scholarly journals A Clinical-Epidemiological and Geospatial Study of Tuberculosis in a Neglected Area in the Amazonian Region Highlights the Urgent Need for Control Measures

2021 ◽  
Vol 18 (3) ◽  
pp. 1335
Author(s):  
Cristal Ribeiro Mesquita ◽  
Emilyn Costa Conceição ◽  
Lúcia Helena Martins Tavares Monteiro ◽  
Odinea Maria da Silva ◽  
Luana Nepomuceno Gondim Costa Lima ◽  
...  
Keyword(s):  
Communicable Disease ◽  
Secondary Data ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Molecular Testing ◽  
Cure Rate ◽  
Mdr Tb ◽  
Marajó Island ◽  
Epidemiological Trends ◽  
Amazonian Region

Tuberculosis (TB) is an infectious communicable disease, which despite global efforts, still needs special attention in regions with difficult access. This study aims to describe the spatial and epidemiological trends of TB incidences from 2013 to 2018 in Marajó Island, the Amazonian region, Pará, Brazil. We have obtained secondary data from the Brazilian TB databases and performed geospatial and statistical analyses on the data for new TB cases, relapses, and re-admissions. From 2013 to 2018, 749 new cases were reported, in which the diagnostics (culture) was not performed for 652 (87.2%) patient samples, the drug resistance test (DST) was performed for nine (1.2%) samples, and one (0.13%) was multidrug-resistant TB (MDR-TB). The rapid molecular testing (RMT) was performed on 40 (5.3%) patient samples, with results indicating that eight (20%) were susceptible to rifampicin and two (5%) were rifampicin resistant. Overall, the cure rate was 449 (66.7%), while relapses and re-admissions were 41 and 44, respectively. On the geospatial distribution, the municipality of Soure stands out with a high number of incidences, relapses, and re-admissions. Spatially, the eight MDR cases were randomly distributed. Our data highlight the urgent need for TB control measures in this region, by introducing the Xpert-Ultra® MTB/RIF (Cepheid, Sunnyvale, CA, USA) and Ogawa-Kudoh.

Communicable diseases in humanitarian operations and disasters

2020 ◽  
pp. bmjmilitary-2020-001415 ◽  
Author(s):  
Ronan James Murphy
Keyword(s):  
Communicable Disease ◽  
Evidence Base ◽  
Multidrug Resistant ◽  
Communicable Diseases ◽  
Control Measures ◽  
Diagnostic Tools ◽  
Humanitarian Operations ◽  
The Uk ◽  
Tools And Techniques ◽  
Austere Environments

Military organisations have battled communicable disease for millennia. They have pioneered disease prevention from the Crusades to the World Wars and continue to do so today. Predeployment vaccinations and chemoprophylaxis are effective in preventing communicable disease, as is reliable vector destruction and bite prevention, especially in the era of multidrug resistant organisms. These measures are unlikely to be fully possible in disasters, but reactive vaccination and efforts to reduce exposure to communicable disease should be a priority. Communicable diseases can be challenging to diagnose—the UK Defence Medical Services have become familiar with tools such as multiplex PCR and mass spectrometry. These have the potential to accurately identify organisms and sensitivity patterns in austere environments. Management of communicable diseases depends on accurate diagnosis and has a largely well-established evidence base but can be limited by a lack of resources and skills in an austere setting, therefore telemedicine can assist diagnosis and treatment of infections by projecting specialist skill. Systems such as EpiNATO2 are useful in monitoring diseases and identifying trends in order to establish control measures. Many of these tools and techniques are effective in austere environments and offer learning opportunities for those providing care in similar settings. Further research is ongoing into diagnostic tools as well as remote management.

scholarly journals Three Consecutive Waves of Cholera Outbreak in Ethiopia (2015- 2017): Explanatory Analysis

2020 ◽  
Vol 30 (4) ◽  
Author(s):  
Neamin Tesfay ◽  
Mengistu Biru
Keyword(s):  
Case Fatality ◽  
Secondary Data ◽  
Case Definition ◽  
Control Measures ◽  
Watery Diarrhea ◽  
Health Authorities ◽  
Time Period ◽  
Disease Occurrence ◽  
Public Health Authorities ◽  
Epidemiological Trends

