Pub Date : 2025-05-01Epub Date: 2025-01-31DOI: 10.1016/j.jctube.2025.100514
Takuya Akutsu , Kazuya Tone , Airi Hasegawa , Takaaki Kitayama , Shunsuke Inaki , Mina Gochi , Masamichi Takagi , Jun Araya
Background
The addition of aminoglycosides to a macrolide-based regimen is recommended for refractory Mycobacterium avium complex pulmonary disease (MAC-PD). For intravenous amikacin (AMK) administration three times a week, the ATS/ERS/ESCMID/IDSA guidelines recommend targeting a peak serum concentration of 65–80 µg/mL. However, the feasibility of achieving the guideline-recommended AMK concentration remains unclear.
Methods
From 2018 to 2022, we retrospectively analyzed patients with refractory MAC-PD treated with AMK thrice weekly for ≥3 months combined with an oral regimen of ≥2 drugs, including macrolides. The peak serum concentration and therapeutic effects of AMK were evaluated.
Results
The median age of the 9 patients was 70 years (range: 50–79 years; 2 men and 7 women). The causative organism was M. avium in all cases. All cases demonstrated susceptibility to AMK, which was administered at a median dose of 700 mg/day (15.8 mg/kg/day) for a median duration of 6 months. One patient experienced hearing loss, which led to AMK discontinuation at 4 months. The median AMK peak concentration was 47.1 μg/mL, with a tendency to be higher in the clinical efficacy group compared to the nonefficacy group. None of patient, except one, achieved the target AMK peak concentration.
Conclusions
In this preliminary study, the guideline-recommended AMK concentration for MAC-PD was not achieved in the majority of patients. Due to the small sample size and retrospective design, robust conclusions regarding the association between AMK concentrations and clinical outcomes could not be drawn. Prospective randomized controlled trials are required to better define the optimal AMK concentration for efficacy and safety.
{"title":"Challenges in achieving the guideline-recommended amikacin level for Mycobacterium avium complex pulmonary disease","authors":"Takuya Akutsu , Kazuya Tone , Airi Hasegawa , Takaaki Kitayama , Shunsuke Inaki , Mina Gochi , Masamichi Takagi , Jun Araya","doi":"10.1016/j.jctube.2025.100514","DOIUrl":"10.1016/j.jctube.2025.100514","url":null,"abstract":"<div><h3>Background</h3><div>The addition of aminoglycosides to a macrolide-based regimen is recommended for refractory <em>Mycobacterium avium</em> complex pulmonary disease (MAC-PD). For intravenous amikacin (AMK) administration three times a week, the ATS/ERS/ESCMID/IDSA guidelines recommend targeting a peak serum concentration of 65–80 µg/mL. However, the feasibility of achieving the guideline-recommended AMK concentration remains unclear.</div></div><div><h3>Methods</h3><div>From 2018 to 2022, we retrospectively analyzed patients with refractory MAC-PD treated with AMK thrice weekly for ≥3 months combined with an oral regimen of ≥2 drugs, including macrolides. The peak serum concentration and therapeutic effects of AMK were evaluated.</div></div><div><h3>Results</h3><div>The median age of the 9 patients was 70 years (range: 50–79 years; 2 men and 7 women). The causative organism was <em>M. avium</em> in all cases. All cases demonstrated susceptibility to AMK, which was administered at a median dose of 700 mg/day (15.8 mg/kg/day) for a median duration of 6 months. One patient experienced hearing loss, which led to AMK discontinuation at 4 months. The median AMK peak concentration was 47.1 μg/mL, with a tendency to be higher in the clinical efficacy group compared to the nonefficacy group. None of patient, except one, achieved the target AMK peak concentration.</div></div><div><h3>Conclusions</h3><div>In this preliminary study, the guideline-recommended AMK concentration for MAC-PD was not achieved in the majority of patients. Due to the small sample size and retrospective design, robust conclusions regarding the association between AMK concentrations and clinical outcomes could not be drawn. Prospective randomized controlled trials are required to better define the optimal AMK concentration for efficacy and safety.</div></div><div><h3>Trial registration</h3><div>Not applicable.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100514"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-03-27DOI: 10.1016/j.jctube.2025.100521
Rattanaporn Mahatanan , Maria Alkozah , Devin Lee , Anais A. Ovalle , Natalie B.V. Riblet , Elizabeth A. Talbot
Background
Implantable cardiac device-related (ICDR) nontuberculous mycobacteria (NTM) infections are increasingly reported in the literature, but guidelines for optimal management are lacking.
