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 Værktøj 1 SSI's overvågning af tuberkulose i Danmark
2 WHO Tuberculosis data
3 Periskope TB risk calculator
4 The Online TST/IGRA Interpreter
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 Efficacy and tolerability of a 4-month ofloxacin-containing regimen compared to a 6-month regimen in the treatment of patients with superficial lymph node tuberculosis: a randomized trial
BMC Infectious Diseases, 26.07.2024 Tilføjet 26.07.2024 Abstract Background Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. Methods New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. Results Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. Conclusion The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen. Læs mere Tjek på PubMed2 Safety of high-dose amikacin in the first week of all-oral rifampicin-resistant tuberculosis treatment for the prevention of acquired resistance (STAKE): protocol for a single-arm clinical trial
Snobre, J., Gasana, J., Ngabonziza, J. C. S., Cuella-Martin, I., Rigouts, L., Jacobs, B. K., de Viron, E., Herssens, N., Ntihumby, J. B., Klibazayre, A., Ndayishimiye, C., Van Deun, A., Affolabi, D., Merle, C. S., Muvunyi, C., Sturkenboom, M. G. G., Migambi, P., de Jong, B. C., Mucyo, Y., Decroo, T. BMJ Open, 26.07.2024 Tilføjet 26.07.2024 IntroductionAn effective rifampicin-resistant tuberculosis (RR-TB) treatment regimen should include prevention of resistance amplification. While bedaquiline (BDQ) has been recommended in all-oral RR-TB treatment regimen since 2019, resistance is rising at alarming rates. This may be due to BDQ’s delayed bactericidal effect, which increases the risk of selecting for resistance to fluoroquinolones and/or BDQ in the first week of treatment when the bacterial load is highest. We aim to strengthen the first week of treatment with the injectable drug amikacin (AMK). To limit the ototoxicity risk while maximising the bactericidal effect, we will evaluate the safety of adding a 30 mg/kg AMK injection on the first and fourth day of treatment. Methods and analysisWe will conduct a single-arm clinical trial on 20 RR-TB patients nested within an operational study called ShoRRT (All oral Shorter Treatment Regimen for Drug resistant Tuberculosis). In addition to all-oral RR-TB treatment, patients will receive two doses of AMK. The primary safety endpoint is any grade 3–4 adverse event during the first 2 weeks of treatment related to the use of AMK. With a sample size of 20 patients, we will have at least 80% statistical power to support the alternative hypothesis, indicating that less than 14% of patients treated with AMK experience a grade 3–4 adverse event related to its use. Safety data obtained from this study will inform a larger multicountry study on using two high doses of AMK to prevent acquired resistance. Ethics and disseminationApproval was obtained from the ethics committee of Rwanda, Rwanda Food and Drug Authority, Universitair Ziekenhuis, the Institute of Tropical Medicine ethics review board. All participants will provide informed consent. Study results will be disseminated through peer-reviewed journals and conferences. Trial registration number NCT05555303. Læs mere Tjek på PubMed3 Efficacy and tolerability of a 4-month ofloxacin-containing regimen compared to a 6-month regimen in the treatment of patients with superficial lymph node tuberculosis: a randomized trial
BMC Infectious Diseases, 25.07.2024 Tilføjet 25.07.2024 Abstract Background Tuberculosis (TB) lymphadenitis is the most common form of extra-pulmonary TB, and the treatment duration is six months. This non-inferiority based randomized clinical trial in South India evaluated the efficacy and safety of a four-month ofloxacin containing regimen in tuberculosis lymphadenitis (TBL) patients. Methods New, adult, HIV-negative, microbiologically and or histopathologically confirmed superficial lymph node TB patients were randomized to either four-month oflaxacin containing test regimen [ofloxacin (O), isoniazid (H), rifampicin (R), pyrazinamide (Z) -2RHZO daily/ 2RHO thrice-weekly] or a six-month thrice-weekly control regimen (2HRZ, ethambutol/4RH). The treatment was directly observed. Clinical progress was monitored monthly during and up to 12 months post-treatment, and thereafter every three months up to 24 months. The primary outcome was determined by response at the end of treatment and TB recurrence during the 24 months post-treatment. Results Of the 302 patients randomized, 298 (98.7%) were eligible for modified intention-to-treat (ITT) analysis and 294 (97%) for per-protocol (PP) analysis. The TB recurrence-free favourable response in the PP analysis was 94.0% (95% CI: 90.1–97.8) and 94.5% (95% CI: 90.8–98.2) in the test and control regimen respectively, while in the ITT analysis, it was 92.7% and 93.2%. The TB recurrence-free favourable response in the test regimen was non-inferior to the control regimen 0.5% (95% CI: -4.8-5.9) in the PP analysis based on the 6% non-inferiority margin. Treatment was modified for drug toxicity in two patients in the test regimen, while one patient had a paradoxical reaction. Conclusion The 4-month ofloxacin containing regimen was found to be non-inferior and as safe as the 6-month thrice-weekly control regimen. Læs mere Tjek på PubMed4 Correction: Risk factors of adult isoniazid-resistant and rifampicin-susceptible tuberculosis in Nanjing, 2019–2021
