scholarly journals Yield of Systematic Longitudinal Screening of Household Contacts of Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistant (XDR) Tuberculosis Patients in Mumbai, India

2020 ◽  
Vol 5 (2) ◽  
pp. 83
Author(s):  
Roma Haresh Paryani ◽  
Vivek Gupta ◽  
Pramila Singh ◽  
Madhur Verma ◽  
Sabira Sheikh ◽  
...  
Keyword(s):  
Contact Tracing ◽  
Drug Resistant ◽  
Household Contacts ◽  
Tb Treatment ◽  
Extensively Drug Resistant ◽  
High Incidence ◽  
Resistance Patterns ◽  
One Year ◽  
Index Cases

While risk of tuberculosis (TB) is high among household contacts (HHCs) of pre-extensively drug resistant (pre-XDR) TB and XDR-TB, data on yield of systematic longitudinal screening are lacking. We aim to describe the yield of systematic longitudinal TB contact tracing among HHCs of patients with pre-XDR-TB and XDR-TB. At the Médecins Sans Frontières (MSF) clinic, Mumbai, India a cohort comprising 518 HHCs of 109 pre-XDR and XDR index cases was enrolled between January 2016 and June 2018. Regular HHC follow-ups were done till one year post treatment of index cases. Of 518 HHCs, 23 had TB (21 on TB treatment and two newly diagnosed) at the time of first visit. Of the rest, 19% HHCs had no follow-ups. Fourteen (3.5%) TB cases were identified among 400 HHCs; incidence rate: 2072/100,000 person-years (95% CI: 1227–3499). The overall yield of household contact tracing was 3% (16/518). Of 14 who were diagnosed with TB during follow-up, six had drug susceptible TB (DSTB); six had pre-XDR-TB and one had XDR-TB. Five of fourteen cases had resistance patterns concordant with their index case. In view of the high incidence of TB among HHCs of pre-XDR and XDR-TB cases, follow-up of HHCs for at least the duration of index cases’ treatment should be considered.

scholarly journals Long-term mortality and active TB disease among patients who were lost to follow-up during second line tuberculosis treatment in 2011-2014: population-based study in the country of Georgia

2021 ◽  
Author(s):  
Giorgi Kuchukhidze ◽  
Davit Baliashvili ◽  
Natalia Adamashvili ◽  
Ana Kasradze ◽  
Russell R Kempker ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Positive Culture ◽  
Population Based ◽  
Drug Resistant ◽  
Second Line ◽  
Adjusted Risk ◽  
Tb Treatment ◽  
Country Of Georgia

Abstract BACKGROUND High rates of loss to follow-up (LFU) exist among patients with multi-drug and extensively drug-resistant tuberculosis (M/XDR TB); We aimed to identify long-term clinical outcomes of patients who were LFU during second-line TB treatment. METHODS We conducted a follow-up study among adults who received second-line TB treatment in the country of Georgia during 2011-2014 with a final outcome of LFU. We attempted to interview all LFU patients, administered a structured questionnaire and obtained sputum samples. Active TB at follow-up was defined by positive sputum Xpert-TB/RIF or culture. RESULTS Follow-up information was obtained for 461 patients, among these patients, 107 (23%) died and 177 (38%) were contacted, of those contacted 123 (69%) consented to participate and 92 provided sputum samples. Thirteen (14%) had active TB with an estimated infectious time-period for transmitting drug-resistant TB in the community of 480 days (IQR=803). In multivariable analysis, positive culture at the time of LFU was associated with active TB at the time of our study (adjusted risk ratio=13.3, 95% CI: 4.2, 42.2) CONCLUSIONS Nearly one-quarter of patients on second-line TB treatment who were LFU died. Among those LFU evaluated in our study, one in seven remained in the community with positive sputum cultures. To reduce death and transmission of disease, additional strategies are needed to encourage patients to complete treatment.

