International Journal of Tuberculosis and Lung Disease最新文献

Geographic information systems may help focus TB screening and treatment efforts to populations in greatest need, such as people born in endemic countries (PBEC).North Carolina USA census and TB surveillance data were used to examine the relationship between the population proportion of PBEC and incident TB cases in the subsequent 5-year period by census tract. Census tract population:incident TB ratios for thresholds of PBEC were used to measure screening efficiency.Of 3,290 PBEC TB cases, 2,764 (84%) had a mappable address. The proportion of census tract PBEC during 2006-2010 was strongly associated with incident TB in that tract in 2011-2015 (p < 0.001). Thresholds of 6%, 12%, and 19% PBEC in a tract during 2006-2010 as cutoffs for screening would have detected 75%, 50%, and 25% of incident TB cases in 2011-2015 with respective population:incident TB ratios of 11,840, 6,864, and 5,524 population/case. The same thresholds using 2011-2015 census data would have detected 75%, 50%, and 25% of incident TB cases during 2016-2018 with population:incident TB ratios of 17,804, 10,807, and 7,031 population/case.Census tract demographics are a simple and powerful tool to focus targeted testing and treatment of latent TB in areas likely to have incident TB disease..

Eight districts in central Uganda with 105 health facilities.To evaluate the effectiveness of the community awareness, screening, testing, diagnosis, and treatment (CAST-TB) campaigns on the number of people screened for, presumed to have, and diagnosed with TB disease.We designed a quasi-experimental study and utilised Bayesian Structural Time-Series analysis for counterfactual predictions over 24 months (12 months before vs 12 months during intervention). The intervention was the CAST-TB campaigns. The outcomes included the number of people screened for, presumed to have, and diagnosed with TB disease.The intervention led to a 36% (95% credible interval [CrI] 8.4-65, P = 0.005) increase in the number of people screened for TB disease (1,194,257 observed vs 875,211 predicted), a 29% (95% CrI 5.3-52, P = 0.01) increase in the number of people presumed to have TB disease (25,784 observed vs 19,997 predicted), and a 49% (95% CrI 25-75) increase in the number of people diagnosed with TB disease (2,566 observed vs 1,719 counterfactual).CAST-TB campaigns improved the number of people screened for, presumed to have, and diagnosed with TB disease in central Uganda, supporting scale-up efforts nationally and across sub-Saharan Africa where such indicators are suboptimal..

TB remains a major global health challenge. Glutathione (GSH) and N-acetylcysteine (NAC) have been proposed as adjunctive therapies with potential clinical and immunomodulatory benefits. This systematic review aims to evaluate the efficacy, safety, and immunomodulatory effects of GSH and NAC as adjunctive therapies in TB management.PubMed/MEDLINE, Embase, and Cochrane CENTRAL were searched until October 15, 2024. We included studies assessing the efficacy of GSH and NAC in TB management, focusing on clinical outcomes such as lung function recovery, sputum conversion, hepatoprotection, and immune response modulation. The quality of the studies was assessed using the Cochrane Risk of Bias tool.Eight controlled trials were included. GSH and NAC significantly improved lung function accelerated sputum conversion, and provided hepatoprotective effects. GSH, particularly in its liposomal form, enhanced immune responses by modulating cytokine levels and reducing oxidative stress. Most adverse effects reported were mild and manageable, indicating a favourable safety profile for both agents.GSH and NAC show promise as adjunctive therapies in TB management, demonstrating improvements in lung function, sputum conversion, and hepatoprotection while also enhancing immune responses..

To evaluate currently recommended dosage using the population pharmacokinetics (PK) of bedaquiline (BDQ), clofazimine, cycloserine, linezolid (LZD) and moxifloxacin (MFX) in patients with multidrug-resistant TB (MDR-TB) and type II diabetes mellitus (DM).A prospective multi-centre PK study was conducted in China between 2016 and 2019. Population PK models were developed using nonlinear mixed-effect analyses based on the blood samples collected by rich sampling. The probability of target attainment (PTA) analysis was estimated using the Monte Carlo simulation.A total of 1,450 plasma samples were collected from 58 participants with DM. Simulations showed that the WHO-recommended regimens of LZD (600 mg daily) and MFX (400 mg daily) achieved > 90% PTA for M. tuberculosis isolates with MICs below 0.50 and 0.25 mg/L, respectively. The currently recommended BDQ regimen (400 mg daily for 2 weeks, followed by 200 mg thrice weekly) might fail to achieve >90% PTA at an MIC of 0.06 mg/L or higher.The population PK models for the five second-line drugs were established in Chinese patients with MDR-TB and DM. The model-based dosage evaluation showed that dosing adjustments may be necessary for isolates with borderline resistance levels..

Post-infectious bronchiolitis obliterans (PIBO) is a complication of severe childhood respiratory infection resulting in small airway injury, bronchiectasis, and prolonged respiratory consequences. Risk factors for PIBO and PIBO-associated bronchiectasis are unclear.This retrospective study identified all children with PIBO at a South African tertiary hospital between 1 January 2016 and 31 December 2022. The clinical characteristics, chest CT findings, and details of prior hospitalisation for respiratory infection were collected, and the characteristics of those with and without bronchiectasis were compared.A total of 59 children were included (median age at primary lung insult: 10 months, IQR 6-17; median age at PIBO diagnosis: 16 months, IQR 11-28). Twenty-three had comorbidities, most frequently premature birth (30.5%) and HIV infection (6.8%). The most common pathogen was adenovirus (n = 41; 69.5%). At initial lung insult, 19 (32.2%) required mechanical ventilation. Mosaic attenuation on the chest CT was present in all. Thirty-three (55.9%) had bronchiectasis. The clinical characteristics, ventilation, causative pathogen, and comorbidity were similar in those with and without bronchiectasis.Bronchiectasis occurs frequently in paediatric PIBO and is present within months of initial respiratory insult with no identified risk factors. Premature birth is common and may contribute to PIBO development..