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Guidelines 1 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. 2 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. 3 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 4 Tjekliste ved screening før behandling med anti-TNF-alpha (2014)
Skema til screening før behandling med anti-TNF-alfa 5 Screening, profylakse og information før behandling med anti-TNF-alpha (2011)
Med baggrund i hyppigheden hvor med anti-TNF-alfa behandling anvendes, er denne guideline begrænset til denne gruppe af lægemidler (infliximab og adalimumab). Etanercept er omtalt enkelte steder på grund af dets anvendelse i reumatologien og dermatologien. For en lang række andre immunmodulatorer, inkl. azathioprin, 6-mercaptopurin og methotrexat gør lignende overvejelser sig gældende, og principperne kan med fordel anvendes også ved behandling med disse lægemidler. Evidens herfor ligger dog uden for denne guidelines kommissorium. Specielle forholdsregler for det enkelte lægemiddel skal i hvert enkelt tilfælde vurderes før behandlingsstart. 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 Facilitators and barriers for tuberculosis preventive treatment among patients with latent tuberculosis infection: a qualitative study BMC Infectious Diseases, 23.09.2023 Tilføjet 23.09.2023 Abstract Background Various factors influence tuberculosis preventive treatment (TPT) decisions thus it is important to understand the health beliefs and concerns of patients before starting TPT to ensure treatment compliance. This study aims to explore facilitators and barriers for TPT among patients diagnosed with Latent Tuberculosis infection (LTBI) attending six primary healthcare clinics in Selangor, Malaysia. Method In-depth interviews were conducted face-to-face or via telephone among patients with a clinical diagnosis of LTBI using a semi-structured topic guide developed based on the common-sense model of self-regulation and literature review. Audio recordings of interviews were transcribed verbatim and analysed thematically. Results We conducted 26 In-depth interviews; Good knowledge of active tuberculosis (TB) and its associated complications, including the perceived seriousness and transmissibility of active TB, facilitates treatment. LTBI is viewed as a concern when immune status is compromised, thus fostering TPT. However, optimal health is a barrier for TPT. Owing to the lack of knowledge, patients rely on healthcare practitioners (HCPs) to determine their treatment paths. HCPs possessing comprehensive knowledge play a role in facilitating TPT whereas barriers to TPT encompass misinterpretation of tuberculin skin test (TST), inadequate explanation of TST, and apprehensions about potential medication side effects. Conclusions Knowledge of LTBI can influence TPT uptake and patients often entrust their HCPs for treatment decisions. Improving knowledge of LTBI both among patients and HCPs can lead to more effective doctor-patient consultation and consequently boost the acceptance of TPT. Quality assurance should be enhanced to ensure the effective usage of TST as a screening tool. Læs mere Tjek på PubMed2 Effectiveness and safety of tuberculosis preventive treatment for contacts of multidrug-resistant tuberculosis patients: A systematic review and Meta-analysis Guozhong Zhou, Shiqi Luo, Jian He, Nan Chen, Yu Zhang, Shunli Cai, Xin Guo, Hongbo Chen, Chao Song Clinical Microbiology and Infection, 22.09.2023 Tilføjet 22.09.2023 Contacts of patients with multidrug-resistant tuberculosis (MDR-TB) are at risk of developing TB disease. Tuberculosis preventive treatment (TPT) is an intervention that can potentially reduce this risk. Læs mere Tjek på PubMed3 Distinct healthcare utilization profiles of high healthcare use tuberculosis survivors: A latent class analysis Kamila Romanowski, Mohammad Ehsanul Karim, Mark Gilbert, Victoria J. Cook, James C. Johnston PLoS One Infectious Diseases, 21.09.2023 Tilføjet 21.09.2023 by Kamila Romanowski, Mohammad Ehsanul Karim, Mark Gilbert, Victoria J. Cook, James C. Johnston Background Recent data have demonstrated that healthcare use after treatment for respiratory tuberculosis (TB) remains elevated in the years following treatment completion. However, it remains unclear which TB survivors are high healthcare users and whether any variation exists within this population. Thus, the primary objective of this study was to identify distinct profiles of high healthcare-use TB survivors to help