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Tuberculosis

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Salmaan Keshavjee - One of the best experts on this subject based on the ideXlab platform.

  • incidence of multidrug resistant Tuberculosis disease in children systematic review and global estimates
    The Lancet, 2014
    Co-Authors: Helen E Jenkins, Arielle W Tolman, Courtney M Yuen, Jonathan B Parr, Salmaan Keshavjee, Carlos M Perezvelez
    Abstract:

    Summary Background Multidrug-resistant Tuberculosis threatens to reverse recent reductions in global Tuberculosis incidence. Although children younger than 15 years constitute more than 25% of the worldwide population, the global incidence of multidrug-resistant Tuberculosis disease in children has never been quantified. We aimed to estimate the regional and global annual incidence of multidrug-resistant Tuberculosis in children. Methods We developed two models: one to estimate the setting-specific risk of multidrug-resistant Tuberculosis among child cases of Tuberculosis, and a second to estimate the setting-specific incidence of Tuberculosis disease in children. The model for risk of multidrug-resistant Tuberculosis among children with Tuberculosis needed a systematic literature review. We multiplied the setting-specific estimates of multidrug-resistant Tuberculosis risk and Tuberculosis incidence to estimate regional and global incidence of multidrug-resistant Tuberculosis disease in children in 2010. Findings We identified 3403 papers, of which 97 studies met inclusion criteria for the systematic review of risk of multidrug-resistant Tuberculosis. 31 studies reported the risk of multidrug-resistant Tuberculosis in both children and treatment-naive adults with Tuberculosis and were used for evaluation of the linear association between multidrug-resistant disease risk in these two patient groups. We identified that the setting-specific risk of multidrug-resistant Tuberculosis was nearly identical in children and treatment-naive adults with Tuberculosis, consistent with the assertion that multidrug-resistant disease in both groups reflects the local risk of transmitted multidrug-resistant Tuberculosis. After application of these calculated risks, we estimated that around 999 792 (95% CI 937 877–1 055 414) children developed Tuberculosis disease in 2010, of whom 31 948 (25 594–38 663) had multidrug-resistant disease. Interpretation Our estimates underscore that many cases of Tuberculosis and multidrug-resistant Tuberculosis disease are not being detected in children. Future estimates can be refined as more and better Tuberculosis data and new diagnostic instruments become available. Funding US National Institutes of Health, the Helmut Wolfgang Schumann Fellowship in Preventive Medicine at Harvard Medical School, the Norman E Zinberg Fellowship at Harvard Medical School, and the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at the Brigham and Women's Hospital.

  • treatment of extensively drug resistant Tuberculosis in tomsk russia a retrospective cohort study
    The Lancet, 2008
    Co-Authors: Salmaan Keshavjee, I Y Gelmanova, Paul Farmer, Sergey P Mishustin, A K Strelis, Yevgeny G Andreev
    Abstract:

    Summary Background Mycobacterium Tuberculosis strains that cause untreatable drug-resistant disease are a threat worldwide. We describe the treatment, management, and outcomes of patients with extensively drug-resistant Tuberculosis in Tomsk, Russia. Methods We undertook a retrospective cohort study of 608 patients with multidrug resistant Tuberculosis who had treatment in civilian or prison services, between Sept 10, 2000, and Nov 1, 2004, according to the treatment strategy recommended by WHO. Clinical characteristics, management practices, and treatment outcomes of patients with extensively drug-resistant (XDR) Tuberculosis and non-extensively drug-resistant (non-XDR) Tuberculosis are described. The main outcome was the frequency of poor and favourable outcomes at the end of treatment. Findings Of 608 patients with multidrug resistant Tuberculosis, 29 (4·8%) patients had baseline XDR Tuberculosis. Treatment failure was more common in patients with XDR Tuberculosis than in those with non-XDR Tuberculosis (31% vs 8·5%, p=0·0008). 48·3% of patients with XDR Tuberculosis and 66·7% of patients with non-XDR Tuberculosis had treatment cure or completion (p=0·04). The frequency and management of adverse events did not differ between patients with XDR and non-XDR Tuberculosis. Interpretation The chronic features of Tuberculosis in these patients suggest that extensively drug-resistant Tuberculosis may be acquired through previous treatments that include second-line drugs. Aggressive management of this infectious disease is feasible and can prevent high mortality rates and further transmission of drug-resistant strains of Mycobacterium Tuberculosis . Funding Bill & Melinda Gates Foundation, Eli Lilly Foundation, The Open Society Institute, Frank Hatch Fellowships in Global Health Equity at the Brigham & Women's Hospital, Infectious Disease Society of America, the Heiser Foundation, the United States National Institutes of Health, and the John D and Catherine T MacArthur Foundation.

