Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/tuberkulose#tuberkulose_diagnostik_og_behandling_(2023).pdf
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
https://infmed.dk/tuberkulose#tuberkuloseinfektion_hos_immunsupprimerede_(2023).pdf
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
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 Assessment for Antibodies to Rifapentine and Isoniazid in Persons Developing Flu-like Reactions During Treatment of Latent Tuberculosis Infection
Journal of Infectious Diseases, 20.04.2024 Tilføjet 20.04.2024 Abstract Background Flu-like reactions can occur after exposure to rifampin, rifapentine, or isoniazid. Prior studies have reported the presence of antibodies to rifampin, but associations with underlying pathogenesis are unclear.Methods We evaluated PREVENT TB study participants who received weekly isoniazid + rifapentine for 3 months (3HP) or daily isoniazid for 9 months (9H) as treatment for M. tuberculosis infection. Flu-like reaction was defined as a grade ≥2 of any of flu-like symptoms. Controls (3HP or 9H) did not report flu-like reactions. We developed a competitive enzyme-linked immunosorbent assays (ELISA) to detect antibodies against rifapentine, isoniazid, rifampin, and rifapentine metabolite.Results Among 128 participants, 69 received 3HP (22 with flu-like reactions; 47 controls) and 59 received 9H (12 with flu-like reactions; 47 controls). In participants receiving 3HP, anti-rifapentine IgG was identified in 2/22 (9%) participants with flu-like reactions and 6/47 (13%) controls (P = 0.7), anti-isoniazid IgG in 2/22 (9%) participants with flu-like reactions and 4/47 (9%) controls (P = 0.9), and anti-rifapentine metabolite IgG in 2/47 (4%) controls (P = 0.9). Among participants receiving 9H, IgG and IgM anti-isoniazid antibodies were each present in 4/47 (9%) controls, respectively, but none among participants with flu-like reactions; anti-rifapentine IgG antibodies were not present in any participants with flu-like reactions or controls.Conclusions We detected anti-rifapentine, anti-isoniazid, and anti-rifapentine metabolite antibodies, but the proportions of participants with antibodies were low, and did not differ between participants with flu-like reactions and those without such reactions. This suggests that flu-like reactions associated with 3HP and 9H were not antibody-mediated. Læs mere Tjek på PubMed2 Duration of Effective Tuberculosis Treatment, not Acid-Fast Bacilli (AFB) Smear Status, as the Determinant for Deisolation in Community Settings
Clinical Infectious Diseases, 18.04.2024 Tilføjet 18.04.2024 3 NTCA Guidelines for Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings
Clinical Infectious Diseases, 18.04.2024 Tilføjet 18.04.2024 4 Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay
BMC Infectious Diseases, 17.04.2024 Tilføjet 17.04.2024 Abstract Background Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). Methods PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. Results From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count ( Læs mere Tjek på PubMed5 Increased tuberculosis case detection in Tanzanian children and adults using African giant pouched rats
BMC Infectious Diseases, 16.04.2024 Tilføjet 16.04.2024 Abstract Background African giant pouched rats, trained by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO), have demonstrated their ability to detect tuberculosis (TB) from sputum. We assessed rat-based case detection and compared the mycobacterium bacillary load (MTB-load) in children versus adults. Methods From January–December 2022, samples were collected prospectively from 69 Directly Observed Therapy (DOT) facilities’ presumed TB patients. Using an average of five rats, APOPO re-evaluated patients with bacteriologically negative (sputum-smear microscopy or Xpert MTB/RIF) results. Rat-positive samples were tested using concentrated smear light-emitting diode microscopy to confirm TB detection before treatment initiation. The rats’ identification of pulmonary TB is based on smelling TB-specific volatile organic compounds (VOCs) in sputum. Using STATA, Chi-square for odds ratio and confidence interval was calculated and evaluated: (1) the yield of rat-based TB detection compared to that of the health facilities; (2) rat-based TB detection in children versus adults; and (3) rats’ ability to detect TB across MTB-loads and between children and adults. Results From 35,766 patients, 5.3% (1900/35,766) were smear-positive and 94.7% (33,866/35,766) were smear or Xpert-negatives at DOTS facility. Of those with negative results, 2029 TB cases were detected using rats, contributing to 