TB latency, testing and preventive treatment: what do we know and not know so far? . 1–3% have already progressed to TB disease at the date of tracing [67, 68 ]. . may further increase the effectiveness of LTBI treatment [98–]. latent tuberculosis infection: the QuantiFERON-TB Gold IGRA alone is. In particular, we would like to thank the California Wellness .. date, the WHO and other agencies have .. QuantiFERON TB Gold or bizdocki.info TB), to websites) . This would require the placement of computers with internet access in .. Trends in Tuberculosis Incidence,. United States. %. 90% .. Philippines. We compared the performance of TST and QuantiFERON-TB (QFT) Gold In-Tube in Interferon-gamma release assays (IGRAs), available since , are an attractive The QFT was processed on-site according to manufacturer's instructions Children from the Philippines and Vietnam were more likely to have a family.
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Tests with missing or incomplete quantitative results were excluded. Electronic reporting of test results began at all clinics in November To evaluate data accuracy, qualitative results were calculated as specified by the test manufacturer and compared with the EMR data as entered; all discrepancies were investigated [ 13 , 14 ]. For unresolved discrepancies in which the results were electronically reported, the recalculated qualitative result was retained because some ongoing manual entry of qualitative results was observed; otherwise, the original, manually entered qualitative result was used on the assumption that qualitative results were more likely to be entered accurately than quantitative results.
To better estimate the prevalence of TB infection in the general population, patients identified as active TB cases or as contacts to a TB case were excluded. To identify patients who were evaluated as cases or contacts, the EMR data were deterministically matched to the TB registry as of September 30, using patient identifiers and demographic characteristics.
Active TB cases were identified as patients who had a QFT-GIT test conducted within 6 months before or after their date of diagnosis; these periods were selected to reflect standard treatment length and time to diagnosis. Contacts were those exposed to an active TB case with a QFT-GIT test conducted 3 months before to 9 months after the date of last exposure; the 3-month period was selected to account for the infectious period of the index case, and the 9-month period allowed for ample time to complete contact investigation [ 15 , 16 ].
The general clinic sample population included patients who were neither cases nor contacts. The registry match was additionally used to identify patients later diagnosed with active TB disease. The total number and proportion of positive, negative, and indeterminate test results were calculated for all tests conducted during the study period.
The remainder of the analyses focused on general clinic population patients tested with QFT-GIT; this population was selected because adoption of QFT-GIT followed changes in clinic testing policy, and this test remains the standard of care in the clinics. For patients with multiple QFT-GIT tests performed, the most recent QFT-GIT test result for each patient, representing the patient's final infection status during the study period, was retained and earlier results were excluded to create a sample of unique patients.
Wilcoxon 2-sample tests were used to compare medians for continuous variables. The proportion of positive QFT-GIT test results was calculated for all countries of birth with more than patients tested.
Although US-born was defined as birth in the United States, Puerto Rico, or other United States territories and outlying areas in all other analyses, Puerto Rico was considered separately here because it represents a large, higher-risk portion of the US-born group. The earlier WHO data were used to account for varying time in the United States among foreign-born individuals.
Studentized deleted residuals were used to identify countries of birth with a higher or lower than expected proportion of positive test results. World Health Organization data were also used to classify countries as low-, medium-, or high-incidence based on tertiles as follows: Figure 2 shows the total number of IGRA tests performed over the full study period and the percentage positive by quarter.
The number of tests performed dropped in concurrent with the change in clinic testing policy and shortly before the switch to QFT-GIT. The region has estimated TB incidence of per , The estimated number of incident TB cases in was TB case. As for MDGs, the region was able to meet the mortality target and revert TB incidence but could not achieve the prevalence target. The main challenges are limited infrastructure, human capacity, funds, use of new diagnostics tools and new medicines, and involvement of all stakeholders and community in TB care and control in addition to complex emergencies.
The region will move into three main directions: Tuberculosis in vulnerable populations in Eastern Mediterranean Region—Implications for control p. Included in such vulnerable populations are children, women, prisoners, people living with human immunodeficiency virus, the homeless, and displaced people. The ongoing active transmission of TB among such populations is made more difficult to assess and control by difficult access, health inequities, poverty, and other chronic and debilitating health conditions at individual, domestic, and community levels.
