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https://www.infmed.dk/tuberkulose#tuberkulose_diagnostik_og_behandling_(2023).pdf
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https://www.infmed.dk/tuberkulose#tuberkuloseinfektion_hos_immunsupprimerede_(2023).pdf
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Guidelines 1 Retningslinjer for screening og profylakse før behandling med biologiske lægemidler (2023)
Omhandler biologiske og målrettede syntetiske lægemidler (BMSL) til patienter i forhold til risiko for tuberkulose (TB), Humant Papillom Virus (HPV), Hepatitis B og C (HBV og HCV), Varicella Zoster Virus (VZV), Herpes Simplex Virus (HSV), Cytomegalovirus (CMV), Epstein Barr Virus (EBV) og Humant Immundefekt Virus (HIV) og øvrige infektioner. Vejledningen er udarbejdet af repræsentanter fra Dansk Selskab for Gastroenterologi og Hepatologi (DSGH), Dansk Reumatologisk Selskab (DRS), Dansk Dermatologisk Selskab (DDS) og Dansk Selskab for Infektionsmedicin (DSI). 2 Tuberkulose - diagnostik og behandling (2023)
Denne vejledning omhandler diagnostik og behandling af voksne med TB, herunder pulmonal- og ekstrapulmonal-TB samt antibiotika-resistent TB. For håndtering af infektioner forårsaget af andre mykobakterier henvises til anden litteratur. 26.09.23: Moxifloxacin varighed ændret til 8 uger (tabel 10) 3 Tuberkuloseinfektion hos immunsupprimerede (2023)
Denne vejledning omhandler vurdering og behandling af tuberkuloseinfektion hos voksne, som skal behandles med immunsupprimerende medicin i form af f.eks TNF-α hæmmere eller andre immunsupprimerende biologiske lægemidler, hvor der er øget risiko for tuberkulosereaktivering. Guideline dækker ikke børn, personer med medfødt immundefekt, HIV positive, patienter i dialyse, patienter med dysreguleret diabetes, silicose, erhvervede immundefekter eller patienter i konventionel kortvarig kemoterapi. Denne guideline omhandler ikke klassisk smitteopsporing blandt tuberkuloseeksponerede eller udredning på mistanke om aktiv tuberkulose. 4 Vaccination af voksne kandidater og recipienter til solid organtransplantation (2022)
Udarbejdet af en arbejdsgrupper bestående af medlemmer fra Dansk Selskab for Infektionsmedicin og Dansk Transplantationsselskab Links 1 Tuberkulose behandlingsskema
2 SSI's opgørelse over tuberkulose 2019-20 i Danmark
3 Sundhedsstyrelsens vejledning om forebyggelse af tuberkulose (2015)
4 ECDC Tuberculosis surveillance and monitoring in Europe (2020)
5 WHO Global tuberculosis reports
6 WHO Tuberculosis surveillance and monitoring report in Europe
7 WHO Towards tuberculosis elimination (2014): an action framework for low-incidence countries
8 WHO Latent TB Infection (2018)
9 Region Hovedstadens vejledning om smitteopsporing
Nye artikler 1 Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, Indonesia Lika Apriani, Susan McAllister, Katrina Sharples, Isni Nurul Aini, Hanifah Nurhasanah, Dwi Febni Ratnaningsih, Agnes Rengga Indrati, Rovina Ruslami, Bachti Alisjahbana, Reinout van Crevel, Philip C. Hill PLoS One Infectious Diseases, 19.03.2024 Tilføjet 19.03.2024 by Lika Apriani, Susan McAllister, Katrina Sharples, Isni Nurul Aini, Hanifah Nurhasanah, Dwi Febni Ratnaningsih, Agnes Rengga Indrati, Rovina Ruslami, Bachti Alisjahbana, Reinout van Crevel, Philip C. Hill Background No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students. Methods Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen’s Kappa coefficient. Logistic regression was used to identify factors associated with test positivity. Results Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21–0.45, P Læs mere Tjek på PubMed2 Incidence and risk factors for HIV-tuberculosis coinfection in the Cologne–Bonn region: a retrospective cohort study Infection, 16.03.2024 Tilføjet 16.03.2024 Abstract Purpose The risk of developing active tuberculosis (TB) is considerably increased in people living with HIV/AIDS (PLWH). However, incidence of HIV/TB coinfection is difficult to assess as surveillance data are lacking in many countries. Here, we aimed to perform a quantitative analysis of HIV/TB coinfections within the Cologne/Bonn HIV cohort and to determine risk factors for active TB. Methods We systematically evaluated data of patients with HIV/TB coinfection between 2006 and 2017. In this retrospective analysis, we compared HIV/TB-coinfected patients with a cohort of HIV-positive patients. The incidence density rate (IDR) was calculated for active TB cases at different time points. Results During 2006–2017, 60 out of 4673 PLWH were diagnosed with active TB. Overall IDR was 0.181 cases/100 patient-years and ranged from 0.266 in 2006–2009 to 0.133 in 2014–2017. Patients originating from Sub-Saharan Africa had a significantly (p Læs mere Tjek på PubMed3 Redirecting raltitrexed from cancer cell thymidylate synthase to Mycobacterium tuberculosis phosphopantetheinyl transferase Amrita Singh, Samantha Ottavi, Inna Krieger, Kyle Planck, Andrew