BACKGROUND: Cholera is an acute epidemic infectious disease. It is characterized by watery diarrhea, extreme loss of fluid and electrolytes, and severe dehydration. Ethiopia faced three consecutive waves of cholera outbreaks: nearly all regional states and city administrations, with the exception of one, were affected. The study was conducted with the aim of describing the epidemiology of the outbreak within the defined three years.METHODS: Secondary data review was conducted along with explanatory methods of analysis individual patient data reported from different corners of the country in the time period of 2015 –2017. Cases were identified using the case definition stated on the national guideline for cholera control in Ethiopia.RESULT: A total of 36,154 cholera cases and 246 deaths were reported (overall case-fatality rate [CFR=0.7%] affecting all regions of the country except Gambella). The outbreak began in 2015 with 238 cases and 2 deaths [CFR=0.8%]. The largest outbreak during the period under this study occurred in 2016, with 29,338 cases and 188 deaths [CFR=0. 6%]. Following a decline in disease occurrence, the country experienced a resurgence of epidemic cholera during 2017 (6,578 cases and 56 deaths; CFR, 0.9%), which declined rapidly to a few cases. AR was higher in males [37.01/100,000] and persons in the age group of 15–44years [44.10/100,000] in 2016.CONCLUSION: The outbreak affected nearly every corner of the country. Taken together, the epidemiological trends of cholera in Ethiopia showed an annual decrement in frequency and length of outbreaks during the 3 years under review. The recent decreases in cholera case counts may reflect cholera control measures put in place by public health authorities of the national Ministry of Health.

scholarly journals Epidemiology of Antituberculosis Drug Resistance in Saudi Arabia: Findings of the First National Survey

2013 ◽  
Vol 57 (5) ◽  
pp. 2161-2166 ◽  
Author(s):  
Sahal Al-Hajoj ◽  
Bright Varghese ◽  
Mohammed M. Shoukri ◽  
Ruba Al-Omari ◽  
Mais Al-Herbwai ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Saudi Arabia ◽  
National Survey ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Drug Susceptibility Testing ◽  
Control Measures ◽  
Foreign Born ◽  
Primary Drug Resistance ◽  
Mdr Tb

ABSTRACTThe real magnitude of antituberculosis (anti-TB) drug resistance in Saudi Arabia is still unknown because the available data are based on retrospective laboratory studies that were limited to hospitals or cities. A representative national survey was therefore conducted to investigate the levels and patterns of anti-TB drug resistance and explore risk factors. Between August 2009 and July 2010, all culture-positive TB patients diagnosed in any of the tuberculosis reference laboratories of the country were enrolled. Isolates obtained from each patient were tested for susceptibility to first-line anti-TB drugs by the automated Bactec MGIT 960 method. Of the 2,235 patients enrolled, 75 cases (3.4%) were lost due to culture contamination and 256 (11.5%) yielded nontuberculous mycobacteria (NTM). Finally, 1,904 patients (85.2% of those enrolled) had available drug susceptibility testing results. Monoresistance to streptomycin (8.1%; 95% confidence interval [CI], 7.2 to 9.1), isoniazid (5.4%; 95% CI, 4.7 to 6.2), rifampin (1%; 95% CI, 0.7 to 1.3) and ethambutol (0.8%; 95% CI, 0.5 to 1.2) were observed. Multidrug-resistant TB (MDR-TB) was found in 1.8% (95% CI, 1.4 to 2.4) and 15.9% (95% CI, 15.4 to 16.5) of new and previously treated TB cases, respectively. A treatment history of active TB, being foreign-born, having pulmonary TB, and living in the Western part of the country were the strongest independent predictors of MDR-TB. Results from the first representative national anti-TB drug resistance survey in Saudi Arabia suggest that the proportion of MDR-TB is relatively low, though there is a higher primary drug resistance. A strengthened continuous surveillance system to monitor trends over time and second-line anti-TB drug resistance as well as implementation of innovative control measures, particularly among immigrants, is warranted.

scholarly journals CURRENT STRATEGIES IN THE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS

