRL) for Tuberculosis ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Andrews F, Welch S, Scandrett K, Kaur H, O'Shea MK, Dedicoat M. Outcomes of TB contact tracing and predictors of success: a 10-year retrospective cohort analysis in Birmingham, UK. Int J Tuberc Lung Dis 2023; 27:766-771. [PMID: 37749842 PMCID: PMC10519394 DOI: 10.5588/ijtld.22.0575] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND: Contacts of TB cases in Birmingham and Solihull, UK, are offered screening for TB infection. Between 1990 and 2010, only 59.1% of contacts completed screening. The service has since increased screening staff numbers, changed screening locations and increased screening follow-up. Our primary aim was to identify whether screening completion rates have improved. Our secondary aim was to identify predictors of screening completion.METHODS: This was a retrospective analysis of all contacts of TB patients in Birmingham and Solihull between 1 January 2011 and 31 December 2020, stratified by pulmonary and extrapulmonary TB (PTB or EPTB) index infection. Multiple logistic regression analysis for predictors of screening completion was performed.RESULTS: A total of 3,255 index cases and 27,820 contacts were identified. TB incidence has declined, in keeping with national trends. Screening completion has improved from 59.1% of contacts to 74.9% overall since service improvements were made, with improvement in screening completion for contacts of both PTB and EPTB index cases (OR 1.087, 95% CI 1.074-1.101; P < 0.001) and (OR 1.048, 95% CI 1.019-1.078; P = 0.001), respectively.CONCLUSIONS: Changes made to the TB service have improved screening outcomes over the last decade. Significant predictors of screening completion have been identified, highlighting areas for targeted resource allocation.
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Affiliation(s)
- F Andrews
- Warwick Medical School, University of Warwick, Warwick
| | - S Welch
- University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - K Scandrett
- Test Evaluation Research Group, Institute of Applied Health Research, and
| | - H Kaur
- University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - M K O'Shea
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - M Dedicoat
- Warwick Medical School, University of Warwick, Warwick, University Hospitals Birmingham NHS Foundation Trust, Birmingham
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25
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Wang T, Zhou C, Shang L, Zhou X. Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study. BMC Infect Dis 2023; 23:586. [PMID: 37674123 PMCID: PMC10483793 DOI: 10.1186/s12879-023-08568-3] [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: 06/01/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area. METHODS We collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables. RESULTS We included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15-44 years (OR 1.817; 95% CI 1.162-2.840; P < 0.01) and 45-59 years (OR 2.175; 95% CI 1.335-3.543; P < 0.01) had significantly higher incidences of drug resistance than children and the elderly. Patients with a cough of ≥ 2 weeks had a significantly higher chance of drug resistance than those with < 2 weeks or no cough symptoms (OR 2.069; 95% CI 1.234-3.469; P < 0.01). Alcoholism (OR 1.741; 95% CI 1.107-2.736; P < 0.05) and high bacterial counts on sputum acid-fast smears (OR 1.846; 95% CI 1.115-3.058; P < 0.05) were significant in the univariate analysis. CONCLUSIONS Sputum smear-positive TB predominated in Yi men (15-44 years) with high smoking, alcoholism, and HIV rates. Extrapulmonary TB, especially abdominal TB, prevailed. Recent drug resistance testing revealed higher rates in 15-59 age group and ≥ 2 weeks cough duration. Alcohol abuse and high sputum AFB counts correlated with drug resistance. Strengthen screening and supervision to curb TB transmission and drug-resistant cases in the region.
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Affiliation(s)
- Tao Wang
- Department of Radiology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, China
| | - Chaoxin Zhou
- Department of Radiology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, China
| | - Lan Shang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Xiyuan Zhou
- Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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26
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Brehm TT, Terhalle E. [Extrapulmonary tuberculosis]. Dtsch Med Wochenschr 2023; 148:1242-1249. [PMID: 37793616 DOI: 10.1055/a-1937-8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Extrapulmonary tuberculosis (TB) presents unique diagnostic and therapeutic challenges. The site of involvement can vary widely, with common sites including the lymph nodes, pleura, skin, ear, nose and throat, genitourinary system, pericardium, gastrointestinal tract, bones and joints, and central nervous system. Clinical manifestations of extrapulmonary TB are diverse and often non-specific. Diagnosis is based on a combination of clinical suspicion, imaging, histopathology, and microbiology. Treatment of extrapulmonary TB generally follows similar principles to pulmonary TB, but the duration of treatment depends on the site of involvement and the extent of the disease. Increased awareness among healthcare providers is essential for the timely recognition and effective management of extrapulmonary TB cases.
