scholarly journals 5 New guidelines for managing tuberculosis

2019 ◽  
Vol 95 (1130) ◽  
pp. 686.2-686
Author(s):  
Paul Nunn
Keyword(s):  
Causes Of Death ◽  
Meta Analysis ◽  
Infectious Agent ◽  
Drug Resistant ◽  
New Agents ◽  
Pulmonary Tb ◽  
Effectiveness Analysis ◽  
Mdr Tb ◽  
New Guidelines ◽  
The Uk

In 2018, tuberculosis (TB) was still among the top 10 leading causes of death, and the leading infectious agent, above HIV/AIDS. An estimated 10 million cases occurred in 2018, with 1.2 million deaths in people uninfected with HIV, and another 250,000 cases of HIV-associated TB. Among all TB cases, 8–6% were HIV infected; 57% were men, 32% women and 11% children (<15 years). About 500,000 cases of rifampicin resistant RR-TB also occurred. Between 2000 and 2018 TB incidence fell on average about 1.6% annually, and 2% between 2017 and 2018. The new global control targets will be presented and recent changes to guidelines positioned in this new scenario.Guidelines for TB management from the UK, US and WHO were reviewed for recent changes. NICE’s 2016 guidance not to screen contacts of non-pulmonary TB met with widespread criticism, but has recently been supported by a cost-effectiveness analysis. A 2019 meta-analysis of the seminal 2014 studies, OFLOTUB, ReMOX and RIFAQUIN trials showed that while none of those trials showed non-inferiority of a four month fluoroquinolone-containing regimen in all patients, those with low smear grade or no cavitation may be treated with 4-month rifampicin containing regimens. ATS/CDC/IDSA guidelines reflect this, but had not been accepted in the UK by October 2019. WHO has recently recommended the use of new agents in the treatment of rifampicin and multi-drug resistant TB. The rapidly-evolving picture of treatment recommendations for MDR-TB will be explained.

scholarly journals Risk factors associated with drug-resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Ayinalem Alemu ◽  
Zebenay Workneh Bitew ◽  
Getu Diriba ◽  
Balako Gumi
Keyword(s):  
Risk Factors ◽  
Meta Analysis ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Pulmonary Tb ◽  
Factors Associated ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
History Of

The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programs including Ethiopia. Different risk factors are associated with the emergence of DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with drug-resistant TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist was followed to conduct this study. We systematically searched the articles from electronic databases and gray literature sources. We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of studies. Data were analyzed using STATA version 15. We estimated the pooled OR along with 95%CI for each risk factor. The heterogeneity of the studies was assessed using the forest plot and I heterogeneity test. Besides, we explored the presence of publication bias through visual inspection of the funnel plot and Egger’s regression test. After intense searching, we found 2238 articles, and 27 eligible studies were included in the final analysis. Based on the pooled analysis of the odds ratio, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), having a history of the previous TB (OR; 4.83, 95% CI; 3.02, 6.64), having contact with a known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), having contact with a known MDR-TB patient (OR; 2.54, 95% CI; 1.46, 3.63), and having pulmonary TB (OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of drug-resistant TB. While older age TB patients (OR; 0.77, 95% CI; 0.60, 0.95) including age above 45 years OR; (0.76, 95% CI; 0.55, 0.97), and males (OR; 0.86, 95% CI; 0.76, 0.97) were found to had lower risk of DR-TB compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti TB treatment. Besides, having contact with a known TB patient, having contact with a known MDR-TB patient, having pulmonary TB, and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.

scholarly journals Gambaran Kepatuhan Minum Obat Pada Pasien TB Paru : Literature Review

2021 ◽  
Vol 1 ◽  
pp. 1863-1874
Author(s):  
Pinaka Swasti Ratu Suryantari ◽  
I Irnawati
Keyword(s):  
Literature Review ◽  
Keyword Search ◽  
Pill Count ◽  
World Health ◽  
Drug Resistant ◽  
Pulmonary Tb ◽  
Tb Treatment ◽  
The World ◽  
Mdr Tb ◽  
Elementary School Education