inform post-treatment support and care. Methods Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals who completed treatment for incident respiratory TB between 1990 and 2019. We defined high healthcare-use TB survivors as those in the top 10% of annual emergency department visits, hospital admissions, or general practitioner visits among the study population during the five-year period immediately following TB treatment completion. We then used latent class analysis to categorize the identified high healthcare-use TB survivors into subgroups. Results Of the 1,240 people who completed treatment for respiratory TB, 258 (20.8%) people were identified as high post- TB healthcare users. Latent class analysis results in a 2-class solution. Class 1 (n = 196; 76.0%) included older individuals (median age 71.0; IQR 59.8, 79.0) with a higher probability of pre-existing hypertension and diabetes (41.3% and 33.2%, respectively). Class 2 (n = 62; 24.0%) comprised of younger individuals (median age 31.0; IQR 27.0, 41.0) with a high probability (61.3%) of immigrating to Canada within five years of their TB diagnosis and a low probability (11.3%) of moderate to high continuity of primary care. Discussion Our findings suggest that foreign-born high healthcare-use TB survivors in a high-resource setting may be categorized into distinct profiles to help guide the development of person-centred care strategies targeting the long-term health impacts TB survivors face. Læs mere Tjek på PubMed4 The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis BMC Infectious Diseases, 21.09.2023 Tilføjet 21.09.2023 Abstract Background Tuberculosis, along with HIV, is the leading cause of mortality and morbidity globally. Despite the fact that several primary studies have been conducted on the incidence rate of tuberculosis in HIV-infected people in Sub-Saharan Africa, the regional-level tuberculosis incidence rate remains unknown. The objective of this study is to determine the tuberculosis incidence rate and its associated factors in HIV-infected people in Sub-Saharan Africa. Methods A systematic review and meta-analysis were conducted by searching four databases for studies published in English between January 1, 2000, and November 25, 2022. The study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. To assess the quality of the studies, the Joanna Briggs Institute critical appraisal checklist was used. A random-effects model meta-analysis was used to determine the pooled incidence of tuberculosis using STATA version 15. The I2 heterogeneity test was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. Funnel plots and Egger’s regression tests were used to investigate publication bias. The pooled estimate predictors of tuberculosis incidence rate with a 95% confidence interval were also determined using the hazard ratio of each factor (HR). Results Out of a total of 3339 studies, 43 were included in the analysis. The overall pooled incidence rate of tuberculosis in HIV-infected people was 3.49 per 100 person-years (95% CI: 2.88–4.17). In the subgroup analysis, the pooled incidence rate of tuberculosis in HIV-infected children was 3.42 per 100 person-years (95% CI: 1.78, 5.57), and it was 3.79 per 100 person-years (95% CI: 2.63, 5.15) in adults. A meta-analysis revealed that underweight (AHR = 1.79, 95% CI: 1.61–1.96), low CD4 count (AHR = 1.23, 95% CI: 1.13–1.35), male gender (AHR = 1.43, 95% CI: 1.22–1.64), advanced WHO clinical stages (AHR = 2.29, 95% CI: 1.34–3.23), anemia (AHR = 1.73, 95% CI: 1.34–2.13), bedridden or ambulatory (AHR = 1.87, 95%), lack of isoniazid preventive therapy (AHR = 3.32, 95% CI: 1.08–2.28), and lack of cotrimoxazole (AHR = 1.68, 95% CI: 1.08–2.28) were risk factors for tuberculosis incidence. HIV patients who received antiretroviral therapy had a 0.53 times higher risk of acquiring tuberculosis than HIV patients who did not receive antiretroviral therapy (AHR = 0.53; 95% CI: 0.3–0.77). Conclusion In this systematic review and meta-analysis study, the incidence rate of tuberculosis among HIV-positive people was higher than the WHO 2022 Africa regional estimated report. To reduce the incidence of tuberculosis among HIV patients, HIV patients should take isoniazid prevention therapy (IPT), cotrimoxazole prophylaxis, and antiretroviral therapy (ART) without interruption, as well as increase the frequency and diversity of their nutritional intake. Active tuberculosis screening should be increased among HIV-infected people. Læs mere