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27
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Niu T, He F, Yang J, Ma C, Xu J, Sun T, Zhang X, Chen S, Ru C. The epidemiological characteristics and infection risk factors for extrapulmonary tuberculosis in patients hospitalized with pulmonary tuberculosis infection in China from 2017 to 2021. BMC Infect Dis 2023; 23:488. [PMID: 37653382 PMCID: PMC10472653 DOI: 10.1186/s12879-023-08410-w] [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: 01/04/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) complicated with extrapulmonary tuberculosis (EPTB) infection can aggravate the disease, but there have been few reports. METHODS Retrospective analysis was used to collect the clinical data of PTB patients with pathogen positive in a teaching hospital from 2017 to 2021. We describe the incidence, the invasive site of EPTB patients, and analyze the infection risk factors for PTB with EPTB by univariate and multivariate logistic regression models. We also compared the complications, disease burden with chi-square test and rank-sum test. RESULTS A total of 1806 PTB were included, of which 263 (14.6%) were complicated with EPTB. The common invasive sites for EPTB were neck lymph nodes (16.49%), intestines (16.13%), and meninges (10.75%). Age ≤ 40 (OR = 1.735; 95%CI [1.267-2.376]; P = 0.001), malnutrition (OR = 2.029; 95%CI [1.097-3.753]; P = 0.022), anemia (OR = 1.739; 95%CI[1.127-2.683]; P = 0.012), and osteoporosis (OR = 4.147; 95%CI [1.577-10.905]; P = 0.004) were all independent risk factors for PTB infection with EPTB. The incidence of extrathoracic hydrothorax, intestinal bacterial infection, urinary tract bacterial infection, and abdominal bacterial infection were higher in patients with PTB with EPTB. PTB with EPTB patients also had longer median hospitalization durations (19 vs. 14 days), during which time they incurred higher total costs, laboratory test costs, imaging examination costs, and drug use costs. CONCLUSION This study found important risk factors for PTB complicated with EPTB, such as age ≤ 40, malnutrition, anemia, and osteoporosis. PTB with EPTB patients have more extrapulmonary complications and higher hospitalization disease burden.
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Affiliation(s)
- Tianshui Niu
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Fei He
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jianshe Yang
- Shanghai Research Center for Thyroid Diseases, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Chengxi Ma
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jingyi Xu
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Tianzhi Sun
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Xin Zhang
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Shuyi Chen
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Chuhui Ru
- Department of Pulmonary and Critical Care Medicine Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Chaw L, Mat Salleh L, Abdul Hamid R, Thu K. Epidemiology of extrapulmonary tuberculosis in Brunei Darussalam: a retrospective cohort study. BMJ Open 2023; 13:e073266. [PMID: 37612110 PMCID: PMC10450043 DOI: 10.1136/bmjopen-2023-073266] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES We reported the incidence and associated factors of extrapulmonary tuberculosis (EPTB). DESIGN A retrospective cohort study. SETTING Brunei Darussalam, an intermediate tuberculosis (TB)-burden country with stagnating annual TB rates. PARTICIPANTS All active TB cases identified in the country between January 2001 and December 2018 (18 years). PRIMARY AND SECONDARY OUTCOME MEASURES Annual proportions of EPTB (overall and specific) were calculated. Multiple logistic regression was done to investigate factors associated with developing EPTB, when compared with pulmonary TB (PTB). Χ2 trend test was used to determine any trends during the 18-year study period. RESULTS We identified 3916 TB cases, among which 743 (19.0%) were EPTB cases. Lymphatic (44.8%) and pleural (19.4%) EPTB were most common. The main modes of diagnosis were tissue biopsy (73.6%) and radiological assessment (18.3%). Treatment success and mortality rate were 79.7% and 7.0%, respectively. Associations with specific EPTB types varies with age-group and gender. Younger age-group (adjusted OR (aOR)≥1.94) and women (aOR: 2.45 (95% CI: 1.94 to 3.11)) had higher adjusted odds of developing lymphatic EPTB, but had lower adjusted odds of developing pleural EPTB (younger age-group (aOR≤0.54) and women (aOR: 0.41 (95% CI: 0.17 to 0.90)). When compared to foreign residents, locals had higher adjusted odds of skeletal (aOR: 4.44 (95% CI: 2.04 to 11.69)), gastrointestinal (aOR: 3.91 (95% CI: 1.84 to 9.66)) and other types of EPTB (aOR: 3.42 (95% CI: 1.53 to 9.14)). No significant trend differences were observed for overall and specific EPTB types. CONCLUSION Despite being generally non-infectious and less recognised than PTB, understanding EPTB epidemiology is important as it also contributes to the overall TB burden in a country. Examining EPTB cases by their specific anatomical site would provide more information on risk factors. Raising public awareness on the EPTB symptoms and that TB affects lungs and other parts of the body could promote early health seeking behaviour and early EPTB diagnosis.