BMC Infectious Diseases, 25.07.2024 Tilføjet 25.07.2024 5 Spatiotemporal analysis of regional and age differences in tuberculosis prevalence in mainland China
Fengwen Huang, Stephen Temitayo Bello Tropical Medicine & International Health, 25.07.2024 Tilføjet 25.07.2024 6 HIV-Associated Tuberculosis
C. Corey Hardin, Graeme Meintjes, and Gary MaartensFrom the Department of Medicine, University of Cape Town and Groote Schuur Hospital (G. Meintjes), and the Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine (G. Meintjes, G. Maartens), and the Division of Clinical Pharmacology, Department of Medicine (G. Maartens), University of Cape Town — all in Cape Town, South Africa; and Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (G. Meintjes). New England Journal of Medicine, 25.07.2024 Tilføjet 25.07.2024 New England Journal of Medicine, Volume 391, Issue 4, Page 343-355, July 25, 2024. Læs mere Tjek på PubMed7 The T120P or M172V mutation on rv2172c confers high level para-aminosalicylic acid resistance in Mycobacterium tuberculosis
Jin-Tian Xu Ji-Fang Yu Tao Cheng Ao Feng Ping Yang Jing Gu Hong-Jun Yu Jiao-Yu Deng a Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of Chinab University of Chinese Academy of Sciences, Beijing, People’s Republic of Chinac Department of Biochemistry and Molecular Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China Emerg Microbes Infect, 24.07.2024 Tilføjet 24.07.2024 8 Prediabetes and the treatment outcome of tuberculosis: A meta‐analysis
Lingbo Liang, Qiaoli Su Tropical Medicine & International Health, 23.07.2024 Tilføjet 23.07.2024 9 EfpA is required for regrowth of Mycobacterium tuberculosis following isoniazid exposure
Adam H. RobertsChristopher W. MoonValwynne FaulknerSharon L. KendallSimon J. WaddellJoanna Bacon1Discovery Group, VDEC, UK Health Security Agency, Porton Down, Salisbury, United Kingdom2Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom3Centre for Emerging, Endemic and Exotic Diseases, Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United KingdomSean Wasserman Antimicrobial Agents And Chemotherapy, 23.07.2024 Tilføjet 23.07.2024 10 Research - Potential of Pan-Tuberculosis Treatment to Drive Emergence of Novel Resistance
Emerging Infectious Diseases, 23.07.2024 Tilføjet 23.07.2024 Research - Potential of Pan-Tuberculosis Treatment to Drive Emergence of Novel Resistance Læs mere Tjek på PubMed11 Correction: Risk factors of adult isoniazid-resistant and rifampicin-susceptible tuberculosis in Nanjing, 2019–2021
BMC Infectious Diseases, 23.07.2024 Tilføjet 23.07.2024 12 Plasma Immune Biomarkers Predictive of Progression to Active Tuberculosis in Household Contacts of TB Patients
Journal of Infectious Diseases, 21.07.2024 Tilføjet 21.07.2024 Abstract Background The progression from Mycobacterium tuberculosis infection to active tuberculosis (TB) disease varies among individuals, and identifying biomarkers to predict progression is crucial for guiding interventions. In this study, we aimed to determine plasma immune biomarker profiles in healthy household contacts of index pulmonary TB (PTB) patients who either progressed to TB or remained as non-progressors.Methods A cohort of household contacts of adults with PTB was enrolled, consisting of 15 contacts who progressed to TB disease and 15 non-progressors. Plasma samples were collected at baseline, 4 months, and 12 months to identify predictive TB progression markers.Results Our findings revealed that individuals in the progressor group exhibited significantly decreased levels of IFNγ, IL-2, TNFα, IL1α, IL1β, IL-17A, and IL-1Ra at baseline, months 4 and 12. In contrast, the progressor group displayed significantly elevated levels of IFNα, IFNβ, IL-6, IL-12, GM-CSF, IL-10, IL-33, CCL2, CCL11, CXCL8, CXCL10, CX3CL1, VEGF, Granzyme-B and PDL-1 compared to the non-progressor group at baseline, months 4 and 12. ROC analysis identified IFNγ, GM-CSF, IL-1Ra, CCL2 and CXCL10 as the most promising predictive markers, with an AUC of ≥90. Furthermore, combinatorial analysis demonstrated that GM-CSF, CXCL10 and IL-1Ra, when used in combination, exhibited high accuracy in predicting progression to active TB disease.Conclusions Our study suggests that a specific set of plasma biomarkers GM-CSF, CXCL10 and IL-1Ra, can effectively identify household contacts at significant risk of developing TB disease. These findings have important implications for early intervention and preventive strategies in TB-endemic regions. Læs mere Tjek på PubMed13 Immunological roads diverged: mapping tuberculosis outcomes in mice
