Incidence Of Mycobacterium Tuberculosis Infection Research Articles

Incidence of tuberculous infection in a TB-endemic city.

<sec id="st1"><title>BACKGROUND</title>Current metrics for TB transmission include TB notifications, disease mortality, and prevalence surveys. These metrics are helpful to national TB programs to assess the burden of disease, but they do not directly measure incident infection in the community.</sec><sec id="st2"><title>METHODS</title>To estimate incidence of Mycobacterium tuberculosis infection in Kampala, Uganda, we performed a prospective cohort study between 2014 and 2017 which enrolled of 1,275 adult residents without signs of tuberculous infection (tuberculin skin test [TST] <5 mm and no signs of TB disease) and followed them for conversion of TST at 1 year.</sec><sec id="st3"><title>RESULTS</title>During follow-up, 194 participants converted the TST and 158 converted by one year. The incidence density of TST conversion was 13.2 conversions/100 person-year (95% CI 11.6-15.1), which corresponds to an annual cumulative incidence of tuberculous infection of 12.4% (95% CI 10.7-14.3). Cumulative incidence was greater among older participants and among men. Among participants who reported prior exposure to TB cases, the cumulative risk was highest among those reporting exposure during follow-up.</sec><sec id="st4"><title>CONCLUSIONS</title>The high annual incidence of infection suggests that residents of Kampala have adequate contact for infection with undetected, infectious cases of TB as they go about their daily lives.</sec>.

Trends in the incidence of Rifampicin resistant Mycobacterium tuberculosis infection in northeastern Nigeria

Mycobacterium tuberculosis is a respiratory bacterial pathogen that causes Tuberculosis. About one-quarter of the global population is infected, most of which are asymptomatic with a 5–15% risk of developing active disease across their lifespan. The progression of the disease has been enhanced by HIV coinfection and the emergence of Mycobacterium tuberculosis strains that are resistant to first-line anti-TB drugs, especially Rifampicin. Rifampicin resistance is brought about by mutation in the gene coding for beta-subunit of the enzyme RNA polymerase (rpoB) and is a surrogate marker for multidrug-resistant Tuberculosis (MDR-TB). Herein, using the GeneXpert MTB/RIF molecular technique, we examined the incidence of Mycobacterium tuberculosis infection and evaluate rpoB gene mutation among Mycobacterium tuberculosis isolates identified from presumptive pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) patients attending the directly observed treatment short-course (DOTS) clinic, University of Maiduguri Teaching Hospital, Nigeria. A total of two thousand four hundred and fifty-one (2451) presumptive TB cases (PTB = 2279, EPTB = 172) were analyzed from January 2018 to July 2019. The incidence of Mycobacterium tuberculosis infection was 22.68% (Mean±S.E = 46.33 ± 15.41). The incidence of Rifampicin-resistant Mycobacterium tuberculosis was 4.50% (Mean±S.E = 2.08 ± 1.02). The incidence of Mycobacterium tuberculosis and HIV co-infection was 16.59%, while the incidence of Rifampicin-resistant Mycobacterium tuberculosis and HIV co-infection was 4.23%. The peak incidence of M. tuberculosis infection was observed during the first quarter of each year and this variation was observed to be statistically significant (f = 9.34606; p < .05; CI95; p = 0.000068). Incidence of Rifampicin-resistant Mycobacterium tuberculosis was observed to be more prevalent among female patients that are 15 years or older (Fischer's exact test = 0.533; p < .05; CI95; p = 0.465348). The incidence rates reported herein are higher than the WHO-reported national average. By this report, it can be affirmed that the incidence of Mycobacterium tuberculosis infection in northeastern Nigeria is increasing and the rate of infection follows a seasonal trend.

Tuberculosis infection control measures and knowledge in primary health centres in Bandung, Indonesia.