Perkowski, Takushi Kaneko, Andrew M. Davis, Christine Suh, David Zhang, Laurent Goullieux, Alexander Alex, Christine Roubert, Mark Gardner, Marian Preston, Dave M. Smith, Yan Ling, Julia Roberts, Bastien Cautain, Anna Upton, Christopher B. Cooper, Natalya Serbina, Zaid Tanvir, John Mosior, Ouathek Ouerfelli, Guangli Yang, Ben S. Gold, Kyu Y. Rhee, James C. Sacchettini, Nader Fotouhi, Jeffrey Aubé, Carl Nathan Science Advances, 16.03.2024 Tilføjet 16.03.2024 4 Correction: Early mortality in tuberculosis patients initially lost to follow up following diagnosis in provincial hospitals and primary health care facilities in Western Cape, South Africa Muhammad Osman, Sue-Ann Meehan, Arne von Delft, Karen Du Preez, Rory Dunbar, Florian M. Marx, Andrew Boulle, Alex Welte, Pren Naidoo, Anneke C. Hesseling PLoS One Infectious Diseases, 15.03.2024 Tilføjet 15.03.2024 by Muhammad Osman, Sue-Ann Meehan, Arne von Delft, Karen Du Preez, Rory Dunbar, Florian M. Marx, Andrew Boulle, Alex Welte, Pren Naidoo, Anneke C. Hesseling Læs mere Tjek på PubMed5 The trajectories of CD4 T lymphocytes over time in patients who have defaulted on treatment for tuberculosis in a cohort of people living with HIV, Recife/PE Rossana Cunha, Demócrito de B. M. Filho, Maria de Fátima P. M. Albuquerque, Heloísa R. Lacerda, George T. N. Diniz, Ulisses R. Montarroyos, Laura C. Rodrigues, Líbia Cristina R. Vilela Moura, Ricardo A. A. Ximenes PLoS One Infectious Diseases, 14.03.2024 Tilføjet 14.03.2024 by Rossana Cunha, Demócrito de B. M. Filho, Maria de Fátima P. M. Albuquerque, Heloísa R. Lacerda, George T. N. Diniz, Ulisses R. Montarroyos, Laura C. Rodrigues, Líbia Cristina R. Vilela Moura, Ricardo A. A. Ximenes Background The CD4 T lymphocyte count in people living with HIV (PLHIV) is a predictor for the progression of the disease (AIDS), survival and response to antiretroviral treatment (ART). A CD4 T lymphocyte count of less than 200 cells/mm3 is indicative of a greater risk for the onset of opportunistic diseases and death. Defaulting on treatment for tuberculosis (TB) may impact immune recovery in PLHIV who are taking ART. The aim of this study was to investigate an association of the CD4 lymphocyte with TB treatment Trajectory and with death. Methods A cohort of PLHIV over eighteen years of age and who were taking ART and who had defaulted on pulmonary TB treatment. Latent Class analysis was used to identify different trajectories of CD4 T lymphocyte counts over time. Results Latent class 1 (High CD4 trajectory) grouped individuals together who were characterized as maintaining a low probability (0 to 29%) of a CD4 count ≤ 200 cells/mm3over time, while latent class 2 (Low CD4 trajectory) grouped individuals together with a high probability (93% to 60%), and latent class 3 (Fluctuating CD4 trajectory), grouped individuals with a fluctuating probability (66% to 0%). The chance of defaulting on treatment earlier (≤ 90 days) was four times higher in latent class 2 (Low CD4 trajectory). Although there was no statistical significance, there was a higher frequency of deaths in this same latent class. Conclusion Individuals with a high probability of a CD4 count ≤ 200 cells/ mm3 should be monitored in order to avoid treatment default and thereby prevent death. New studies should be conducted with a larger sample size and a longer follow-up time in PLHIV who initiated ART treatment early so as to support clinical decisions for a better understanding of immune behavior. Læs mere Tjek på PubMed6 Characteristics, predictors and consequences of tuberculosis treatment interruption: A multicentre retrospective cohort study Ai Ling Oh, Mohd Makmor‐Bakry, Farida Islahudin, Chuo Yew Ting, Swee Kim Chan, Siew Teck Tie Tropical Medicine & International Health, 13.03.2024 Tilføjet 13.03.2024 7 Availability of drugs and resistance testing for BPaLM regimen for rifampicin-resistant tuberculosis in Europe Gunar Günther, Lorenzo Guglielmetti, Yousra Kherabi, Raquel Duarte, Christoph Lange, Tuberculosis Network European Trials group, Tonia Adamides, Onno Akkerman, Aase Bengaard Andersen, Ágnes Bakos, Agnar Bjarnason, Judith Bruchfeld, Dumitru Chesov, Luigi Ruffo Codecasa, Daniela Cirillo, Manfred Danilovits, Edita Davidavičienė, Raquel Duarte, Maria Luiza De Souza Galvão, Sandrine Garnier, Majlinda Gjocaj, Gunar Günther, Elmira Ibraim, Michael Kappnik, Naira Khachatryan, Dzmitry Klimuk, Liga Kuksa, Mathilde Frechet Jachym, Kamilla Josefsdottir, Anna Kaluzhenina, Christoph Lange, Ulrich Mack, Mateja Jankovic Makek, Katerina Manika, Anne- Marie Mclaughlin, Donika Mema, Anne Torunn Mengshoel, Inge Muylle, Zorica Nanovic, Şeref Özkara, Sivan Perl, Dragica Pesut, Despo Pierdou, Galym Ryskulov, Marcin Skowroński, Ivan Solovic, Mariia Sukholytka, Petra Svetina, Yana Terleeva, Simon Tiberi, Tamara Togonidze, Stefania Torri, Laziz Turaev, Ruzilya Usmanova, Gil Wirtz, Tuula Vasankari, Elena Zhdanova Clinical Microbiology and Infection, 13.03.2024 