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Rodríguez-Molino P, Tebruegge M, Noguera-Julian A, Neth O, Fidler K, Brinkmann F, Sainz T, Ivaskeviciene I, Ritz N, Brito MJ, Milheiro Silva T, Chechenieva V, Serdiuk M, Lancella L, Russo C, Soler-García A, Navarro ML, Krueger R, Feiterna-Sperling C, Starshinova A, Hiteva A, Hoffmann A, Kalibatas P, Lo Vecchio A, Scarano SM, Bustillo M, Blázquez Gamero D, Espiau M, Buonsenso D, Falcón L, Turnbull L, Colino E, Rueda S, Buxbaum C, Carazo B, Alvarez C, Dapena M, Piqueras A, Velizarova S, Ozere I, Götzinger F, Pareja M, Garrote Llanos MI, Soto B, Rodríguez Martín S, Korta JJ, Pérez-Gorricho B, Herranz M, Hernández-Bartolomé Á, Díaz-Almirón M, Kohns Vasconcelos M, Ferreras-Antolín L, Santiago-García B. Tuberculosis disease in immunocompromised children and adolescents: a pTBnet multi-centre case-control study. Clin Infect Dis 2024:ciae158. [PMID: 38568992 DOI: 10.1093/cid/ciae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND In high-resource settings the survival of immunocompromised (IC) children has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools and outcome of IC children with TB in Europe. METHODS Multicentre, matched case-control study within the Paediatric Tuberculosis Network European Trials Group (ptbnet), capturing TB cases <18 years diagnosed 2000-2020. RESULTS 417 TB cases were included, comprising 139 children with IC (HIV, inborn errors of immunity, drug-induced immunosuppression and other immunocompromising conditions) and 278 non-IC children as controls. Non-respiratory TB was more frequent among cases than controls (32.4% vs. 21.2%; p = 0.013). IC patients had an increased likelihood of presenting with severe disease (57.6% vs. 38.5%; p < 0.001; OR [95% CI]: 2.073 [1.37-3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs. 6.0%; p < 0.001) and QuantiFERON-TB Gold assay (30.0% vs. 7.3%; p < 0.001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs. 49.3%; p = 0.083). Although the mortality in IC children was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs. 6.1%; p = 0.004). CONCLUSIONS IC children with TB disease in Europe have increased rates of non-respiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in IC patients, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies.
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Affiliation(s)
- Paula Rodríguez-Molino
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain. La Paz Research Institute (IdiPAZ), Madrid, Spain. Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Tebruegge
- Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Great Ormond Street Institute of Child Health, Department of Infection, Immunity & Inflammation, University College London, London, United Kingdom
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica (RITIP) Seville, Spain
| | - Katy Fidler
- Paediatric Infectious Diseases Department, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| | - Folke Brinkmann
- Department of Pediatric Pneumology, Allergology and CF Center, University Children's Hospital Bochum, Bochum, Germany
| | - Talia Sainz
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain. La Paz Research Institute (IdiPAZ), Madrid, Spain. Faculty of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inga Ivaskeviciene
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Nicole Ritz
- Department of Paediatrics & Paediatric Infectious Diseases, Children's Hospital of Central Switzerland, Lucerne, Switzerland. Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research University of Basel, Basel, Switzerland
| | - Maria Joao Brito
- Infectious diseases Unit, Pediatrics department. Hospital Dona Estefânia. Centro Hospitalar e Universitário Lisboa Central. Lisboa. Portugal
| | - Tiago Milheiro Silva
- Infectious diseases Unit, Pediatrics department. Hospital Dona Estefânia. Centro Hospitalar e Universitário Lisboa Central. Lisboa. Portugal
| | - Vira Chechenieva
- Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
- Centre for Treatment Children with HIV/AIDS, National Specialised Children's Hospital "OKHMATDYT", Kyiv, Ukraine
- Pediatric TB Department, National institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine, Kyiv, Ukraine
| | - Maryna Serdiuk
- Centre for Treatment Children with HIV/AIDS, National Specialised Children's Hospital "OKHMATDYT", Kyiv, Ukraine
| | - Laura Lancella
- Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cristina Russo
- Virology and Mycobacteria Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Aleix Soler-García
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Maria Luisa Navarro
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Renate Krueger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Cornelia Feiterna-Sperling
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Starshinova
- St. Petersburg Research Institute of Phthisiopulmonology, Russia
| | - Antonina Hiteva
- St. Petersburg Research Institute of Phthisiopulmonology, Russia
| | - Anna Hoffmann
- Department of Pediatric Pneumology, Allergology and CF Center, University Children's Hospital Bochum, Bochum, Germany
| | - Paulius Kalibatas
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrea Lo Vecchio
- Pediatric Infectious Disease Unit, University Hospital Policlinico "Federico II" and Department of Translational Medical Sciences - Section of Pediatrics, University of Naples "Federico II", Italy
| | - Sara Maria Scarano
- Pediatric Infectious Disease Unit, University Hospital Policlinico "Federico II" and Department of Translational Medical Sciences - Section of Pediatrics, University of Naples "Federico II", Italy
| | - Matilde Bustillo
- Pediatrics Infectious Diseases Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Daniel Blázquez Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - María Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lola Falcón
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica (RITIP) Seville, Spain
| | | | - Elena Colino
- Pediatric Infectious Diseases Unit, Complejo Hospitalario Insular Materno Infantil Las Palmas, Las Palmas de Gran Canaria
| | - Santiago Rueda
- Department of Pediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Charlotte Buxbaum
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Begoña Carazo
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario Regional de Málaga, Málaga, Spain
| | - Cristina Alvarez
- Pediatrics Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Marta Dapena
- Pediatric Infectious Diseases Unit, Hospital General de Castellón, Castellón, Spain
| | - Anabel Piqueras
- Pediatrics Department, Hospital Universitario La Fe, Valencia, Spain
| | - Svetlana Velizarova
- Children's Clinic, Department of Pulmonary Diseases, MHATLD "St Sofia", Medical University Sofia, Sofia, Bulgaria
| | - Iveta Ozere
- Centre of Tuberculosis and Lung Diseases of Riga Eastern Clinical University Hospital, Latvia
| | - Florian Götzinger
- Department of Paediatrics & National Reference Centre for Paediatric Tuberculosis, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - Marta Pareja
- Pediatrics Department, Albacete University Hospital, Albacete, Spain
| | | | - Beatriz Soto
- Pediatrics Department, Getafe University Hospital, Getafe, Spain
| | - Sonia Rodríguez Martín
- Pediatrics Department, Príncipe de Asturias University Hospital, Alcalá de Henares, Spain. Medicine Department, Faculty of Medicine, University of Alcalá, Spain
| | - Jose Javier Korta
- Pediatrics Department, Donostia University Hospital, San Sebastián, Spain
| | - Beatriz Pérez-Gorricho