Richard E Chaisson - One of the best experts on this subject based on the ideXlab platform.

  • How to eliminate Tuberculosis 3 Controlling the seedbeds of Tuberculosis: diagnosis and treatment of Tuberculosis infection
    2020
    Co-Authors: Molebogeng X Rangaka, Solange C. Cavalcante, Ben J. Marais, Sok Thim, Neil A. Martinson, Soumya Swaminathan, Richard E Chaisson
    Abstract:

    The billions of people with latent Tuberculosis infection serve as the seedbeds for future cases of active Tuberculosis. Virtually all episodes of Tuberculosis disease are preceded by a period of asymptomatic Mycobacterium Tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt Tuberculosis transmission and reduce the global burden of Tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for Tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-fi nding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide Tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for Tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new Tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical Tuberculosis infections, develop novel diagnostics and drug regimens specifi cally for subclinical Tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes.

  • Controlling the seedbeds of Tuberculosis: diagnosis and treatment of Tuberculosis infection
    The Lancet, 2015
    Co-Authors: Molebogeng X Rangaka, Solange C. Cavalcante, Ben J. Marais, Sok Thim, Neil A. Martinson, Soumya Swaminathan, Richard E Chaisson
    Abstract:

    Summary The billions of people with latent Tuberculosis infection serve as the seedbeds for future cases of active Tuberculosis. Virtually all episodes of Tuberculosis disease are preceded by a period of asymptomatic Mycobacterium Tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a crucial opportunity to interrupt Tuberculosis transmission and reduce the global burden of Tuberculosis disease. Programmes focusing on single strategies rather than comprehensive programmes that deliver an integrated arsenal for Tuberculosis control might continue to struggle. Tuberculosis preventive therapy is a poorly used method that is essential for controlling the reservoirs of disease that drive the epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission, and health systems strengthening could ultimately lead to worldwide Tuberculosis elimination. In this Series paper we outline challenges to implementation of preventive therapy and provide pragmatic suggestions for overcoming them. We further advocate for Tuberculosis preventive therapy as the core of a renewed worldwide focus to implement a comprehensive epidemic control strategy that would reduce new Tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical Tuberculosis infections, develop novel diagnostics and drug regimens specifically for subclinical Tuberculosis infection, strengthen health systems and community engagement, and enhance sustainable large scale implementation of preventive therapy programmes.

  • latent mycobacterium Tuberculosis infection
    The New England Journal of Medicine, 2015
    Co-Authors: Haileyesus Getahun, Richard E Chaisson, Alberto Matteelli, Mario Raviglione
    Abstract:

    The natural history of Tuberculosis begins with the inhalation of Mycobacterium Tuberculosis organisms; a period of bacterial replication and dissemination ensues, followed by immunologic containment of viable bacilli. The result of this process is asymptomatic latent Tuberculosis infection, which is defined as a state of persistent bacterial viability, immune control, and no evidence of clinically manifested active Tuberculosis. 1 Currently, it is not possible to directly diagnose M. Tuberculosis infection in humans; therefore, latent Tuberculosis infection is diagnosed by response to in vivo or in vitro stimulation by M. Tuberculosis antigens with the use of the tuberculin skin test or interferon-γ release assays (IGRAs). Studies suggest that active Tuberculosis will develop in 5 to 15% of persons with latent infection during their lifetimes 2 (and a higher percentage if the persons are immunocompromised); thus, persons with latent infection serve, according to Osler, as the “seedbeds” of Tuberculosis in the community. 3 This article will review the pathogenesis, epidemiology, diagnosis, and treatment of latent Tuberculosis infection. It will address critical gaps in the understanding of this complex condition and propose the necessary research agenda.

  • Tuberculosis and diabetes mellitus convergence of two epidemics
    Lancet Infectious Diseases, 2009
    Co-Authors: Kelly E Dooley, Richard E Chaisson
    Abstract:

    The link between diabetes mellitus and Tuberculosis has been recognised for centuries. In recent decades, Tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor Tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for Tuberculosis and might affect disease presentation and treatment response. Furthermore, Tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the Tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for Tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause Tuberculosis, the effects of Tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and Tuberculosis.

Mercedes C Becerra - One of the best experts on this subject based on the ideXlab platform.