Methods
We searched Medline, Embase, and Scopus from inception to 1/20/2022 for cases of ICDR NTM infection. Cardiac devices include but are not limited to prosthetic valves, cardiovascular implantable device (CIED), and left ventricular-assist devices (LVAD). We categorized outcomes as death, failure, relapse, cure, and treatment complete.
Main results
A total of 81 articles met our inclusion criteria, representing 122 patients. Eleven different NTM species were reported, with rapidly growing mycobacteria (RGM) including M. fortuitum, M. chelonae, and M. abscessus comprising approximately 60 % of the identified organisms. Prosthetic heart valves (N = 61; 50 %) and CIED (N = 46; 38 %) were the most frequently associated cardiac devices. Favorable outcomes, defined as treatment complete and cure, were significantly associated with device removal after adjusting for age, gender, and device type (aOR 3.45, 95 %CI 1.30–9.14).
Conclusion
We found that patients who underwent device removal had better outcomes than those with retained devices. Device removal should be strongly considered when possible.
背景植入式心脏装置相关（ICDR）非结核分枝杆菌（NTM）感染在文献中越来越多地报道，但缺乏最佳管理指南。方法检索Medline、Embase和Scopus自成立以来至2022年1月20日的ICDR NTM感染病例。心脏装置包括但不限于人工瓣膜、心血管植入式装置（CIED）和左心室辅助装置（LVAD）。我们将结果分类为死亡、失败、复发、治愈和治疗完成。主要结果共有81篇文章符合我们的纳入标准，代表122例患者。报告了11种不同的NTM物种，其中快速生长的分枝杆菌（RGM）包括M. fortuitum， M. chelonae和M.脓肿，约占鉴定生物的60%。人工心脏瓣膜(N = 61；50%)和CIED (N = 46；38%)是最常见的相关心脏装置。在调整了年龄、性别和装置类型后，良好的结果（定义为治疗完成和治愈）与装置移除显著相关（aOR 3.45, 95% CI 1.30-9.14）。结论：我们发现取出装置的患者比保留装置的患者预后更好。在可能的情况下，应该强烈考虑移除设备。
{"title":"Matters of the heart: A scoping review toward better management of nontuberculous mycobacterial infections of cardiac devices","authors":"Rattanaporn Mahatanan , Maria Alkozah , Devin Lee , Anais A. Ovalle , Natalie B.V. Riblet , Elizabeth A. Talbot","doi":"10.1016/j.jctube.2025.100521","DOIUrl":"10.1016/j.jctube.2025.100521","url":null,"abstract":"<div><h3>Background</h3><div>Implantable cardiac device-related (ICDR) nontuberculous mycobacteria (NTM) infections are increasingly reported in the literature, but guidelines for optimal management are lacking.</div></div><div><h3>Methods</h3><div>We searched Medline, Embase, and Scopus from inception to 1/20/2022 for cases of ICDR NTM infection. Cardiac devices include but are not limited to prosthetic valves, cardiovascular implantable device (CIED), and left ventricular-assist devices (LVAD). We categorized outcomes as death, failure, relapse, cure, and treatment complete.</div></div><div><h3>Main results</h3><div>A total of 81 articles met our inclusion criteria, representing 122 patients. Eleven different NTM species were reported, with rapidly growing mycobacteria (RGM) including <em>M. fortuitum, M. chelonae,</em> and <em>M. abscessus</em> comprising approximately 60 % of the identified organisms. Prosthetic heart valves (N = 61; 50 %) and CIED (N = 46; 38 %) were the most frequently associated cardiac devices. Favorable outcomes, defined as treatment complete and cure, were significantly associated with device removal after adjusting for age, gender, and device type (aOR 3.45, 95 %CI 1.30–9.14).</div></div><div><h3>Conclusion</h3><div>We found that patients who underwent device removal had better outcomes than those with retained devices. Device removal should be strongly considered when possible.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100521"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-03-19DOI: 10.1016/j.jctube.2025.100519
Ghassan Ilaiwy , Jessica Keim-Malpass , Romella Tuppal , Alexander F. Ritua , Flordeliza R. Bassiag , Tania A. Thomas
Background
Children aged 5–14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis evaluating the expansion of TB infection (TBI) testing and treatment among pediatric (5–14 years) HHCs of index PWTB in the Philippines to assist the National TB program in choosing the most cost-effective testing and treatment strategy for TBI among HHCs of index PWTB.
