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Validation of the clinical tuberculosis screening algorithm used in Nigerian national tuberculosis control programme for screening people living with HIV

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Health 2013年第11期5卷 1737-1741页

作者： Emmanuel N. Aguwa Chika N. Onwasigwe Joseph N. Chukwu Daniel C. Oshi Charles C. Nwafor Babatunde I. Omotowo Anne C. Ndu Anthony O. Meka Osa-Eloka C. Ekwueme Nwachukwu C. Ugwunna Moses C. Anyim Department of Community Medicine University of Nigeria Nsukka Nigeria Department of Community Medicine University of Nigeria Nsukka Nigeria German leprosy and tuberculosis Relief Association Enugu Nigeria

Background: In high HIV prevalence, tuberculosis diagnosis is challenging. Some countries hence use clinical algorithms to screen for tuberculosis in People Living with HIV (PLHIV). Objectives: The aim of the study was to validate the national algorithm for clinical tuberculosis screening of persons living with HIV who attend comprehensive HIV clinics. Methods: A cross-sectional study of PLHIV who presented with cough of at least 2 weeks duration between 2009 and 2011 at St Patrick’s Hospital, Ebonyi State, Nigeria. Sputum smear microscopy for acid fast bacilli was obtained from the participants. Results: Three hundred and twelve PLHIV were studied: 146 (46.8%) males and 166 (53.2%) females. Only 55 (17.6%) of the participants had smear positive pulmonary tuberculosis. Weight loss (c2 = 2.33;P = 0.127), hemoptysis (c2 = 0.03;P = 0.864), night sweats (c2 = 1.52;P = 0.218), fever (c2 = 3.49;P = 0.06), anorexia (c2 = 0.49;P = 0.484), chest pain (c2 = 2.48;P = 0.115), breathlessness (c2 = 0.63;P = 0.426) were not significant in PLHWA with/without pulmonary tuberculosis. Cough, fever, night sweat and weight loss combined gave a sensitivity of 97.0%, specificity of 10.9%, negative predictive value (NPV) of 93.3% and positive predictive value (PPV) of 21.8%. Conclusion: Findings suggest that though national screening algorithm is a valid tool to screen for tuberculosis in PLHIV, it will lead to many false positive results.

关键词： HIV tuberculosis PLHIV Screening Tool Validation

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Implementing a Short Regimen for Multidrug-Resistant tuberculosis in Kinshasa, Democratic Republic of Congo: A Cohort Study 2014-2017

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Journal of tuberculosis Research 2020年第3期8卷 111-126页

作者： Innocent Murhula Kashongwe Leopoldine Mbulula Fina Mawete Nicole Anshambi Nadine Maingowa Michel Kaswa Jean Marie Ntumba Kayembe Francois Bompeka Lepira Zacharie Munogolo Kashongwe Pulmonology Unit Internal Medicine Kinshasa University Hospital Kinshasa Democratic Republic of the Congo Drug Resistant tuberculosis Unit “Centre Excellence Damien” Damian Foundation Kinshasa Democratic Republic of the Congo national tuberculosis program of the Democratic Republic of the Congo Kinshasa Democratic Republic of the Congo Provincial Coordination for tuberculosis Control Kinshasa Democratic Republic of the Congo

Setting: Kinshasa, capital of Democratic Republic of Congo, has the high rate of multidrug resistant tuberculosis (MDR-TB) which is associated with poor treatment outcomes until 2013. A new approach was needed. Objectives: To implement a new strategy in order to improve treatment outcomes. Design: A retrospective cohort study reviewing all the patients diagnosed MDR tuberculosis between 2014 and 2017. The study was conducted in the national tuberculosis program (NTP) framework comparing the short regimen and the WHO standard regimen. Results: From 1246 patients diagnosed RR/TB, 1073 were included in the analysis: 948 on shorter regimen, and 125 on WHO standard regimen. The strategy was based on patient-centered care. In the short regimen group, 62.7% were male, 61.4% were age 25 - 44 years, 52.6% had previous history of TB, 39.3% underweight, 12.5% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 163). In the long regimen group, 75% were male, 37.6% were age 14 - 44 years, 61.6% underweight, 18.4% HIV positive. The median time from diagnosis to treatment was 19 days (0 - 114). Favorable outcomes represented 81.9% in the short regimen group versus 72% in the long regimen group. Death and loss to follow-up were more observed in long regimen group (27.2% versus 15.4%). Factors associated with unfavorable outcomes in the short regimen group included sex, age ≥ 45 years, previous TB history, HIV status, delay to begin treatment. For the long regimen, the factors age and delay emerged, underweight and HIV were borderline. Drug adverse events were reported respectively in 43.5% and 42.4% for short and long regimen;with gastrointestinal disturbances, vestibular troubles, ototoxicity, arthralgia and anemia as the most common in the 2 groups. Conclusion: The new approach improved favorable outcomes. Both short and long regimens reached a high level of favorable outcome compared to the previous study. The short regim