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mercedes Herranz
- Pediatrics Department, Navarra University Hospital, Navarra, Spain
| | - Ángel Hernández-Bartolomé
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain
| | | | - Malte Kohns Vasconcelos
- Institute for Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Ferreras-Antolín
- Paediatric Infectious Diseases and Immunodeficiencies Unit. St. George's University Hospital, NHS Foundation Trust. London, United Kingdom
| | - Begoña Santiago-García
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. UDIMIFFA, Gregorio Marañón Research Health Institute (IiSGM), UCM, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Ulanova V, Kivrane A, Viksna A, Pahirko L, Freimane L, Sadovska D, Ozere I, Cirule A, Sevostjanovs E, Grinberga S, Bandere D, Ranka R. Effect of NAT2, GSTM1 and CYP2E1 genetic polymorphisms on plasma concentration of isoniazid and its metabolites in patients with tuberculosis, and the assessment of exposure-response relationships. Front Pharmacol 2024; 15:1332752. [PMID: 38584604 PMCID: PMC10995391 DOI: 10.3389/fphar.2024.1332752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Objectives: Isoniazid is a key drug in the chemotherapy of tuberculosis (TB), however, interindividual variability in pharmacokinetic parameters and drug plasma levels may affect drug responses including drug induced hepatotoxicity. The current study investigated the relationships between isoniazid exposure and isoniazid metabolism-related genetic factors in the context of occurrence of drug induced hepatotoxicity and TB treatment outcomes. Methods: Demographic characteristics and clinical information were collected in a prospective TB cohort study in Latvia (N = 34). Time to sputum culture conversion (tSCC) was used as a treatment response marker. Blood plasma concentrations of isoniazid (INH) and its metabolites acetylisoniazid (AcINH) and isonicotinic acid (INA) were determined at three time points (pre-dose (0 h), 2 h and 6 h after drug intake) using liquid chromatography-tandem mass spectrometry. Genetic variations of three key INH-metabolizing enzymes (NAT2, CYP2E1, and GSTM1) were investigated by application PCR- and Next-generation sequencing-based methods. Depending on variables, group comparisons were performed by Student's t-test, one-way ANOVA, Mann-Whitney-Wilcoxon, and Kruskal-Wallis tests. Pearson correlation coefficient was calculated for the pairs of normally distributed variables; model with rank transformations were used for non-normally distributed variables. Time-to-event analysis was performed to analyze the tSCC data. The cumulative probability of tSCC was obtained using Kaplan-Meier estimators. Cox proportional hazards models were fitted to estimate hazard rate ratios of successful tSCC. Results: High TB treatment success rate (94.1%) was achieved despite the variability in INH exposure. Clinical and demographic factors were not associated with either tSCC, hepatotoxicity, or INH pharmacokinetics parameters. Correlations between plasma concentrations of INH and its metabolites were NAT2 phenotype-dependent, while GSTM1 genetic variants did not showed any effects. CYP2E1*6 (T > A) allelic variant was associated with INH pharmacokinetic parameters. Decreased level of AcINH was associated with hepatotoxicity, while decreased values of INA/INH and AcINH/INH were associated with month two sputum culture positivity. Conclusion: Our findings suggest that CYP2E1, but not GSTM1, significantly affects the INH pharmacokinetics along with NAT2. AcINH plasma level could serve as a biomarker for INH-related hepatotoxicity, and the inclusion of INH metabolite screening in TB therapeutic drug monitoring could be beneficial in clinical studies for determination of optimal dosing strategies.
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Affiliation(s)
- Viktorija Ulanova
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Agnija Kivrane
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Anda Viksna
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
- Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Upeslejas, Latvia
| | - Leonora Pahirko
- Faculty of Physics, Mathematics, and Optometry, University of Latvia, Riga, Latvia
| | - Lauma Freimane
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Darja Sadovska
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Iveta Ozere
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
- Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Upeslejas, Latvia
| | - Andra Cirule
- Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Upeslejas, Latvia
| | | | | | - Dace Bandere
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Renate Ranka
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
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3
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Vīksna A, Sadovska D, Berge I, Bogdanova I, Vaivode A, Freimane L, Norvaiša I, Ozere I, Ranka R. Genotypic and phenotypic comparison of drug resistance profiles of clinical multidrug-resistant Mycobacterium tuberculosis isolates using whole genome sequencing in Latvia. BMC Infect Dis 2023; 23:638. [PMID: 37770850 PMCID: PMC10540372 DOI: 10.1186/s12879-023-08629-7] [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: 02/28/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in many high tuberculosis (TB) burden countries. Phenotypic drug susceptibility testing (DST) take several weeks or months to result, but line probe assays and Xpert/Rif Ultra assay detect a limited number of resistance conferring gene mutations. Whole genome sequencing (WGS) is an advanced molecular testing method which theoretically can predict the resistance of M. tuberculosis (Mtb) isolates to all anti-TB agents through a single analysis. METHODS Here, we aimed to identify the level of concordance between the phenotypic and WGS-based genotypic drug susceptibility (DS) patterns of MDR-TB isolates. Overall, data for 12 anti-TB medications were analyzed. RESULTS In total, 63 MDR-TB Mtb isolates were included in the analysis, representing 27.4% of the total number of MDR-TB cases in Latvia in 2012-2014. Among them, five different sublineages were detected, and 2.2.1 (Beijing group) and 4.3.3 (Latin American-Mediterranean group) were the most abundant. There were 100% agreement between phenotypic and genotypic DS pattern for isoniazid, rifampicin, and linezolid. High concordance rate (> 90%) between phenotypic and genotypic DST results was detected for ofloxacin (93.7%), pyrazinamide (93.7%) and streptomycin (95.4%). Phenotypic and genotypic DS patterns were poorly correlated for ethionamide (agreement 56.4%), ethambutol (85.7%), amikacin (82.5%), capreomycin (81.0%), kanamycin (85.4%), and moxifloxacin (77.8%). For capreomycin, resistance conferring mutations were not identified in several phenotypically resistant isolates, and, in contrary, for ethionamide, ethambutol, amikacin, kanamycin, and moxifloxacin the resistance-related mutations were identified in several phenotypically sensitive isolates. CONCLUSIONS WGS is a valuable tool for rapid genotypic DST for all anti-TB agents. For isoniazid and rifampicin phenotypic DST potentially can be replaced by genotypic DST based on 100% agreement between the tests. However, discrepant results for other anti-TB agents limit their prescription based solely on WGS data. For clinical decision, at the current level of knowledge, there is a need for combination of genotypic DST with modern, validated phenotypic DST methodologies for those medications which did not showed 100% agreement between the methods.