Health care workers (HCWs) in low- and middle-income countries (LMICs) continue to have an unacceptably high prevalence and incidence of Mycobacterium tuberculosis infection due to high exposure to tuberculosis (TB) cases at health care facilities and often inadequate infection control measures. This can contribute to an increased risk of transmission not only to HCWs themselves but also to patients and the general population. We assessed implementation of TB infection control measures in primary health centres (PHCs) in Bandung, Indonesia, and TB knowledge among HCWs. A cross-sectional study was conducted between May and November 2017 amongst a stratified sample of the PHCs, and their HCWs, that manage TB patients in Bandung. Questionnaires were used to assess TB infection control measures plus HCW knowledge. Summary statistics, linear regression and the Kruskal-Wallis test were used for analysis. The median number of TB infection control measures implemented in 24 PHCs was 21 of 41 assessed. Only one of five management controls was implemented, 15 of 24 administrative controls, three of nine environmental controls and one of three personal respiratory protection controls. PHCs with TB laboratory facilities and high TB case numbers were more likely to implement TB infection control measures than other PHCs (p=0.003). In 398 HCWs, the median number of correct responses for knowledge was 10 (IQR 9-11) out of 11. HCWs had good TB knowledge. TB infection control measures were generally not implemented and need to be strengthened in PHCs to reduce M. tuberculosis transmission to HCWs, patients and visitors.

Incidence and prevalence of tuberculosis in incarcerated populations: a systematic review and meta-analysis

SummaryBackgroundPrisons are recognised as high-risk environments for tuberculosis, but there has been little systematic investigation of the global and regional incidence and prevalence of tuberculosis, and its determinants, in prisons. We did a systematic review and meta-analysis to assess the incidence and prevalence of tuberculosis in incarcerated populations by geographical region.MethodsIn this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Knowledge, and the LILACS electronic database from Jan 1, 1980, to Nov 15, 2020, for cross-sectional and cohort studies reporting the incidence of Mycobacterium tuberculosis infection, incidence of tuberculosis, or prevalence of tuberculosis among incarcerated individuals in all geographical regions. We extracted data from individual studies, and calculated pooled estimates of incidence and prevalence through hierarchical Bayesian meta-regression modelling. We also did subgroup analyses by region. Incidence rate ratios between prisons and the general population were calculated by dividing the incidence of tuberculosis in prisons by WHO estimates of the national population-level incidence.FindingsWe identified 159 relevant studies; 11 investigated the incidence of M tuberculosis infection (n=16 318), 51 investigated the incidence of tuberculosis (n=1 858 323), and 106 investigated the prevalence of tuberculosis (n=6 727 513) in incarcerated populations. The overall pooled incidence of M tuberculosis infection among prisoners was 15·0 (95% credible interval [CrI] 3·8–41·6) per 100 person-years. The incidence of tuberculosis (per 100 000 person-years) among prisoners was highest in studies from the WHO African (2190 [95% CrI 810–4840] cases) and South-East Asia (1550 [240–5300] cases) regions and in South America (970 [460–1860] cases), and lowest in North America (30 [20–50] cases) and the WHO Eastern Mediterranean region (270 [50–880] cases). The prevalence of tuberculosis was greater than 1000 per 100 000 prisoners in all global regions except for North America and the Western Pacific, and highest in the WHO South-East Asia region (1810 [95% CrI 670–4000] cases per 100 000 prisoners). The incidence rate ratio between prisons and the general population was much higher in South America (26·9; 95% CrI 17·1–40·1) than in other regions, but was nevertheless higher than ten in the WHO African (12·6; 6·2–22·3), Eastern Mediterranean (15·6; 6·5–32·5), and South-East Asia (11·7; 4·1–27·1) regions.InterpretationGlobally, people in prison are at high risk of contracting M tuberculosis infection and developing tuberculosis, with consistent disparities between prisons and the general population across regions. Tuberculosis control programmes should prioritise preventive interventions among incarcerated populations.FundingUS National Institutes of Health.

Risk of incident Mycobacterium tuberculosis infection in patients with inflammatory bowel disease: a nationwide population-based study in South Korea.