AbstractCompliance in treatment and taking Anti Tuberculosis Drugs (OAT) in pulmonary TB Patients is very necessary for consistency in increasing the success rate of treatment. Pulmonary TB Treatment must be done regularly. Otherwise, resistance to Anti Tuberculosis Drugs (OAT) will occur, the duration of taking the drug will be longer, and there will be an increase in the dose consumed. Especially, it is about an adherence to take OAT in patients with Multy-Drug Resistant (MDR) TB and TB with HIV. To find out the description of medication adherence in pulmonary TB patients and and characteristics in pulmonary TB patients. This study used a literature review design. The pill count compliance measurement method was conducted through a keyword search and used 5 articles from Google Scholar, ProQuest, and PubMed published in 2017 – 2021. From the 5 articles reviewed, the results showed that most of the respondents were male (68% or 314 respondents). The education level of most of the respondents was elementary school education (34% or 105 respondents). Most of the respondents were employed (62% or 164 respondents). Compliance with taking medication in pulmonary TB patients was 322 (70%) compliant, given intervention was 159 (92%) compliant, without intervention was 163 (56%) compliant, MDR TB non-adherent was 105 (95%), and TB with HIV 135 was (86%) complied. Compliance with taking Anti Tuberculosis Drugs (OAT) in pulmonary TB patients must be continuously improved and maintained to achieve the World Health Organization's target of increasing the success of pulmonary TB treatment consistently at results of 90%.Keywords: Compliance, Taking Medicines, TB Drugs, Pill Count, and Pulmonary TB AbstrakKepatuhan dalam pengobatan dan minum Obat Anti Tuberkulosis (OAT) pada pasien TB Paru sangat diperlukan konsistensinya dalam meningkatkan angka keberhasilan pengobatan. Pengobatan TB Paru harus dilakukan secara teratur, jika tidak akan terjadi resistensi pada Obat Anti Tuberkulosis (OAT), semakin lama durasi minum obat dan terjadi peningkatan dosis yang dikonsumsi. Terutama kepatuhan minum OAT pada pasien TB Multy Drug Resistant (MDR) dan TB dengan HIV. Mengetahui gambaran kepatuhan minum obat pada pasien TB Paru dan karakteristik pada pasien TB Paru. Desain Literature Review dengan metode pengukuran kepatuhan pill count melakukan pencarian melalui kata kunci dan menggunakan 5 artikel dari database hasil penulusuran elektronik pada Google Cendekia, ProQuest, Pubmed yang dipublish pada tahun 2017 – 2021. Dari 5 artikel yang di review di dapatkan hasil responden pada artikel sebagian besar berjenis kelamin laki – laki yaitu 314 (68%). Tingkat pendidikan responden sebagian besar berpendidikan SD yaitu 105 (34%), dan sebagian besar responden bekerja yaitu 164 (62%). Kepatuhan minum obat pada pasein TB dengan mengabaikan intervensi yang diberikan yaitu 322 (70%) patuh, diberikan intervensi 159 (92%) patuh, tanpa intervensi yang diberikan 163 (56%) patuh, TB MDR tidak patuh 105 (95%), dan TB dengan HIV 135 (86%) patuh. Kepatuhan minum Obat Anti Tuberkulosis (OAT) pada pasien TB Paru harus terus ditingkatkan dan dipertahankan untuk mencapai target World Heatlh Organisation dalam meningkatkan keberhasilan pengobatan TB Paru secara konsisten pada hasil ≥ 90%.Kata kunci: Kepatuhan; Minum Obat; Obat TB; Pill Count; dan TB Paru

scholarly journals Resistance at No Cost: The Transmissibility and Potential for Disease Progression of Drug-ResistantM. Tuberculosis

2018 ◽  
Author(s):  
Mercedes C. Becerra ◽  
Chuan-Chin Huang ◽  
Leonid Lecca ◽  
Jaime Bayona ◽  
Carmen Contreras ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Drug Resistant ◽  
Resistance Mutations ◽  
Pulmonary Tb ◽  
Genetic Fingerprint ◽  
Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
The Impact

AbstractBackgroundThe future trajectory of drug resistant tuberculosis strongly depends on the fitness costs of drug resistance mutations. Here, we measured the association of phenotypic drug resistance and the risk of TB infection and disease among household contacts (HHCs) of patients with pulmonary TB.MethodsWe evaluated 12767 HHCs of patients with drug sensitive and resistant pulmonary TB at baseline, two, six, and 12 months to ascertain infection status and to determine whether they developed tuberculosis disease. We also assessed the impact of drug resistance phenotype on the likelihood that a TB strain shared a genetic fingerprint with at least one other TB patient in the cohort.FindingsAmong 3339 TB patients for whom were DST available, 1274 (38%) had TB that was resistant to at least one drug and 478 (14⋅3%) had multi-drug resistant (MDR) TB, i.e. TB resistant to both INH and rifampicin. Compared to HHCs of drug sensitive TB patients, those exposed to a patient with MDR-TB had an 8% (95% CI: 4-13%) higher risk of infection by the end of follow up. We found no statistically significant difference in the relative hazard of incident TB disease among HHCs exposed to MDR-TB compared to DS-TB (Adjusted HR 1⋅28 [(95% CI: ⋅9-1⋅83]). Patients with MDR-TB were more likely to be part of a genetic cluster than were DS-TB patients.InterpretationClinical strains of MDR M. tuberculosis are neither less transmissible than drug sensitive strains nor less likely to cause disease. (ClinicalTrials.gov number,NCT00676754)FundingNational Institutes of Health: NIH/NIAID CETR U19AI109755StatementAll authors have seen the manuscript and approved the manuscript.