Methods
Using a Markov state transition model, eligible HHCs age 5–14 years are screened for TBI with either the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Those who test positive are then simulated to receive one of the following TPT strategies: 6 months of daily isoniazid (6H), 3 months of weekly isoniazid and rifapentine (3HP), 3 months of daily isoniazid plus rifampicin (3HR) and the current practice of no testing or treatment for TBI (NTT). The analysis assesses the projected cost and quality-adjusted life years (QALY) gained for every strategy from the perspective of the Philippines public healthcare system over a time horizon of 20 years. The total cost and gain in QALYs are presented as an incremental cost-effectiveness ratio (ICER) comparing cost per QALY gained for each strategy over NTT.
Results
Our model estimates that expanding TPT coverage to HHCs aged 5–14 years would be cost-effective with incremental cost-effectiveness ratios (ICERs) ranging from 1,024 $/QALY gained when using TST and 6H (Uncertainty range: 497–––2,334) to 2,293 $/QALY gained when IGRA and 3HR are used (Uncertainty range: 1,140 – 5,203). These findings were robust to sensitivity analyses over a wide range of parameter values.
Conclusion
Expanding TPT coverage to HHCs aged 5–14 years is cost-effective when using TST and 6H closely followed by a strategy combining TST and 3HP.
{"title":"Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines","authors":"Ghassan Ilaiwy , Jessica Keim-Malpass , Romella Tuppal , Alexander F. Ritua , Flordeliza R. Bassiag , Tania A. Thomas","doi":"10.1016/j.jctube.2025.100519","DOIUrl":"10.1016/j.jctube.2025.100519","url":null,"abstract":"<div><h3>Background</h3><div>Children aged 5–14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis evaluating the expansion of TB infection (TBI) testing and treatment among pediatric (5–14 years) HHCs of index PWTB in the Philippines to assist the National TB program in choosing the most cost-effective testing and treatment strategy for TBI among HHCs of index PWTB.</div></div><div><h3>Methods</h3><div>Using a Markov state transition model, eligible HHCs age 5–14 years are screened for TBI with either the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Those who test positive are then simulated to receive one of the following TPT strategies: 6 months of daily isoniazid (6H), 3 months of weekly isoniazid and rifapentine (3HP), 3 months of daily isoniazid plus rifampicin (3HR) and the current practice of no testing or treatment for TBI (NTT). The analysis assesses the projected cost and quality-adjusted life years (QALY) gained for every strategy from the perspective of the Philippines public healthcare system over a time horizon of 20 years. The total cost and gain in QALYs are presented as an incremental cost-effectiveness ratio (ICER) comparing cost per QALY gained for each strategy over NTT.</div></div><div><h3>Results</h3><div>Our model estimates that expanding TPT coverage to HHCs aged 5–14 years would be cost-effective with incremental cost-effectiveness ratios (ICERs) ranging from 1,024 $/QALY gained when using TST and 6H (Uncertainty range: 497–––2,334) to 2,293 $/QALY gained when IGRA and 3HR are used (Uncertainty range: 1,140 – 5,203). These findings were robust to sensitivity analyses over a wide range of parameter values.</div></div><div><h3>Conclusion</h3><div>Expanding TPT coverage to HHCs aged 5–14 years is cost-effective when using TST and 6H closely followed by a strategy combining TST and 3HP.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100519"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-03-14DOI: 10.1016/j.jctube.2025.100518
Valeriu Crudu , Dumitru Chesov , Alexandru Codreanu , Nadejda Turcanu , Nelly Ciobanu , Liuba Nepoliuc , Doina Rusu
Introduction
Tuberculosis infection (TBI) is diagnosed based on a positive immune response to M. tuberculosis antigens. This study aimed to evaluate both the qualitative and quantitative performance of two novel IGRA-based tests, the STANDARD E TB-Feron ELISA (TB-Feron-ELISA) and the STANDARD F TB-Feron FIA (IFN-γ) (TB-Feron-FIA), and compare their results to those of QuantiFERON-TB Gold Plus (QuantiFERON).