The low incidence of Mycobacterium tuberculosis infection and lack of adequate controls have prevented researchers from estimating tuberculosis (TB) risk in inflammatory bowel disease (IBD) patients. To evaluate the risk of incident TB among IBD patients. Using the 2011-2013 data of the South Korean National Health Insurance (NHI) system, we calculated the incidence rates (IRs), standardised incidence ratio (SIR) and number needed to screen (NNS) for incident TB in IBD patients compared to the general population in terms of subtype, age, gender and IBD medications. The IR, SIR and NNS for TB in IBD patients were 223.9/100000 person-years, 2.64 (2.30-3.01) and 446.6 (392.8-517.6), respectively. The TB IR in Crohn's disease (CD) patients was significantly higher than that in ulcerative colitis (UC) patients (340.1/100000 person-years vs. 165.5/100000 person-years, respectively; P<0.001). The SIR and NNS for TB among CD patients were 4.00 (3.59-4.45) and 604.2 (506.1-749.6), respectively; those among UC patients were 1.95 (1.66-2.27) and 294.0 (246.9-363.4). The TB IRs in IBD patients did not differ significantly by age or gender (Ptrend =0.505 and P=0.861, respectively). The TB IRs among IBDpatients prescribed 5-ASA, corticosteroids, immunomodulators and anti-TNF-α were 143.5, 208.5, 284.6 and 554.1 per 100000 person-years, respectively. Among IBD patients treated using anti-TNF-α, the TB IR was significantly higher than that among all IBD patients (P<0.001); the SIR and NNS for TB were 6.53 (5.99-7.09) and 180.5 (144.6-240.1) respectively. Clinicians should be aware of the increased risk of active tuberculosis in patients with IBD who are receiving anti-TNF-α therapy.

An analysis of latent tuberculosis infection among patients with rheumatic diseases

To investigate the incidence of latent tuberculosis infection (LTBI) in patients with rheumatic diseases in order to find evidence for the prevention of mycobacterium tuberculosis (MTB) in these patients. From January 2013 to July 2015, 759 patients with rheumatic diseases and 38 health controls were enrolled. All of them underwent interferon-gamma release assays(T-SPOT.TB)to screen for LTBI. Incidence of MTB infection was evaluated in different groups and test was used for statistical analysis between groups. The incidences of LTBI in patients and health controls were 27.27%(207/759) and 10.53%(4/38), respectively. In 2013, 24.66%(73/296) (standardized infection rate 23.37%) patients with rheumatic diseases were positive for LTBI screening test. In 2014 and 2015, the percentages were 32.02%(73/296) (standardized infection rate was 32.15%) and 25.96%(73/228) (standardized infection rate was 28.46%), respectively, which was statistically significant in these 3 groups (P=0.004). the infection rate in 2014 tended to be higher than that in 2013 (P=0.001). There were 30.24%(88/291) male and 25.43%(119/468)female patients who were considered as LTBI. But the difference was not significant between genders. The infection rates between patients older than 60 years old and less was significantly different, which were 45.65%(42/92) and 24.74%(165/667), respectively (P=0.000). As far as diseases were concerned including rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis and other rheumatic diseases, the incidences were 33.93%(57/168), 22.06%(45/204), 25.73%(44/171) and 28.24%(61/216) respectively, without statistical significance. The incidence of LTBI is high in patients with rheumatic diseases. Attention should be paid especially to elderly patients and rheumatoid arthritis patients who have relatively higher rates of LTBI. Careful monitoring and prevention measures are suggested to take in these patients.

Implant-associated mycobacterium tuberculosis infection following surgical management of fractures: a retrospective observational study.

In this retrospective observational cohort study, we describe 17 patients out of 1775 treated for various fractures who developed mycobacterium tuberculosis (MTB) infection after surgery. The cohort comprised 15 men and two women with a mean age of 40 years (24 to 70). A total of ten fractures were open and seven were closed. Of these, seven patients underwent intramedullary nailing of a fracture of the long bone, seven had fractures fixed with plates, two with Kirschner-wires and screws, and one had a hemiarthroplasty of the hip with an Austin Moore prosthesis. All patients were followed-up for two years. In all patients, the infection resolved, and in 14 the fractures united. Nonunion was seen in two patients one of whom underwent two-stage total hip arthroplasty (THA) and the other patient was treated using excision arthoplasty. Another patient was treated using two-stage THA. With only sporadic case reports in the literature, MTB infection is rarely clinically suspected, even in underdeveloped and developing countries, where pulmonary and other forms of TB are endemic. In developed countries there is also an increased incidence among immunocompromised patients. In this paper we discuss the pathogenesis and incidence of MTB infection after surgical management of fractures and suggest protocols for early diagnosis and management.