  • yield of contact investigations in households of patients with drug resistant Tuberculosis systematic review and meta analysis
    Clinical Infectious Diseases, 2014
    Co-Authors: Sarita N Shah, Arielle W Tolman, Courtney M Yuen, Mercedes C Becerra
    Abstract:

    Contact investigations among individuals living with drug-susceptible Tuberculosis patients (source cases) have shown a high yield of Tuberculosis disease and latent Tuberculosis, but the yield of such investigations in households of drug-resistant Tuberculosis source cases is unknown. In this systematic review and meta-analysis, we found 25 studies that evaluated a median of 111 (interquartile range, 21–302) household contacts of drug-resistant Tuberculosis source cases. The pooled yield was 7.8% (95% CI, 5.6%–10.0%) for active Tuberculosis and 47.2% (95% CI, 30.0%–61.4%) for latent Tuberculosis, although there was significant statistical heterogeneity (P < .0001). More than 50% of secondary cases with drug susceptibility test results were concordant with those of the source case. Among studies that followed household members, the majority of secondary cases were detected within 1 year of the source case's diagnosis. Household contact investigation around drug-resistant Tuberculosis patients is a high-yield intervention for detection of drug-resistant Tuberculosis and prevention of ongoing transmission.

Jessie K Mbwambo - One of the best experts on this subject based on the ideXlab platform.

  • sputum smear negative pulmonary Tuberculosis sensitivity and specificity of diagnostic algorithm
    BMC Research Notes, 2011
    Co-Authors: Hedwiga F Swai, Ferdinand Mugusi, Jessie K Mbwambo
    Abstract:

    Background The diagnosis of pulmonary Tuberculosis in patients with Human Immunodeficiency Virus (HIV) is complicated by the increased presence of sputum smear negative Tuberculosis. Diagnosis of smear negative pulmonary Tuberculosis is made by an algorithm recommended by the National Tuberculosis and Leprosy Programme that uses symptoms, signs and laboratory results. The objective of this study is to determine the sensitivity and specificity of the Tuberculosis treatment algorithm used for the diagnosis of sputum smear negative pulmonary Tuberculosis.

Ted Cohen - One of the best experts on this subject based on the ideXlab platform.

  • the prevalence and drug sensitivity of Tuberculosis among patients dying in hospital in kwazulu natal south africa a postmortem study
    PLOS Medicine, 2010
    Co-Authors: Ted Cohen, Kristina Wallengren, Gonzalo G Alvarez, Elizabeth Y Samuel, Megan Murray, Douglas Wilson
    Abstract:

    Background: Tuberculosis is the leading cause of death in South Africa by death notification, but accurate diagnosis of Tuberculosis is challenging in this setting of high HIV prevalence. We conducted limited autopsies on young adults dying in a single public hospital in the province of KwaZulu-Natal between October 2008 and August 2009 in order to estimate the magnitude of deaths attributable to Tuberculosis. Methods and Findings: We studied a representative sample of 240 adult inpatients (aged 20–45 years) dying after admission to Edendale Hospital. Limited autopsies included collection of respiratory tract secretions and tissue by needle core biopsies of lung, liver, and spleen. Specimens were examined by fluorescent microscopy for acid-fast bacilli and cultured in liquid media; cultures positive for M. Tuberculosis were tested for drug susceptibility to first- and second-line antibiotics. Ninety-four percent of our study cohort was HIV seropositive and 50% of decedents had culture-positive Tuberculosis at the time of death. Fifty percent of the participants were on treatment for Tuberculosis at the time of death and 58% of these treated individuals remained culture positive at the time of death. Of the 50% not receiving Tuberculosis treatment, 42% were culture positive. Seventeen percent of all positive cultures were resistant to both isoniazid and rifampin (i.e., multidrug resistant); 16% of patients dying during the initiation phase of their first ever course of Tuberculosis treatment were infected with multidrug-resistant bacilli. Conclusions: Our findings reveal the immense toll of Tuberculosis among HIV-positive individuals in KwaZulu-Natal. The majority of decedents who remained culture positive despite receiving Tuberculosis treatment were infected with pansusceptible M. Tuberculosis, suggesting that the diagnosis of Tuberculosis was made too late to alter the fatal course of the infection. There is also a significant burden of undetected multidrug-resistant Tuberculosis among HIV-coinfected individuals dying in this setting. New public health approaches that improve early diagnosis of Tuberculosis and accelerate the initiation of treatment are urgently needed in this setting.