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Affiliation(s)
- Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
| | - Lena Mat Salleh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- Disease Control Division, Department of Environmental Health Services, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
| | - Rafizah Abdul Hamid
- Disease Control Division, Department of Environmental Health Services, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
| | - Kyaw Thu
- Disease Control Division, Department of Environmental Health Services, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
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Kang W, Yu J, Liang C, Wang Q, Li L, Du J, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Yan X, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A. E, Du Y, Liu F, Cui W, Yang S, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Li Y, Dong Y, Tang S. Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China. Int J Clin Pract 2023; 2023:5562495. [PMID: 37609664 PMCID: PMC10442182 DOI: 10.1155/2023/5562495] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023] Open
Abstract
Background Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases are commonly observed clinically, knowledge regarding concurrent PTB-EPTB is limited. Here, a large-scale multicenter observational study conducted in China aimed to study the epidemiology of concurrent PTB-EPTB cases by diagnostically defining TB types and then implementing association rules analysis. Methods The retrospective study was conducted at 21 hospitals in 15 provinces in China and included all inpatients with confirmed TB diagnoses admitted from Jan 2011 to Dec 2017. Association rules analysis was conducted for cases with concurrent PTB and various types of EPTB using the Apriori algorithm. Results Evaluation of 438,979TB inpatients indicated PTB was the most commonly diagnosed (82.05%) followed by tuberculous pleurisy (23.62%). Concurrent PTB-EPTB was found in 129,422 cases (29.48%) of which tuberculous pleurisy was the most common concurrent EPTB type observed. The multivariable logistic regression models demonstrated that odds ratios of concurrent PTB-EPTB cases varied by gender and age group. For PTB cases with concurrent EPTB, the strongest association was found between PTB and concurrent bronchial tuberculosis (lift = 1.09). For EPTB cases with concurrent PTB, the strongest association was found between pharyngeal/laryngeal tuberculosis and concurrent PTB (lift = 1.11). Confidence and lift values of concurrent PTB-EPTB cases varied with gender and age. Conclusions Numerous concurrent PTB-EPTB case types were observed, with confidence and lift values varying with gender and age. Clinicians should screen for concurrent PTB-EPTB in order to improve treatment outcomes.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jiajia Yu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Chen Liang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Quanhong Wang
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Liang Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Jian Du
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Hongyan Chen
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Jianxiong Liu
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Mingwu Li
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Jingmin Qin
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Wei Shu
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Peilan Zong
- Jiangxi Chest (Third People) Hospital, No. 346 Dieshan Road, Donghu District, Nanchang, Jiangxi 330006, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing 400036, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, No. 2, Lakeside, Cangshan District, Fuzhou 350008, China
| | - Zaoxian Mei
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Qunyi Deng
- Third People's Hospital of Shenzhen, 29 Bulan Road, District Longgang, Shenzhen 518112, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wenge Han
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Meiying Wu
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Xinguo Zhao
- The Fifth People's Hospital of Wuxi, No. 1215, GuangRui Road, Wuxi 214001, China
| | - Lei Tan
- TB Hospital of Siping City, No. 10 Dongshan Road, Tiedong District, Siping, Jilin Province 136001, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Chao Zheng
- The First Affiliated of XiaMen University, ZhenhaiRoud, Siming District, Xiamen, Fujian, China
| | - Hongwei Liu
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Xinjie Li
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Ertai A.