Abdominal tuberculosis presenting as ascites in an older indigenous woman: a case report

Introduction: Indigenous people tend to have higher incidence of Mycobacterium tuberculosis infection (TB). The diagnosis of TB is a challenge among older patients because of its non-specific presentation, especially for cases of extrapulmonary TB. Case presentation: A 77-year-old indigenous woman presented with ascites secondary to abdominal TB. A computed tomography scan of the abdomen showed free fluid. The patient had a positive tuberculin test, and the ascitic fluid was an exudate with an adenosine deaminase activity test value of 80.76 IU l − 1.The mesenteric lymph biopsy showed a central area with caseating granulomas and peripheral giant cells, suggestive of TB commitment at the mesenteric lymph node level. The diagnosis was confirmed by a positive TB ascitic fluid culture. Anti-TB treatment improved the patient's symptoms. Conclusion: In patients with ascites as the primary symptom, abdominal TB should be suspected, especially among those belonging to special population groups such as indigenous or older people.

Detecting Latent Tuberculosis Infection Prior to Kidney Transplantation in a Tertiary Hospital in Saudi Arabia: Comparison of the T-SPOT.TB Test and Tuberculin Test

Background: Tuberculosis (TB) remains a major worldwide public health problem with over 8.8 million newly diagnosed cases in 2010. Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have a significantly higher incidence of Mycobacterium tuberculosis infection or disease than healthy individuals. Most cases of active tuberculosis (TB) in patients with ESRD are due to the reactivation of a latent infection, and this patient group is at roughly 10to 25-fold higher risk for reactivating TB infection than the general population. Candidates for solid organ transplantation are routinely screened for latent tuberculosis infection (LTBI). In this study we aimed to compare Tuberculin Skin Test (TST) with T-SPOT.TB, for the detection of LTBI in candidates for kidney transplantation. Methods: Prospective study of 133 HD Patients who did not have a diagnosis of active TB Research Article ar Article British Microbiology Research Journal, 3(2): 116-127, 2013 117 diseases or LTBI previously referred, through a 5-month period, to our institutions. Forty four kidney donors without evidence of renal insufficiency or immunocompromising conditions by medical history served as control group. All patients were tested with tuberculin (TST), and T-Spot.TB and the results were compared. Results: In donors, the concordance between the T-SPOT and the TST was moderate (90.9 %, к=0.46). Forty of 44 donors (90.9%) had concordance results between the T-Spot TB and TST.In hemodialysis patients, the concordance between the T-SPOT.TB and the TST was poor (60.15 %, к=0.07). Fifty three of 133 patients (40%) had discordant results between the T-SPOT.TB and TST. Of these, 13 patients had a positive TST but negative T-SPOT.TB and 40 had a positive T-SPOT.TB but a negative TST. Conclusion: Our data strongly argue against the use of TST in screening of LTBI in HD patients. T-SPOT.TB test in dialysis patients correlated better than TST with the risk of TB infection (e.g. increased age and low body mass index). It is a more reliable and powerful diagnostic tool than TST. However, further studies should be carried out to determine the tests with higher sensitivity and most permitted specificity.