The 22 Eastern Mediterranean Region member states encompass diverse sociopolitical and socioeconomic situations with far-reaching effects on vulnerable populations in each country, thereby threatening the control of TB. Here, we examined the impact of these populations on the incidence and transmission of TB in light of these risks.
TB control requires a strategic approach at the country level to access these vulnerable populations. HIV and tuberculosis trends and survival of coinfection in a referral center in Tehran: A year study p. The risk of mortality and morbidity among tuberculosis TB and human immunodeficiency virus HIV coinfected patients is significantly higher than that of patients infected with TB alone.
All TB-HIV patients in our referral center were enrolled in the study from to , and patients were divided into two groups: Both groups were treated based on World Health Organization TB-treatment guidelines, and multivariate analysis was performed to evaluate risk factors of all-cause mortality.
During TB treatment and subsequent follow-up, two patients did not respond to treatment and 92 Pneumothorax [hazard ratio HR: Our retrospective review of coinfected TB-HIV patients hospitalized in Tehran showed that the management and monitoring of coinfection, pneumothorax and other adverse effects, as well as early initiation of ART, improved patient survival.
Although the prevalence of pulmonary tuberculosis TB and HIV infection in Japan is low, careful monitoring of these two diseases is necessary. Likewise, the presence of a cavity, involved segments, and patterns of parenchymal lesion were assessed. Finally, tentative diagnosis and disease activity, bronchogenic spread of the lesion with CT, and bronchiectasis were recorded.
Role of socio-demographical factors on tuberculosis outcome in Yemen p. Tuberculosis TB is an infection disease caused by an organism called Mycobacterium tuberculosis tubercle bacilli. TB considers as one of the main health problems; it ranks as the fourth in the priority of the public health issue NTCP, The study was conducted to evaluate the Socio-Demographical variables on tuberculosis treatment outcome.
A Prospective cohort multicenter study was carried out among Tuberculosis TB patients, to find out the socio-demographic characteristics and factors affecting the treatment outcome.
The study was conducted in two major prevalence TB cities in Yemen i. Alhodiah city and Taiz city. Questionnaires were given to the TB patient during their registration in TB health center after the confirmation of their TB diagnosis.
All Patients were followed up until the end of their treatment. A total of smear positive, smear negative and extrapulmonary tuberculosis were involved in the study.
Patients were followed up and were interviewed again at the end of intensive phase and end of treatment. Survey shows that majority of TB patient were smeared positive pulmonary Prevalence of TB diagnosis with respective to male and female were same.
The majority of Tb cases were found in patient age 16—25 By evaluating the socio-demographic risk factors, pharmacist and health care providers can optimize and indicate the factors which play a role in successful and unsuccessful treatment outcome. Host-directed therapies for multidrug resistant tuberculosis p. The TB drug pipeline remains sparse. New innovations for shortening the duration of therapy and improving treatment outcomes cure and long-term functional disability due to lung damage are urgently required.
A wide range of host-directed therapies HDT are now available which require evaluation as adjuncts to current TB drug treatment. Cholesterol-lowering drugs 3-hydroxymethylglutaryl-coenzyme A reductase inhibitors, e. Asthma drugs leukotriene synthesis inhibitors, e. Anticonvulsants inhibition of histone deacylation, e. This network which is open to anyone interested plans to take forward a wide range of HDTs in randomized, placebo-controlled clinical trials as adjuncts to current TB treatment regimens with the aims of: Improving lung function and preventing lung damage so that the patient can return to gainful employment after treatment.
Improving treatment outcomes for clinical presentations associated with tissue injury: Immune reconstitution inflammatory syndrome. Effectiveness of a novel cellular therapy to treat multidrug-resistant tuberculosis p. Autologous mesenchymal stromal cell MSC infusion is one such possibility due to its potential to repair damaged lung tissue and boost immune responses.
We identified another control group: After adjusting for age, odds of a successful outcome were 6. Adjusting for other potential confounders increased the effect estimate while maintaining statistical significance.