Tjek på PubMed5 The impact of preventive treatment for multidrug- and rifampin-resistant tuberculosis exceeds trial-based estimates Clinical Infectious Diseases, 21.09.2023 Tilføjet 21.09.2023 AbstractBackgroundSeveral clinical trials of tuberculosis preventive treatment (TPT) for household contacts of patients with multidrug- or rifampin-resistant tuberculosis (MDR/RR-TB) are nearing completion. The potential benefits of delivering TPT to MDR/RR-TB contacts extend beyond the outcomes that clinical trials can measure.MethodsWe developed an agent-based, household-structured TB and MDR/RR-TB transmission model, calibrated to an illustrative setting in India. We simulated contact investigation in households of patients with MDR/RR-TB, comparing an MDR/RR-TPT regimen (assuming 6-month duration, 70% efficacy) and associated active case finding against alternatives of contact investigation without TPT or no household intervention. We simulated the TB and MDR/RR-TB incidence averted relative to placebo over two years, as measurable by a typical trial, as well as the incidence averted over a longer time horizon, in the broader population, and relative to no contact investigation.ResultsObserving TPT and placebo recipients for two years as in a typical trial, MDR/RR-TPT was measured to prevent 72% [Interquartile range: 45–100%] of incident MDR/RR-TB among recipients; median number-needed-to-treat to prevent one MDR/RR-TB case was 73, compared to placebo. This number-needed-to-treat decreased to 54 with 13-18 years of observation, to 27 when downstream transmission effects were also considered, and to 12 when the effects of active TB screening were included by comparing to a no-household-contact-intervention scenario.ConclusionsIf forthcoming trial results demonstrate efficacy, the long-term population impact of TPT for MDR/RR-TB – including the large effect of increased active TB detection among MDR/RR-TB contacts – could be much greater than suggested by trial outcomes alone. Læs mere Tjek på PubMed6 Impact of COVID-19 pandemic on Tuberculosis and HIV services in Ghana: An interrupted time series analysis Eric Osei, Hubert Amu, Gideon Kye-Duodu, Mavis Pearl Kwabla, Evans Danso, Fred N. Binka, So Yoon Kim PLoS One Infectious Diseases, 21.09.2023 Tilføjet 21.09.2023 by Eric Osei, Hubert Amu, Gideon Kye-Duodu, Mavis Pearl Kwabla, Evans Danso, Fred N. Binka, So Yoon Kim Introduction The Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap. Method The study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period. Results The study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant. Conclusion This study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised. Læs mere Tjek på PubMed7 Mycobacterium tuberculosis protein MoxR1 enhances virulence by inhibiting host cell death pathways and disrupting cellular bioenergetics Neha QuadirMohd. ShariqJavaid Ahmad SheikhJasdeep SinghNeha SharmaSeyed Ehtesham HasnainNasreen Zafar Ehteshama National Institute of Pathology, ICMR, Safdarjung Hospital Campus, New Delhi, Indiab Institute of Molecular Medicine, Jamia Hamdard, Hamdard Nagar, New Delhi, Indiac Department of Biotechnology, Jamia Hamdard, Hamdard Nagar, New Delhi, Indiad Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, New Delhi, Indiae Department of Life Science,School of Basic Science and Research, Sharda University, Greater Noida, India Virulence, 20.09.2023 Tilføjet 20.09.2023 8 Macrophage innate immune responses delineate between defective translocon assemblies produced by Yersinia pseudotuberculosis YopD mutants Salah I. FaragMonika K. FrancisJyoti M. GurungSun Nyunt WaiHans StenlundMatthew S. FrancisAftab Nadeema Department of Molecular Biology, Umeå University, Umeå, Swedenb Umeå Centre for Microbial Research, Umeå University, Umeå, Swedenc The Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Swedend Department of Plant Physiology, Umeå Plant Science Centre (UPSC), Umeå University, Umeå, Swedene Swedish Metabolomics Centre (SMC), Umeå, Sweden Virulence, 20.09.2023 Tilføjet 20.09.2023 9 Pathogenicity and virulence of Mycobacterium tuberculosis Kathryn C. RahlwesBeatriz R.S. DiasPriscila C. CamposSamuel Alvarez-ArguedasMichael U. Shiloha Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USAb Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX, USA Virulence, 20.09.2023 Tilføjet 20.09.2023 10 The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis BMC Infectious Diseases, 19.09.2023 Tilføjet 19.09.2023 Abstract Background