Infecção por Mycobacterium tuberculosis entre agentes comunitários de saúde que atuam no controle da TB

To evaluate the incidence of Mycobacterium tuberculosis infection, using tuberculin skin test, among community health agents (CHAs) monitoring TB patients in the city of Cachoeiro de Itapemirim, Brazil. We included 30 CHAs acting in the Family Health Program and 30 of their family members residing in the same household. The tuberculin skin test results of each CHA were compared with those of the corresponding family member. Of the 30 CHAs, 27 (90.0%) were female, compared with 23 (76.7%) of the 30 family members (p = 0.299). The mean age of the CHA group and of the family member group was, respectively, 36.8 and 39.7 years. No statistically significant difference was found between the groups regarding the level of education. Regarding M. tuberculosis exposure, the same number of participants in the two groups reported having known or had contact with a TB patient (17 individuals; 56.7%). There was a statistically significant difference regarding positive tuberculin skin test results (26.7% in the CHA groupand 3.3% in the family member group; p = 0,011). M. tuberculosis infection was significantly higher among CHAs than among their family members, fueling the debate on the occupational risk involved in the activities of these professionals.

Interpretation of Repeat Tuberculin Skin Testing in International Adoptees

Internationally-adopted children are a unique group of Bacille Calmette-Guérin (BCG)-vaccinated children with high rates of latent tuberculosis infection (LTBI) in whom serial tuberculin skin tests (TST) are recommended. No study has measured the incidence of TST conversion in these children. Internationally-adopted children completed baseline and follow-up TST to measure the incidence of Mycobacterium tuberculosis infection and factors associated with TST conversion. Data were collected regarding age, gender, birth country, vaccination history, history of tuberculosis (TB) exposure, previous TB screening, and preadoptive environment. All children completed physical examinations including a standardized evaluation for TB, anthropometric assessment, and documentation of BCG scar. Fourteen percent of children (N = 390) had evidence of LTBI at baseline. Children were more likely to have LTBI if they were older, BCG vaccinated, or had been in the United States longer. An additional 13% of children had TST indurations > or = 10 mm at follow-up testing. Regardless of BCG vaccination status or nutritional status, children who were younger at baseline were more likely to have a TST induration > or = 10 mm at follow-up. International adoptees have significant risk of LTBI. Although our findings suggest that recent infection with M. tuberculosis led to TST conversion in some children, the increase in follow-up TST induration could also be attributed to TST boosting resulting from prior BCG vaccination. When serial TST testing is completed in young, BCG-vaccinated children, interpretation of the follow-up TST should consider baseline TST results.

Susceptibility to Mycobacterial Infections in Children With X-Linked Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) is a rare disorder of phagocytic oxidative bursts leading to recurrent pyogenic infections. Affected individuals are most prone to infections caused by staphylococci, Salmonella, Candida, and Aspergillus, but previously we observed a high incidence of Mycobacterium tuberculosis infection in Chinese children with CGD. To determine the spectrum of infections in patients with X-linked CGD, with an emphasis on mycobacterial infections, and to review all CYBB gene mutations identified in our center. From 1988 to 2005, 17 Chinese male children were diagnosed to have X-linked CGD. Fifteen mutations were identified, including 3 splice site defects (IVS1-1G>C, 266G>A, IVS3-1G>A), 5 missense mutations (591T>C, 627T>A, 949T>A, 1039T>A, 1512G>C), 3 nonsense mutations (882C>T, 1451C>A, 1569G>T), 1 insertion (756_757insA), and 3 deletions (660_662delTTC, 727delT, 1341delT). Eight of these were novel mutations. Recurrent pneumonia, lymphadenitis, and bacterial skin abscess were the commonest types of infection. Seven patients had tuberculosis (TB). Seven patients had prolonged scarring or abscess formation at the Calmette-Guérin bacillus (BCG) injection site, and 1 had disseminated BCG infection. Three patients had pulmonary aspergillosis. Four patients underwent hemopoietic stem cell transplantation, but 2 died of complications. Patients with CGD are susceptible to TB and BCG complications. Our observation suggests that oxidative burst is probably important in host defense against mycobacterial infections. Because interferon-gamma is the key cytokine involved in mycobacterial immunity, there may be a stronger indication for its use in CGD patients living in areas endemic for TB.