Methods
At Chiril Draganiuc Phthisiopneumology Institute in the Republic of Moldova, we prospectively enrolled three cohorts of adults: healthy individuals with no known close contact with TB, patients with active tuberculosis (TB), and individuals with a history of TB. The active TB and past TB cohorts were used to assess the tests’ sensitivity, while the healthy group was used to evaluate specificity. Both qualitative and quantitative results from the TB-Feron ELISA and TB-Feron FIA were compared with those of QuantiFERON.
Results
The TB-Feron-FIA demonstrated a sensitivity of 80.58 % (95 %CI: 71.90–87.06) in the active TB cohort and 82.93 % (95 %CI: 68.74–91.47) in the past TB cohort, with a specificity of 85.19 % (95 % CI: 73.40–92.30). The TB-Feron-ELISA showed a sensitivity of 80.58 % (95 %CI: 71.90–87.06) in the active TB cohort and 78.57 % (95 %CI: 64.06–88.29) in the past TB cohort, with a specificity of 85.19 % (95 %CI: 73.40–92.30). The agreement coefficient (κ) with QuantiFERON was 0.766 (95 %CI: 0.689–0.843) for TB-Feron-FIA and 0.809 (95 %CI: 0.739–0.880) for TB-Feron-ELISA.
Conclusions
Both the TB-Feron-ELISA and TB-Feron-FIA demonstrated good diagnostic accuracy for identifying individuals with TBI, comparable to the performance of QuantiFERON.
{"title":"Diagnostic accuracy study of STANDARD TB-Feron FIA and STANDARD TB-Feron ELISA tests for tuberculosis infection diagnosis in Eastern European setting","authors":"Valeriu Crudu , Dumitru Chesov , Alexandru Codreanu , Nadejda Turcanu , Nelly Ciobanu , Liuba Nepoliuc , Doina Rusu","doi":"10.1016/j.jctube.2025.100518","DOIUrl":"10.1016/j.jctube.2025.100518","url":null,"abstract":"<div><h3>Introduction</h3><div>Tuberculosis infection (TBI) is diagnosed based on a positive immune response to <em>M. tuberculosis</em> antigens. This study aimed to evaluate both the qualitative and quantitative performance of two novel IGRA-based tests, the STANDARD E TB-Feron ELISA (TB-Feron-ELISA) and the STANDARD F TB-Feron FIA (IFN-γ) (TB-Feron-FIA), and compare their results to those of QuantiFERON-TB Gold Plus (QuantiFERON).</div></div><div><h3>Methods</h3><div>At Chiril Draganiuc Phthisiopneumology Institute in the Republic of Moldova, we prospectively enrolled three cohorts of adults: healthy individuals with no known close contact with TB, patients with active tuberculosis (TB), and individuals with a history of TB. The active TB and past TB cohorts were used to assess the tests’ sensitivity, while the healthy group was used to evaluate specificity. Both qualitative and quantitative results from the TB-Feron ELISA and TB-Feron FIA were compared with those of QuantiFERON.</div></div><div><h3>Results</h3><div>The TB-Feron-FIA demonstrated a sensitivity of 80.58 % (95 %CI: 71.90–87.06) in the active TB cohort and 82.93 % (95 %CI: 68.74–91.47) in the past TB cohort, with a specificity of 85.19 % (95 % CI: 73.40–92.30). The TB-Feron-ELISA showed a sensitivity of 80.58 % (95 %CI: 71.90–87.06) in the active TB cohort and 78.57 % (95 %CI: 64.06–88.29) in the past TB cohort, with a specificity of 85.19 % (95 %CI: 73.40–92.30). The agreement coefficient (κ) with QuantiFERON was 0.766 (95 %CI: 0.689–0.843) for TB-Feron-FIA and 0.809 (95 %CI: 0.739–0.880) for TB-Feron-ELISA.</div></div><div><h3>Conclusions</h3><div>Both the TB-Feron-ELISA and TB-Feron-FIA demonstrated good diagnostic accuracy for identifying individuals with TBI, comparable to the performance of QuantiFERON.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100518"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-03-26DOI: 10.1016/j.jctube.2025.100522
Fatemeh Estaji , Ali Kamali , Masoud Keikha
{"title":"Strengthening the global Response to Tuberculosis: Insights from the 2024 WHO global TB report","authors":"Fatemeh Estaji , Ali Kamali , Masoud Keikha","doi":"10.1016/j.jctube.2025.100522","DOIUrl":"10.1016/j.jctube.2025.100522","url":null,"abstract":"","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100522"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-01DOI: 10.1016/j.jctube.2025.100523
Joseph Baruch Baluku , Diana Karungi , Brenda Namanda , Sharon Namiiro , Shamim Katusabe , Angut Mary Madalen , Martin Nabwana , Ronald Olum , Felix Bongomin , Edwin Nuwagira , Grace Kansiime , Christian Kraef , Megan Shaughnessy , Joshua Rhein , David Meya
Background
Cardiovascular disease (CVD) is the leading cause of mortality among people with HIV (PWH), but the influence of co-infections like tuberculosis (TB) on CVD risk remains underexplored. We aimed to compare cardiometabolic profiles of PWH with and without prior TB to determine if prior TB is associated with distinct cardiometabolic profiles.