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Yingrong Du
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Fenglin Liu
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Song Yang
- Chongqing Public Health Medical Center, No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing 400036, China
| | - Xiaohong Chen
- Fuzhou Pulmonary Hospital of Fujian, No. 2, Lakeside, Cangshan District, Fuzhou 350008, China
| | - Junfeng Han
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Qingyao Xie
- Third People's Hospital of Shenzhen, 29 Bulan Road, District Longgang, Shenzhen 518112, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Wenyu Liu
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Peijun Tang
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Jian Zheng
- The Fifth People's Hospital of Wuxi, No. 1215, GuangRui Road, Wuxi 214001, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiangyang Yao
- The First Affiliated of XiaMen University, ZhenhaiRoud, Siming District, Xiamen, Fujian, China
| | - Tong Ren
- Shenyang Chest Hospital, No. 11 Beihai Street, Dadong District, Shenyang110044, China
| | - Yan Li
- Guang Zhou Chest Hospital, No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou, Guangdong 510095, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, No. 106, Yan ‘An Road, Tianshan District, Urumqi, Xinjiang 830049, China
| | - Lei Wu
- The Third People's Hospital of Kunming, No. 319 Wu Jing Road, Kunming, Yunnan 650041, China
| | - Qiang Song
- Shandong Provincial Chest Hospital, No. 12, Lieshishandong Road, Licheng District, Jinan, Shandong 250000, China
| | - Mei Yang
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun, Jilin 130123, China
| | - Yuanyuan Liu
- Tianjin Haihe Hospital, Number 890, Shuanggangzhenjingu Road, Jinnan District, Tianjin 300350, China
| | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Kun Yan
- Weifang No. 2 People's Hospital, No. 7th Yuanxiao Street, Kuiwen District 261041, China
| | - Xinghua Shen
- The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Suzhou, Jiangsu 215000, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, No. 149 Delian Road, Zunyi, Guizhou 563000, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, No. 608 Dongfeng East Road, Lianchi District, Baoding, Hebei 071000, China
| | - Youcai Li
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - Yongkang Dong
- Taiyuan Fourth People's Hospital, Number 231, Xikuang Street, Wanbailin District, Taiyuan, Shanxi 030024, China
| | - Shenjie Tang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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Sasaninia K, Kelley M, Abnousian A, Owens J, Yoon S, Beever A, Kachour N, Yegiazaryan A, Kolloli A, Kumar R, Ramasamy S, Subbian S, Venketaraman V. Liposomal Glutathione Supplementation Mitigates Extrapulmonary Tuberculosis in the Liver and Spleen. Front Biosci (Elite Ed) 2023; 15:15. [PMID: 37743234 DOI: 10.31083/j.fbe1503015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/21/2022] [Revised: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Extrapulmonary tuberculosis (EPTB) accounts for a fifth of all Mycobacterium tuberculosis (M. tb) infections worldwide. The rise of multidrug resistance in M. tb alongside the hepatotoxicity associated with antibiotics presents challenges in managing and treating tuberculosis (TB), thereby prompting a need for new therapeutic approaches. Administration of liposomal glutathione (L-GSH) has previously been shown to lower oxidative stress, enhance a granulomatous response, and reduce the burden of M. tb in the lungs of M. tb-infected mice. However, the effects of L-GSH supplementation during active EPTB in the liver and spleen have yet to be explored. METHODS In this study, we evaluated hepatic glutathione (GSH) and malondialdehyde (MDA) levels, and the cytokine profiles of untreated and L-GSH-treated M. tb-infected wild type (WT) mice. Additionally, the hepatic and splenic M. tb burdens and tissue pathologies were also assessed. RESULTS L-GSH supplementation increased total hepatic levels and reduced GSH. A decrease in the levels of MDA, oxidized GSH, and interleukin (IL)-6 was also detected following L-GSH treatment. Furthermore, L-GSH supplementation was observed to increase interferon-gamma (IFN-γ) and tumor necrosis factor (TNF)-α production and decrease IL-10 levels. M. tb survival was significantly reduced in the liver and spleen following L-GSH supplementation. L-GSH treatment also provided a host-protective effect in the liver and spleen of M. tb-infected mice. CONCLUSIONS Overall, L-GSH supplementation elevated the levels of total and reduced forms of GSH in the liver and reduced the burden of M. tb by decreasing oxidative stress, enhancing the production of immunosupportive cytokines, and reducing the levels of immunosuppressive cytokines. These observed benefits highlight the potential of L-GSH supplementation during active EPTB and provide insight into novel therapeutic interventions against M. tb infections.
