Reducing the risk of tuberculosis transmission for HCWs in high incidence settings

AbstractGlobally, tuberculosis (TB) is a leading cause of death from a single infectious agent. Healthcare workers (HCWs) are at increased risk of hospital-acquired TB infection due to persistent exposure to Mycobacterium tuberculosis (Mtb) in healthcare settings. The World Health Organization (WHO) has developed an international system of infection prevention and control (IPC) interventions to interrupt the cycle of nosocomial TB transmission. The guidelines on TB IPC have proposed a comprehensive hierarchy of three core practices, comprising: administrative controls, environmental controls, and personal respiratory protection. However, the implementation of most recommendations goes beyond minimal physical and organisational requirements and thus cannot be appropriately introduced in resource-constrained settings and areas of high TB incidence. In many low- and middle-income countries (LMICs) the lack of knowledge, expertise and practice on TB IPC is a major barrier to the implementation of essential interventions. HCWs often underestimate the risk of airborne Mtb dissemination during tidal breathing. The lack of required expertise and funding to design, install and maintain the environmental control systems can lead to inadequate dilution of infectious particles in the air, and in turn, increase the risk of TB dissemination. Insufficient supply of particulate respirators and lack of direction on the re-use of respiratory protection is associated with unsafe working practices and increased risk of TB transmission between patients and HCWs. Delayed diagnosis and initiation of treatment are commonly influenced by the effectiveness of healthcare systems to identify TB patients, and the availability of rapid molecular diagnostic tools. Failure to recognise resistance to first-line drugs contributes to the emergence of drug-resistant Mtb strains, including multidrug-resistant and extensively drug-resistant Mtb. Future guideline development must consider the social, economic, cultural and climatic conditions to ensure that recommended control measures can be implemented in not only high-income countries, but more importantly low-income, high TB burden settings. Urgent action and more ambitious investments are needed at both regional and national levels to get back on track to reach the global TB targets, especially in the context of the COVID-19 pandemic.

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Diagnosing Bacterial Vaginosis with a Novel, Clinically-Actionable Molecular Diagnostic Tool

10.1101/334177 ◽

2018 ◽

Cited By ~ 1

Author(s):

Joseph P. Jarvis ◽

Doug Rains ◽

Steven J. Kradel ◽

James Elliott ◽

Evan E. Diamond ◽

...

Keyword(s):

Bacterial Vaginosis ◽

Pathogenic Bacteria ◽

Reproductive Age ◽

Medical Decision ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Lactobacillus Species ◽

Research Subjects ◽

Asymptomatic Patients ◽

Increased Risk

Abstract/SummaryBacterial vaginosis is a common condition among women of reproductive age and is associated with potentially serious side-effects, including an increased risk of preterm birth. Recent advancements in microbiome sequencing technologies have produced novel insights into the complicated mechanisms underlying bacterial vaginosis and have given rise to new methods of diagnosis. Here we report on the validation of a quantitative, molecular diagnostic algorithm based on the relative abundances of ten potentially pathogenic bacteria and four commensal Lactobacillus species in research subjects (n = 172) classified as symptomatic (n = 149) or asymptomatic (n = 23). We observe a clear and reinforcing pattern among patients diagnosed by the algorithm that is consistent with the current understanding of biological dynamics and dysregulation of the vaginal microbiome during infection. Using this enhanced assessment of the underlying biology of infection, we demonstrate improved diagnostic sensitivity (93%) and specificity (90%) relative to current diagnostic tools. Our algorithm also appears to provide enhanced diagnostic capabilities in ambiguous classes of patients for whom diagnosis and medical decision-making is complicated, including asymptomatic patients and those deemed “intermediate” by Nugent scoring. Ultimately, we establish CLS2.0q as a quantitative, sensitive, specific, accurate, robust, and flexible algorithm for the clinical diagnosis of bacterial vaginosis – importantly, one that is also ideal for the differential diagnosis of non-BV infections with clinically similar presentations.

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Pathology of renal cancer and other tumours affecting the kidney

10.1093/med/9780199659579.003.0085 ◽

2017 ◽

Author(s):

Antonio Lopez-Beltran ◽

Rodolfo Montironi ◽

Liang Cheng

Keyword(s):

Diagnostic Techniques ◽

Clinical Findings ◽

Classification Systems ◽

World Health ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Molecular Diagnostic Techniques ◽

Renal Neoplasms ◽

Benign Tumours ◽

Health Organization

In the past 50 years, classification systems for renal neoplasms have become increasingly complex as distinctive morphologic patterns in renal neoplasms have been recognized and correlated with clinical findings. In addition to classic histopatology, more sophisticated diagnostic tools, including electron microscopy, immunohistochemistry, cytogenetics, and molecular diagnostic techniques have greatly influenced distinctions between various types of renal neoplasms. The current World Health Organization classification of renal neoplasms encompasses nearly 50 distinctive renal neoplasms categorized as malignant or benign tumours. These categories have been expanded during recent years to incorporate newer histotypes, thus suggesting that the next revision of this classification will incorporate some recently recognized entities. In this chapter, we examine clinicopathologic and genetic features of the renal tumours most often seen in clinical practice.