Rachel K. Meade, Clare M. Smith Trends in Microbiology, 21.07.2024 Tilføjet 21.07.2024 The journey from phenotypic observation to causal genetic mechanism is a long and challenging road. For pathogens like Mycobacterium tuberculosis (Mtb), which causes tuberculosis (TB), host–pathogen coevolution has spanned millennia, costing millions of human lives. Mammalian models can systematically recapitulate host genetic variation, producing a spectrum of disease outcomes. Leveraging genome sequences and deep phenotyping data from infected mouse genetic reference populations (GRPs), quantitative trait locus (QTL) mapping approaches have successfully identified host genomic regions associated with TB phenotypes. Here, we review the ongoing optimization of QTL mapping study design alongside advances in mouse GRPs. These next-generation resources and approaches have enabled identification of novel host–pathogen interactions governing one of the most prevalent infectious diseases in the world today. Læs mere Tjek på PubMed14 Targeted nanopore sequencing using clinical specimens for the rapid diagnosis of extrapulmonary tuberculosis
BMC Infectious Diseases, 20.07.2024 Tilføjet 20.07.2024 Abstract Background The clinical presentation of extrapulmonary tuberculosis (EPTB) is atypical and it is easily confused with other diseases such as common infections, making prompt diagnosis a great challenge. This study aimed to evaluate the accuracy of targeted nanopore sequencing (TNS) in the diagnosis of EPTB. The diagnostic accuracy of TNS using different types of extrapulmonary specimens was also evaluated. Methods We reviewed the clinical data of patients with suspected EPTB for whom TNS was conducted and who were hospitalized at our center. The true positive, false positive, false negative, and true negative values were determined. Indices of diagnostic accuracy were computed, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for TNS and acid-fast bacilli (AFB) culture, and compared with those from clinical diagnosis. Results 149 patients were included in the analysis. The overall sensitivity, specificity, PPV, NPV, and AUC of TNS for the diagnosis of EPTB were 86.4%, 87.5%, 97.3%, 55.3%, and 0.87, respectively. For diagnosis by AFB culture, these values were 25.6%, 100.0%, 100.0%, 20.5%, and 0.63, respectively. The most common specimens used were lymph node tissue, cerebrospinal fluid, pleural effusion, and pleural tissue. The diagnostic accuracy of TNS using all types of extrapulmonary specimens was good. Conclusions TNS demonstrates good diagnostic accuracy in the rapid diagnosis of EPTB and this was true across different types of extrapulmonary specimens. Læs mere Tjek på PubMed15 Pharmacokinetic–pharmacodynamic modeling of tuberculosis time to positivity and colony-forming unit to assess the response to dose-ranging linezolid
Segolene SimeonMaria Garcia-CremadesRada SavicBelén P. Solans1Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA2UCSF Center for Tuberculosis, University of California, San Francisco, California, USA3Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain4Institute of Industrial Pharmacy, Complutense University of Madrid, Madrid, SpainJared A. Silverman Antimicrobial Agents And Chemotherapy, 18.07.2024 Tilføjet 18.07.2024 16 Retraction: Epidemiological insights into paratuberculosis in camels in Saudi Arabia: Bayesian estimation of true prevalence and identification of risk factors
The PLOS ONE Editors PLoS One Infectious Diseases, 18.07.2024 Tilføjet 18.07.2024 17 Prior tuberculosis, radiographic lung abnormalities and prevalent diabetes in rural South Africa
BMC Infectious Diseases, 17.07.2024 Tilføjet 17.07.2024 Abstract Background Growing evidence suggests that chronic inflammation caused by tuberculosis (TB) may increase the incidence of diabetes. However, the relationship between post-TB pulmonary abnormalities and diabetes has not been well characterized. Methods We analyzed data from a cross-sectional study in KwaZulu-Natal, South Africa, of people 15 years and older who underwent chest X-ray and diabetes screening with hemoglobin A1c testing. The analytic sample was restricted to persons with prior TB, defined by either (1) a self-reported history of TB treatment, (2) radiologist-confirmed prior TB on chest radiography, and (3) a negative sputum culture and GeneXpert. Chest X-rays of all participants were evaluated by the study radiologist to determine the presence of TB lung abnormalities. To assess the relationships between our outcome of interest, prevalent