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Affiliation(s)
- Kayvan Sasaninia
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Melissa Kelley
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Arbi Abnousian
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - James Owens
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - SonYeol Yoon
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Abrianna Beever
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nala Kachour
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Aram Yegiazaryan
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Afsal Kolloli
- Public Health Research Institute at New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Ranjeet Kumar
- Public Health Research Institute at New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Santhamani Ramasamy
- Public Health Research Institute at New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Selvakumar Subbian
- Public Health Research Institute at New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Vishwanath Venketaraman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA
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Tri Wicaksana AAF, Bramantono B, Rusli M, Arfijanto MV, Hadi U. Puzzling Clinical Appearance of a Pancreatic Tuberculosis Case. Acta Med Indones 2023; 55:315-319. [PMID: 37915150] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Tuberculosis (TB) is generally known as an infectious disease caused by Mycobacterium tuberculosis. Not only the lungs, TB can also infect various other organs. Pancreatic TB is a rare manifestation of extrapulmonary TB infection accounting for only 0-4.7% of the total TB cases worldwide. It's still intricating for clinicians to diagnose pancreatic TB due to the extremely rare prevalence and non-specific clinical signs and symptoms. Herein we report a 71-year-old male patient complaining of jaundice and weight loss. Clinical condition, laboratory and tumor markers, also MRI imaging showed no abnormality. We made the diagnosis through histopathological examination of tissues extracted from bypass biliodigestive procedure, showing granulomas, along with confirmed bacteriological analysis with Ziehl Nelsen staining. This patient received Fixed Drug Combination (FDC) of anti-tuberculosis therapy for 6 months. The patient gained weight, had an improvement of serum bilirubin level and had no remaining lesion in abdominal CT scan.
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Dahiya B, Mehta N, Soni A, Mehta PK. Diagnosis of extrapulmonary tuberculosis by GeneXpert MTB/RIF Ultra assay. Expert Rev Mol Diagn 2023; 23:561-582. [PMID: 37318829 DOI: 10.1080/14737159.2023.2223980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Diagnosis of extrapulmonary tuberculosis (EPTB) is an arduous task owing to different anatomical locations, unusual clinical presentations, and sparse bacillary load in clinical specimens. Although GeneXpert® MTB/RIF is a windfall in TB diagnostics including EPTB, it yields low sensitivities but high specificities in many EPTB specimens. To further improve the sensitivity of GeneXpert®, GeneXpert® Ultra, a fully nested real-time PCR targeting IS6110, IS1081 and rpoB (Rv0664) has been endorsed by the WHO (2017), wherein melt curve analysis is utilized to detect rifampicin-resistance (RIF-R). AREA COVERED We described the assay chemistry/work design of Xpert Ultra and evaluated its performance in several EPTB types, that is, TB lymphadenitis, TB pleuritis, TB meningitis, and so on, against the microbiological reference standard or composite reference standard. Notably, Xpert Ultra exhibited better sensitivities than Xpert, but mostly at the compensation of specificity values. Moreover, Xpert Ultra exhibited low false-negative and false-positive RIF-R results, compared with Xpert. We also detailed other molecular tests, that is, Truenat MTBTM/TruPlus, commercial real-time PCR, line probe assay, and so on, for EPTB diagnosis. EXPERT OPINION A combination of clinical features, imaging, histopathological findings, and Xpert Ultra are adequate for definite EPTB diagnosis so as to initiate an early anti-tubercular therapy.