Tilføjet 13.03.2024 Multidrug-resistant/Rifampicin-resistant tuberculosis (TB) is a major obstacle to successful TB control. The recommendation by the World Health Organization to use bedaquiline, pretomanid, linezolid and moxifloxacin (BPaL(M)) for 6 months, based on results of three trials with high efficacy and low toxicity, has revolutionized treatment options. Læs mere Tjek på PubMed8 Tuberculosis infection and hypertension: prevalence estimates from the US National Health and Nutrition Examination Survey Salindri, A. D., Auld, S. C., Gujral, U. P., Urbina, E. M., Andrews, J. R., Huaman, M. A., Magee, M. J. BMJ Open, 13.03.2024 Tilføjet 13.03.2024 ObjectivesTuberculosis infection (TBI) is marked by dynamic host–pathogen interactions with persistent low-grade inflammation and is associated with increased risk of cardiovascular diseases (CVD) including acute coronary syndrome, myocardial infarction and stroke. However, few studies assess the relationship between TBI and hypertension, an intermediate of CVD. We sought to determine the association between TBI and hypertension using data representative of the adult US population. MethodsWe performed cross-sectional analyses using data from the 2011–2012 US National Health and Nutrition Examination Survey (NHANES). Eligible participants included adults with valid QuantiFERON-TB Gold In-Tube (QFT-GIT) test results who also had blood pressure measures and no history of TB disease. TBI was defined by a positive QFT-GIT. We defined hypertension by either elevated measured blood pressure levels (ie, systolic ≥130 mm Hg or diastolic ≥80 mm Hg) or known hypertension indications (ie, self-reported previous diagnosis or use of antihypertensive medications). Analyses were performed using robust quasi-Poisson regressions and accounted for the stratified probability sampling design of NHANES. ResultsThe overall prevalence of TBI was 5.7% (95% CI 4.7% to 6.7%) and hypertension was present among 48.9% (95% CI 45.2% to 52.7%) of participants. The prevalence of hypertension was higher among those with TBI (58.5%, 95% CI 52.4% to 64.5%) than those without TBI (48.3%, 95% CI 44.5% to 52.1%) (prevalence ratio (PR) 1.2, 95% CI 1.1 to 1.3). However, after adjusting for confounders, the prevalence of hypertension was similar for those with and without TBI (adjusted PR 1.0, 95% CI 1.0 to 1.1). The unadjusted prevalence of hypertension was higher among those with TBI versus no TBI, especially among individuals without CVD risk factors including those with normal body mass index (PR 1.6, 95% CI 1.2 to 2.0), euglycaemia (PR 1.3, 95% CI 1.1 to 1.5) or non-smokers (PR 1.2, 95% CI 1.1 to 1.4). ConclusionsMore than half of adults with TBI in the USA had hypertension. Importantly, we observed a relationship between TBI and hypertension among those without established CVD risk factors. SummaryThe prevalence of hypertension was high (59%) among adults with TBI in the USA. In addition, we found that the prevalence of hypertension was significantly higher among adults with positive QFT without established hypertension risk factors. Læs mere Tjek på PubMed9 [Articles] Prevalence of subclinical pulmonary tuberculosis in adults in community settings: an individual participant data meta-analysis Logan Stuck, Eveline Klinkenberg, Nahid Abdelgadir Ali, Egbal Ahmed Basheir Abukaraig, Yaw Adusi-Poku, Zeleke Alebachew Wagaw, Razia Fatima, Nathan Kapata, Pascalina Kapata-Chanda, Bruce Kirenga, Llang B Maama-Maime, Sayoki G Mfinanga, Sizulu Moyo, Lindiwe Mvusi, Ndahafa Nandjebo, Hai Viet Nguyen, Hoa Binh Nguyen, Joshua Obasanya, Bashorun Adedapo Olufemi, Philip Patrobas Dashi, Thato J Raleting Letsie, Nunurai Ruswa, Elizeus Rutebemberwa, Mbazi Senkoro, Tieng Sivanna, Huot Chan Yuda, Irwin Law, Ikushi Onozaki, Edine Tiemersma, Frank Cobelens, scTB Meta Investigator Group Lancet Infectious Diseases, 13.03.2024 Tilføjet 13.03.2024 The majority of people in the community who have pulmonary tuberculosis do not report cough, a quarter report no tuberculosis-suggestive symptoms at all, and a quarter of those not reporting any cough have positive sputum smears, suggesting infectiousness. In high-incidence settings, subclinical tuberculosis could contribute considerably to the tuberculosis burden and to Mycobacterium tuberculosis transmission. Læs mere Tjek på PubMed10 Sub-MIC levels of bedaquiline and clofazimine can select Mycobacterium tuberculosis mutants with increased MIC Cristina VillellasFrederik StevenaertBart RemmerieKoen Andries1Janssen Research and Development, Beerse, Belgium, Sean Wasserman Antimicrobial Agents And Chemotherapy, 13.03.2024 Tilføjet 13.03.2024 11 Interventions to improve latent and active tuberculosis treatment completion rates in underserved groups in low incidence countries: a scoping review Dretzke, J., Hobart, C., Basu, A., Ahyow, L., Nagasivam, A., Moore, D. J., Gajraj, R., Roy, A. BMJ Open, 12.03.2024 Tilføjet 12.03.2024 BackgroundPeople in underserved