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Development of Nanobodies Targeting Peste des Petits Ruminants Virus: The Prospect in Disease Diagnosis and Therapy

Animals ◽

10.3390/ani11082206 ◽

2021 ◽

Vol 11 (8) ◽

pp. 2206

Author(s):

Edson Kinimi ◽

Serge Muyldermans ◽

Cécile Vincke ◽

Steven Odongo ◽

Richard Kock ◽

...

Keyword(s):

Heavy Chain ◽

Low Income ◽

Disease Diagnosis ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Enzyme Linked Immunosorbent Assay ◽

Domestic Sheep ◽

Gene Repertoire ◽

Peste Des Petits Ruminants ◽

Sheep And Goats

Peste des petits ruminants virus (PPRV) causes a highly devastating disease, peste des petits ruminants (PPR) of sheep and goats, that threatens food security, small ruminant production, and the conservation of wild small ruminants in many developing countries, especially in Africa. Robust serological and molecular diagnostic tools are available to detect PPRV infection, but they were mainly developed for domestic sheep and goats. The presence of a wide host range for PPRV does present serological diagnostic challenges. New innovative diagnostic tools are needed to detect PPRV in atypical hosts (e.g., Camelidae, Suidae, and Bovinae), in wildlife ecosystems and in complex field situations. Interestingly, single-domain antigen binding fragments (nanobodies) derived from heavy-chain-only camelid antibodies have emerged as a new hope in the development of accurate, rapid, and cost-effective diagnostic tools in veterinary and biomedical fields that are suitable for low-income countries. The main objective of this study was to construct an immune nanobody library to retrieve PPRV-reactive nanobodies that enable the development of diagnostic and therapeutic nanobodies in the future. Here, a strategy was developed whereby an alpaca (Vicugna pacos) was immunized with a live attenuated vaccine strain (PPRV/N/75/1) to raise an affinity-matured immune response in the heavy-chain-only antibody classes. The nanobody gene repertoire was engineered in pMECS-GG phagemid, whereby a ccdB gene (encoding a lethal protein) was substituted by the nanobody gene. An immune nanobody library with approximately sixty-four million independent transformants was constructed, of which 100% contained an insert with the proper size of nanobody gene. Following phage display and biopanning, nine nanobodies that specifically recognise completely inactivated PPRV were identified on enzyme-linked immunosorbent assay. They showed superb potency in rapidly identifying PPRV, which is likely to open a new perspective in the diagnosis and possible treatment of PPR infection.

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Challenges and Progress with Diagnosing Pulmonary Tuberculosis in Low- and Middle-Income Countries

Diagnostics ◽

10.3390/diagnostics8040078 ◽

2018 ◽

Vol 8 (4) ◽

pp. 78 ◽

Cited By ~ 11

Author(s):

Anthony Harries ◽

Ajay Kumar

Keyword(s):

World Health ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Sputum Smear ◽

Smear Microscopy ◽

Molecular Diagnostic Techniques ◽

Tuberculin Skin Testing ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Case finding and the diagnosis of tuberculosis (TB) are key activities to reach the World Health Organization’s End TB targets by 2030. This paper focuses on the diagnosis of pulmonary TB (PTB) in low- and middle-income countries. Sputum smear microscopy, despite its many limitations, remains the primary diagnostic tool in peripheral health facilities; however, this is being replaced by molecular diagnostic techniques, particularly Xpert MTB/RIF, which allows a bacteriologically confirmed diagnosis of TB along with information about whether or not the organism is resistant to rifampicin within two hours. Other useful diagnostic tools at peripheral facilities include chest radiography, urine lipoarabinomannan (TB-LAM) in HIV-infected patients with advanced immunodeficiency, and the loop-mediated isothermal amplification (TB-LAMP) test which may be superior to smear microscopy. National Reference Laboratories work at a higher level, largely performing culture and phenotypic drug susceptibility testing which is complemented by genotypic methods such as line probe assays for detecting resistance to isoniazid, rifampicin, and second-line drugs. Tuberculin skin testing, interferon gamma release assays, and commercial serological tests are not recommended for the diagnosis of active TB. Linking diagnosis to treatment and care is often poor, and this aspect of TB management needs far more attention than it currently receives.