52% (2029/3929 of total TB identified), which otherwise would have been missed. Compared to DOT facilities, rats were six-fold more likely to detect TB among Acid Fast Bacilli (AFB) 1+/scanty [90% (1829/2029) versus 60% (1139/1900), odds ratio, OR = 6.11, 95% confidence interval, CI: 5.14–7.26]; twice more likely to identify TB cases among children [71% (91/129) versus 51% (1795/3542), OR = 2.3, 95% CI: 1.59–3.42]; and twice more likely to identify TB cases among children with AFB 1+/scanty than adults with the same MTB-load [5% (86/1703) versus 3% (28/1067), OR = 2.0, 95% CI: 1.28–3.03]. Conclusions Rats contributed over half of the TB cases identified in program settings, and children, especially those with a lower MTB-load, were more likely to be diagnosed with TB by rats. The chemical signatures, VOCs, were only available for adults, and further research describing the characteristics of VOCs in children versus adults may pave the way to enhance TB diagnosis in children. Læs mere Tjek på PubMed6 Dual-centre evaluation of the FluoroType MTBDR version 2 assay for detection of Mycobacterium tuberculosis complex and resistance-conferring mutations in pulmonary and extrapulmonary samples from Denmark, Germany and Sierra Leone
Erik Svensson, Hannah Ketelsen, Sönke Andres, Dorte Bek Folkvardsen, Doris Hillemann, Ousman Conteh, Anders Norman, Stefan Niemann, Troels Lillebaek, Martin Kuhns Clinical Microbiology and Infection, 14.04.2024 Tilføjet 14.04.2024 We evaluated the ability of FluoroType MTBDR version 2 (FTv2; Hain Lifescience), a second-step real-time PCR assay, to simultaneously detect Mycobacterium tuberculosis complex (MTBC) DNA and mutations conferring resistance to rifampicin (RIF) and isoniazid (INH), in pulmonary and extrapulmonary samples from patients and compared them with corresponding cultures. Læs mere Tjek på PubMed7 [Articles] Safety of a controlled human infection model of tuberculosis with aerosolised, live-attenuated Mycobacterium bovis BCG versus intradermal BCG in BCG-naive adults in the UK: a dose-escalation, randomised, controlled, phase 1 trial
Iman Satti, Julia L Marshall, Stephanie A Harris, Rachel Wittenberg, Rachel Tanner, Raquel Lopez Ramon, Morven Wilkie, Fernando Ramos Lopez, Michael Riste, Daniel Wright, Marco Polo Peralta Alvarez, Nicola Williams, Hazel Morrison, Elena Stylianou, Pedro Folegatti, Daniel Jenkin, Samantha Vermaak, Linnea Rask, Ingrid Cabrera Puig, Rebecca Powell Doherty, Alison Lawrie, Paul Moss, Timothy Hinks, Henry Bettinson, Helen McShane Lancet Infectious Diseases, 13.04.2024 Tilføjet 13.04.2024 This first-in-human aerosol BCG controlled human infection model was sufficiently well tolerated. Further work will evaluate the utility of this model in assessing vaccine efficacy and identifying potential correlates of protection. Læs mere Tjek på PubMed8 Incipient tuberculosis: a comprehensive overview
Infection, 10.04.2024 Tilføjet 10.04.2024 Abstract In the context of the evolving global health landscape shaped by the COVID-19 pandemic, tuberculosis (TB) is gaining renewed attention as a reemerging threat even in low-endemic countries. Immunological tests such as the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are pivotal in identifying tuberculosis infection (TBI). However, their inability to distinguish between past and ongoing infection poses a diagnostic challenge, possibly leading to the unnecessary treatment of a significant portion of the population with potential side effects. This review delves into the concept of incipient tuberculosis (ITB), a dynamic, presymptomatic stage characterized by heightened Mycobacterium tuberculosis complex (MTC) metabolic activity and replication that result in minimal radiological changes, signifying a transitional state between TBI and TB. Key focus areas include epidemiological factors, underlying pathogenesis, imaging findings, and the ongoing challenges in the identification of individuals with ITB through the development of new biomarkers and the use of whole-genome sequencing-based analyses to implement early treatment strategies. Læs mere Tjek på PubMed9 Assessing potential drug-drug interactions between clofazimine and other frequently used agents to treat drug-resistant tuberculosis