groups have higher rates of tuberculosis (TB) and poorer treatment outcomes compared with people with no social risk factors. ObjectivesThis scoping review aimed to identify interventions that improve TB treatment adherence or completion rates. Eligibility criteriaStudies of any design focusing on interventions to improve adherence or completion of TB treatment in underserved populations in low incidence countries. Sources of evidenceMEDLINE, Embase and Cochrane CENTRAL were searched (January 2015 to December 2023). Charting methodsPiloted data extraction forms were used. Findings were tabulated and reported narratively. Formal risk of bias assessment or synthesis was not undertaken. Results47 studies were identified. There was substantial heterogeneity in study design, population, intervention components, usual care and definition of completion rates. Most studies were in migrants or refugees, with fewer in populations with other risk factors (eg, homelessness, imprisonment or substance abuse). Based on controlled studies, there was limited evidence to suggest that shorter treatment regimens, video-observed therapy (compared with directly observed therapy), directly observed therapy (compared with self-administered treatment) and approaches that include tailored health or social support beyond TB treatment may lead to improved outcomes. This evidence is mostly observational and subject to confounding. There were no studies in Gypsy, Roma and Traveller populations, or individuals with mental health disorders and only one in sex workers. Barriers to treatment adherence included a lack of knowledge around TB, lack of general health or social support and side effects. Facilitators included health education, trusted relationships between patients and healthcare staff, social support and reduced treatment duration. ConclusionsThe evidence base is limited, and few controlled studies exist. Further high-quality research in well-defined underserved populations is needed to confirm the limited findings and inform policy and practice in TB management. Further qualitative research should include more people from underserved groups. Læs mere Tjek på PubMed12 Screening for Latent Tuberculosis in Migrants – Status Quo and Future Challenges Eskild Petersen, Seif Al-Abri, Amina Al Jardani, Ziad A Memish, Eleni Aklillu, Francine Ntoumi, Peter Mwaba, Christian Wejse, Alimuddin Zumla, Fatma Al-Yaquobi International Journal of Infectious Diseases, 11.03.2024 Tilføjet 11.03.2024 It has been previously estimated that the global prevalence of latent TB infection (LTBI) is 24% of the world\'s population [1;2]. The World Health Organization (WHO) estimated in 2023 that 1.8 billion people are infected with Mycobacterium tuberculosis, but without clinical symptoms of active tuberculosis, which is the definition of latent TB infection [3;4]. This represents a 4.5% increase from 2020. With the COVID-19 pandemic now over, TB is once again the leading cause of death from a single infectious agent, with 1.4 million deaths among HIV-negative people and 187,000 deaths among HIV-positive people estimated in 2021 [3]. Læs mere Tjek på PubMed13 Pharmacokinetic-Pharmacodynamic Evidence from a Phase 3 Trial to Support Flat-Dosing of Rifampicin for Tuberculosis Clinical Infectious Diseases, 11.03.2024 Tilføjet 11.03.2024 Abstract Background The optimal dosing strategy for rifampicin in treating drug-susceptible tuberculosis (TB) is still highly debated. In the Phase 3 clinical trial Study 31/ACTG 5349 (NCT02410772), all participants in the control regimen arm received 600 mg rifampicin daily as a flat dose. Here, we evaluated relationships between rifampicin exposure and efficacy and safety outcomes.Methods We analyzed rifampicin concentration time profiles using population nonlinear mixed-effects models. We compared simulated rifampicin exposure from flat- and weight-banded dosing. We evaluated the effect of rifampicin exposure on stable culture conversion at 6 months, TB-related unfavorable outcomes at 9, 12, and 18 months using Cox proportional hazard models, and all trial-defined safety outcomes using logistic regression.Results Our model derived rifampicin exposure ranged from 4.57 mg·h/L to 140.0 mg·h/L with a median of 41.8 mg·h/L. Pharmacokinetic simulations demonstrated that flat-dosed rifampicin provided exposure coverage similar to weight-banded dose. Exposure-efficacy analysis (N=680) showed that participants with rifampicin exposure below the median experienced similar hazards of stable culture conversion and TB-related unfavorable outcomes compared to those with exposure above the median. Exposure-safety analysis (N=722) showed that increased rifampicin exposure was not associated with increased grade 3 or higher adverse events, or serious adverse events.Conclusions Flat-dosing of rifampicin at 600 mg daily may be a reasonable alternative to the incumbent weight-banded dosing strategy for the standard