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Prevalence of psoriasis and associated risk factors in China: protocol of a nationwide, population-based, cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-027685 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027685 ◽

Cited By ~ 1

Author(s):

Jing Li ◽

Meiwen Yu ◽

Ya-wen Wang ◽

Jia-an Zhang ◽

Mei Ju ◽

...

Keyword(s):

Risk Factors ◽

Low Income ◽

Sampling Design ◽

Population Based ◽

Cross Sectional Study ◽

World Health ◽

Sectional Study ◽

Cross Sectional ◽

World Health Assembly Resolution ◽

Increased Risk

IntroductionPsoriasis is a chronic inflammatory skin disease which could lead to serious complications and increased risk of cardiovascular diseases. Psoriasis was recognised as a serious non-communicable disease with important public health impact by member states in the World Health Assembly resolution in 2014. However, data on psoriasis epidemiology are scarce worldwide, especially from low-income and middle-income countries. Only a few epidemiological studies on psoriasis have been conducted in parts of China, mostly without appropriate sampling design and data analysis.AimThis study aims to obtain the prevalence of psoriasis in China and relevant risk factors through a nationwide, population-based study with adequate statistical design.Methods and analysisThis is a cross-sectional study to be conducted in 60 sites across China. A multistage, cluster random sampling design is used. Participants should have local household registration or be residing in the survey area for at least 6 months during the past year. The presence of psoriasis is ascertained independently by two certified dermatologists. If any discrepancies in the diagnosis occur, consensus will be met via discussion. All participants will be interviewed with a questionnaire to collect sociodemographic and disease information. The field survey will be implemented from October 2018 to June 2019. All statistical analyses will be conducted using survey procedures in SAS V.9.2 software to adjust for the complex sample design.Ethics and disseminationThe study has been reviewed and approved by the ethics committee of the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College (Nanjing, China). A written informed consent will be obtained from all participants before the questionnaire survey. Findings of the study will be disseminated through publications in peer-reviewed journals.

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The Global call for action on infection prevention and control

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-03-2018-0063 ◽

2019 ◽

Vol 32 (6) ◽

pp. 927-940 ◽

Cited By ~ 1

Author(s):

Gertrude Sika Avortri ◽

Juliet Nabyonga-Orem

Keyword(s):

Low Income ◽

Prevention And Control ◽

Infection Prevention ◽

Grey Literature ◽

Disease Outbreaks ◽

World Health ◽

Low Income Countries ◽

Infection Prevention And Control ◽

Content Type ◽

And Control

Purpose Healthcare-associated infections (HAIs) constitute a major threat to patient safety and affect hundreds of millions of people worldwide. The World Health Organization in 2016 published guidelines on the core components for infection prevention and control (IPC) programme. This was in response to a global call for focused action. The purpose of this paper is to examine and promote understanding of the tenets of the IPC guidelines and highlight their implications for implementation in low-income countries. Design/methodology/approach Drawing from personal experiences in leading the implementation of health programmes as well as a review of published and grey literature on IPC, authors discussed and proposed practical approaches to implement IPC priorities in low-income setting. Findings Availability of locally generated evidence is paramount to guide strengthening leadership and institutionalisation of IPC programmes. Preventing infections is everybody’s responsibility and should be viewed as such and accorded the required attention. Originality/value Drawing from recent experiences from disease outbreaks and given the heavy burden of HAIs especially in low-income settings, this paper highlights practical approaches to guide implementation of the major components of IPC.

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AMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS)

Wellcome Open Research ◽

10.12688/wellcomeopenres.12527.1 ◽

2017 ◽

Vol 2 ◽

pp. 92 ◽

Cited By ~ 43

Author(s):

Anna C. Seale ◽

N. Claire Gordon ◽

Jasmin Islam ◽

Sharon J. Peacock ◽

J. Anthony G. Scott

Keyword(s):

Low Income ◽

Surveillance System ◽

World Health ◽

Low Income Countries ◽

Drug Resistant ◽

Middle Income ◽

Surveillance Programme ◽

Antimicrobial Surveillance ◽

Life Threatening ◽

Health Organization

Drug-resistant infections caused by bacteria with increasing antimicrobial resistance (AMR) threaten our ability to treat life-threatening conditions. Tackling AMR requires international collaboration and partnership. An early and leading priority to do this is to strengthen AMR surveillance, particularly in low-income countries where the burden of infectious diseases is highest and where data are most limited. The World Health Organization (WHO) has developed the Global AMR Surveillance System (GLASS) as one of a number of measures designed to tackle the problem of AMR, and WHO member states have been encouraged to produce National Action Plans for AMR by 2017. However, low-income countries are unlikely to have the resources or capacity to implement all the components in the GLASS manual. To facilitate their efforts, we developed a guideline that is aligned to the GLASS procedures, but written specifically for implementation in low-income countries. The guideline allows for flexibility across different systems, but has sufficient standardisation of core protocols to ensure that, if followed, data will be valid and comparable. This will ensure that the surveillance programme can provide health intelligence data to inform evidence-based interventions at local, national and international levels.