Methods
We conducted a comparative, cross-sectional study at a tertiary hospital in Kampala, Uganda. Participants were randomly sampled PWH aged ≥ 18 years on antiretroviral therapy. Specifically, we enrolled PWH with and without prior active TB (ratio of 1:1). Anthropometric measurements, blood pressure, fasting blood glucose (FBG), lipid profile, and glycated hemoglobin were assessed.
Results
A total of 396 participants were enrolled (196 TB survivors and 200 controls). TB survivors had higher median FBG (5.5 vs. 5.1 mmol/l, p < 0.001) and a higher prevalence of DM (17.9 % vs. 9.5 %, p = 0.015). However, they had lower body mass index (23.0 vs. 25.1 kg/m2, p < 0.001) and waist circumference (81.0 vs. 84.0 cm, p = 0.026). TB survivors had higher HDL-c levels (1.0 vs. 0.8 mmol/l, p < 0.001), lower LDL-c levels (2.7 vs. 3.1 mmol/l, p < 0.001) and lower prevalence of dyslipidemia (81.7 % vs. 96.5 %, p < 0.001). Prior TB was independently associated with higher prevalence of elevated FBG (adjusted prevalence ratio (aPR) 1.79, 95 % CI 1.10–2.92) and DM (aPR 2.34, 95 % CI 1.11–4.94), but decreased risk of obesity (aPR 0.42, 95 % CI 0.20–0.88).
Conclusion
TB survivors with HIV exhibit a higher risk of DM but lower risk of obesity compared to those without a history of TB, indicating a need for blood glucose monitoring among TB survivors.
背景：心血管疾病（CVD）是HIV感染者（PWH）死亡的主要原因，但结核病（TB）等合并感染对CVD风险的影响仍未得到充分探讨。我们的目的是比较有和没有结核病病史的PWH的心脏代谢谱，以确定结核病病史是否与不同的心脏代谢谱相关。方法我们在乌干达坎帕拉的一家三级医院进行了一项比较的横断面研究。参与者随机抽取年龄≥18岁且接受抗逆转录病毒治疗的PWH。具体来说，我们纳入了有和没有先前活动性结核病的PWH（比例为1:1）。测量人体测量、血压、空腹血糖（FBG）、血脂和糖化血红蛋白。结果共纳入396名参与者（196名结核病幸存者和200名对照组）。结核病幸存者的中位空腹血糖较高(5.5 vs. 5.1 mmol/l, p <；0.001)和更高的糖尿病患病率（17.9%比9.5%,p = 0.015）。然而，他们的身体质量指数较低(23.0比25.1 kg/m2, p <；0.001)和腰围（81.0比84.0 cm, p = 0.026）。结核病幸存者的HDL-c水平较高(1.0 vs 0.8 mmol/l, p <；0.001)，较低的LDL-c水平(2.7 vs. 3.1 mmol/l, p <；0.001)和较低的血脂异常患病率(81.7%对96.5%,p <；0.001)。既往结核病与较高的FBG患病率（调整患病率比（aPR） 1.79, 95% CI 1.10-2.92）和DM （aPR 2.34, 95% CI 1.11-4.94）独立相关，但降低肥胖风险（aPR 0.42, 95% CI 0.20-0.88）。结论：与没有结核病史的结核病幸存者相比，感染艾滋病毒的结核病幸存者患糖尿病的风险更高，但肥胖的风险较低，这表明需要对结核病幸存者进行血糖监测。
{"title":"Association of prior tuberculosis with altered cardiometabolic profiles of people with HIV: A comparative cross-sectional study in Uganda","authors":"Joseph Baruch Baluku , Diana Karungi , Brenda Namanda , Sharon Namiiro , Shamim Katusabe , Angut Mary Madalen , Martin Nabwana , Ronald Olum , Felix Bongomin , Edwin Nuwagira , Grace Kansiime , Christian Kraef , Megan Shaughnessy , Joshua Rhein , David Meya","doi":"10.1016/j.jctube.2025.100523","DOIUrl":"10.1016/j.jctube.2025.100523","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading cause of mortality among people with HIV (PWH), but the influence of co-infections like tuberculosis (TB) on CVD risk remains underexplored. We aimed to compare cardiometabolic profiles of PWH with and without prior TB to determine if prior TB is associated with distinct cardiometabolic profiles.