diabetes (HBA1c ≥6.5%), and our exposure of interest, chest X-ray abnormalities, we fitted logistic regression models adjusted for potential clinical and demographic confounders. In secondary analyses, we used the computer-aided detection system CAD4TB, which scores X-rays from 10 to 100 for detection of TB disease, as our exposure interest, and repeated analyses with a comparator group that had no history of TB disease. Results In the analytic cohort of people with prior TB (n = 3,276), approximately two-thirds (64.9%) were women, and the average age was 50.8 years (SD 17.4). The prevalence of diabetes was 10.9%, and 53.0% of people were living with HIV. In univariate analyses, there was no association between diabetes prevalence and radiologist chest X-ray abnormalities (OR 1.23, 95%CI 0.95–1.58). In multivariate analyses, the presence of pulmonary abnormalities was associated with an 29% reduction in the odds of prevalent diabetes (aOR 0.71, 95%CI 0.53–0.97, p = 0.030). A similar inverse relationship was observed for diabetes with each 10-unit increase in the CAD4TB chest X-ray scores among people with prior TB (aOR 0.92, 95%CI 0.87–0.97; p = 0.002), but this relationship was less pronounced in the no TB comparator group (aOR 0.96, 95%CI 0.94–0.99). Conclusions Among people with prior TB, pulmonary abnormalities on digital chest X-ray are inversely associated with prevalent diabetes. The severity of radiographic post-TB lung disease does not appear to be a determinant of diabetes in this South African population. Læs mere Tjek på PubMed18 Prevalence of vitamin D deficiency and the effect of vitamin D3 supplementation on response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis
BMC Infectious Diseases, 17.07.2024 Tilføjet 17.07.2024 Abstract Background We aimed to assess serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in extrapulmonary tuberculosis (EPTB) patients and to evaluate the effect of vitamin D3 supplementation on their treatment course. Methods Serum 25(OH)D3concentrations were measured in 47 newly diagnosed EPTB patients and 42 controls. Vitamin D-deficient EPTB patients were randomly assigned to receive 50,000 IU of vitamin D3 (cholecalciferol) orally once a week for 6 weeks (total 300,000 IU), followed by maintenance doses of 1000 IU a day besides anti-TB drugs or the first line anti-TB treatment only. Follow up serum 25(OH)D3 concentrations were measured after 3 months of starting vitamin D3 supplementation. Both groups were evaluated for clinical, laboratory, and radiological outcomes after treatment. Results Serum 25(OH)D3 concentrations were significantly lower among TB cases (17.1 ± 5.5 nmol/L) compared to healthy controls (51.8 ± 27.3 nmol/L), and vitamin D deficiency was observed in all EPTB patients (n = 47). Patients in VD3 supplementation group had significantly higher weight gain and serum albumin level at 2 months and end of treatment, higher hemoglobin concentration at the end of treatment, significantly lower CRP and ESR at 2 months and at the end of treatment. In cases with TB pleurisy, a significant higher rate of full resolution of pleural fluid after 6 months of anti-TB treatment and shorter treatment duration were noted compared to the other group. Conclusions Vitamin D deficiency is prevalent in EPTB patients, in whom, vitamin D supplementation is a useful adjunctive therapy to anti-TB drugs and improves treatment course. Læs mere Tjek på PubMed19 One Half of the Pair: Prioritizing Tuberculosis Transmitters for Early Detection
Barun Mathema, Joseph Burzynski American Journal of Respiratory and Critical Care Medicine , 16.07.2024 Tilføjet 16.07.2024 American Journal of Respiratory and Critical Care Medicine, Volume 210, Issue 2, Page 143-144, July 15, 2024. Læs mere Tjek på PubMed20 Who Transmits Tuberculosis to Whom: A Cross-Sectional Analysis of a Cohort Study in Lima, Peru
Letizia Trevisi, Meredith B. Brooks, Mercedes C. Becerra, Roger I. Calderón, Carmen C. Contreras, Jerome T. Galea, Judith Jimenez, Leonid Lecca, Rosa M. Yataco, Ximena Tovar, Zibiao Zhang, Megan B. Murray, Chuan-Chin Huang American Journal of Respiratory and Critical Care Medicine , 16.07.2024 Tilføjet 16.07.2024 American Journal of Respiratory and Critical Care Medicine, Volume 210, Issue 2, Page 222-233, July 15, 2024. Læs mere Tjek på PubMed |
Ph.d. forsvar ved Andreas Arnholdt Pedersen
Emil Aarestrup auditorium, Odense Universityhospital (og online)
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Medical Artificial Intelligence Toolbox (MAIT) seminar 2024
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Nordic Society of Clinical Microbiology and Infectious Diseases (NSCMID) annual meeting 2024
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European Respiratory Society (ERS) Congress 2024
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