Tuberculosis, along with HIV, is the leading cause of mortality and morbidity globally. Despite the fact that several primary studies have been conducted on the incidence rate of tuberculosis in HIV-infected people in Sub-Saharan Africa, the regional-level tuberculosis incidence rate remains unknown. The objective of this study is to determine the tuberculosis incidence rate and its associated factors in HIV-infected people in Sub-Saharan Africa. Methods A systematic review and meta-analysis were conducted by searching four databases for studies published in English between January 1, 2000, and November 25, 2022. The study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. To assess the quality of the studies, the Joanna Briggs Institute critical appraisal checklist was used. A random-effects model meta-analysis was used to determine the pooled incidence of tuberculosis using STATA version 15. The I2 heterogeneity test was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. Funnel plots and Egger’s regression tests were used to investigate publication bias. The pooled estimate predictors of tuberculosis incidence rate with a 95% confidence interval were also determined using the hazard ratio of each factor (HR). Results Out of a total of 3339 studies, 43 were included in the analysis. The overall pooled incidence rate of tuberculosis in HIV-infected people was 3.49 per 100 person-years (95% CI: 2.88–4.17). In the subgroup analysis, the pooled incidence rate of tuberculosis in HIV-infected children was 3.42 per 100 person-years (95% CI: 1.78, 5.57), and it was 3.79 per 100 person-years (95% CI: 2.63, 5.15) in adults. A meta-analysis revealed that underweight (AHR = 1.79, 95% CI: 1.61–1.96), low CD4 count (AHR = 1.23, 95% CI: 1.13–1.35), male gender (AHR = 1.43, 95% CI: 1.22–1.64), advanced WHO clinical stages (AHR = 2.29, 95% CI: 1.34–3.23), anemia (AHR = 1.73, 95% CI: 1.34–2.13), bedridden or ambulatory (AHR = 1.87, 95%), lack of isoniazid preventive therapy (AHR = 3.32, 95% CI: 1.08–2.28), and lack of cotrimoxazole (AHR = 1.68, 95% CI: 1.08–2.28) were risk factors for tuberculosis incidence. HIV patients who received antiretroviral therapy had a 0.53 times higher risk of acquiring tuberculosis than HIV patients who did not receive antiretroviral therapy (AHR = 0.53; 95% CI: 0.3–0.77). Conclusion In this systematic review and meta-analysis study, the incidence rate of tuberculosis among HIV-positive people was higher than the WHO 2022 Africa regional estimated report. To reduce the incidence of tuberculosis among HIV patients, HIV patients should take isoniazid prevention therapy (IPT), cotrimoxazole prophylaxis, and antiretroviral therapy (ART) without interruption, as well as increase the frequency and diversity of their nutritional intake. Active tuberculosis screening should be increased among HIV-infected people. Læs mere Tjek på PubMed11 The Cyclooxygenase 2 inhibitor etoricoxib as adjunctive therapy in tuberculosis impairs macrophage control of mycobacterial growth Journal of Infectious Diseases, 18.09.2023 Tilføjet 18.09.2023 AbstractBackgroundCurrent Tuberculosis treatment regimens could be improved by adjunct host-directed-therapies (HDT) targeting host responses. We investigated the anti-mycobacterial capacity of macrophages from tuberculosis patients in a phase 1/2 randomized clinical trial (TBCOX2) of the Cyclooxygenase-2 inhibitor etoricoxib.MethodsPBMC from 15 tuberculosis patients treated with adjunctive COX-2i and 18 controls (standard therapy) were collected on day 56 after treatment initiation. The ex vivo capacity of macrophages to control mycobacterial infection was assessed by challenge with Mycobacterium avium, using an in vitro culture model. Macrophage inflammatory responses were analyzed by gene expression signatures, and concentrations of cytokines were analyzed in supernatants by multiplex.ResultsMacrophages from patients receiving adjunctive COX-2i treatment had higher Mav loads than controls after 6 days, suggesting an impaired capacity to control mycobacterial infection compared to macrophages from the control group. Macrophages from the COX-2i group had lower gene expression of TNF, IL-1B, CCL4, CXCL9, and CXCL10 and lowered production of cytokines IFN-β and S100A8/A9 than controls.ConclusionsOur data suggest potential unfavorable effects with impaired macrophage capacity to control mycobacterial growth in tuberculosis patients receiving COX-2i treatment. Larger clinical trials are required to