Allan KengoFirdaus NabeemeeahPaolo DentiRyan SabetGifty Okyere-ManuPattamukkil AbrahamLubbe WeisnerModiehi Helen MosalaSibongile TshabalalaJanine ScholefieldJuan Eduardo Resendiz-GalvanNeil A. MartinsonEbrahim Variava1Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa2Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa3Bioengineering and Integrated Genomics Group, Council for Scientific and Industrial Research, Pretoria, South Africa4Johns Hopkins University Center for Tuberculosis Research, Division of Infectious Diseases, School of Medicine, Baltimore, Maryland, USA5Department of Internal Medicine, University of the Witwatersrand, Klerksdorp/Tshepong Hospital Complex North-West Province, Klerksdorp-Tshepong, South Africa, James E. Leggett Antimicrobial Agents And Chemotherapy, 10.04.2024 Tilføjet 10.04.2024 10 Clinical outcomes in children living with HIV treated for non-severe tuberculosis in the SHINE Trial
Clinical Infectious Diseases, 10.04.2024 Tilføjet 10.04.2024 Abstract Background Children living with HIV(CLWH) are at high risk of tuberculosis(TB) and face poor outcomes, despite antiretroviral treatment(ART). We evaluated outcomes in CLWH and HIV-uninfected children treated for non-severe TB in the SHINE trial.Methods SHINE was a randomized trial that enrolled children aged Læs mere Tjek på PubMed11 Incipient tuberculosis: a comprehensive overview
Infection, 9.04.2024 Tilføjet 9.04.2024 Abstract In the context of the evolving global health landscape shaped by the COVID-19 pandemic, tuberculosis (TB) is gaining renewed attention as a reemerging threat even in low-endemic countries. Immunological tests such as the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are pivotal in identifying tuberculosis infection (TBI). However, their inability to distinguish between past and ongoing infection poses a diagnostic challenge, possibly leading to the unnecessary treatment of a significant portion of the population with potential side effects. This review delves into the concept of incipient tuberculosis (ITB), a dynamic, presymptomatic stage characterized by heightened Mycobacterium tuberculosis complex (MTC) metabolic activity and replication that result in minimal radiological changes, signifying a transitional state between TBI and TB. Key focus areas include epidemiological factors, underlying pathogenesis, imaging findings, and the ongoing challenges in the identification of individuals with ITB through the development of new biomarkers and the use of whole-genome sequencing-based analyses to implement early treatment strategies. Læs mere Tjek på PubMed12 Transcriptomic responses to antibiotic exposure in Mycobacterium tuberculosis
Husain PoonawalaYu ZhangSravya KuchibhotlaAnna G. GreenDaniela Maria CirilloFederico Di MarcoAndrea SpitlaeriPaolo MiottoMaha R. Farhat1Department of Medicine and Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA2Department of Medicine and Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, Massachusetts, USA3Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Boston, Massachusetts, USA4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA5Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA6Harvard College, Cambridge, Massachusetts, USA7Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy8Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy9Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA, Sean Wasserman Antimicrobial Agents And Chemotherapy, 9.04.2024 Tilføjet 9.04.2024 13 Normalizing granuloma vasculature and matrix improves drug delivery and reduces bacterial burden in tuberculosis-infected rabbits
Meenal DattaLaura E. ViaVéronique DartoisDanielle M. WeinerMatthew ZimmermanFirat KayaApril M. WalkerJoel D. FleegleIsaac D. RapleeColton McNinchMaksym ZarodniukWalid S. KamounChangli YueAshwin S. KumarSonu SubudhiLei XuClifton E. BarryRakesh K. JainaDepartment of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556bEdwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114cTuberculosis Research Section, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, NIH, Bethesda, MD 20892dCenter for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110eHackensack Meridian School of Medicine, Hackensack Meridian Health, Nutley, NJ 07110fTuberculosis Imaging Program, Division of Intramural Research, National Institute of Allergy and Infectious Disease, NIH, Bethesda, MD 20892gBioinformatics and Computational Bioscience Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892 Proceedings of the National Academy of Sciences, 4.04.2024 Tilføjet 4.04.2024 Proceedings of the National Academy of Sciences, Volume 121, Issue 14, April 2024. Læs mere Tjek på PubMed14 Tuberculosis disease in immunocompromised children and adolescents: a pTBnet multi-centre case-control study
Clinical Infectious Diseases, 4.04.2024 Tilføjet 4.04.2024 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 Læs mere Tjek på PubMed15 The plasma kynurenine-to-tryptophan ratio as a biomarker of tuberculosis disease in people living with HIV on antiretroviral therapy: an exploratory nested case–control study