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Affiliation(s)
- Anda Vīksna
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Ropaži Municipality, Stopiņi Parish, Upeslejas, Latvia
- Rīga Stradiņš University, Riga, Latvia
| | - Darja Sadovska
- Latvian Biomedical Research and Study Centre, Ratsupites Str. 1, Riga, LV-1067, Latvia
| | - Iveta Berge
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Ropaži Municipality, Stopiņi Parish, Upeslejas, Latvia
| | - Ineta Bogdanova
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Ropaži Municipality, Stopiņi Parish, Upeslejas, Latvia
| | - Annija Vaivode
- Latvian Biomedical Research and Study Centre, Ratsupites Str. 1, Riga, LV-1067, Latvia
| | - Lauma Freimane
- Latvian Biomedical Research and Study Centre, Ratsupites Str. 1, Riga, LV-1067, Latvia
| | - Inga Norvaiša
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Ropaži Municipality, Stopiņi Parish, Upeslejas, Latvia
| | - Iveta Ozere
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Ropaži Municipality, Stopiņi Parish, Upeslejas, Latvia
- Rīga Stradiņš University, Riga, Latvia
| | - Renāte Ranka
- Latvian Biomedical Research and Study Centre, Ratsupites Str. 1, Riga, LV-1067, Latvia.
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4
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Buonsenso D, Noguera-Julian A, Moroni R, Hernández-Bartolomé A, Fritschi N, Lancella L, Cursi L, Soler-Garcia A, Krüger R, Feiterna-Sperling C, Sali M, Lo Vecchio A, Scarano S, Hernanz Lobo A, Espiau M, Soriano-Arandes A, Cetin BS, Brinkmann F, Ozere I, Baquero-Artigao F, Tsolia M, Milheiro Silva T, Bustillo-Alonso M, Martín Nalda A, Mancini M, Starshinova A, Ritz N, Velizarova S, Ferreras-Antolín L, Götzinger F, Bilogortseva O, Chechenyeva V, Tebruegge M, Santiago-García B. Performance of QuantiFERON-TB Gold Plus assays in paediatric tuberculosis: a multicentre PTBNET study. Thorax 2023; 78:288-296. [PMID: 36283826 DOI: 10.1136/thorax-2022-218929] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Abstract
RATIONALE In 2016, a new interferon-gamma release assay (IGRA) was introduced, QuantiFERON-TB Gold Plus (QFT-Plus), claimed to have improved sensitivity in active tuberculosis (TB). OBJECTIVES This study aimed to determine the performance of QFT-Plus, compared with previous generation IGRAs and the tuberculin skin test (TST), in children with TB in Europe. METHODS Multicentre, ambispective cohort study within the Paediatric Tuberculosis Network European Trials Group (ptbnet), a dedicated paediatric TB research network comprising >300 members, capturing TB cases <18 years-of-age diagnosed between January 2009 and December 2019. MEASUREMENTS AND MAIN RESULTS 1001 TB cases from 16 countries were included (mean age (IQR) 5.6 (2.4-12.1) years). QFT-Plus was performed in 358, QFT Gold in-Tube (QFT-GIT) in 600, T-SPOT.TB in 58 and TST in 636 cases. The overall test sensitivities were: QFT-Plus 83.8% (95% CI 80.2% to 87.8%), QFT-GIT 85.5% (95% CI 82.7% to 88.3%), T-SPOT.TB 77.6% (95% CI 66.9% to 88.3%) and TST (cut-off ≥10 mm) 83.3% (95% CI 83.3% to 86.2%). There was a trend for tests to have lower sensitivity in patients with miliary and/or central nervous system (CNS) TB (73.1%, 70.9%, 63.6% and 43.5%, respectively), and in immunocompromised patients (75.0%, 59.6%, 45.5% and 59.1%, respectively). CONCLUSIONS The results indicate that the latest generation IGRA assay, QFT-Plus, does not perform better than previous generation IGRAs or the TST in children with TB disease. Overall, tests performed worse in CNS and miliary TB, and in immunocompromised children. None of the tests evaluated had sufficiently high sensitivity to be used as a rule-out test in children with suspected TB.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Milano, Italy.,Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain
| | - Rossana Moroni
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angel Hernández-Bartolomé
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas {CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Laura Lancella
- Paediatric Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Cursi
- Paediatric Infectious Diseases Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - Aleix Soler-Garcia
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Cornelia Feiterna-Sperling
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Michela Sali
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Milano, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Sara Scarano
- Department of Translational Medical Sciences, Pediatric Infectious Diseases Unit, University of Naples Federico II, Naples, Italy
| | - Alicia Hernanz Lobo
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas {CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Benhur Sirvan Cetin
- Department of Pediatric Infectious Diseases, Erciyes University, Kayseri, Turkey
| | - Folke Brinkmann
- Department of Paediatric Pulmonology, Children's Hospital, Ruhr-University, Bochum, Germany
| | | | - Fernando Baquero-Artigao
- Red de Investigación Translacional en Infectología Pediátrica, Madrid, Spain.,Hospital Infantil La Paz, Madrid, Spain.,CIBERINFEC, ISCIII, Madrid, Spain
| | - Maria Tsolia
- Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | | | | | - Andrea Martín Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Margherita Mancini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Anna Starshinova
- St. Petersburg Scientific Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital Basel and Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital Lucerne Lucerne Cantonal Hospital, Lucerne, Switzerland.,Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | | | - Laura Ferreras-Antolín
- Paediatric Infectious Diseases Unit, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Florian Götzinger
- Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Klinik Ottakring, Vienna, Austria
| | - Olga Bilogortseva
- Ukraine. Department of Children Phthisiology, National Institution of Phthisiology and Pulmonology of National Academy of Medical sciences of Ukraine, Kiev, Ukraine.,Infectious diseases Centre «Clinic for treatment of children with HIV/AIDS» National Specialized Children's Hospital 'OKHMATDYT', Kiev, Ukraine
| | - Vira Chechenyeva
- Ukraine. Department of Children Phthisiology, National Institution of Phthisiology and Pulmonology of National Academy of Medical sciences of Ukraine, Kiev, Ukraine.,Infectious diseases Centre «Clinic for treatment of children with HIV/AIDS» National Specialized Children's Hospital 'OKHMATDYT', Kiev, Ukraine
| | - Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Begoña Santiago-García
- Paediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain. Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas {CIBER INFEC), Instituto de Salud Carlos III, Madrid, Spain
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5