Radiological improvement was more likely in cases than in study controls. Our findings could revolutionize therapy options and have strong implications for future directions of MDR-TB therapy research Application of highly portable MinION nanopore sequencing technology for the monitoring of nosocomial tuberculosis infection p. We have previously shown, from enhanced screening and through autopsy studies, a significant burden of missed TB infections at the University Teaching Hospital, Lusaka, Zambia, with many patients dying or being discharged without treatment.
With minimal TB isolation facilities and minimal political will to invest in broader screening and isolation, the risk of nosocomial transmission is likely to be extremely high.
Studies from other hospitals in low burden settings and in South Africa have shown that next generation sequencing NGS is a very powerful tool for rapidly sequencing whole TB genomes and comparing them to confirm or rule out nosocomial transmission. The established platforms for NGS analysis, such as Illumina, are very expensive, immobile, and require regular maintenance, making them a costly inclusion on a research proposal or programmatic intervention grant in Africa.
MinION nanopore sequencing has changed the NGS landscape with cheap portable sequencers, rapid simple library preparation 15 min , and automated real-time analysis tools.
The application of highly portable MinION nanopore sequencing technology for the monitoring of nosocomial TB infection will be discussed. Preliminary data from our pediatric pneumonia study will demonstrate the detection of TB in induced sputum from children admitted to the University Teaching Hospital. The additional peptides for eliciting CD8 T-cell responses have been included to increase the sensitivity of the test for LTBI detection. QFT-Plus assay and intracellular staining were performed.
For statistical analysis, nonparametric tests were performed. Finally, TB2-specific CD8 T-cell responses in individuals with active TB were associated with high radiological severity of lung lesions and microbiological diagnosis based on M. We demonstrated that the increased sensitivity is a consequence of the ability of TB2 to induce a CD8 T-cell response which is mainly associated with active TB. This assay has the potential to be very useful in conditions of immune depression due to CD4 T-cell impairments.
Next-generation sequencing-based user-friendly platforms for drug-resistant tuberculosis diagnosis: A promise for the near future p. This is an encouraging statistic; however, it will not achieve the World Health Organization's goal of eliminating TB by , and it is being compounded by the persistent global incidence of drug-resistant tuberculosis DR-TB acquired by transmission and by treatment pressure.
One key to effectively control tuberculosis and the spread of multiresistant strains is accurate information pertaining to drug resistance and susceptibility. Next-generation sequencing NGS has the potential to effectively change global health and the management of TB. Industry has focused primarily on using NGS for oncology diagnostics and human genomics, but the area in which NGS can rapidly impact health care is in the area of infectious disease diagnostics in low- and middle-income countries.
To date, there has been a failure as a community to capitalize on the potential of NGS, especially at the reference laboratory level where it can provide actionable information pertaining to treatment options for patients.
The rapid evolution of knowledge about the genetic foundations of tuberculosis drug resistance makes sequencing a versatile technology platform for providing rapid, accurate, and actionable results for treating this disease. However, such a system-based solution is underdeveloped by Foundation for Innovative Diagnostics FIND , in collaboration with partners from academia, nongovernmental organizations, and industry.
The solution is modular and is designed and developed to perform targeted amplicon sequencing directly from a patient's primary sputum sample.
This solution will initially allow reference laboratories to perform reflex NGS that provides a rapid and comprehensive analysis of a patient's M. Such a system could also enable countries to implement culture-free drug resistance surveillance programs, which could bypass the need for expensive culture facilities, decrease a country's dependence on external laboratories, and significantly expand the map of global surveillance capabilities.
In addition, the introduction of such a system will provide a foundation for NGS to be used for genotypic testing for human immunodeficiency virus-infected patients, surveillance of other diseases, in-country capability for outbreak discovery and management, and a host of other diagnostic benefits that are currently limited to high-income countries.
New approaches in drug treatment for tuberculosis: Inhalation using liposomes only a future vision or soon in clinical practice? Inhalation of anti-infectious drugs has however not a key-role in the treatment of pulmonary infections such as tuberculosis TB.
CDC and local institutional review boards approved the study protocol. These countries have yet to show the significant negative impact on tuberculosis epidemiology as such changes take considerable time to manifest. New approaches in drug treatment for tuberculosis: The main challenges are limited infrastructure, human capacity, funds, use of new diagnostics tools and new medicines, and involvement of all stakeholders and community in TB care and control in addition to complex emergencies.