Limited impact of tuberculosis control in Hong Kong: attributable to high risks of reactivation disease

Over 50% of the global burden of tuberculosis occurs in South East Asia and the Western Pacific. Since 1950, notification rates in high-income countries in these settings have declined slowly and have remained over ten-fold greater than those in Western populations. The reasons for the slow decline are poorly understood. Using an age-structured model describing the incidence of Mycobacterium tuberculosis infection and disease applied to notification data from Hong Kong, we illustrate that in Hong Kong, a high prevalence of M. tuberculosis infection among older individuals and a high risk of disease through reactivation (e.g. up to 17-fold greater than that estimated for infected males in the United Kingdom) may explain this slow decline. If this feature of the epidemiology of tuberculosis is widespread, the WHO directly observed treatment short-course (DOTS) strategy may have a smaller impact in Asia in the short term than has been implied by recent predictions, all of which have been based on disease risk estimates derived from Western Europe. As a result, it may be difficult to meet the targets for tuberculosis control, which have been prescribed by the UN Millennium Development Goals.

Clinical Features and Outcome of Tuberculosis in Solid Organ Transplant Recipients

: Taiwan is an area with moderate to high incidence of Mycobacterium tuberculosis infection. The risk of M tuberculosis infection in transplantation recipients is considered to be significant. Our aim in this study was to investigate the clinical spectrums of M tuberculosis-infected transplantation recipients in a southeast Asian country, Taiwan. : We retrospectively analyzed the demographic data, clinical features, treatment, and outcome of M tuberculosis infection in kidney, heart, and liver transplant recipients from May 1996 to April 2005 at the National Taiwan University Hospital. : Fifteen patients who had received solid organ transplantation developed tuberculosis (kidney = 6, heart = 7, liver = 2). The median duration from transplantation to diagnosis of tuberculosis was 31 months. The cumulative incidence of post-transplantation tuberculosis was 2.0% (15/760), ie, approximately 3 times that of the general population. Ten patients (66.7%) had pulmonary tuberculosis, 1 (6.7%) had extrapulmonary tuberculosis, and 4 (26.7%) had disseminated tuberculosis. Nine patients completed the anti-tuberculosis treatment; the median treatment duration was 12 months (pulmonary: 9 months; extrapulmonary: 13.5 months). No treatment failure was noted in patients receiving the complete treatment course. The graft failure and mortality rates of post-transplantation tuberculosis were 13.3% each (2/15). The tuberculosis-associated mortality rate was 6.7% (1/15). : Cumulative incidence of tuberculosis was slightly higher in transplant recipients than in the general population in Taiwan. Conventional 4-combined anti-tuberculosis regimen for 12 months can treat the potentially fatal infection successfully in post-transplantation tuberculosis patients without recurrence.

Nosocomial Mycobacterium tuberculosis transmission among healthcare students in a high incidence region, in Vitória, State of Espírito Santo

This open comparative study for evaluating hypersensitivity to tuberculin among medical students (n=441), nursing students (n=178) and economics students (n=230) in Vitória, State of Espírito Santo, had the aim of assessing whether the prevalence of positive tuberculin tests among healthcare students could be used as a sentinel event for nosocomial transmission in localities with high endemicity. There was a significant change in the frequency of purified protein derivative reactivity in the nursing students (20.3%) and medical students (18.4%), in comparison with the economics students (6%) (p <0.001). As expected, the medical and nursing students had more knowledge about tuberculosis than did the economics students (p <0.001). Our data suggest that the incidence of Mycobacterium tuberculosis infection among nursing and medical students in our region, which has high endemicity of tuberculosis, does not differ from what is found in low-incidence countries. These data reinforce the need for implementing biosafety programs for this target population.

Prevalence and incidence of Mycobacterium tuberculosis infection in nursing students in Vitória, Espírito Santo

This prospective study evaluated the incidence of Mycobacterium tuberculosis infection among nursing students at the Federal University of Espírito Santo, using the purified protein derivative test. In parallel, we evaluated whether knowledge on tuberculosis transmission mechanisms had any impact on nursing students' attitudes in relation to the risk of tuberculosis infection. The incidence of tuberculin conversion was 10.5% per year (p=0.035, 95% CI = 3.63-17.43), whereas the expected conversion rate in the overall population in Brazil is 0.5% per year. These results indicate nursing students as a group at risk for TB infection. Among the risk factors studied only the use of NIOSH95 masks was associated with protection against infection (RR=0.2). Furthermore there was no statistical difference among students that PPD converted and those who remained negative regarding disease knowledge and the existence of adequate facilities for patient hospitalization. Our data reinforces the need for implementing special biosafety programs targeting this professional group.