of care 6-month regimen. Future research should assess the optimal dosing strategy for rifampicin, at doses higher than the current recommendation. Læs mere Tjek på PubMed14 National cross-sectional cluster survey of tuberculosis prevalence in Timor-Leste: a study protocol Lopes, C., Joao, J. C., Lowbridge, C., Martins, N., dos Santos, R. I. G., da Silva, E., Dias, J., Ramalingam, S., Amaral, S., Oakley, T., Ico, L. d. C., Sarmento, N., Yan, J., Francis, J. R. BMJ Open, 9.03.2024 Tilføjet 9.03.2024 IntroductionTimor-Leste has one of the world’s highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known. TB prevalence surveys offer the best means of determining robust estimates of disease burden. This study aims to provide an estimate of the prevalence of bacteriologically confirmed pulmonary TB in Timor-Leste and provide additional insights into diagnostic coverage and health-seeking behaviour of persons with symptoms suggestive of TB. Methods and analysisA national population-based cross-sectional cluster survey will be conducted in which participants aged 15 years and older will be screened for pulmonary TB using an algorithm consisting of symptom screening and digital X-ray of the chest with computer-aided detection software for X-ray interpretation. Xpert Ultra and liquid culture methods will be used to confirm survey TB cases. Additional data will be collected from persons reporting symptoms suggestive of TB to assess health-seeking behaviour and access to TB diagnosis and care. The survey aims to screen a target sample population of 20 068 people, living within 50 clusters, representing every municipality of Timor-Leste. Bacteriologically confirmed pulmonary TB prevalence will be estimated using WHO-recommended methods. Ethics and disseminationResearch ethics approval has been granted by the human research ethics committee of the Northern Territory, Australia, and the Instituto Nacional da Saúde, Timor-Leste. The results will be published in a peer-reviewed scientific journal and disseminated with relevant stakeholders. Trial registration numberACTRN12623000718640. Læs mere Tjek på PubMed15 Restocking the tuberculosis drug arsenal Eric L. Nuermberger, Richard E. Chaisson Nature, 8.03.2024 Tilføjet 8.03.2024 16 [Articles] Effectiveness of a comprehensive package based on electronic medication monitors at improving treatment outcomes among tuberculosis patients in Tibet: a multicentre randomised controlled trial Xiaolin Wei, Joseph Paul Hicks, Zhitong Zhang, Victoria Haldane, Pande Pasang, Linhua Li, Tingting Yin, Bei Zhang, Yinlong Li, Qiuyu Pan, Xiaoqiu Liu, John Walley, Jun Hu Lancet, 8.03.2024 Tilføjet 8.03.2024 The interventions were effective at improving tuberculosis treatment adherence and outcomes, and the trial suggests that a comprehensive package involving electronic medication monitors might positively affect tuberculosis programmes in high-burden and low-resource settings. Læs mere Tjek på PubMed17 Phospholipase C epsilon-1 (PLCƐ1) mediates macrophage activation and protection against tuberculosis Ananya GuptaShyamala ThirunavukkarasuJavier Rangel-MorenoMushtaq AhmedRosemary V. SwansonStanley Kimbung MbandiAlan V. SmrckaDeepak KaushalThomas J. ScribaShabaana A. Khader1Department of Microbiology, The University of Chicago, Chicago, Illinois, USA2Department of Molecular Microbiology, Washington University in St. Louis, St. Louis, Missouri, USA3Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA4South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa5Department of Pharmacology, University of Michigan, Ann Arbor, Michigan, USA6Southwest National Primate Research Centre (SNPRC) at Texas Biomedical Research Institute, San Antonio, Texas, USA, Sabine Ehrt Infection and Immunity, 7.03.2024 Tilføjet 7.03.2024 18 Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review Gebreyohannes, E. A., Wolde, H. F., Akalu, T. Y., Clements, A. C. A., Alene, K. A. BMJ Open, 7.03.2024 Tilføjet 7.03.2024 ObjectivesThis systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes. DesignA systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sourcesPubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv. Data extraction and synthesisThree reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively. ResultsEleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success. ConclusionThe impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources. Læs mere Tjek på PubMed19 Detection of Mycobacterium tuberculosis DNA in CD34+ peripheral blood mononuclear cells of adults with tuberculosis infection and disease Federica Repele, Tonino Alonzi, Assunta Navarra, Chiara Farroni, Andrea Salmi, Gilda Cuzzi, Giovanni Delogu, Gina Gualano, Vincenzo Puro, Gabriella De Carli, Enrico Girardi, Fabrizio Palmieri, Adrian R Martineau, Delia Goletti International Journal of Infectious Diseases, 7.03.2024 Tilføjet 7.03.2024 Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb) and