Rehabilitation of the Institutionalized Patient: Description of a Programme and Follow-up of 60 Patients

1977 ◽  
Vol 130 (5) ◽  
pp. 484-488 ◽  
Author(s):  
G. H. B. Baker ◽  
T. J. Woods ◽  
J. A. Anderson
Keyword(s):  
Psychiatric Hospital ◽  
Social Worker ◽  
Medical Staff ◽  
Community Based ◽  
Rehabilitation Unit ◽  
High Incidence ◽  
Bus Driver ◽  
One Year ◽  
Intensive Rehabilitation

SummaryThe programme in an intensive rehabilitation unit in a large psychiatric hospital is described. Features include the use of non-medical staff as primary therapists, the use of a mini-bus to facilitate regular visits by patients to their home areas, the inclusion of the mini-bus driver on weekly staff conferences, the use of sociodrama, the re-organization of hospital money payments to patients, the promotion of relations with community-based facilities through occasional ‘teach-in’ days, and a special liaison social worker providing intensive follow-up after discharge. Rehabilitation was prolonged (average stay about one year) and about half of those selected for rehabilitation from the long-stay wards were discharged. Follow-up showed that these patients benefited from discharge, in spite of a relatively high incidence of psychopathology and of social problems. Those transferred back to long-stay wards showed increased institutionalization.

Treatment of patients with multidrug­resistant and extensively drug resistant tuberculosis depending on the composition of individualized regimens: immediate and long­term results

2021 ◽  
pp. 7-15
Author(s):  
Yu.I. Feshchenko ◽  
N.A. Litvinenko ◽  
N.V. Grankina ◽  
M.V. Pogrebna ◽  
Yu.O. Senko ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Treatment Effectiveness ◽  
Individualized Treatment ◽  
Fluoroquinolone Resistance ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Treatment Regimens ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant

Objective — to study the effectiveness of treatment of MDR-TB (multidrug-resistant tuberculosis) and preXDR-TB/XDR-TB (pre-extensively and extensively drug resistant tuberculosis), depending on the composition of ITRs (individualized treatment regimens). Materials and methods. Тhe prospective observational study included 566 patients with MDR/preXDR-TB and XDR-TB during 2016—2020 on the scientific clinical bases of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine» and ME «Kryvyi Rih Anti-tuberculosis Dispensary» Dnipropetrovsk Regional Council Department. Patients were prescribed individualized treatment regimens in cases where short (standard or modified) regimens could not be prescribed. Patients were divided into comparison groups: 469 of them were treated with antimycobacterial therapy including bedaquiline and other effective antimycobacterial drugs groups A—C (without delamanid) — group 1. And 97 patients who were treated with the inclusion of both new antimycobacterial drugs (bedaquiline and delamanid) — group 2. Results and discussion. Regardless of whether the delamanid, in addition to bedaquiline and other drugs selected for the scheme according to WHO recommendations, «effective treatment» was found in 91.3 against 88.6 % of patients. In the remote period (6-month — 4-year follow-up period) there was no recurrence of the disease, regardless of the composition of the regime. The loss of treatment effectiveness was due to deaths from non-tuberculosis reasons and those lost for follow-up. Conclusions. For highly effective treatment, individualized regimens should include bedaquidine and linezolid from group A, and for previously ineffectively treated patients, clofazimine and carbapenems must be included (possibility to include 4 or more effective AMDs in ITR). For patients with fluoroquinolone resistance, treatment should include delamanid.

scholarly journals Incidence of Infection of Enterovirus 71 and Coxsackieviruses A6 and A16 among Household Contacts of Index Cases in Dong Thap Province, Southern Vietnam

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
C. Q. Hoang ◽  
H. D. Nguyen ◽  
N. X. Ho ◽  
T. H. T. Vu ◽  
T. T. M. Pham ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Geometric Mean ◽  
Age Groups ◽  
Enterovirus 71 ◽  
Foot And Mouth Disease ◽  
Household Contacts ◽  
Significant Difference ◽  
Antibody Titers ◽  
Index Cases

Background. Scarce information exists about immunity to hand, foot, and mouth disease (HFMD) among household contacts of index cases in Vietnam and what that means for reducing ongoing HFMD transmission in the community. Methods. We analyzed neutralizing antibodies (NT) and the incidence of enterovirus (EVs) infection among household contacts of index cases in a province where HFMD remains endemic. Throat swab and 2 mL blood samples from household contacts were collected at enrollment, during and after 2 weeks follow-up. Results. The incidence of EV-A71 infection among household contacts was 40/84 (47.6%, 95% Cl: 36.9-58.3%), compared with 106/336 (31.5%, 95% Cl: 26.6-36.5%) for CV-A6 and 36/107 (33.6%, 95% Cl: 24.7-42.6%) for CV-A16. The incidence of CV-A6 infection was fairly constant across ages; in contrast, CV-A71 and CV-A16 had some variation across ages. At baseline, higher geometric mean titer (GMT) of EV-A71, CV-A6, and CV-A16 antibody titers was found for 25-34-year groups (range 216.3 to 305.0) compared to the other age groups. There was a statistically significant difference in GMT values of CV-A6 and CV-A16 between those who had an infection or did not have infection among households with an index case of these serotypes. Conclusions. Our results indicated that adults were becoming infected with HFMD and could be contributing to the transmission. There is, therefore, a need for considering the household setting as an additional target for intervention programs for HFMD.