关键词： MDR-TB Short Regimen Patient Centered Card

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Did “Screeners” Increase Pediatric tuberculosis Case Notification in Sindh, Pakistan?

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Journal of tuberculosis Research 2017年第1期5卷 81-86页

作者： Afshan Khurshid Sven Gudmund Hinderaker Einar Heldal Razia Fatima Mahboobul Haq Aashifa Yaqoob Amanullah Ansari Kashif Anwar Ejaz Qadeer Ajay M. V. Kumar Provincial TB Control program Sindh Pakistan University of Bergen Bergen Norway Norwegian Institute of Public Health Oslo Norway national TB Control program Islamabad Pakistan national TB Control program Research Islamabad Pakistan Pakistan Institute of Medical Sciences Islamabad Pakistan International Union against tuberculosis and Lung Disease Paris France International Union against tuberculosis and Lung Disease South-East Asia Office New Delhi India

To identify missing childhood tuberculosis (TB) cases, “screeners” (hospital-based health workers trained to screen accompanying contacts of TB patients for symptoms) were introduced in eight tertiary care hospitals of Sindh, Pakistan in 2013. There was a 55% increase in childhood TB notifications in 2014 compared to 2012 in facilities with screeners (n = 8) compared to 40% increase in facilities without screeners (n = 22). This apparent association disappeared when stratified by presence of “trained pediatrician” whose introduction was associated with a massive increase in notifications while transfer was associated with a marked decrease. In conclusion, screeners were not associated with increase in pediatric TB case notifications.

关键词： Childhood tuberculosis Pediatricians Screener Xpert MTB/RIF SORT IT

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Characteristics of distribution of Mycobacterium tuberculosis lineages in China

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Science China(Life Sciences) 2018年第6期61卷 651-659页

作者： Haixia Chen Li He Chao Cai Jingyi Liu Junnan Jia Liang Ma Hairong Huang Lixia Wang Xumin Ni Jimin Gao Weimin Li Zhejiang Provincial Key Laboratory for Technology and Application of Model Organisms School of Laboratory Medicine and Life Science Wenzhou Medical University Wenzhou 325035 China national tuberculosis Clinical Lab of China Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing Chest Hospital Capital Medical University Beijing 101149 China Academy of Mathematics and Systems Science Chinese Academy of Sciences Beijing 100190 China School of Mathematical Sciences Univsersity of Chinese Academy of Sciences Beijing 100049 China Beijing Key Laboratory in Drug Resistance tuberculosis Research Beijing Chest Hospital Capital Medical University Beijing 101149 China Beijing Municipal Key Laboratory of Clinical Epidemiology School of Public Health Capital Medical University Beijing 100069 China Beijing Institute of Genomies Chinese Academy of Sciences Bering 100101 China national Center for tuberculosis Control and Prevention Chinese Center for Disease Control and Prevention Beijing 102206 China Department of Mathematics School of Science Beijing Jiaotong University Beijing 100044 China

The genotyping methods of Mycobacterium tuberculosis would dramatically improve our understanding of the molecular epidemiology of tuberculosis. 3,929 isolates, from a national Survey of Drug-Resistant tuberculosis in 2007 in China, were successfully genotyped by large sequence polymorphisms and 15 loci variable number tandem repeats. We found that 2,905(2,905/3,929, 73.9%) cases belonged to Lineage 2, dominated in the east and central regions, 975 cases(975/3,929, 24.8%) were Lineage 4, highly prevailed in the west regions, and 36 and 13 cases were Lineage 3 and Lineage 1, respectively. We also explored the associations between lineages(Lineage 2 vs. Lineage 4) and clinical characteristics by logistic regression. For Lineage 2, the risk factors were Han-ethnicity population and fever. However, for Lineage 4, they were occupation(farmer), and degree of education(non-literate). Fully understanding of the distribution of Mycobacterium tuberculosis lineage and its risk factors would play a critical role in tuberculosis prevention, control, and treatment.