represents a major public health threat worldwide, with 10.6 million cases and about 1.3 million deaths in 2022 [1]. For TB control and for reducing Mtb transmission it is crucial to diagnose TB infection (TBI) and identify the subset of infected people at highest risk of progression from infection to disease, who will benefit the most from preventive therapy [2]. Currently, there is no gold standard test for TBI diagnosis [3]. Læs mere Tjek på PubMed20 World TB Day 2024 Theme “Yes! We Can End TB” can be made a reality through concerted global efforts that advance detection, diagnosis, and treatment of tuberculosis infection and disease Delia Goletti, Seif Al-Abri, Giovanni Battista Migliori, Cecilia Lindestam Arlehamn, Pranabashis Haldar, Christopher Sundling, Christopher da Costa, Kin Wang To, Adrian R. Martineau, Eskild Petersen, Alimuddin Zumla, Shui Shan Lee International Journal of Infectious Diseases, 7.03.2024 Tilføjet 7.03.2024 Every year, World TB Day is commemorated on March 24th, and is targeted at raising public and political awareness of tuberculosis (TB), a preventable and treatable disease. World TB Day commemorates the day in 1882 when Professor Robert Koch announced his discovery of the microbial cause of tuberculosis, the TB bacillus Mycobacterium tuberculosis. Læs mere Tjek på PubMed |
Værktøj 1 SSI's overvågning af tuberkulose i Danmark
2 WHO Tuberculosis data
3 Periskope TB risk calculator
4 The Online TST/IGRA Interpreter
Referencer 1 An All-Oral 6-Month Regimen for Multidrug-Resistant Tuberculosis: A Multicenter, Randomized Controlled Clinical Trial (the NExT Study). Am J Respir Crit Care Med 2022; 205(10):1214-1227
Esmail A, Oelofse S, Lombard C, Perumal R, Mbuthini L, Goolam Mahomed A, Variava E, Black J, Oluboyo P, Gwentshu N, Ngam E, Ackerman T, Marais L, Mottay L, Meier S, Pooran A, Tomasicchio M, Te Riele J, Derendinger B, Ndjeka N, Maartens G, Warren R, Martinson N, Dheda K
Improving treatment outcomes while reducing drug toxicity and shortening the treatment duration to ∼6 months remains an aspirational goal for the treatment of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB). To conduct a multicenter randomized controlled trial in adults with MDR/RR-TB (i.e., without resistance to fluoroquinolones or aminoglycosides). Participants were randomly assigned (1:1 ratio) to a ∼6-month all-oral regimen that included levofloxacin, bedaquiline, and linezolid, or the standard-of-care (SOC) ⩾9-month World Health Organization (WHO)-approved injectable-based regimen. The primary endpoint was a favorable WHO-defined treatment outcome (which mandates that prespecified drug substitution is counted as an unfavorable outcome) 24 months after treatment initiation. The trial was stopped prematurely when bedaquiline-based therapy became the standard of care in South Africa. In total, 93 of 111 randomized participants (44 in the comparator arm and 49 in the interventional arm) were included in the modified intention-to-treat analysis; 51 (55%) were HIV coinfected (median CD4 count, 158 cells/ml). Participants in the intervention arm were 2.2 times more likely to experience a favorable 24-month outcome than participants in the SOC arm (51% [25 of 49] vs. 22.7% [10 of 44]; risk ratio, 2.2 [1.2-4.1]; = 0.006). Toxicity-related drug substitution occurred more frequently in the SOC arm (65.9% [29 of 44] vs. 34.7% [17 of 49]; = 0.001)], 82.8% (24 of 29) owing to kanamycin (mainly hearing loss; replaced by bedaquiline) in the SOC arm, and 64.7% (11 of 17) owing to linezolid (mainly anemia) in the interventional arm. Adverse event-related treatment discontinuation in the safety population was more common in the SOC arm (56.4% [31 of 55] vs. 32.1% [17 of 56]; = 0.007). However, grade 3 adverse events were more common in the interventional arm (55.4% [31 of 56] vs. 32.7 [18 of 55]; = 0.022). Culture conversion was significantly better in the intervention arm (hazard ratio, 2.6 [1.4-4.9]; = 0.003) after censoring those with bedaquiline replacement in the SOC arm (and this pattern remained consistent after censoring for drug replacement in both arms; = 0.01). Compared with traditional injectable-containing regimens, an all-oral 6-month levofloxacin, bedaquiline, and linezolid-containing MDR/RR-TB regimen was associated with a significantly improved 24-month WHO-defined treatment outcome (predominantly owing to toxicity-related drug substitution). However, drug toxicity occurred frequently in both arms. These findings inform strategies to develop future regimens for MDR/RR-TB.Clinical trial registered with www.clinicaltrials.gov (NCT02454205). PMID: 351759052 Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis. N Engl J Med 2021; 384(18):1705-1718
Dorman SE, Nahid P, Kurbatova EV, Phillips PPJ, Bryant K, Dooley KE, Engle M, Goldberg SV, Phan HTT, Hakim J, Johnson JL, Lourens M, Martinson NA, Muzanyi G, Narunsky K, Nerette S, Nguyen NV, Pham TH, Pierre S, Purfield AE, Samaneka W, Savic RM, Sanne I, Scott NA, Shenje J, Sizemore E, Vernon A, Waja Z, Weiner M, Swindells S, Chaisson RE