2018 ◽  
Vol 11 (7) ◽  
pp. 70
Author(s):  
Neethu Td ◽  
Mebin Alias
Keyword(s):  
Treatment Regimen ◽  
Current Knowledge ◽  
Multidrug Resistant ◽  
Control Measures ◽  
World Health ◽  
Drug Resistant ◽  
Proper Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Objective: The objective of the study was to analyze and review the current knowledge about the principles of treatment of multidrug-resistant tuberculosis (MDR-TB), World Health Organization treatment regimen to treat MDR-TB, mechanism of resistance, and risk factors for emergence of resistance, and novel antitubercular drugs (ATDs) available and control measures to improve treatment outcomes of MDR-TB.Methods: Various articles were reviewed from PubMed and other databases and were analyzed to write the review.Results: Mycobacterium is a largely curable infectious disease if proper treatment should be followed. The success of the treatment depends on the designing of proper treatment regimen and patient adherence to that medication.Conclusion: Mycobacterium tuberculosis is now the most lethal infectious pathogen. Drug resistance has become a major problem in the treatment of TB. In MDR-TB, the bacteria is resistant to at least isoniazid (INH) and rifampicin (RIF), and in extensively drug-resistant TB the bacteria is resistant to INH, RIF, any fluoroquinolone, and at least one of three injectable second-line drugs for TB such as kanamycin, capreomycin, and amikacin. More recently, a more worrying situation has emerged with the description of M. tuberculosis strains that have been found resistant to all antibiotics that were available for testing, a situation labeled as totally drug resistant-TB. Other reasons like poor planning by the authorities and the government may also result in the emergence of resistant strain. Rather than the effective chemotherapy and the moderately protective vaccine, new anti-TB agents, and novel controlled release nanoparticulate system like polymeric nanocarrier systems containing existing ATDs are urgently needed to decrease the global incidence of TB.

SHEA-CDC TB Survey, Part I: Status of TB Infection Control Programs at Member Hospitals, 1989-1992

1995 ◽  
Vol 16 (3) ◽  
pp. 129-134
Author(s):  
Scott K. Fridkin ◽  
Lilia Manangan ◽  
Elizabeth Bolyard ◽  
William R. Jarvis ◽  
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Tuberculin Skin Testing ◽  
Respiratory Protection ◽  
Mdr Tb ◽  
Reported Data ◽  
Tb Infection Control

AbstractObjective:To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.Design:Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.Results:Respondents’ hospitals (210 [58%]) had a median of 2,400 healthcare workers (range, 396 to 13,745), 437 beds (range, 48 to 1,250), 5.6 patients with TB per year (range, 0 to 492), and 0 multidrug-resistant (MDR) TB patients per year (range, 0 to 33). Of 166 respondents’ hospitals for which data were provided for 1989 through 1992, the number caring for MDR-TB patients increased from 10 (6%) in 1989 to 49 (30%) in 1992. Reported policies for routine healthcare worker tuberculin skin testing varied. The median skin-test positivity rate for healthcare workers at the time of hire increased from 0.54% in 1989 to 0.81% in 1992, but the median conversion rate during routine testing remained similar: 0.35% in 1989 and 0.33% in 1992. Among 196 hospitals with reported data on respiratory protection use for 1989 through 1992, the use of either surgical submicron, dust-mist, or dust-fume-mist respirators for healthcare workers increased from 9 (5%) in 1989 to 85 (43%) in 1992. Of 181 hospitals with reported data, 113 (62%) had acid-fast bacilli isolation facilities consistent with the 1990 CDC guideline (ie, a single patient room, negative air pressure relative to the hallway, air exhausted directly outside, and ≥ 6 air exchanges per hour).Conclusions:While the number of surveyed hospitals caring for TB and MDR-TB patients increased during 1989 through 1992, TB infection control measures at many hospitals still did not meet the 1990 CDC guideline recommendations.

scholarly journals Trends in multidrug-resistant tuberculosis in Scotland, 2000-7

2009 ◽  
Vol 14 (11) ◽  
Author(s):  
L F Anderson ◽  
I F Laurenson ◽  
O Blatchford ◽  
E Shakir ◽  
J McMenamin ◽  
...  
Keyword(s):  
Risk Factors ◽  
United Kingdom ◽  
Treatment Outcome ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Self Report ◽  
Factors Associated ◽  
The United Kingdom ◽  
Mdr Tb

Overall numbers of multidrug-resistant (MDR) tuberculosis (TB) rose sharply in the United Kingdom and Scotland in 2007. Risk factors associated with MDR TB in the United Kingdom have been identified but there has been no previous report on risk factors associated with MDR TB in Scotland. Enhanced Surveillance of Mycobacterial Infections (ESMI) data were used to examine demographic and clinical characteristics and treatment outcome of MDR TB cases notified in Scotland between 2000-7. There was a total of 11 culture-positive cases of MDR TB, five of which were notified in 2007. The majority of patients were female, 15-44 years old and unemployed. All were born outside the United Kingdom and most had arrived within the past year from or frequently travelled to their home countries in China, the Indian subcontinent or Africa. Except for one individual, our patients did not self report a history of previous diagnosis of TB which was previously identified as a risk factor for MDR TB in the United Kingdom. Only three patients received directly observed treatment (DOT). Only two patients had completed treatment at 12 months, partially due to the inadequate length of follow-up under the current ESMI system. Our results suggest that most patients had primary resistance due to transmission of MDR TB in high incidence countries and thus point to the importance of international efforts to control MDR TB in these countries. In Scotland, national efforts should be made to increase the number of MDR TB patients receiving DOT and to extend follow-up to improve monitoring of treatment outcome. It is important to identify high risk groups for MDR TB infection in order to deliver effective community-based disease control measures.