关键词： Mycobacterium 肺结核中国特征分发风险因素传染病学中央区域

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Sensorineural Hearing Loss in Multidrug-Resistant tuberculosis Patients in Kinshasa (Democratic Republic of Congo): Prospective Cohort Study of Therapeutic Regimen with Aminoglycoside versus Bedaquiline

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Journal of tuberculosis Research 2023年第3期11卷 109-119页

作者： Mireille A. Mpwate Eddy M. Mbambu Christian N. Matanda Gabriel M. Lema Michel K. Kaswa Murielle L. Aloni Nicole M. Anshambi Fabrice M. Matuta Luc L. Lukasu Dominique M. Mupepe Serge K. Mpwate Pierre Z. Akilimali Zacharie M. Kashongwe Richard N. Matanda Department of Otorhinolaryngology University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo national tuberculosis Control program in the Democratic Republic of Congo Kinshasa Democratic Republic of Congo Provincial Coordination for the Fight against tuberculosis Kinshasa Democratic Republic of Congo Multidrug-Resistant tuberculosis Unit “Centre d’Excellence Damien” Damien Foundation Kinshasa Democratic Republic of Congo Division of Cardiology Department of Internal Medicine University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo Department of Anatomy-Pathology University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo Kinshasa School of Public Health Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of Congo Pneumology Unit Department of Internal Medicine University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo

Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB p

关键词： Multidrug-Resistant tuberculosis Aminoglycosides Bedaquiline Hearing Loss

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Determinants of the Sensorineural Hearing Loss in Patients with Multidrug-Resistant tuberculosis in Kinshasa (Democratic Republic of the Congo): A Prospective Cohort Study

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第6期12卷 411-425页

作者： Mireille Avilaw Mpwate Eddy Mampuya Mbambu Gabriel Mabuaka Lema Christian Nzanza Matanda Dominique Mayuku Mupepe Michel Kayomo Kaswa Murielle Luengiladio Aloni Nicole Muzutie Anshambi Fabrice Mankangu Matuta Luc Losenga Lukasu Serge Katya Mpwate Pierre Zalagile Akilimali Innocent Murhula Kashongwe Zacharie Munogolo Kashongwe Jean Marie Ntumba Kayembe Richard Nzanza Matanda Department of Otorhinolaryngology University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo Division of Cardiology Department of Internal Medicine University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo national tuberculosis Control program in Democratic Republic of The Congo Kinshasa Democratic Republic of The Congo Provincial Coordination for The Fight against tuberculosis Kinshasa Democratic Republic of The Congo Multidrug-Resistant tuberculosis Unit “Centre d’Excellence Damien” Damien Foundation Kinshasa Democratic Republic of The Congo Department of Anatomy-Pathology University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo Kinshasa School of Public Health Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of The Congo Pneumology Unit Department of Internal Medicine University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo

Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB

关键词： Multidrug-Resistant tuberculosis Determinants Hearing Loss DRC

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T Regulatory Cells and BCG as a Vaccine against tuberculosis: An Overview

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World Journal of Vaccines 2015年第2期5卷 96-105页

作者： Om Parkash Department of Immunology National JALMA Institute for Leprosy and Other Mycobacterial Diseases Tajganj Agra India

Bacille Calmette Guerin (BCG), which has been used since 1921 as the only vaccine against tuber-culosis (TB), protects poorly, if at all, against pulmonary tuberculosis among adults in high incident developing countries. This failure has been attributed to the possible down modulating action of T regulatory cells (Tregs), which can be stimulated by environmental mycobacteria and expanded by BCG vaccination. Tregs induced at the site of BCG vaccination may interfere with protection against tuberculosis. This communication describes the contribution of Tregs towards dampening the efficacy of BCG and plausible approaches to countering this down modulating effect of Tregs. Probably, antigen specific inhibition of the local recruitment of Tregs whilst avoiding generalised disturbance of immune homeostasis could prove to be worthwhile. Alternatively, drugs with short half life may achieve more acceptable transient inhibition of Tregs function than the prolonged action of monoclonal antibodies. Evolving novel safe strategies is a challenge for developing a better anti TB vaccine.