</div></div><div><h3>Methods</h3><div>We conducted a comparative, cross-sectional study at a tertiary hospital in Kampala, Uganda. Participants were randomly sampled PWH aged ≥ 18 years on antiretroviral therapy. Specifically, we enrolled PWH with and without prior active TB (ratio of 1:1). Anthropometric measurements, blood pressure, fasting blood glucose (FBG), lipid profile, and glycated hemoglobin were assessed.</div></div><div><h3>Results</h3><div>A total of 396 participants were enrolled (196 TB survivors and 200 controls). TB survivors had higher median FBG (5.5 vs. 5.1 mmol/l, p < 0.001) and a higher prevalence of DM (17.9 % vs. 9.5 %, p = 0.015). However, they had lower body mass index (23.0 vs. 25.1 kg/m<sup>2</sup>, p < 0.001) and waist circumference (81.0 vs. 84.0 cm, p = 0.026). TB survivors had higher HDL-c levels (1.0 vs. 0.8 mmol/l, p < 0.001), lower LDL-c levels (2.7 vs. 3.1 mmol/l, p < 0.001) and lower prevalence of dyslipidemia (81.7 % vs. 96.5 %, p < 0.001). Prior TB was independently associated with higher prevalence of elevated FBG (adjusted prevalence ratio (aPR) 1.79, 95 % CI 1.10–2.92) and DM (aPR 2.34, 95 % CI 1.11–4.94), but decreased risk of obesity (aPR 0.42, 95 % CI 0.20–0.88).</div></div><div><h3>Conclusion</h3><div>TB survivors with HIV exhibit a higher risk of DM but lower risk of obesity compared to those without a history of TB, indicating a need for blood glucose monitoring among TB survivors.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100523"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-18DOI: 10.1016/j.jctube.2025.100527
Jay Phansalkar , Rajas Karajgikar , Jai Patel , Shauna Williams , Lisa Gittens-Williams , Alfred A. Lardizabal
Treating latent tuberculosis infection (LTBI) is a core intervention in reducing the burden of tuberculosis. Treatment for LTBI is challenging due to the many steps in the process, collectively termed the cascade of care. In pregnant patients with LTBI, these challenges are heightened due to the medical and social intricacies introduced by pregnancy. In this study, we evaluate the effectiveness of a screening intervention for LTBI in the prenatal clinic of an inner-city hospital in the United States, and analyze the cascade of care to identify areas for improvement. Of the n = 99 patients who had a positive QuantiFERON Gold Test (QFN), 96.7 % had a chest x-ray (CXR) ordered by their provider, 95.6 % completed the CXR, 82.8 % were referred to the TB clinic, 44.4 % scheduled an appointment with the TB clinic, 23.2 % attended an appointment at the TB clinic, 21.2 % started medical treatment of LTBI, and 17.2 % completed LTBI treatment. Together this data shows that majority of patients in the prenatal clinic with a positive QFN do not complete LTBI treatment. Most patients are lost during the steps that transition them from obstetric care to the care of the TB clinic. Improving the cascade of care for LTBI will require increased education of patients on the importance of treating LTBI, and improving the process that transitions patients from obstetric care to the care of the TB clinic.