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The War against Tuberculosis: A Review of Natural Compounds and Their Derivatives

Molecules ◽

10.3390/molecules25133011 ◽

2020 ◽

Vol 25 (13) ◽

pp. 3011 ◽

Cited By ~ 1

Author(s):

Morgan Maiolini ◽

Stacey Gause ◽

Jerika Taylor ◽

Tara Steakin ◽

Ginger Shipp ◽

...

Keyword(s):

Low Income ◽

Bacterial Cell ◽

Treatment Options ◽

Epigallocatechin Gallate ◽

Natural Compounds ◽

Additional Treatment ◽

World Health ◽

Low Income Countries ◽

Drug Resistant ◽

Cell Structures

Tuberculosis (TB), caused by the bacterial organism Mycobacterium tuberculosis, pose a major threat to public health, especially in middle and low-income countries. Worldwide in 2018, approximately 10 million new cases of TB were reported to the World Health Organization (WHO). There are a limited number of medications available to treat TB; additionally, multi-drug resistant TB and extensively-drug resistant TB strains are becoming more prevalent. As a result of various factors, such as increased costs of developing new medications and adverse side effects from current medications, researchers continue to evaluate natural compounds for additional treatment options. These substances have the potential to target bacterial cell structures and may contribute to successful treatment. For example, a study reported that green and black tea, which contains epigallocatechin gallate (a phenolic antioxidant), may decrease the risk of contracting TB in experimental subjects; cumin (a seed from the parsley plant) has been demonstrated to improve the bioavailability of rifampicin, an important anti-TB medication, and propolis (a natural substance produced by honeybees) has been shown to improve the binding affinity of anti-TB medications to bacterial cell structures. In this article, we review the opportunistic pathogen M. tuberculosis, various potential therapeutic targets, available therapies, and natural compounds that may have anti-TB properties. In conclusion, different natural compounds alone as well as in combination with already approved medication regimens should continue to be investigated as treatment options for TB.

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Intragenic Distribution of IS 6110 in Clinical Mycobacterium tuberculosis Strains: Bioinformatic Evidence for Gene Disruption Leading to Underdiagnosed Antibiotic Resistance

Microbiology Spectrum ◽

10.1128/spectrum.00019-21 ◽

2021 ◽

Author(s):

Rudy Antoine ◽

Cyril Gaudin ◽

Ruben C. Hartkoorn

Keyword(s):

Antibiotic Resistance ◽

Mycobacterium Tuberculosis ◽

Gene Disruption ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Drug Resistant ◽

Single Nucleotide ◽

Drug Resistant Tuberculosis ◽

Treatment Choices ◽

Resistant Tuberculosis

To help control the spread of drug-resistant tuberculosis and to guide treatment choices, it is important that rapid and accurate molecular diagnostic tools are used. Current molecular diagnostic tools detect the most common antibiotic-resistance-conferring mutations in the form of single nucleotide changes, small deletions, or insertions.

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Postpartum moderate to severe anemia in a low-income country, Burkina Faso

10.21203/rs.2.16342/v1 ◽

2019 ◽

Author(s):

Hyacinthe ZAMANE ◽

Abou Coulibaly ◽

Issa Ouédraogo ◽

Guémilatou Coulibaly-Diallo ◽

Ali Ouedraogo ◽

...

Keyword(s):

Burkina Faso ◽

Low Income ◽

Maternal Mortality Ratio ◽

Secondary Analysis ◽

World Health ◽

Severe Anemia ◽

Contributing Factors ◽

Low Income Country ◽

Increased Risk ◽

Sahel Region

Abstract Background In Burkina Faso, Sahelian country with limited resources, the maternal mortality ratio is still high and anemia is one of the major contributing factors. To identify epidemiological aspects of postpartum anemia in order to better guide public policy in its prevention and management.Methods This was a secondary analysis of data from the 2010 Demographic and Health Survey in Burkina Faso. The classification of anemia in women according to the World Health Organization was considered. For the research of associated factors, moderate or severe anemia was considered.Results A total of 1616 women were included. Hemoglobin levels were less than 12 g/dl in 839 women (51.9%). It was less than 10 g/dl in 251 cases (15.5%). There has been a significant increase in the risk of postpartum anemia for women in the Sahel region (OR=2.9; IC [1.2-7.4]; p=0.024). The adjusted effect of the woman's status about postpartum amenorrhea also showed an increased risk in women still having no return from menstruation.Conclusion Anemia is common during postpartum. It is of multifactorial origin. Further studies are needed to better adapt its current prevention strategies and investigate the relationship between Sahel region and anemia.

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