scholarly journals Value of pyrazinamide for composition of new treatment regimens for multidrug-resistant Mycobacterium tuberculosis in China

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hui Xia ◽  
Susan van den Hof ◽  
Frank Cobelens ◽  
Yang Zhou ◽  
Bing Zhao ◽  
...  
Keyword(s):  
Hot Spot ◽  
Scale Up ◽  
Point Mutations ◽  
Previous Treatment ◽  
Multidrug Resistant ◽  
Drug Susceptibility Testing ◽  
New Drugs ◽  
Beijing Genotype ◽  
Molecular Testing ◽  
Mdr Tb

Abstract Background Pyrazinamide still may be a useful drug for treatment of rifampin-resistant (RR-TB) or multidrug-resistant tuberculosis (MDR-TB) in China while awaiting scale up of new drugs and regimens including bedaquiline and linezolid. The level of pyrazinamide resistance among MDR-TB patients in China is not well established. Therefore, we assessed pyrazinamide resistance in a representative sample and explored determinants and patterns of pncA mutations. Methods MDR-TB isolates from the 2007 national drug resistance survey of China were sub-cultured and examined for pyrazinamide susceptibility by BACTEC MGIT 960 method. pncA mutations were identified by sequencing. Characteristics associated with pyrazinamide resistance were analyzed using univariable and multivariable log-binominal regression. Results Of 401 MDR-TB isolates, 324 were successfully sub-cultured and underwent drug susceptibility testing. Pyrazinamide resistance was prevalent in 40.7% of samples, similarly among new and previously treated MDR-TB patients. Pyrazinamide resistance in MDR-TB patients was associated with lower age (adjusted OR 0.54; 95% CI, 0.34–0.87 for those aged ≧60 years compared to < 40 years). Pyrazinamide resistance was not associated with gender, residential area, previous treatment history and Beijing genotype. Of 132 patients with pyrazinamide resistant MDR-TB, 97 (73.5%) had a mutation in the pncA gene; with 61 different point mutations causing amino acid change, and 11 frameshifts in the pncA gene. The mutations were scattered throughout the whole pncA gene and no hot spot region was identified. Conclusions Pyrazinamide resistance among MDR-TB patients in China is common, although less so in elderly patients. Therefore, pyrazinamide should only be used for treatment of RR/MDR-TB in China if susceptibility is confirmed. Molecular testing for detection of pyrazinamide resistance only based on pncA mutations has certain value for the rapid detection of pyrazinamide resistance in MDR-TB strains but other gene mutations conferring to pyrazinamide resistance still need to be explored to increase its predictive ability .

scholarly journals TREATMENT OUTCOMES OF MULTIDRUG RESISTANT TUBERCULOSIS PATIENTS IN EAST JAVA FROM 2014 TO 2017

2020 ◽  
Vol 8 (2) ◽  
pp. 141
Author(s):  
Lailatul Fitriya ◽  
Kurnia Dwi Artanti
Keyword(s):  
Treatment Outcomes ◽  
Health Workers ◽  
Treatment Success ◽  
Public Health Problem ◽  
Secondary Data ◽  
Multidrug Resistant ◽  
Major Public Health Problem ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Background: Multidrug resistant tuberculosis (MDR TB) is a major public health problem marked by the Mycobacterium tuberculosis strain that is resistant to first line anti TB drugs, including rifampicin and isoniazid simultaneously. A patient confirmed as having MDR TB can transmit this form of TB to other individuals. Therefore, treatment success is the main target when addressing MDR TB. Purpose: This study aimed to assess the treatment outcomes of MDR TB patients in East Java Province from 2014 to 2017. Method: This is a quantitative-descriptive study using the secondary data of drug resistant TB patients sourced from the e-TB Manager website in the East Java Province Health Office. Results: The results show that the average MDR TB patients was 47 years old, 57.44% were male, 37.52% had a negative HIV status, 44.87% were relapse patients, 71.95% had undergone two or less previous treatments, and 69.24% had sputum culture conversion. The treatment outcomes included 161 patients (31.14%) confirmed as cured, 27 patients (5.22%) completing treatment, 174 patients (33.65%) defaulting, two patients (0.38%) confirmed as having failed treatment, and 59 patients (11.41%) dying during the treatment period. Conclusion: The treatment success rate was low and the number of defaults was high. Therefore, it is hoped that there will be support from those closest to the patient and health workers who will maintain and increase the patient's motivation to complete the treatment.