{"title":"Cascade of care for the diagnosis and treatment of latent tuberculosis infection in an inner-city hospital prenatal clinic","authors":"Jay Phansalkar , Rajas Karajgikar , Jai Patel , Shauna Williams , Lisa Gittens-Williams , Alfred A. Lardizabal","doi":"10.1016/j.jctube.2025.100527","DOIUrl":"10.1016/j.jctube.2025.100527","url":null,"abstract":"<div><div>Treating latent tuberculosis infection (LTBI) is a core intervention in reducing the burden of tuberculosis. Treatment for LTBI is challenging due to the many steps in the process, collectively termed the cascade of care. In pregnant patients with LTBI, these challenges are heightened due to the medical and social intricacies introduced by pregnancy. In this study, we evaluate the effectiveness of a screening intervention for LTBI in the prenatal clinic of an inner-city hospital in the United States, and analyze the cascade of care to identify areas for improvement. Of the n = 99 patients who had a positive QuantiFERON Gold Test (QFN), 96.7 % had a chest x-ray (CXR) ordered by their provider, 95.6 % completed the CXR, 82.8 % were referred to the TB clinic, 44.4 % scheduled an appointment with the TB clinic, 23.2 % attended an appointment at the TB clinic, 21.2 % started medical treatment of LTBI, and 17.2 % completed LTBI treatment. Together this data shows that majority of patients in the prenatal clinic with a positive QFN do not complete LTBI treatment. Most patients are lost during the steps that transition them from obstetric care to the care of the TB clinic. Improving the cascade of care for LTBI will require increased education of patients on the importance of treating LTBI, and improving the process that transitions patients from obstetric care to the care of the TB clinic.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100527"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Xpert MTB/XDR assay has been approved by World Health Organization (WHO) as a reflex test on sputum samples after testing for rifampicin resistance. Recently, the Union Health Ministry of India in September 2024 approved the introduction of the six-month BPaLM regimen under its National TB Elimination Program (NTEP). In this study, the Xpert MTB/XDR assay was used to detect extensive drug resistance in pulmonary and extra-pulmonary tuberculosis patients with positive result for MTBC, and RIF resistance by the Xpert MTB/RIF ULTRA assay. We also aimed to assess the eligibility of patients for the BPaLM regimen based on the drug susceptibility profile of this test in a high burden Indian setting.
We conducted a single centre prospective cohort study between January 2023 to August 2024 on 42 old, and 68 new patients presenting with MDR/RR tuberculosis. A total of 110 samples (82 pulmonary and 28 extra pulmonary samples) were included in the study. The Xpert MTB/XDR assay was used to determine the susceptibilities to isoniazid, fluoroquinolones, amikacin, kanamycin, capreomycin, and ethionamide.
Out of 110 samples processed, 13 samples were ‘not detected’ by the assay while three gave invalid results. Resistance to isoniazid, fluoroquinolones, amikacin, kanamycin, capreomycin and ethionamide was detected in 85/94 cases (90·42%), 74/94 cases (78·72%), 08/94 cases (8·5%), 13/94 cases (13·83%), 08/94 cases (8·5%), and 14/94 cases (14·89%) respectively.
With the updated definitions of drug-resistant TB and high burden of fluoroquinolone resistance the Xpert MTB/XDR assay has a limited application in India.
Detection of extensive drug resistance by the Xpert MTB/XDR assay in multidrug resistant tuberculosis cases at a tertiary care centre in northern India, and therapeutic decision making for the six-month BPaLM regimen.
{"title":"Detection of extensive drug resistance by the Xpert MTB/XDR assay in multidrug resistant tuberculosis cases at a tertiary care centre in northern India, and therapeutic decision making for the six-month BPaLM regimen","authors":"Richa Misra , Parijat Das , Alok Nath , Zafar Neyaz","doi":"10.1016/j.jctube.2025.100520","DOIUrl":"10.1016/j.jctube.2025.100520","url":null,"abstract":"<div><div>The Xpert MTB/XDR assay has been approved by World Health Organization (WHO) as a reflex test on sputum samples after testing for rifampicin resistance. Recently, the Union Health Ministry of India in September 2024 approved the introduction of the six-month BPaLM regimen under its National TB Elimination Program (NTEP). In this study, the Xpert MTB/XDR assay was used to detect extensive drug resistance in pulmonary and extra-pulmonary tuberculosis patients with positive result for MTBC, and RIF resistance by the Xpert MTB/RIF ULTRA assay. We also aimed to assess the eligibility of patients for the BPaLM regimen based on the drug susceptibility profile of this test in a high burden Indian setting.</div><div>We conducted a single centre prospective cohort study between January 2023 to August 2024 on 42 old, and 68 new patients presenting with MDR/RR tuberculosis. A total of 110 samples (82 pulmonary and 28 extra pulmonary samples) were included in the study. The Xpert MTB/XDR assay was used to determine the susceptibilities to isoniazid, fluoroquinolones, amikacin, kanamycin, capreomycin, and ethionamide.