BMC Infectious Diseases, 4.04.2024 Tilføjet 4.04.2024 Abstract Background Non-sputum-based tests are needed to predict or diagnose tuberculosis (TB) disease in people living with HIV (PWH). The enzyme indoleamine 2, 3-dioxygenase-1 (IDO1) is expressed in tuberculoid granuloma and catabolizes tryptophan (Trp) to kynurenine (Kyn). IDO1 activity compromises innate and adaptive immune responses, promoting mycobacterial survival. The plasma Kyn-to-Trp (K/T) ratio is a potential TB diagnostic and/or predictive biomarker in PWH on long-term antiretroviral therapy (ART). Methods We compared plasma K/T ratios in samples from PWH, who were followed up prospectively and developed TB disease after ART initiation. Controls were matched for age and duration of ART. Kyn and Trp were measured at 3 timepoints; at TB diagnosis, 6 months before TB diagnosis and 6 months after TB diagnosis, using ultra performance liquid chromatography combined with mass spectrometry. Results The K/T ratios were higher for patients with TB disease at time of diagnosis (median, 0.086; IQR, 0.069–0.123) compared to controls (0.055; IQR 0.045–0.064; p = 0.006), but not before or after TB diagnosis. K/T ratios significantly declined after successful TB treatment, but increased upon treatment failure. The K/T ratios showed a parabolic correlation with CD4 cell counts in participants with TB (p = 0.005), but there was no correlation in controls. Conclusions The plasma K/T ratio helped identify TB disease and may serve as an adjunctive biomarker for for monitoring TB treatment in PWH. Validation studies to ascertain these findings and evaluate the optimum cut-off for diagnosis of TB disease in PWH should be undertaken in well-designed prospective cohorts. Trial registration ClinicalTrials.gov Identifier: NCT00411983. Læs mere Tjek på PubMed16 The clinical profile and outcomes of drug resistant tuberculosis in Central Province of Zambia
BMC Infectious Diseases, 4.04.2024 Tilføjet 4.04.2024 Abstract Background The emergence of Drug Resistant Tuberculosis (DR-TB) is one of the main public health and economic problems facing the world today. DR-TB affects mostly those in economically productive years and prevents them from being part of the workforce needed for economic growth. The aim of this study was to determine the Clinical Profile and Outcomes of DR-TB in Central Province of Zambia. Methods This was a retrospective cross sectional study that involved a review of records of patients with confirmed DR-TB who were managed at Kabwe Central Hospital’s Multi-Drug Resistant TB (MDR-TB) Ward from the year 2017 to 2021. 183 patients were managed during this period and all were recruited in the study. Data was collected from DR-TB registers and patient files and then entered in SPSS version 22 where all statistical analyses were performed. Results The study revealed that the prevalence of DR-TB among registered TB patients in Central Province was 1.4%. Majority of those affected were adults between the ages of 26 and 45 years (63.9%). The study also found that more than half of the patients were from Kabwe District (60.7%). Other districts with significant number of cases included Kapiri Mposhi 19 (10.4%), Chibombo 12 (6.6%), Chisamba 10 (5.5%), Mumbwa 7 (3.8%) and Mkushi 7 (3.8%). Furthermore, the analysis established that most of the patients had RR-TB (89.6%). 9.3% had MDR-TB, 0.5% had IR-TB and 0.5% had XDR-TB. RR-TB was present in 93.8% of new cases and 88.9% of relapse cases. MDR-TB was present in 6.2% of new cases and 10% of relapse cases. With regard to outcomes of DR-TB, the investigation revealed that 16.9% of the patients had been declared cured, 45.9% had completed treatment, 6% were lost to follow up and 21.3% had died. Risk factors for mortality on multivariate analysis included age 36–45 years (adjusted odds ratio [aOR] 0.253, 95% CI [0.70–0.908] p = 0.035) and male gender (aOR 0.261, 95% CI [0.107–0.638] p = 0.003). Conclusion The research has shown beyond doubt that the burden of DR-TB in Central Province is high. The study recommends putting measures in place that will help improve surveillance, early detection, early initiation of treatment and proper follow up of patients. Læs mere Tjek på PubMed17 [News] Phase 2 trial of a novel tuberculosis drug launched
Ed Holt The Lancet Microbe, 4.04.2024 Tilføjet 4.04.2024 During the Union World Conference on Lung Health 2023, held in Paris, France, on Nov 15–18, results from preclinical studies and a phase 1 trial of a novel candidate tuberculosis drug were presented. The new compound, named TBAJ-876, belongs to the diarylquinoline class of antibiotics (like bedaquiline). Læs mere Tjek på PubMed18 [Articles] Accuracy of the tuberculosis molecular bacterial load assay to diagnose and monitor response to anti-tuberculosis therapy: a longitudinal comparative study with standard-of-care smear microscopy, Xpert MTB/RIF Ultra, and culture in Uganda