关键词： BCG Vaccine tuberculosis T Regulatory Cells

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Antimicrobial Susceptibility Testing and Molecular Characterization of Mycobacterium fortuitum Isolates in China

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Biomedical and Environmental Sciences 2017年第5期30卷 376-379页

作者： ZHENG Hui Wen PANG Yu HE Guang Xue SONG Yuan Yuan ZHAO Yan Lin national institute for communicable disease control and prevention Chinese center for disease control and prevention Beijing 102206 China national tuberculosis Reference Laboratory Chinese Center for Disease Control and Prevention Beijing 102206 China Science and Technology Department Chinese Center for Disease Control and Prevention Beijing 102206 China

We performed molecular identification of clinical isolates of Mycobacterium fortuitum（M. fortuitum） and conducted drug susceptibility testing to analyze the in vitro susceptibility of clinical M. fortuitum isolates and potential molecular mechanism conferring resistance to fluoroquinolone and macrolide drugs. The results showed that moxifloxacin had the highest in vitro activity against M. fortuitum, and most M. fortuitum isolates were resistant to clarithromycin and linezolid in China. The loss of genetic mutation in clarithromycin-and amikacin-resistant isolates indicates that some other intrinsic mechanism conferring clarithromycin and amikacin resistance plays an essential role in M. fortuitum infection.

关键词： Nontuberculosis Genotype Phenotype Susceptibility

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Comparison of Histological, Microbiological, and Molecular Methods in Diagnosis of Patients with TBLN Having Different Anti-TB Treatment Background

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Biomedical and Environmental Sciences 2017年第6期30卷 418-425页

作者： CHE Nan Ying HUANG Shao Jun MA Yan HAN Yi LIU Zi Chen ZHANG Chen MU Jing ZHAO Dan QU Yang ZHANG Hai Qing LIU Zhi Dong XU Shao Fa Department of Pathology Beijing Tuberculosis & Thoracic Tumor Research Institute Beijing Chest Hospital Capital Medical University Beijing 101149 China Department of Thoracic Surgery The affiliated hospital of Inner Mongolia Medical University Hohhot 010110 Inner Mongolia China Clinical Center Beijing Tuberculosis & Thoracic Tumor Research Institute Beijing Chest Hospital Capital Medical University Beo'ing 101149 China Department of Thoracic Surgery Beijing Tuberculosis & Thoracic Tumor Research Institute Beijing Chest Hospital Capital Medical University Beijing 101149 China

Objective The influence of anti-tuberculosis （TB） treatment history on tuberculous lymphadenitis （TBLN） diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN. Methods In this study, suspected patients with TBLN and having different anti-T8 treatment background were enrolled. All the samples were tested simultaneously by histology, ZiehI-Neelsen （ZN） staining, mycobacterial culture （culture）, Xpert MTB/RIF （xpert）, real-time PCR, and high-resolution melting curve PCR （HRM）. Thereafter, the performance of these methods on samples with different anti-TB treatment background was assessed. Results In our study, 89 patients were prospectively included 82 patients with TBLN and 7 with other diseases. The overall sensitivities of Xpert, real-time PCR, histology, ZN staining, and culture were 86.6%, 69.5%, 58.5%, 43.9%, and 22.0%, respectively. The anti-TB treatment history revealed dramatic influences on the sensitivity of culture （P 〈 0.0001）. In fact, the treatment that lasted over 3 months also influenced the sensitivity of Xpert （P 〈 0.05）. However, the treatment history did not affect the performance of remaining tests （P 〉 0.05）. For rifampicin drug susceptibility test （DST）, the anti-T8 treatment showed only significant influence on the success rate of culture DST （P = 0.001）, but not on those of Xpert and HRM tests （P 〉 0.05）. Conclusion Other tests as welt as culture should be considered for patients with TBLN having retreatment history or over 1-month treatment to avoid false negative results.

关键词： Tuberculous lymphadenitis Mycobacterial culture Molecular test Anti-TB treatment Drugresistance

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Decliners of provider-initiated HIV testing and counselling: Characteristics of participants who refused HIV testing in a population survey in Zambia

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Asian Pacific Journal of Tropical Biomedicine 2015年第8期5卷 669-672页

作者： Pascalina Chanda-Kapata William Ngosa Albertina Ngomah Moraes Nicole Maddox Nathan Kapata Department of Disease Surveillance Control and ResearchMinistry of Health Center of Tropical Medicine and Travel Medicine Amsterdam Medical Centre University of Amsterdam national TB/leprosy Control programme Ministry of Community DevelopmentMother and Child Health

Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme ***: This cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the ***: Out of the 44 791 tuberculosis survey participants, 14 164(31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15-24 years were associated with higher refusal ***: Strategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented.

关键词： HIV/AIDS Zambia Testing Refusals Population survey

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