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Affiliation(s)
- Bhawna Dahiya
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
| | - Neeru Mehta
- Department of Medical Electronics, Ambedkar Delhi Skill & Entrepreneurship University, Shakarpur, New Delhi, India
| | - Aishwarya Soni
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
- Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal, Sonipat, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
- Microbiology Department, Faculty of Allied Health Sciences, SGT University, Budhera, Gurgaon, India
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Taylan M, Dogru S, Sezgi C, Yilmaz S. Epidemiological trends and seasonal dynamics of tuberculosis in Southeastern Turkey. Niger J Clin Pract 2023; 26:928-933. [PMID: 37635576 DOI: 10.4103/njcp.njcp_629_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Tuberculosis (TB) is an important public health issue. Determining TB trend and seasonal variability provides useful information for designing treatment strategies and control programs. Aim The present study attempts to investigate the epidemiological trend and the seasonal variations. Materials and Methods TB data containing 2450 cases were collected over a period of seven years in the province of Diyarbakir in southeast Turkey. Trend function and seasonal variability were investigated by statistical curve fitting, surface fitting, and autoregressive time series analysis. Results The study revealed a gradually decreasing trend in the number of TB cases over a period of seven years. Total TB incidence had seasonal variations (P = 0.04); there was a greater number of TB cases between April and July, with a peak in June. There were significant monthly seasonal variations with June peaks among females (P < 0.001), in patients in the age groups of 0-15 (P < 0.001) and 36-45 years (P < 0.001), in new cases (P < 0.001) and in the patients with pulmonary TB (P = 0.01). The extra-pulmonary TB cases peak in May (P = 0.01). Pulmonary TB and TB patients in the 36-45 age group had summer peak, while the other groups peaked at spring. Conclusions Spring and summer peaks detected in total TB cases and in many subgroups indicate that multicenter and comprehensive clinical studies are needed to explain these variations.
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Affiliation(s)
- M Taylan
- Department of Chest Disease, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - S Dogru
- Department of Chest Disease, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - C Sezgi
- Department of Chest Disease, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - S Yilmaz
- Department of Chest Disease, Dicle University Faculty of Medicine, Diyarbakir, Turkey
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Yu Y, Yu Q, Shen KR, Xu DT, Hu W, Li SY, Cai QS, Chen Y. New-onset extrapulmonary tuberculosis in negative latent tuberculosis infection screening patients with Crohn's disease under anti-TNF therapy in a tuberculosis-endemic region: A case series. J Dig Dis 2023; 24:369-375. [PMID: 37464547 DOI: 10.1111/1751-2980.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Yue Yu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiao Yu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ke Ren Shen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ding Ting Xu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wen Hu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shu Yan Li
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qing Shan Cai
- Zhengjiang Tuberculosis Diagnosis and Treatment Center, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, China
| | - Yan Chen
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Rager N, Stévart O, Ziereisen F, Van den Wijngaert S, Mouchet F, Dreesman A. A Rare Case of Extrapulmonary Tuberculosis in a Teenager. Pediatr Infect Dis J 2023; 42:e188-e189. [PMID: 36795571 DOI: 10.1097/inf.0000000000003860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Noa Rager
- Department of Pediatrics, CHU St Pierre, Brussels, Belgium, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Oriane Stévart
- Department of Pediatrics, CHU St Pierre, Brussels, Belgium
| | | | - Sigi Van den Wijngaert
- Department of Microbiology, Laboratoire Hospitalier Universitaire Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB) Site Hallepoort, Brussels, Belgium
| | | | - Alexandra Dreesman
- Department of Pediatrics, CHU St Pierre, Brussels, Belgium, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Jia QJ, Zeng MC, Cheng QL, Huang YY, Wu YF, Li QC, Wang L, Ai LY, Fang ZJ, Cheng S, Shu LP. The Retrospective Diagnostic Potential of GeneXpert MTB/RIF for the Analysis of Formalin-Fixed Paraffin-Embedded Tissue from Extrapulmonary Tuberculosis Patients. Biomed Environ Sci 2023; 36:295-298. [PMID: 37005084 DOI: 10.3967/bes2023.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/13/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Qing Jun Jia
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Mei Chun Zeng
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Qing Lin Cheng
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Yin Yan Huang
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Yi Fei Wu
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Qing Chun Li
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Le Wang
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Li Yun Ai
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Zi Jian Fang
- Department of TB Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Shi Cheng
- Department of Microbiological Examination, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
| | - Li Ping Shu
- Department of Nutrition and Food Safety, Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, Zhejiang, China
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Dabitao D, Bishai WR. Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes. Curr Top Microbiol Immunol 2023; 441:139-183. [PMID: 37695428 DOI: 10.1007/978-3-031-35139-6_6] [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] [Indexed: 09/12/2023]
Abstract
Tuberculosis remains a daunting public health concern in many countries of the world. A consistent observation in the global epidemiology of tuberculosis is an excess of cases of active pulmonary tuberculosis among males compared with females. Data from both humans and animals also suggest that males are more susceptible than females to develop active pulmonary disease. Similarly, male sex has been associated with poor treatment outcomes. Despite this growing body of evidence, little is known about the mechanisms driving sex bias in tuberculosis disease. Two dominant hypotheses have been proposed to explain the predominance of active pulmonary tuberculosis among males. The first is based on the contribution of biological factors, such as sex hormones and genetic factors, on host immunity during tuberculosis. The second is focused on non-biological factors such as smoking, professional exposure, and health-seeking behaviors, known to be influenced by gender. In this chapter, we review the literature regarding these two prevailing hypotheses by presenting human but also experimental animal studies. In addition, we presented studies aiming at examining the impact of sex and gender on other clinical forms of tuberculosis such as latent tuberculosis infection and extrapulmonary tuberculosis, which both appear to have their own specificities in relation to sex. We also highlighted potential intersections between sex and gender in the context of tuberculosis and shared future directions that could guide in elucidating mechanisms of sex-based differences in tuberculosis pathogenesis and treatment outcomes.