analyze the safety of COX-2i as HDT in patients with tuberculosis. Læs mere Tjek på PubMed12 Immunosuppressed Pets as a Conduit for Zoonotic Tuberculosis Ciara Ottewill, Lorraine Dolan, Esther López Bailén, Emma Roycroft, Margaret Fitzgibbon, Emer O. Donohue, Anne Marie McLaughlin, Guy McGrath, Joseph Keane American Journal of Respiratory and Critical Care Medicine , 16.09.2023 Tilføjet 16.09.2023 American Journal of Respiratory and Critical Care Medicine, Volume 208, Issue 6, Page 732-733, September 15, 2023. Læs mere Tjek på PubMed13 [Editorial] Tuberculosis: a different way of doing things The Lancet Lancet, 15.09.2023 Tilføjet 15.09.2023 Readers could be forgiven for feeling a sense of déjà vu. The UN General Assembly will hold a high-level meeting on tuberculosis on Sept 22, where countries will reaffirm their commitment to ending tuberculosis by 2030, and pledge to treat 45 million people, to provide preventive treatment for another 45 million, and to spend US$22 billion per year on tuberculosis by 2027. But this is not the first UN high-level meeting on tuberculosis. A similar gathering in 2018 saw ambitious targets set for treatment, prevention, and funding. Læs mere Tjek på PubMed14 Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study Chijioke-Akaniro, O., Onyemaechi, S., Kuye, J., Ubochioma, E., Omoniyi, A., Urhioke, O., Lawanson, A., Ombeka, V. O., Hassan, A., Asuke, S., Anyaike, C., Merle, C. S. BMJ Open, 14.09.2023 Tilføjet 14.09.2023 ObjectivesThis study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria. DesignThis is a mixed methods study comprising a quantitative retrospective review and qualitative study. SettingPrivate health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria. ParticipantsWe used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities. Primary and secondary outcome measuresThe study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification. ResultsA total of 13 (11.0%) out of 118 private HF were designated as ‘engaged’ TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB. ConclusionMost private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria. Læs mere Tjek på PubMed15 Host cell environments and antibiotic efficacy in tuberculosis Nathan J. Day, Pierre Santucci, Maximiliano G. Gutierrez Trends in Microbiology, 13.09.2023 Tilføjet 13.09.2023 The aetiologic agent of tuberculosis (TB), Mycobacterium tuberculosis (Mtb), can survive, persist, and proliferate in a variety of heterogeneous subcellular compartments. Therefore, TB chemotherapy requires antibiotics crossing multiple biological membranes to reach distinct subcellular compartments and target these bacterial populations. These compartments are also dynamic, and our understanding of intracellular pharmacokinetics (PK) often represents a challenge for antitubercular drug development. In recent years, the development of high-resolution imaging approaches in the context of host–pathogen interactions has revealed the intracellular distribution of antibiotics at a new level, yielding discoveries with important clinical implications. In this review, we describe the current knowledge regarding cellular PK of antibiotics and the complexity of drug distribution within the context of TB. We also discuss the recent advances in quantitative imaging and highlight their applications for drug development in the context of how intracellular environments and microbial localisation affect TB treatment efficacy. Læs mere Tjek på PubMed16 Best practice guidelines for professional nurses to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection: A scoping review Eric Tornu, Portia Jordan, Michael McCaul PLoS One Infectious Diseases, 13.09.2023 Tilføjet 13.09.2023 by Eric Tornu, Portia Jordan, Michael McCaul Background Adults with tuberculosis-human immunodeficiency virus coinfection require professional nurses’ support to manage their illness, treatment and its effect on their daily lives. This scoping review maps recommendations in clinical or best practice guidelines that guide professional nurses to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection in primary healthcare settings. Methods We conducted a scoping review by searching for guidelines in six online databases, guideline clearing houses and search engines from 16th April 2022 to 25th May 2022. The title, abstract and full-text screening of guidelines were conducted independently and in duplicate by two reviewers based on predetermined eligibility criteria. The