Rifapentine-based regimens have potent antimycobacterial activity that may allow for a shorter course in patients with drug-susceptible pulmonary tuberculosis. PMID: 339513603 Treatment of Highly Drug-Resistant Pulmonary Tuberculosis. N Engl J Med 2020; 382(10):893-902
Conradie F, Diacon AH, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Egizi E, Moreira J, Timm J, McHugh TD, Wills GH, Bateson A, Hunt R, Van Niekerk C, Li M, Olugbosi M, Spigelman M
Patients with highly drug-resistant forms of tuberculosis have limited treatment options and historically have had poor outcomes. PMID: 321308134 Tuberculosis. N Engl J Med 2013; 368(8):745-55 5 Persistent high incidence of tuberculosis in immigrants in a low-incidence country. Emerg Infect Dis 2002; 8(7):679-84
Lillebaek T, Andersen AB, Dirksen A, Smith E, Skovgaard LT, Kok-Jensen A
Immigration from areas of high incidence is thought to have fueled the resurgence of tuberculosis (TB) in areas of low incidence. To reduce the risk of disease in low-incidence areas, the main countermeasure has been the screening of immigrants on arrival. This measure is based on the assumption of a prompt decline in the incidence of TB in immigrants during their first few years of residence in a country with low overall incidence. We have documented that this assumption is not true for 619 Somali immigrants reported in Denmark as having TB. The annual incidence of TB declined only gradually during the first 7 years of residence, from an initial 2,000 per 100,000 to 700 per 100,000. The decline was described by an exponential function with a half-time of 5.7 (95% confidence interval 4.0 to 9.7) years. This finding seriously challenges the adequacy of the customary practice of screening solely on arrival. PMID: 120954346 European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J 2002; 19(4):765-75
Broekmans JF, Migliori GB, Rieder HL, Lees J, Ruutu P, Loddenkemper R, Raviglione MC
As countries approach the elimination phase of tuberculosis, specific problems and challenges emerge, due to the steadily declining incidence in the native population, the gradually increasing importance of the importation of latent tuberculosis infection and tuberculosis from other countries and the emergence of groups at particularly high risk of tuberculosis. Therefore, a Working Group of the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Royal Netherlands Tuberculosis Association (KNCV) have developed a new framework for low incidence countries based on concepts and definitions consistent with those of previous recommendations from WHO/IUATLD Working Groups. In low-incidence countries, a broader spectrum of interventions is available and feasible, including: 1) a general approach to tuberculosis which ensures rapid detection and treatment of all the cases and prevention of unnecessary deaths; 2) an overall control strategy aimed at reducing the incidence of tuberculosis infection (risk-group management and prevention of transmission of infection in institutional settings) and 3) a tuberculosis elimination strategy aimed at reducing the prevalence of tuberculosis infection (outbreak management and provision of preventive therapy for specified groups and individuals). Government and private sector commitment towards elimination, effective case detection among symptomatic individuals together with active case finding in special groups, standard treatment of disease and infection, access to tuberculosis diagnostic and treatment services, prevention (e.g. through screening and bacille Calmette-Guéria immunization in specified groups), surveillance and treatment outcome monitoring are prerequisites to implementing the policy package recommended in this new framework document. PMID: 119990077 Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001; 345(15):1098-104
Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, Siegel JN, Braun MM
Infliximab is a humanized antibody against tumor necrosis factor alpha (TNF-alpha) that is used in the treatment of Crohn's disease and rheumatoid arthritis. Approximately 147,000 patients throughout the world have received infliximab. Excess TNF-alpha in association with tuberculosis may cause weight loss and night sweats, yet in animal models it has a protective role in the host response to tuberculosis. There is no direct evidence of a protective role of TNF-alpha in patients with tuberculosis. PMID: 115965898 Risk of Mycobacterium tuberculosis transmission in a low-incidence country due to immigration from high-incidence areas. J Clin Microbiol 2001; 39(3):855-61
Lillebaek T, Andersen AB, Bauer J, Dirksen A, Glismann S, de Haas P, Kok-Jensen A