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Affiliation(s)
- Djeneba Dabitao
- Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University Clinical Research Center (UCRC), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - William R Bishai
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
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Liu QX, Tang DY, Xiang X, He JQ. Associations between nutritional and immune status and clinicopathologic factors in patients with tuberculosis: A comprehensive analysis. Front Cell Infect Microbiol 2022; 12:1013751. [PMID: 36506012 PMCID: PMC9731357 DOI: 10.3389/fcimb.2022.1013751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/07/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study was designed to assess and analyze nutritional status (NS) and immune status in patients with tuberculosis. Methods A retrospective analysis was conducted on 93 TB patients hospitalized in the tuberculosis ward of the West China Hospital of Sichuan University. Subgroup comparisons were made according to age (<65 years and ≥65 years), nutritional risk score 2002 (NRS 2002 <3 and ≥3), tuberculosis location [pulmonary tuberculosis and extrapulmonary tuberculosis (including pulmonary tuberculosis complicated with extrapulmonary tuberculosis)], and prognostic nutrition index (PNI) (<45 vs ≥45). Results Significantly increased weight loss was associated with extrapulmonary tuberculosis (P =0.0010). Serum albumin (P =0.0214), total lymphocyte count (P = 0.0009) and PNI (P = 0.0033) were significantly decreased in older patients. Neutrophils/lymphocytes (NLR) (P =0.0002), monocytes/lymphocytes (MLR) (P < 0.0001), and platelets/lymphocytes (PLR) (P =0.0107) were higher. According to NRS 2002, higher nutritional risk was associated with lower body weight and body mass index (BMI) (P < 0.0001), higher weight loss (P = 0.0012), longer duration of hospitalization (P =0.0100), lower serum albumin level and hemoglobin concentration (P <0.01), lower creatinine level, and lower PNI (P < 0.01). 0.0001), lower total lymphocyte count (P = 0.0004), higher neutrophil and monocyte counts (P <0.05), and higher NLR (P = 0.0002), MLR (P = 0.0006), and PLR (P = 0.0156). Lower PNI was associated with lower body weight (P = 0.0001) and BMI (P =0.0074), lower total protein, albumin, and hemoglobin concentrations (P < 0.0001), and lower total lymphocyte count (P < 0.0001) and creatinine levels (P = 0.0336), higher age (P =0.0002) and NRS 2002 score, P < 0.0001), longer hos-pital stay (P = 0.0003), higher neutrophil count (P = 0.0042), and NLR, MLR, and PLR (P <0.0001) were significantly correlated. In multivariate logistic regression analysis, weight loss (OR: 0.209, 95% CI: 0.060-0.722; p =0.013) was significantly associated with higher nutritional risk (NRS 2002≥3). In multiple linear regression analysis, the NRS 2002 score was higher (B=2.018; p =0.023), and extrapulmonary tuberculosis (B=-6.205; p =0.007) was linked with a longer duration of hos-pitalization. Conclusions Older tuberculosis patients are at nutritional risk, and older patients (≥65 years old) need to pay attention to nutritional monitoring and intervention. Older TB patients and those at risk of malnutrition have increased immune ratio and impaired immune function. Management of TB patients using basic diagnostic tools to assess nutritional and immune status and calculate PNI and immunological indexes (NLR, MLR, PLR) to improve treatment outcomes.
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Affiliation(s)
- Quan-Xian Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dao-Yan Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Xiang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
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