Health outcomes of older patients colonized by multi-drug resistant bacteria (MDRB): A one-year follow-up study

2013 ◽  
Vol 56 (1) ◽  
pp. 231-236 ◽  
Author(s):  
Didier Schoevaerdts ◽  
Jean-Philippe Agelas ◽  
Marie-Gabrielle Ingels ◽  
Jacques Jamart ◽  
Malorie Frennet ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Older Patients ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Follow Up Study ◽  
Drug Resistant Bacteria ◽  
One Year

The management of chlamydial infection: setting standards at a regional level

1998 ◽  
Vol 9 (10) ◽  
pp. 600-603 ◽  
Author(s):  
Chris Sonnex ◽  
Olwen Williams
Keyword(s):  
Chlamydial Infection ◽  
Index Patient ◽  
Regional Level ◽  
Contact Tracing ◽  
East Anglia ◽  
Appropriate Treatment ◽  
Genitourinary Medicine ◽  
Index Cases ◽  
Combined Data

Between 1993 and 1997, clinicians from 9 departments of genitourinary medicine (GUM) and one department of sexual health in East Anglia met to audit the process of contact tracing in chlamydial infection. After defining the target group, standards were set for discussion of the diagnosis with the index patient, appropriate treatment of the condition and documented notification of partners. Data were collected for all patients with confirmed chlamydial infection during the periods January to March 1995 and 1996. Considering the combined data for both years, overall 97% of patients were informed of the diagnosis and 100% received appropriate treatment. Notification of partners was addressed at the initial consultation in 99% of cases and again at follow-up in 87%. Where contacts were traceable, there was confirmation that assessment had occurred in 65%, and the index cases reported that 66% had undergone assessment. The achievements and also the problems associated with this audit are discussed.

scholarly journals Contact tracing of passengers exposed to an extensively drug-resistant tuberculosis case during an air flight from Beirut to Paris, October 2006

2007 ◽  
Vol 12 (49) ◽  
Author(s):  
J Chemardin ◽  
M C Paty ◽  
S Renard-Dubois ◽  
N Veziris ◽  
D Antoine
Keyword(s):  
Contact Tracing ◽  
Drug Resistant ◽  
Tuberculosis Case ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant

Contact tracing of air travellers exposed to cases of multi-drug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has become an increasingly important issue.

scholarly journals A Case of Disseminated Extensively Drug Resistant Extrapulmonary Tuberculosis

2020 ◽  
Author(s):  
Diti V Gandhasiri ◽  
Tilak M Dhamgaye ◽  
Ulhas Jadhav ◽  
Babaji Ghewade
Keyword(s):  
Drug Resistance ◽  
Drug Sensitivity ◽  
Extrapulmonary Tuberculosis ◽  
World Health ◽  
Drug Resistant ◽  
Immunocompetent Adult ◽  
Tb Treatment ◽  
Extensively Drug Resistant ◽  
Drug Sensitivity Test ◽  
Hiv Negative

Tuberculosis (TB) strains with drug resistance are more difficult to treat than drug susceptible ones and jeopardise global progress towards the targets set by the World Health Organisation’s End TB Strategy. Although disseminated TB is well known as an opportunistic infection in HIV infected individuals, it is uncommon in HIV negative individuals. The present case is a rare case of Extensively Drug Resistant (XDR)-TB in disseminated TB involving the extrapulmonary sites in an immunocompetent adult. We report a case of a young man who has disseminated TB involving pleura and peritoneum. Prior to this, he had taken category II anti-TB treatment with no satisfactory response. Drug sensitivity test of pleural fluid revealed resistance to quinolones, kanamycin, isoniazid and rifampicin. Patient was administered second line anti-TB therapy with remarkable response. Therefore, this case highlights the importance of investigating aggressively for Drug Resistance (DR) in suspected cases of extrapulmonary TB

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