</div><div>Out of 110 samples processed, 13 samples were ‘not detected’ by the assay while three gave invalid results. Resistance to isoniazid, fluoroquinolones, amikacin, kanamycin, capreomycin and ethionamide was detected in 85/94 cases (90·42%), 74/94 cases (78·72%), 08/94 cases (8·5%), 13/94 cases (13·83%), 08/94 cases (8·5%), and 14/94 cases (14·89%) respectively.</div><div>With the updated definitions of drug-resistant TB and high burden of fluoroquinolone resistance the Xpert MTB/XDR assay has a limited application in India.</div><div>Detection of extensive drug resistance by the Xpert MTB/XDR assay in multidrug resistant tuberculosis cases at a tertiary care centre in northern India, and therapeutic decision making for the six-month BPaLM regimen.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100520"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-11DOI: 10.1016/j.jctube.2025.100526
Harendra Kumar , Fnu Teena , Aneeta Bai , Love Kumar , Sebastian Gallego
Tuberculosis (TB) continues to pose a substantial public health concern in South Asia, especially in India and Pakistan, which together represent a considerable portion of the worldwide TB burden. Notwithstanding national initiatives, international cooperation in tuberculosis control is insufficient, presenting a considerable obstacle to disease eradication. This viewpoint underscores the pressing need for improved collaboration between the two nations to tackle common difficulties, such as multidrug-resistant tuberculosis (MDR-TB), inadequate data exchange, and inconsistencies in treatment procedures. We suggest a framework to enhance bilateral tuberculosis control efforts via enhanced data-sharing methods, standardization of treatment regimens, collaborative research projects, and cross-border healthcare access. The formation of a regional tuberculosis task force and health corridors, equipped with diagnostic and treatment facilities, may improve disease monitoring and patient care, particularly in border areas. Moreover, combined training programs for healthcare professionals and legislative measures might enhance a more synchronized response. The World Health Organization (WHO) advocates for a worldwide plan to eradicate tuberculosis, presenting India and Pakistan with the potential to use international collaborations, like the Worldwide Fund and the Stop TB Partnership, to deploy novel diagnostic methods and therapies. A cohesive approach to tuberculosis enhances regional health security and establishes a benchmark for wider infectious disease management efforts. This viewpoint emphasizes the need for a collaborative strategy for tuberculosis control, promoting policy-oriented initiatives that surpass political divisions to attain a shared objective—diminishing tuberculosis incidence and enhancing public health outcomes in both countries.
{"title":"Bridging gaps in tuberculosis control: addressing cross-border challenges between India and Pakistan","authors":"Harendra Kumar , Fnu Teena , Aneeta Bai , Love Kumar , Sebastian Gallego","doi":"10.1016/j.jctube.2025.100526","DOIUrl":"10.1016/j.jctube.2025.100526","url":null,"abstract":"<div><div>Tuberculosis (TB) continues to pose a substantial public health concern in South Asia, especially in India and Pakistan, which together represent a considerable portion of the worldwide TB burden. Notwithstanding national initiatives, international cooperation in tuberculosis control is insufficient, presenting a considerable obstacle to disease eradication. This viewpoint underscores the pressing need for improved collaboration between the two nations to tackle common difficulties, such as multidrug-resistant tuberculosis (MDR-TB), inadequate data exchange, and inconsistencies in treatment procedures. We suggest a framework to enhance bilateral tuberculosis control efforts via enhanced data-sharing methods, standardization of treatment regimens, collaborative research projects, and cross-border healthcare access. The formation of a regional tuberculosis task force and health corridors, equipped with diagnostic and treatment facilities, may improve disease monitoring and patient care, particularly in border areas. Moreover, combined training programs for healthcare professionals and legislative measures might enhance a more synchronized response. The World Health Organization (WHO) advocates for a worldwide plan to eradicate tuberculosis, presenting India and Pakistan with the potential to use international collaborations, like the Worldwide Fund and the Stop TB Partnership, to deploy novel diagnostic methods and therapies. A cohesive approach to tuberculosis enhances regional health security and establishes a benchmark for wider infectious disease management efforts. This viewpoint emphasizes the need for a collaborative strategy for tuberculosis control, promoting policy-oriented initiatives that surpass political divisions to attain a shared objective—diminishing tuberculosis incidence and enhancing public health outcomes in both countries.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"39 ","pages":"Article 100526"},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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