Does immigration from a high-prevalence area contribute to an increased risk of tuberculosis in a low-incidence country? The tuberculosis incidence in Somalia is among the highest ever registered. Due to civil war and starvation, nearly half of all Somalis have been forced from their homes, causing significant migration to low-incidence countries. In Denmark, two-thirds of all tuberculosis patients are immigrants, half from Somalia. To determine the magnitude of Mycobacterium tuberculosis transmission between Somalis and Danes, we analyzed DNA fingerprint patterns of isolates collected in Denmark from 1992 to 1999, comprising >97% of all culture-positive patients (n = 3,320). Of these, 763 were Somalian immigrants, 55.2% of whom shared identical DNA fingerprint patterns; 74.9% of these were most likely infected before their arrival in Denmark, 23.3% were most likely infected in Denmark by other Somalis, and 1.8% were most likely infected by Danes. In the same period, only 0.9% of all Danish tuberculosis patients were most likely infected by Somalis. The Somalian immigrants in Denmark could be distributed into 35 different clusters with possible active transmission, of which 18 were retrieved among Somalis in the Netherlands. This indicated the existence of some internationally predominant Somalian strains causing clustering less likely to represent recent transmission. In conclusion, M. tuberculosis transmission among Somalis in Denmark is limited, and transmission between Somalis and Danes is nearly nonexistent. The higher transmission rates between nationalities found in the Netherlands do not apply to the situation in Denmark and not necessarily elsewhere, since many different factors may influence the magnitude of active transmission. PMID: 112303959 Genome-sequence-based fluorescent amplified-fragment length polymorphism analysis of Mycobacterium tuberculosis. J Clin Microbiol 2000; 38(3):1121-6
Goulding JN, Stanley J, Saunders N, Arnold C
The whole-genome fingerprinting technique, fluorescent amplified-fragment length polymorphism (FAFLP) analysis, was applied to Mycobacterium tuberculosis. Sixty-five clinical isolates were analyzed to determine the value of FAFLP as a stand-alone genotyping technique and to compare it with the well-established IS6110 typing system. The genome sequence of M. tuberculosis strain H37Rv (S. T. Cole et al., Nature 393:537-544, 1998) was used to model computer-generated informative primer combination(s), and the precision and reproducibility of FAFLP were evaluated by comparing the results of in vitro and computer-generated experiments. Multiplex FAFLP was used to increase resolving power in a predictable and systematic fashion. FAFLP analysis was broadly congruent with IS6110 typing for those strains with multiple IS6110 copies. It was also able to resolve an epidemiologically unlinked group of strains with only one copy of IS6110; up to 10% of clinical isolates may fall into this category. For certain epidemiological investigations, it was concluded that a combination of FAFLP and IS6110 typing would give higher resolution than would either alone. FAFLP data were digital, precise, reproducible, and suitable for rapid electronic dissemination, manipulation, interlaboratory comparison, and storage in national or international epidemiological databases. Because FAFLP samples and analyzes base substitution across the genome as a whole, FAFLP could generate new information about the microevolution of the M. tuberculosis complex. PMID: 1069900610 Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999; 282(7):677-86
Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC
To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997. PMID: 1051772211 [Tuberculosis in Denmark 1972-1996]. Ugeskr Laeger 1999; 161(23):3452-7
Poulsen S, Rønne T, Kok-Jensen A, Bauer JO, Miörner H
The present study is based on notified cases of tuberculosis (TB) in the National tbc. register 1972-1996. A decline in Tb incidence was seen from 1972 and until the mid-1980's. Subsequently the trend has reversed due to an increasing number of TB cases in foreigners. In 1996, 60% of all cases of TB in Denmark were found in foreigners reflecting the rising number of refugees and their families arriving in Denmark from highly endemic areas, mainly Somalia. Among native Danes the TB incidence fell from 14 per 100,000 in 1972 to 4 per 100,000 in the 1980's and stabilized at this very low level. The unchanged incidence in Danes covers a falling incidence in the older and a rising incidence in the younger and middle-aged adult population, mainly in the capital. Approximately half of the cases occur in high-risk groups. The TB-epidemic is close to elimination in the indigenous Danish population, but the disease is maintained at a low level probably due to increased patient and doctor delay and resulting microepidemics primarily in high-risk populations. PMID: 1038835312 Classics in infectious diseases. The etiology of tuberculosis: Robert Koch. Berlin, Germany 1882. Rev Infect Dis 1982; 4(6):1270-4 |
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