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Sadovska D, Nodieva A, Pole I, Ķimsis J, Vīksna A, Ozere I, Norvaiša I, Bandere D, Ranka R. Advantages of analysing both pairwise SNV-distance and differing SNVs between Mycobacterium tuberculosis isolates for recurrent tuberculosis cause determination. Microb Genom 2023; 9. [PMID: 36951900 PMCID: PMC10132068 DOI: 10.1099/mgen.0.000956] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Endogenous reactivation and exogenous reinfection are two possible causes of recurrent tuberculosis (TB). However, in some cases, precise cause determination can be challenging. In this study, we used whole genome sequencing to determine pairwise SNV distances and detect differing SNVs in initial and subsequent isolates for recurrent TB cases when the first and second episodes were caused by Mycobacterium tuberculosis (Mtb) strains with an identical spoligotype pattern. In total, 104 Mtb isolates from 36 recurrent TB and 16 single TB episode patients were included in the study. Most isolate pairs belonged to the SIT1 (n=21), SIT42 (n=9), SIT53 (n=9), and SIT254 (n=7) spoligotypes, and in 27 cases, resistance to at least one anti-TB drug was found in either isolate. Drug susceptibility was more common in the recurrent TB patient cohort, and longitudinal single TB episode isolates were more prone to be drug-resistant (p=0.03), while the association between patient cohort and spoligotype was not statistically significant (p=0.07). The pairwise SNV-distance between the longitudinal single TB episode isolates was small (0-7 SNVs). Among the recurrent TB isolates, based on the high SNV-distance (38-273 SNVs), six reinfection cases (16.7%) were identified. This distance was small (<10 SNVs) in the remaining 30 isolate pairs. Further analysis of differing SNVs revealed that 22 (61.1%) cases could be classified as possible reactivation. Notably, despite the small distance of 2-7 SNVs, initial isolates of eight patients (22.2%) had several SNVs that were not found in the second isolates; therefore, these cases were classified as reinfection with a closely related Mtb strain. No statistically significant difference in the time interval between specimen collection in the reactivation and reinfection Mtb sample groups (p=0.13) or an association between recurrence cause and drug resistance status (p=0.62) or spoligotype (p=0.79) could be detected. The mycobacterial median mutation rate of longitudinal single TB episodes and possible reactivation isolate pairs (n=37) was 0.12 SNVs/genome/year (IQR 0-0.39), and in 18 cases (48.6%), it was equal to zero. No statistically significant differences in mutation rate were found between recurrent TB and longitudinal single TB episode isolates (p=0.087), drug-susceptible and resistant isolates (p=0.37) or isolates of Beijing and other genotype families (p=0.33). Furthermore, four cases of fluoroquinolone resistance development through the acquired SNVs in the gyrA gene were identified. To conclude, this study highlighted the complexity of recurrent episode cause determination and showed the usefulness of differing SNV identification in both Mtb isolates in such cases. Expected drug susceptibility was the only discriminative factor for recurrent TB episode-causing mycobacterial strains, while no differences between reactivation and reinfection sample groups could be identified.
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Affiliation(s)
- Darja Sadovska
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Anda Nodieva
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Stopiņi Region, Upeslejas, Latvia
| | - Ilva Pole
- Latvian Biomedical Research and Study Centre, Riga, Latvia
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Stopiņi Region, Upeslejas, Latvia
| | - Jānis Ķimsis
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Anda Vīksna
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Stopiņi Region, Upeslejas, Latvia
- Department of Infectology, Rīga Stradiņš University, Riga, Latvia
| | - Iveta Ozere
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Stopiņi Region, Upeslejas, Latvia
- Department of Infectology, Rīga Stradiņš University, Riga, Latvia
| | - Inga Norvaiša
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Stopiņi Region, Upeslejas, Latvia
| | - Dace Bandere
- Department of Pharmaceutical Chemistry, Rīga Stradiņš University, Riga, Latvia
| | - Renāte Ranka
- Latvian Biomedical Research and Study Centre, Riga, Latvia
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6
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Noguera-Julian A, Calzada-Hernández J, Brinkmann F, Basu Roy R, Bilogortseva O, Buettcher M, Carvalho I, Chechenyeva V, Falcón L, Goetzinger F, Guerrero-Laleona C, Hoffmann P, Jelusic M, Niehues T, Ozere I, Shackley F, Suciliene E, Welch SB, Schölvinck EH, Ritz N, Tebruegge M. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis 2021; 71:2561-2569. [PMID: 31796965 DOI: 10.1093/cid/ciz1138] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. METHODS Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti-TNF-α therapy. RESULTS Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. CONCLUSIONS LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Joan Calzada-Hernández
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Folke Brinkmann
- Department of Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Robindra Basu Roy
- Department of Paediatrics, Oxford University, Oxford, United Kingdom.,Children's Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | - Olga Bilogortseva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Michael Buettcher
- Lucerne Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Isabel Carvalho
- Department of Pediatrics, Vila Nova de Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Vira Chechenyeva
- Department of Child Phthisiology, National Institute of Phthisiology and Pulmonology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.,Center of Infectious Diseases, "Clinic for Children With HIV/AIDS", National Specialized Children's Hospital (Okhmatdyt), Kiev, Ukraine
| | - Lola Falcón
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Florian Goetzinger
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Vienna, Austria
| | - Carmelo Guerrero-Laleona
- Infectious Diseases Unit, Pediatric Department, Miguel Servet University Hospital-University of Zaragoza, Zaragoza, Spain
| | - Peter Hoffmann
- Department of Internal Medicine, Gastroenterology, and Diabetology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tim Niehues
- Immunodeficiency and Rheumatology Center, Helios Klinikum Krefeld, Krefeld, Germany
| | - Iveta Ozere
- Department of Infectious Diseases and Dermatology, Riga Stradinš University, Riga, Latvia.,Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - Fiona Shackley
- Department of Paediatrics, Sheffield Children's National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Elena Suciliene
- Children Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Steven B Welch
- Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Elisabeth H Schölvinck
- University of Groningen, University Medical Center Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Nicole Ritz
- Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Marc Tebruegge
- Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Infection, Immunity, and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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7
