International Journal of Tuberculosis and Lung Disease最新文献

Mortality and causes of death in non-tuberculous mycobacterial pulmonary disease (NTM-PD) are not well-described over long follow-up periods, particularly in Europe. We investigated whether NTM-PD is associated with higher mortality rates and different causes of death than matched controls.Danish national registers were used to identify patients with NTM-PD from 2000-2017 and to match them 1:4 with controls based on age, sex, cohabitation status, and municipality.We identified 661 patients with NTM-PD (50.4% male, median age 66 years, interquartile range [IQR] 48-84). The 5-year mortality rate for NTM-PD was 51% (95% CI 47-55) compared to 15% (95% CI 14-17) for controls. The hazard ratio (HR) of death for NTM-PD was 3.1 (95% CI 2.7-3.5; P < 0.001) compared to controls, persisting after adjusting for Charlson Comorbidity Index with an adjusted HR of 1.9 (95% CI 1.63-2.22; P < 0.001). Median age at death was 72 years (IQR 58-86) for NTM-PD patients and 81 years (IQR 69-93) for controls. Deaths due to respiratory diseases were more frequent in NTM-PD patients (45.2%) than in controls (11.6%). Mycobacterial infection directly caused death in 5.8% of NTM-PD patients.NTM-PD is associated with significantly higher all-cause mortality than controls, particularly in the initial years following diagnosis. These findings highlight the need for increased attention to NTM-PD and related respiratory conditions..

Cluster randomised trials (CRTs) of TB interventions have achieved mixed results, with many lacking significant reductions in outcomes. Contamination in CRTs, resulting from short and long-term movement between clusters and the general population, may dilute the impact of measured intervention.We systematically reviewed the literature to identify CRTs that aimed to capture the population-level effects of the intervention on TB. Details of trial designs, interventions, outcomes, populations, cluster configurations, and geographic data were extracted to produce text summaries, descriptive statistics, and spatial analyses.We screened 1,039 abstracts and included 20 reports from seven CRTs. The median number of clusters was 32 (IQR 23-61), with populations ranging from 400-50,000 individuals per cluster. Four trials reported spatial data, from which the mean distance between clusters was 12.3 km (range 3.71-35.9). Several trials acknowledged design limitations, such as small cluster sizes and population mobility, which could have led to underestimations of intervention impact. Trials used various geographic, social, and pre-existing TB measures to select and allocate study clusters. Data on the potential for contamination are inconsistent.Gaps remain in the reporting of methods and results, suggesting necessary improvements to standardised reporting tools. These insights can inform recommendations for improved CRT design and reporting practices..

We describe our approach and experience with the routine implementation of stool-based Xpert MTB/RIF Ultra (Xpert) testing for the diagnosis of childhood TB in Zambia.We conducted a method validation and subsequently introduced stool as an alternative sample for routine Xpert testing for children and critically ill adults. We reviewed the impact of stool-based Xpert testing during the first 18 months of routine implementation.The method validation showed 98.0% (95% CI 92.9-99.4) agreement between Xpert results on sputum/gastric aspirate (GA) and stool specimens. During 18 months of routine implementation, 16,210 stool samples were tested, yielding 157 TB cases in children, including five rifampicin (RIF) resistant cases, and 45 cases in critically ill adults. In children aged 0-4 years, 10,288 stool samples were tested compared to 2,459 GA samples in the same period. Childhood TB notifications and the bacteriological confirmation rate increased by 30% and 53%, respectively, in 2021 compared to 2020.The routine implementation of stool testing provided access to Xpert testing for children who could not produce sputum or have GA collected, contributing to increased bacteriological confirmation of TB in children. For critically ill adults with difficulty expectorating sputum, it facilitated a rapid test result..

The WHO recommends shorter TB preventive treatment (TPT) regimens and decentralised delivery models to improve effectiveness. This study evaluated the safety of a 3-month rifampicin-isoniazid (3RH) regimen administered by community health workers (CHWs) in households in Cameroon and Uganda.A cluster-randomised trial was conducted among child contacts of TB patients. We compared the safety of 3RH delivered by CHWs at home (intervention) vs standard-of-care, facility-based administration of 3RH. Safety outcomes included adverse events (AEs), serious adverse events (SAEs), and adverse reactions (ARs). We described the steps from symptom identification by CHWs to classification by a clinician.Of 1,316 children initiated on 3RH, AEs were reported in 8.7% (81/936) in the intervention arm versus 11.3% (43/380) in the standard-of-care arm, P = 0.15. Overall, 37 SAEs occurred in 36 children, all non-medication related. There were 16 ARs reported, occurring in 1.0% (9/936) of children in the intervention arm and 1.6% (6/380) in the standard-of-care arm, P = 0.22. During 4,608 follow-up visits, 21 children reporting AR symptoms were identified by CHWs, 16 were assessed by clinicians, and 4 ARs were confirmed.The 3RH regimen was safe, including when administered by trained CHWs in community settings, supporting its use in decentralised healthcare models..

Low body mass index (BMI) is a globally important risk factor for TB progression. Little is known about this association in people living with HIV (PLHIV) and the functional form of the BMI-TB incidence curve.Secondary analysis of a randomised controlled trial of TB preventive therapy among PLHIV in South Africa, Mozambique, and Ethiopia. Participants received 3 months of weekly high-dose rifapentine-isoniazid given once or twice over a period of 2 years. Multivariable fractional polynomials (MFPs) were used to investigate functional forms of BMI. Time to incident TB was modelled using Cox's proportional hazard regression.A total of 76 TB events were documented, giving an overall TB incidence rate of 1.2 per 100 person-years (95%CI 1.0-1.6). Baseline BMI <18.5 kg/m² was associated with a 2.6-fold increased hazard of TB compared with BMI 18.5-24.9 kg/m² (aHR 2.6, 95% CI 1.4-4.8, P < 0.001). BMI ≥30 kg/m² was associated with a lower hazard of TB (aHR 0.5, 95% CI 0.2-1.0). Continuous and categorical BMI showed weak evidence of quadratic dose-response relationships (P = 0.08 and P = 0.09, respectively). MFP analysis was consistent with a decline in TB incidence for increasing BMI to around 25 kg/m², followed by a less steep decline in TB incidence for increasing BMI >25 kg/m².In PLHIV, BMI showed an inverse log-linear association with TB incidence. The MFP approach showed that the relationship is more complex than a simple log-linear association..

To use molecular techniques to assess the prevalence of M. bovis and M. tuberculosis in tuberculin-positive dairy cattle and to identify the risk factors for TB in these animals.A cross-sectional study was conducted from 2018 to 2020 across Mymensingh, Sirajgonj and Dhaka Districts in Bangladesh. The single intradermal comparative cervical tuberculin test was administered to 1,580 cattle suspected of having bovine TB using both avian and bovine purified protein derivative. Milk and lung tissue samples from positive animals were examined using polymerase chain reaction (PCR) to detect the causative agents of TB. Multivariable logistic regression model identified risk factors, and Sanger's dideoxy sequencing method was used for the phylogenetic analysis of PCR amplicons.Simplex PCR identified Mycobacterium tuberculosis complex in 12.6% of samples. Multiplex PCR detected M. bovis in 6.3% and M. tuberculosis in 3.1% of the samples. Phylogenetic analysis of 12 IS6110 gene sequences (8 M. bovis, 4 M. tuberculosis) confirmed alignment with human isolates from Bangladesh.The study suggests potential reverse zoonotic transmission of M. tuberculosis. Further research is needed to understand the implications and assess TB transmission between humans and cattle in Bangladesh. The findings highlight the need for a comprehensive One Health approach..