Anti-tuberculosis drug resistance patterns and trends in a tuberculosis referral hospital, 1997–2009

2011 ◽  
Vol 139 (12) ◽  
pp. 1909-1918 ◽  
Author(s):  
C. H. LIU ◽  
H. M. LI ◽  
L. LI ◽  
Y. L. HU ◽  
Q. WANG ◽  
...  
Keyword(s):  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Drug Resistant ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
High Prevalence ◽  
Resistance Patterns ◽  
Mdr Tb ◽  
Increasing Trends

SUMMARYInformation about the changing epidemiology of drug-resistant tuberculosis (TB) in hospitals in China over the past decade remains largely unknown. This study examined the susceptibility patterns and trends of drug-resistant TB cases in the 309 Hospital in Beijing, China. Mycobacterium tuberculosis isolates were retrospectively identified, drug susceptibility test (DST) results and clinical data were analysed for the period 1997–2009. Of the 5523 culture-positive TB patients, 47·1% had resistance to any anti-TB drug, 14·8% had mono-resistant TB, 19·8% had poly-resistant TB, 19·4% had multidrug-resistant TB (MDR-TB), and 1·3% had extensively drug-resistant TB (XDR-TB). Drug-resistant TB was significantly associated with age group, residential situation, and TB treatment history (P<0·001). During 1997–2000, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all increased significantly (P<0·001). During 2000–2003, the increasing trends of MDR-TB and XDR-TB cases were reversed. During 2004–2009, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all declined significantly (P<0·001), but the prevalence of MDR-TB and poly-resistant TB cases remained high. Our study provides evidence demonstrating that intensive TB control measures have helped reverse the increasing trends of drug-resistant TB in China, but continuous surveillance of drug-resistant TB and better case management are still needed to further reduce the remaining high prevalence of drug-resistant TB.

scholarly journals Multidrug-Resistant Tuberculosis and Implementation of Control Measures in Ketapang District, West Borneo, Indonesia

2020 ◽  
Vol 40 (1) ◽  
pp. 6-15
Author(s):  
Imelda Nita Saputri ◽  
Eva Lydia Munthe
Keyword(s):  
Diagnostic Tool ◽  
Formal Education ◽  
Sputum Sample ◽  
District General Hospital ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Cross Sectional ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Background: Multidrug-resistant Tuberculosis (MDR-TB) has emerged as a threat of public health in Indonesia. The utilization of GeneXpert MTB/RIF as a rapid yet effective diagnostic tool enables early and appropriate treatment initiation of MDR-TB. This study aims in describing the occurrence of MDR-TB and the implementation of control measures in Ketapang District, West Borneo, Indonesia, since the utilization of GeneXpert MTB/RIF as a diagnostic tool. Methods: This is a cross-sectional descriptive study. The data were taken from medical record of patients with MDR-TB in Dr.Agoesdjam District General Hospital. The diagnosis was obtained from PCR-based analysis GeneXpert MTB/RIF of sputum sample, which detected Mycobacterium tuberculosis resistant to Rifampicin. Results: Seventeen subjects were included in the study. Subjects were 8 (47%) male and 9 (53%) female aged 24-75 years. Most subjects are farmers (35.3%) or housewives (35.3%), and did not receive formal education (41.2%). The main symptom reported upon admission was cough (41.2%). Direct microscopic smear of sputum detected acid-fast bacilli of +2 (29.4%) and +1 (29.4%) the most. The most common feature seen in thoracic X-ray was infiltrate in 100% of cases. Four subjects (23.5%) have type II diabetes mellitus, while one subject (5.9%) is infected with HIV. Subjects are categorized into new case (17.6%), failure of category 1 treatment (41.2%), and failure of category 2 treatment (41.2%). Treatment for MDR-TB has been initiated since 2014, while two subjects have not started taking the regimen. Among 15 subjects receiving treatment, one (6.7%) was recovered, 6 (40%) subjects deceased, and 8 (53.3%) subjects are currently still taking the regimen, while conversion occurred in 8 (53.3%) subjects. Conclusion: Using the GeneXpert MTB/RIF analysis, 17 cases of MDR-TB have been detected in Ketapang district. Management of MDR-TB has been conducted since 2014.

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