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Aleinikova D, Pole I, Kimsis J, Skangale A, Bobrikova O, Kazelnika R, Jansone I, Norvaisa I, Ozere I, Ranka R. Application of whole-genome sequencing in a case study of renal tuberculosis in a child. BMC Infect Dis 2020; 20:105. [PMID: 32024474 PMCID: PMC7003358 DOI: 10.1186/s12879-020-4832-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urogenital tuberculosis (TB) is rare in children and usually develops due to reactivation of the foci in the genitourinary tract after the latency period following initial infection. Urogenital TB in children has no pathognomonic clinical features that can result in overlooking or misdiagnosing this clinical entity. Here, we report important findings regarding the pathogenesis and transmission of TB by using genotyping and whole-genome sequencing (WGS) in a study of renal TB case in a child. CASE PRESENTATION A 13-year-old boy was admitted to the hospital because of high fever, severe dry cough, flank pain and painful urination. Abdominal ultrasonography and CT revealed an 8 mm calculus in the kidney, and clinical findings were initially interpreted as nephrolithiasis. Nevertheless, due to the atypical clinical presentation of kidney stone disease, additional investigations for possible TB were performed. The QuantiFERON®-TB Gold Plus test was positive, and the Mantoux test resulted in 15 mm of induration, confirming infection with Mycobacterium tuberculosis (Mtb). Chest X-ray was normal. Chest CT revealed calcified intrathoracic lymph nodes. The urine sample tested positive for acid-fast bacilli, and Mtb cultures were obtained from urine and bronchial aspirate samples, resulting in a final diagnosis of intrathoracic lymph node and renal TB. Contact investigation revealed that the child's father was diagnosed with TB when the child was 1 year old. Genotyping and WGS analysis of Mtb isolates of the child and his father confirmed the epidemiological link and pointed to the latency of infection in the child. CONCLUSIONS This case report confirmed the development of active TB from calcified lesions in adolescent after 12 years of exposure, demonstrated the absence of microevolutionary changes in the Mtb genome during the period of latency, and proved the importance of appropriate evaluation and management to prevent the progression of TB infection to active TB disease. The use of WGS provided the ultimate resolution for the detection of TB transmission and reactivation events.
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Affiliation(s)
- Darja Aleinikova
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, Riga, LV-1067, Latvia
| | - Ilva Pole
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, Riga, LV-1067, Latvia.,Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Upeslejas, Stopiņi region, LV-2118, Latvia
| | - Janis Kimsis
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, Riga, LV-1067, Latvia
| | - Anita Skangale
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Upeslejas, Stopiņi region, LV-2118, Latvia
| | - Olga Bobrikova
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Upeslejas, Stopiņi region, LV-2118, Latvia
| | | | - Inta Jansone
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, Riga, LV-1067, Latvia
| | - Inga Norvaisa
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Upeslejas, Stopiņi region, LV-2118, Latvia
| | - Iveta Ozere
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Upeslejas, Stopiņi region, LV-2118, Latvia.,Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | - Renate Ranka
- Latvian Biomedical Research and Study Centre, Ratsupites Str 1, k-1, Riga, LV-1067, Latvia. .,Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.
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8
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Pole I, Trofimova J, Norvaisa I, Supply P, Skenders G, Nodieva A, Ozere I, Riekstina V, Igumnova V, Storozenko J, Jansone I, Viksna L, Ranka R. Analysis of Mycobacterium tuberculosis genetic lineages circulating in Riga and Riga region, Latvia, isolated between 2008 and 2012. Infect Genet Evol 2019; 78:104126. [PMID: 31783188 DOI: 10.1016/j.meegid.2019.104126] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 11/17/2022]
Abstract
Although the number of new tuberculosis (TB) cases registered per year has decreased by 3-fold between 2001 and 2017 in Latvia, the TB incidence and rates of multidrug resistant TB in this Baltic country remain substantially higher than in most other European countries. Molecular typing methods of Mycobacterium tuberculosis (MTB) play an important role both in clinical studies of the disease and the epidemiological investigations, allowing to describe and characterize the pathogen's population structure and spread of particular genotypes. Aim of this study was to examine the prevalence of MTB lineages in Riga and Riga region of Latvia within a five-year period (2008-2012), and to evaluate the discriminatory power (DP) of spoligotyping, standard 24-locus MIRU-VNTR and IS6110-RFLP methods in this setting. The results showed that the main MTB spoligotype families were Beijing (25.3%) and LAM (24.3%), followed by T (22.1%), Ural (11.2%), Haarlem (6.6%) and X superfamily (3.4%). This distribution remained stable over the five consecutive years. 67.6% of MTB isolates were pan-susceptible, and 32.4% were resistant to any drug; multi-drug resistance was found in 5.8% of MTB strains, and 7.6% of MTB isolates were extensively drug-resistant. Drug resistance was associated with SIT1, SIT283 and SIT42 genotypes, while SIT1 and SIT42 were overrepresented among multi drug-resistant MTB strains. Overall, DP of spoligotyping method alone was 0.8953, while DP of both 24-locus MIRU-VNTR analysis and IS6110 RFLP was higher (DP = 0.9846 and 0.9927, respectively), mainly due to the improvement of the resolution for the Beijing strains. In conclusion, this work represents the first comprehensive molecular epidemiological description of TB in Latvia, highlighting the high genetic diversity of MTB strains circulating in Riga and Riga region. In combination with detailed epidemiological data this approach was helpful for the in-depth understanding of epidemiological processes in settings where the Next-Gen sequencing is not available as a routine method.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antitubercular Agents/pharmacology
- Child
- Child, Preschool
- Drug Resistance, Multiple, Bacterial/drug effects
- Drug Resistance, Multiple, Bacterial/genetics
- Female
- Genetic Variation
- Genotyping Techniques
- Humans
- Infant
- Infant, Newborn
- Latvia/epidemiology
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Minisatellite Repeats
- Molecular Epidemiology
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Polymorphism, Restriction Fragment Length
- Prevalence
- Tuberculosis/epidemiology
- Tuberculosis/microbiology
- Tuberculosis, Multidrug-Resistant/epidemiology
- Tuberculosis, Multidrug-Resistant/microbiology
- Young Adult
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Affiliation(s)
- Ilva Pole
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Latvia; Latvian Biomedical Research and Study Centre, Latvia
| | - Julija Trofimova
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Latvia
| | - Inga Norvaisa
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Latvia
| | - Philip Supply
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, CIIL - Center for Infection and Immunity of Lille, U1019 - UMR 8204, Lille F-59000, France
| | - Girts Skenders
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Latvia
| | | | - Iveta Ozere
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Latvia; Riga Stradiņš University, Latvia
| | - Vija Riekstina
- Riga East University Hospital, Centre of Tuberculosis and Lung Diseases, Latvia
| | - Viktorija Igumnova
- Latvian Biomedical Research and Study Centre, Latvia; Riga Stradiņš University, Latvia
| | - Jelena Storozenko
- Riga Stradiņš University, Latvia; Riga East University Hospital, Latvian Centre of Infectious Diseases, Latvia
| | - Inta Jansone
- Latvian Biomedical Research and Study Centre, Latvia
| | - Ludmila Viksna
- Riga Stradiņš University, Latvia; Riga East University Hospital, Latvian Centre of Infectious Diseases, Latvia
| | - Renate Ranka
- Latvian Biomedical Research and Study Centre, Latvia; Riga Stradiņš University, Latvia.