scholarly journals S2 Multi-drug Resistant Tuberculosis (MDR-TB) treatment in the UK: a survey of injectable use and toxicity in practice

Thorax ◽  
2010 ◽  
Vol 65 (Suppl 4) ◽  
pp. A4-A5
Author(s):  
A. Sturdy ◽  
A. Goodman ◽  
R. J. Jose ◽  
A. Loyse ◽  
M. O'Donoghue ◽  
...  
Keyword(s):  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Uk

scholarly journals Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Wan-mei Song ◽  
Yi-fan Li ◽  
Yun-xia Liu ◽  
Yao Liu ◽  
Chun-bao Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Meta Analysis ◽  
Low Income Countries ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Background: Drug-resistant tuberculosis (DR-TB), especially multidrug-resistant tuberculosis (MDR-TB) is a public health threat. Little is known about estimates of different profiles and rates of DR-TB among children globally.Methods: We did a systematic review and meta-analysis of observational studies reporting DR-TB among children by searching Embase, PubMed, and Scopus databases from January 1, 2000 to October 1, 2020. Publications reporting more than 60 children with bacteriological confirmed tuberculosis and phenotypical drug susceptibility testing (DST) results were included. Pooled proportions of MDR-TB and sub-analysis by age subgroups, regions, economical levels were performed.Results: We identified 4,063 studies, of which 37 were included. Of 23,652 pediatric TB patients, the proportions of DR-TB, MDR-TB, mono-resistant TB, polydrug resistant TB, extensively drug-resistant TB were 13.59% (1,964/14,453), 3.72% (881/23,652), 6.07% (529/8,719), 1.61% (119/7,361), 0.44% (30/6,763), respectively. The pooled proportion of MDR-TB among 23,652 children of 37 studies was 3.7% (95% CI, 3.5–4.0%). Rate of MDR-TB was much lower in high-income countries (1.8%) than that in lower-middle-income countries (6.3%) and upper-middle-income countries (7.3%). More specifically, the rates of MDR-TB were 1.7% in USA, 1.7% in UK, 2.9% in India, 6.0% in South Africa, 9.8% in China, respectively.Conclusions: The burden of DR-TB remains high in children, and there are potential associations between rates of pediatric MDR-TB and national economical levels. More interventions on child TB cases in low-income countries may be urgently needed in future.

scholarly journals Outcomes in patients of pulmonary tuberculosis treated under RNTCP & follow up after 6 months

2022 ◽  
Vol 8 (4) ◽  
pp. 196-201
Author(s):  
Sonisha Gupta ◽  
Ankur Porwal ◽  
Atul Kumar Gupta
Keyword(s):  
Causes Of Death ◽  
Infectious Agent ◽  
Hiv Positive ◽  
X Ray ◽  
Medical College ◽  
Mdr Tb ◽  
Chest X Ray ◽  
Lost To Follow Up ◽  
Destroyed Lung

Tuberculosis (TB) is, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent.This Prospective study was conducted at Santosh medical college Ghaziabad from 1 April 2018 to 30 September 2019. All diagnosed PTB patients above 12yrs were taken. Patients with EPTB, HIV positive, MDR TB, XDR TB were excluded from the study. At the end of study treatment outcome was evaluated.Total of 208 patients diagnosed as tuberculosis were enrolled in the study. 6 patients died during course of study, 10 were treatment failure, 4 were lost to follow-up, 3 transferred out & 1 shifted to private treatment. 184 patients completed treatment successfully. Out of 184, only 152 patients were available for interview at 6 months follow up after completion of treatment. 19 could not be traced, 11 patients refused and 2 died. Out of 152, 110 were asymptomatic, 1 relapsed & rest 41 patients were symptomatic. All symptomatic patients were subjected to Chest X-Ray. Fibrosis was seen on CXR of 30 patients, bronchiectasis was seen in 3 patients, 1 patient had destroyed lung, nothing abnormal detected in 7 patients.Even after successful treatment under RNTCP, these patients need to be followed up as many of them relapse or suffer from sequelae of tuberculosis.

Hybridization approach to drug discovery inhibiting Mycobacterium tuberculosis. An overview.