Emmanuel Musisi, Samuel Wamutu, Willy Ssengooba, Sharifah Kasiinga, Abdulwahab Sessolo, Ingvar Sanyu, Sylvia Kaswabuli, Josephine Zawedde, Patrick Byanyima, Praiscillia Kia, William Muwambi, Divine Tracy Toskin, Edgar Kigozi, Natasha Walbaum, Evelin Dombay, Mate Bonifac Legrady, Kizza David-Martin Ssemambo, Moses Joloba, Davis Kuchaka, William Worodria, Laurence Huang, Stephen H Gillespie, Wilber Sabiiti The Lancet Microbe, 4.04.2024 Tilføjet 4.04.2024 TB-MBLA has a similar performance to Xpert-Ultra for pretreatment diagnosis of tuberculosis, but is more accurate at detecting and characterising the response to treatment than Xpert-Ultra and standard-of-care smear microscopy. Læs mere Tjek på PubMed19 Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study
Abdullahi, L. H., Oketch, S., Komen, H., Mbithi, I., Millington, K., Mulupi, S., Chakaya, J., Zulu, E. M. BMJ Open, 3.04.2024 Tilføjet 3.04.2024 BackgroundTuberculosis (TB) remains a public health concern in Kenya despite the massive global efforts towards ending TB. The impediments to TB prevention and care efforts include poor health systems, resource limitations and other sociopolitical contexts that inform policy and implementation. Notably, TB cases are much higher in men than women. Therefore, the political economy analysis (PEA) study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. DesignPEA adopts a qualitative, in-depth approach through key informant interviews (KII) and documentary analysis. Setting and participantsThe KIIs were distributed among government entities, academia, non-state actors and community TB groups from Kenya. ResultsThe themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritisation for TB programmes, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programmes were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviours. The themes around the economic situation were poverty and unemployment, food insecurity and malnutrition. The political context centred around the systemic and governance gaps in the health system from the national and devolved health functions. ConclusionBroad contextual factors identified from the PEA widen the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is essential to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care. Læs mere Tjek på PubMed20 Disseminated Tuberculosis of the Axial Skeleton
American Journal of Tropical Medicine and Hygiene, 3.04.2024 Tilføjet 3.04.2024 Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 110 Issue: 4 Pages: 623-624 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 |
World Sepsis Congress Spotlight 2024
Online
Tirsdag d. 23. april
Copenhagen HIV Comorbidity Workshop 2024
København
Torsdag d. 25. april
European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2024
Barcelona, Spanien
Lørdag d. 27. april
Middelfart
Fredag d. 3. maj
Symposium om Antibiotic Stewardship 2024
Auditorium U260, SDU, Odense
Onsdag d. 8. maj
COVID-19 retningslinje (2024v28)
Tilføjet 20. marts 2024
Retningslinjer for screening og profylakse før behandling med biologiske lægemidler (2023)
Tilføjet 9. januar 2024
Antiretroviral behandling af HIV-smittede personer (2024)
Tilføjet 9. januar 2024
Vejledning til udformning af guidelines for dansk selskab for infektionsmedicin (2024)
Tilføjet 5. januar 2024
CVID udredning og opfølgning (2023)
Tilføjet 1. december 2023
International Journal of Infectious Diseases
Tilføjet 20. april 2024
BMJ Open
Tilføjet 20. april 2024
BMC Infectious Diseases
Tilføjet 20. april 2024
Science Advances
Tilføjet 20. april 2024
Lancet Infectious Diseases
Tilføjet 20. april 2024
Udvalgt og kommenteret af Professor Troels Lillebæk
Tilføjet 29. november 2023
Hydrocortisone in Severe Community-Acquired Pneumonia.
Udvalgt og kommenteret af Professor Lars Østergaard
Tilføjet 27. september 2023
Randomized Trial of BCG Vaccine to Protect against Covid-19 in Health Care Workers.
Udvalgt og kommenteret af Professor Niels Obel
Tilføjet 27. september 2023
Udvalgt og kommenteret af Professor Troels Lillebæk
Tilføjet 22. september 2023
New Approaches to Chronic Hepatitis B.
Udvalgt og kommenteret af Professor Nina Weis
Tilføjet 19. januar 2023
Akut bakteriel meningitis (2018)
Uploadet 12. maj 2021
Uploadet 13. maj 2021
COVID-19 retningslinje (2024v28)
Uploadet 20. marts 2024
Uploadet 19. april 2024
Guidelines for diagnostik og behandling af spondylodiskitis (2018)
Uploadet 12. maj 2021