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9
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Osman M, Harausz EP, Garcia-Prats AJ, Schaaf HS, Moore BK, Hicks RM, Achar J, Amanullah F, Barry P, Becerra M, Chiotan DI, Drobac PC, Flood J, Furin J, Gegia M, Isaakidis P, Mariandyshev A, Ozere I, Shah NS, Skrahina A, Yablokova E, Seddon JA, Hesseling AC. Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis. Emerg Infect Dis 2019; 25:441-450. [PMID: 30789141 PMCID: PMC6390755 DOI: 10.3201/eid2503.180852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 countries. These patients were managed during 1999-2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required.
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10
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Harausz EP, Garcia-Prats AJ, Law S, Schaaf HS, Kredo T, Seddon JA, Menzies D, Turkova A, Achar J, Amanullah F, Barry P, Becerra M, Chan ED, Chan PC, Ioana Chiotan D, Crossa A, Drobac PC, Fairlie L, Falzon D, Flood J, Gegia M, Hicks RM, Isaakidis P, Kadri SM, Kampmann B, Madhi SA, Marais E, Mariandyshev A, Méndez-Echevarría A, Moore BK, Nargiza P, Ozere I, Padayatchi N, Ur-Rehman S, Rybak N, Santiago-Garcia B, Shah NS, Sharma S, Shim TS, Skrahina A, Soriano-Arandes A, van den Boom M, van der Werf MJ, van der Werf TS, Williams B, Yablokova E, Yim JJ, Furin J, Hesseling AC. Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis. PLoS Med 2018; 15:e1002591. [PMID: 29995958 PMCID: PMC6040687 DOI: 10.1371/journal.pmed.1002591] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children. METHODS AND FINDINGS To inform the pediatric aspects of the revised World Health Organization (WHO) MDR-TB treatment guidelines, we performed a systematic review and individual patient data (IPD) meta-analysis, describing treatment outcomes in children treated for MDR-TB. To identify eligible reports we searched PubMed, LILACS, Embase, The Cochrane Library, PsychINFO, and BioMedCentral databases through 1 October 2014. To identify unpublished data, we reviewed conference abstracts, contacted experts in the field, and requested data through other routes, including at national and international conferences and through organizations working in pediatric MDR-TB. A cohort was eligible for inclusion if it included a minimum of three children (aged <15 years) who were treated for bacteriologically confirmed or clinically diagnosed MDR-TB, and if treatment outcomes were reported. The search yielded 2,772 reports; after review, 33 studies were eligible for inclusion, with IPD provided for 28 of these. All data were from published or unpublished observational cohorts. We analyzed demographic, clinical, and treatment factors as predictors of treatment outcome. In order to obtain adjusted estimates, we used a random-effects multivariable logistic regression (random intercept and random slope, unless specified otherwise) adjusted for the following covariates: age, sex, HIV infection, malnutrition, severe extrapulmonary disease, or the presence of severe disease on chest radiograph. We analyzed data from 975 children from 18 countries; 731 (75%) had bacteriologically confirmed and 244 (25%) had clinically diagnosed MDR-TB. The median age was 7.1 years. Of 910 (93%) children with documented HIV status, 359 (39%) were infected with HIV. When compared to clinically diagnosed patients, children with confirmed MDR-TB were more likely to be older, to be infected with HIV, to be malnourished, and to have severe tuberculosis (TB) on chest radiograph (p < 0.001 for all characteristics). Overall, 764 of 975 (78%) had a successful treatment outcome at the conclusion of therapy: 548/731 (75%) of confirmed and 216/244 (89%) of clinically diagnosed children (absolute difference 14%, 95% confidence interval [CI] 8%-19%, p < 0.001). Treatment was successful in only 56% of children with bacteriologically confirmed TB who were infected with HIV who did not receive any antiretroviral treatment (ART) during MDR-TB therapy, compared to 82% in children infected with HIV who received ART during MDR-TB therapy (absolute difference 26%, 95% CI 5%-48%, p = 0.006). In children with confirmed MDR-TB, the use of second-line injectable agents and high-dose isoniazid (15-20 mg/kg/day) were associated with treatment success (adjusted odds ratio [aOR] 2.9, 95% CI 1.0-8.3, p = 0.041 and aOR 5.9, 95% CI 1.7-20.5, p = 0.007, respectively). These findings for high-dose isoniazid may have been affected by site effect, as the majority of patients came from Cape Town. Limitations of this study include the difficulty of estimating the treatment effects of individual drugs within multidrug regimens, only observational cohort studies were available for inclusion, and treatment decisions were based on the clinician's perception of illness, with resulting potential for bias. CONCLUSIONS This study suggests that children respond favorably to MDR-TB treatment. The low success rate in children infected with HIV who did not receive ART during their MDR-TB treatment highlights the need for ART in these children. Our findings of individual drug effects on treatment outcome should be further evaluated.