2020 ◽  
Vol 20 ◽  
Author(s):  
Daniele Zampieri ◽  
Maria G. Mamolo
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Drug Discovery ◽  
Cause Of Death ◽  
Medicinal Chemistry ◽  
Causes Of Death ◽  
Infectious Agent ◽  
Drug Resistant ◽  
New Chemical Entities ◽  
Hybrid Ligands

: Tuberculosis is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent mainly due to Mycobacterium tuberculosis (MTB). Recently, clinical prognoses have worsened due to the emergence of multi-drug resistant (MDR) and extensive-drug resistant (XDR) tuberculosis which lead to the need of new, efficient and safely drugs. Among the several strategies, polypharmacology could be considered one of the best solutions, in particular the multi-target directed ligands strategy (MTDLs), based on the synthesis of hybrid ligands acting against two targets of the pathogen. The framework strategy comprises linking, fusing and merging approaches to develop new chemical entities. With these premises, this review aims to provide an overview of recent hybridization approach, in medicinal chemistry, of the most recent and promising multitargeting antimycobacterial candidates.

scholarly journals Drug-resistant TB prevalence study in 5 health institutions in Haiti

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248707
Author(s):  
Jonathan Hoffmann ◽  
Carole Chedid ◽  
Oksana Ocheretina ◽  
Chloé Masetti ◽  
Patrice Joseph ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Molecular Techniques ◽  
Prevalence Study ◽  
Multi Drug Resistance ◽  
Major Public Health Problem ◽  
Drug Resistant ◽  
Cross Sectional ◽  
Pulmonary Tb ◽  
Mdr Tb ◽  
Resistant Strains

Objectives Tuberculosis (TB) is the leading infectious cause of death in the world. Multi-drug resistant TB (MDR-TB) is a major public health problem as treatment is long, costly, and associated to poor outcomes. Here, we report epidemiological data on the prevalence of drug-resistant TB in Haiti. Methods This cross-sectional prevalence study was conducted in five health centers across Haiti. Adult, microbiologically confirmed pulmonary TB patients were included. Molecular genotyping (rpoB gene sequencing and spoligotyping) and phenotypic drug susceptibility testing were used to characterize rifampin-resistant MTB isolates detected by Xpert MTB/RIF. Results Between April 2016 and February 2018, 2,777 patients were diagnosed with pulmonary TB by Xpert MTB/RIF screening and positive MTB cultures. A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) M. tuberculosis strain. Overall HIV prevalence was 14.1%. Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5–4.4, P = 0.001). Among the detected DR-TB strains, T1 (29.3%), LAM9 (13.3%), and H3 (10.7%) were the most frequent clades. In comparison with previous spoligotypes studies with data collected in 2000–2002 and in 2008–2009 on both sensitive and resistant strains of TB in Haiti, we observed a significant increase in the prevalence of the drug-resistant MTB Spoligo-International-Types (SIT) 137 (X2 clade: 8.1% vs. 0.3% in 2000–02 and 0.9% in 2008–09, p<0.001), 5 (T1 clade: 6.8% vs 1.9 in 2000–02 and 1.7% in 2008–09, P = 0.034) and 455 (T1 clade: 5.4% vs 1.6% and 1.1%, P = 0.029). Newly detected spoligotypes (SIT 6, 7, 373, 909 and 1624) were also recorded. Conclusion This study describes the genotypic and phenotypic characteristics of DR-TB strains circulating in Haiti from April 2016 to February 2018. Newly detected MTB clades harboring multi-drug resistance patterns among the Haitian population as well as the higher risk of MDR-TB infection in HIV-positive people highlights the epidemiological relevance of these surveillance data. The importance of detecting RIF-resistant patients, as proxy for MDR-TB in peripheral sites via molecular techniques, is particularly important to provide adequate patient case management, prevent the transmission of resistant strains in the community and to contribute to the surveillance of resistant strains.

‘I’m an expert in me and I know what I can cope with’: Patient expertise in rheumatoid arthritis

2014 ◽  
Vol 10 (3) ◽  
pp. 249-261 ◽  
Author(s):  
Tessa Sanderson ◽  
Jo Angouri
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Healthcare Systems ◽  
Specific Knowledge ◽  
Active Involvement ◽  
Domain Specific ◽  
Access To Health ◽  
Patient Expertise ◽  
Domain Specific Knowledge ◽  
The Uk

The active involvement of patients in decision-making and the focus on patient expertise in managing chronic illness constitutes a priority in many healthcare systems including the NHS in the UK. With easier access to health information, patients are almost expected to be (or present self) as an ‘expert patient’ (Ziebland 2004). This paper draws on the meta-analysis of interview data collected for identifying treatment outcomes important to patients with rheumatoid arthritis (RA). Taking a discourse approach to identity, the discussion focuses on the resources used in the negotiation and co-construction of expert identities, including domain-specific knowledge, access to institutional resources, and ability to self-manage. The analysis shows that expertise is both projected (institutionally sanctioned) and claimed by the patient (self-defined). We close the paper by highlighting the limitations of our pilot study and suggest avenues for further research.

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