guidelines were critically appraised with the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Relevant data regarding the characteristics of the guideline, recommendations and underlying evidence were extracted, analysed and reported. Results The six guidelines on self-management support found were developed in four high-income countries. Five of the guidelines recorded 60% in all AGREE II domains but was informed by outdated evidence produced between 1977 to 2010. Twenty-five practice, education and organisational/policy recommendations were extracted from the high-quality guideline. The guidelines did not report evidence-to-decision frameworks and the strength of the recommendations. The guidelines also lacked direct underlying evidence on the effectiveness and cost of self-management support. Lastly, the review found a paucity of contextual (equity, acceptability and feasibility) evidence on self-management support among adults with tuberculosis-human immunodeficiency virus in the guidelines. Conclusion There is a dearth of updated and relevant high-quality guidelines that guide healthcare professionals to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection in primary healthcare settings. Systematic reviews of effectiveness, economic and contextual evidence related to self-management support interventions are required for guideline production. Læs mere Tjek på PubMed17 [Articles] Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews Stefan Litvinjenko, Olivia Magwood, Shishi Wu, Xiaolin Wei Lancet Infectious Diseases, 9.09.2023 Tilføjet 9.09.2023 The burden of tuberculosis is substantially higher among vulnerable populations than general populations, suggesting a need for improved integration of these groups, including dedicated efforts for their identification, targeted screening and prevention measures, as well as treatment support. Læs mere Tjek på PubMed18 Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study BMC Infectious Diseases, 9.09.2023 Tilføjet 9.09.2023 Abstract Background Tuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area. Methods We collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables. Results We included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15–44 years (OR 1.817; 95% CI 1.162–2.840; P Læs mere Tjek på PubMed19 Prevalence and risk factors of tuberculosis among people living with HIV/AIDS in China: a systematic review and meta-analysis BMC Infectious Diseases, 9.09.2023 Tilføjet 9.09.2023 Abstract Objective To estimate the prevalence and risk factors associated with tuberculosis (TB) among people living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in China. Methods A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. After the literature was screened based on the inclusion and exclusion criteria, STATA® version 17.0 software was used for the meta-analysis. The heterogeneity among study data was assessed using I2 statistics. Subgroup analysis and meta-regressions were performed to further explore the source of heterogeneity. Results A total of 5241 studies were retrieved. Of these, 44 studies were found to be eligible. The pooled prevalence of HIV/TB co-infection was 6.0%. The risk factors for HIV/TB co-infection included a low CD4+ T cell count, smoking, intravenous drug use and several other sociodemographic and clinical factors. Bacillus Calmette–Guérin (BCG) vaccination history was a protective factor. Conclusion A high prevalence of TB was observed among people living with HIV/AIDS in China. Low CD4+ T cell count, smoking, and intravenous drug use were the primary risk factors for HIV/TB co-infection, whereas BCG vaccination history was a protective factor. Checking for TB should be prioritized in HIV screening and healthcare access. Systematic review registration Registered on PROSPERO, Identifier: CRD42022297754. Læs mere Tjek på PubMed20 Pre-XDR congenital tuberculosis in an extremely premature baby Clinical Infectious Diseases, 8.09.2023 Tilføjet 8.09.2023 AbstractWe describe a case of congenital tuberculosis in an extremely premature baby, with rapid molecular detection of a pre-XDR pattern of drug resistance. The baby was treated successfully with a regimen including bedaquline and delamanid, drugs not previously described in the treatment of congenital TB. Læs mere Tjek på PubMed |
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Mandag d. 25. september
Nordic HIV & Virology Conference 2023
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