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Affiliation(s)
- Elizabeth P Harausz
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Military HIV Research Program, Bethesda, Maryland, United States of America
| | - Anthony J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Stephanie Law
- Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - James A Seddon
- Centre for International Child Health, Imperial College, London, United Kingdom
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Anna Turkova
- Imperial College Healthcare NHS Trust, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Jay Achar
- Manson Unit, Médecins Sans Frontières (MSF), London, United Kingdom
| | | | - Pennan Barry
- California Department of Public Health, Sacramento, California, United States of America
| | - Mercedes Becerra
- Partners In Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Edward D Chan
- Denver Veterans Affairs Medical Center, National Jewish Health, Denver, Colorado, United States of America
| | - Pei Chun Chan
- Division of Chronic Infectious Disease, Centers for Disease Control, Taipei, Taiwan
| | - Domnica Ioana Chiotan
- Epidemiological Surveillance Department, Romanian National TB Program, Bucharest, Romania
| | - Aldo Crossa
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
| | - Peter C Drobac
- Partners In Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lee Fairlie
- Wits Reproductive Health & HIV Institute (WRHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Dennis Falzon
- Laboratories, Diagnostics and Drug Resistance Unit, Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Jennifer Flood
- California Department of Public Health, Sacramento, California, United States of America
| | - Medea Gegia
- Technical Support Coordination, Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Robert M Hicks
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Petros Isaakidis
- Médecins Sans Frontières (MSF)/Doctors Without Borders, Mumbai, India
| | - S M Kadri
- Disease Control, Directorate of Health Services, Kashmir, India
| | - Beate Kampmann
- Paediatric Infection & Immunity, Centre of International Child Health, Imperial College London, London, United Kingdom.,Vaccines & Immunity Theme, MRC Unit The Gambia, Banjul, The Gambia
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Else Marais
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand and the National Health Laboratory Services, Johannesburg, South Africa
| | | | - Ana Méndez-Echevarría
- Pediatric, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
| | - Brittany Kathryn Moore
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Parpieva Nargiza
- Republican Scientific Medical Center of Phtiziology and Pulmonology, Ministry of Health, Tashkent, Uzbekistan
| | - Iveta Ozere
- Riga Eastern Clinical University Hospital, Centre for Tuberculosis and Lung Diseases, Riga, Latvia
| | | | | | - Natasha Rybak
- Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Begoña Santiago-Garcia
- Pediatric Infectious Diseases Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - N Sarita Shah
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Sangeeta Sharma
- Department of Pediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Alena Skrahina
- The Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Unit of International Health-Tuberculosis Drassanes-Vall Hebron, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Martin van den Boom
- Joint Tuberculosis, HIV & Viral Hepatitis Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Marieke J van der Werf
- Disease Programme Tuberculosis, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Bhanu Williams
- Northwick Park Hospital, London Northwest Healthcare NHS Trust, London, United Kingdom
| | - Elena Yablokova
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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11
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Herranz M, Pole I, Ozere I, Chiner-Oms Á, Martínez-Lirola M, Pérez-García F, Gijón P, Serrano MJR, Romero LC, Cuevas O, Comas I, Bouza E, Pérez-Lago L, García-de-Viedma D. Mycobacterium tuberculosis Acquires Limited Genetic Diversity in Prolonged Infections, Reactivations and Transmissions Involving Multiple Hosts. Front Microbiol 2018; 8:2661. [PMID: 29403447 PMCID: PMC5780704 DOI: 10.3389/fmicb.2017.02661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/20/2017] [Indexed: 01/03/2023] Open
Abstract
Background:Mycobacterium tuberculosis (MTB) has limited ability to acquire variability. Analysis of its microevolution might help us to evaluate the pathways followed to acquire greater infective success. Whole-genome sequencing (WGS) in the analysis of the transmission of MTB has elucidated the magnitude of variability in MTB. Analysis of transmission currently depends on the identification of clusters, according to the threshold of variability (<5 SNPs) between isolates. Objective: We evaluated whether the acquisition of variability in MTB, was more frequent in situations which could favor it, namely intrapatient, prolonged infections or reactivations and interpatient transmissions involving multiple sequential hosts. Methods: We used WGS to analyze the accumulation of variability in sequential isolates from prolonged infections or translations from latency to reactivation. We then measured microevolution in transmission clusters with prolonged transmission time, high number of involved cases, simultaneous involvement of latency and active transmission. Results: Intrapatient and interpatient acquisition of variability was limited, within the ranges expected according to the thresholds of variability proposed, even though bursts of variability were observed. Conclusions: The thresholds of variability proposed for MTB seem to be valid in most circumstances, including those theoretically favoring acquisition of variability. Our data point to multifactorial modulation of microevolution, although further studies are necessary to elucidate the factors underlying this modulation.
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Affiliation(s)
- Marta Herranz
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ilva Pole
- Childhood Tuberculosis Department, Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia.,Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Iveta Ozere
- Childhood Tuberculosis Department, Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradinš University, Riga, Latvia
| | - Álvaro Chiner-Oms
- Unidad Mixta Genómica y Salud, Centro Superior de Investigación en Salud Pública (FISABIO)-Universitat de València, Valencia, Spain
| | | | - Felipe Pérez-García
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Paloma Gijón
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - María Jesús Ruiz Serrano
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Laura Clotet Romero
- Servei de Vigilància Epidemiològica i Resposta a Emergències de Salut Pública al Vallès Occidental i Vallès Oriental, Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública, Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Oscar Cuevas
- Servicio de Laboratorio, Institut d'Investigació i Innovació Parc Taulí, I3PT Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iñaki Comas
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Emilio Bouza
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Pérez-Lago
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Darío García-de-Viedma
- Servicio Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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12
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Kindermann S, Nodieva A, Sture I, Skangale A, Jagmane A, Lukmanova N, Kirvelaite G, Berzina Z, Dinka L, Pastare R, Kalnina V, Rendniece V, Ozere I, Riekstina V, Baumane M. Tuberculosis in patients on TNFα inhibitor treatment in Latvia. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.pa2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Ziemele B, Ranka R, Ozere I. Pediatric and adolescent tuberculosis in Latvia, 2011–2014: case detection, diagnosis and treatment. Int J Tuberc Lung Dis 2017; 21:637-645. [DOI: 10.5588/ijtld.16.0270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - R. Ranka
- Riga Stradiņš University, Riga, Latvian Biomedical Research and Study Centre, Riga
| | - I. Ozere
- Riga Stradiņš University, Riga, Centre for Tuberculosis and Lung Diseases, Riga East Clinical University Hospital, Riga, Latvia
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14
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Kuksa L, Riekstina V, Leimane V, Ozere I, Skenders G, Van den Bergh R, Kremer K, Acosta CD, Harries AD. Multi- and extensively drug-resistant tuberculosis in Latvia: trends, characteristics and treatment outcomes. Public Health Action 2015; 4:S47-53. [PMID: 26393098 DOI: 10.5588/pha.14.0041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Drug-resistant tuberculosis (TB) is an important public health problem in Latvia. OBJECTIVE To document trends, characteristics and treatment outcomes of registered patients with multi-drug-resistant (MDR-) and extensively drug-resistant (XDR-) TB in Latvia from 2000 to 2010. DESIGN A retrospective national cohort study. RESULTS Of 1779 patients, 1646 (92%) had MDR- and 133 (8%) XDR-TB. Over 11 years, the proportion of XDR-TB among MDR-TB patients increased from 2% to 18%. Compared to MDR-TB patients, those with XDR-TB were significantly more likely to have failed MDR-TB treatment (OR 8.4, 95%CI 4.3-16.2), have human immunodeficiency virus infection (OR 3.2, 95%CI 1.8-5.7), be illegal drug users (OR 5.7, 95%CI 2.6-11.6) or have had contact with MDR-TB patients (OR 1.9, 95%CI 1.3-2.8). Cure rates for XDR-TB were 50%. Compared with MDR-TB patients, those with XDR-TB had a higher risk of treatment failure (29% vs. 8%, respectively, P < 0.001). Unfavourable treatment outcomes were significantly associated with being male; having smear-positive disease; pulmonary cavities; failure, default or relapse after previous MDR-TB treatment; and a history of incarceration. CONCLUSION More MDR-TB in Latvia is now also XDR-TB. This study identified several risk factors for XDR-TB and, for unfavourable treatment outcomes, highlighting the importance of early diagnosis and appropriate management of MDR-/XDR-TB.
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Affiliation(s)
- L Kuksa
- Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia ; Riga Stradins University, Riga, Latvia
| | - V Riekstina
- Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia
| | - V Leimane
- Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia
| | - I Ozere
- Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia ; Riga Stradins University, Riga, Latvia
| | - G Skenders
- Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia
| | - R Van den Bergh
- Medical Department, Operational Center Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - K Kremer
- Tuberculosis and M/XDR-TB Programme, Division of Communicable Diseases, Health Security & Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - C D Acosta
- Tuberculosis and M/XDR-TB Programme, Division of Communicable Diseases, Health Security & Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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15
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Bauskenieks M, Pole I, Skenders G, Jansone I, Broka L, Nodieva A, Ozere I, Kalvisa A, Ranka R, Baumanis V. Genotypic and phenotypic characteristics of aminoglycoside-resistant Mycobacterium tuberculosis isolates in Latvia. Diagn Microbiol Infect Dis 2014; 81:177-82. [PMID: 25557624 DOI: 10.1016/j.diagmicrobio.2014.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 12/03/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
Mutations causing resistance to aminoglycosides, such as kanamycin (KAN), amikacin (AMK), and streptomycin, are not completely understood. In this study, polymorphisms of aminoglycoside resistance influencing genes such as rrs, eis, rpsL, and gidB in 41 drug-resistant and 17 pan-sensitive Mycobacterium tuberculosis clinical isolates in Latvia were analyzed. Mutation A1400G in rrs gene was detected in 92% isolates with high resistance level to KAN and diverse MIC level to AMK. Mutations in promoter region of eis were detected in 80% isolates with low-level MIC of KAN. The association of K43R mutation in rpsL gene, a mutation in the rrs gene at position 513, and various polymorphisms in gidB gene with distinct genetic lineages of M. tuberculosis was observed. The results of this study suggest that association of different controversial mutations of M. tuberculosis genes to the drug resistance phenotype should be done in respect to genetic lineages.
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Affiliation(s)
- Matiss Bauskenieks
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, LV-1067, Latvia
| | - Ilva Pole
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, LV-1067, Latvia; Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Stopinu p., Riga, LV-2118, Latvia
| | - Girts Skenders
- Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Stopinu p., Riga, LV-2118, Latvia
| | - Inta Jansone
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, LV-1067, Latvia
| | - Lonija Broka
- Center of Tuberculosis and Lung Diseases, Riga East University Hospital, Stopinu p., Riga, LV-2118, Latvia
| | - Anda Nodieva
- Rīga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia
| | - Iveta Ozere
- Rīga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia
| | - Adrija Kalvisa
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, LV-1067, Latvia
| | - Renate Ranka
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, LV-1067, Latvia; Rīga Stradiņš University, Dzirciema Street 16, Riga, LV-1007, Latvia.
| | - Viesturs Baumanis
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, LV-1067, Latvia
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16
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Ozere I, Ozolinia A, Bobrikova O. [Primary respiratory tuberculosis in children: Hyperdiagnosis or hypodiagnosis]. Probl Tuberk Bolezn Legk 2005:23-7; discussion 27. [PMID: 16279512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The diagnosis of bacteriologically negative tuberculosis (TB) in children is traditionally based on clinical criteria, such as a history of contact with a patient with TB, a positive tuberculin test suggesting TB infection and radiological TB changes. To improve the early diagnosis of TB, the authors applied computed tomography (CT) to 284 children with suspected TB (a study group) who had negative bacterial tests and normal chest X-ray films. To identify individual diagnostic criteria, the study group was divided into 4 subgroups: 1) 119 patients with positive tuberculin tests (> or = 10 mm induration) and a known contact with a TB patient; 2) 100 patients with positive tuberculin tests (> or = 10 mm induration) without known contact with a TB patient; 3) 33 patients with negative tuberculin tests (> or = 10 mm induration) and a known contact with a TB patient; 4) 32 patients with negative tuberculin tests (> or = 10 mm induration) without known contact with a TB patient. A control comprised 29 children with bacteriologically verified TB and normal chest X-ray films. Conventionally radiological studies revealed undiagnosed lung parenchymal abnormalities in 35 (29.4%), 16 (16.0%), 4 (12.1%), and 5 (15.6%) children in Subgroups 1, 2, 3, and 4, respectively, and in 11 (37.9%) children in the control group. Intrathoracic lymph nodes of > or = 5 mm were rarely diagnosed in all the groups of patients, including children with bacteriologically verified TB. Calcified lymph nodes were visualized in 62 (52.1%), 40 (40.0%), 18 (54.5%), and 7 (21.9%) children in Subgroups 1, 2, 3, and 4, respectively, and in 15 (51.7%) children in the control group. CT revealed an active TB process in 49 (41.2%), 23 (23.0%), 12 (35.4%) and 1 (3.1%) children in Subgroups 1, 2, 3, and 4, respectively. The findings demonstrated the hypodiagnosis of active TB in the infected children contacting a TB patient when CT is not applied.
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