Infectious Complications After Heart Transplantation in Chinese Recipients

Several factors appear to influence the incidence and type of infectious complications among different populations of transplant recipients. This study sought to assess the incidence and type of infection after transplantation in Chinese heart allograft recipients. A total of 130 infectious episodes occurred in 192 consecutive heart transplantation patients between June 1993 and May 2004. The median length of follow-up was 46.7+/-38.4 months. The 1-, 5- and 10-year survival rates were 81.8+/-2.8%, 63.0+/-3.8% and 45.7+/-7.7%. Infection was the leading cause of early and late deaths. Of the infectious episodes, 66 (51%) were caused by bacteria, 35 (27%) by viruses, 10 (8%) by fungi, 7 (5%) by Mycobacterium tuberculosis and 12 (9%) by other pathogens. The most common bacterial infectious episodes were caused by methicillin-resistant Staphylococcus aureus (20 of 66). The most common viral infections were varicella zoster virus infection in 12 (34%), cytomegalovirus infection in 9 (26%) and hepatitis B virus infection in 8 (23%). There was only one episode of clinical syndrome compatible to Pneumocystis jiroveci pneumonia. In conclusion, there was low incidence of Pneumocystis jiroveci pneumonia and cytomegalovirus infection, and high incidence of Mycobacterium tuberculosis infection in Chinese heart allograft recipients.

Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management.

Tuberculosis is a serious opportunistic infection in transplant recipients. On the basis of the compilation of published reports in the literature, the incidence of Mycobacterium tuberculosis infection in organ transplant recipients worldwide ranged from 0.35% to 15%. Nonrenal transplantation (P = .004), rejection within 6 months before the onset of tuberculosis (P = .02) and type of primary immunosuppressive regimen (P = .007) were predictors of M. tuberculosis infection occurring within 12 months after transplantation. Thirty-three percent (155) of 476 transplant patients with tuberculosis had disseminated infection; receipt of OKT3 or anti-T cell antibodies (P = .005) was a significant predictor of disseminated tuberculosis. Overall, the mortality rate among 499 patients was 29%; disseminated infection (P = .0003), prior rejection (P = .006), and receipt of OKT3 or anti-T cell antibodies (P = .0013) were significant predictors of mortality in patients with tuberculosis. Clinically significant hepatotoxicity due to isoniazid occurred in 2.5%, 4.5%, and 41% of renal, heart and lung, and liver transplant recipients, respectively. The diagnosis and effective management of tuberculosis after transplantation warrant recognition of the unique epidemiological and clinical characteristics of tuberculosis in transplant recipients.

Priorities for HIV testing in developing countries?

The specificity and sensitivity of human immunodeficiency virus (HIV) antibody tests have increased and their use has expanded in developed and developing countries since 1985. Lately, more expensive rapid (US $3-12/test) and cheaper HIV tests have been proposed. HIV testing by the inexpensive enzyme-linked immunosorbent assays (ELISAs) is often infeasible in developing countries because of the lack of equipment. In 1990, in Kinshasa, Zaire, only about 50% of blood donors were screened for HIV. Counseling before and after testing at centers sponsored by non-governmental organizations is limited in developing countries. HIV testing can lead to discrimination: people have been put in quarantine because they were found to be HIV positive. In regions of high prevalence, high priority testing for blood transfusion is cost beneficial. A positive HIV test would justify the start of treatment for toxoplasmosis in a patient with a focal neurological deficit. In a region of high HIV prevalence, a patient with chronic diarrhea would benefit more from an HIV test than from gastroenterological tests. The absence of facilities for CD4 cell counting makes it impossible to advise symptom-free HIV infected subjects. Prophylactic isoniazid may decrease the incidence of Mycobacterium tuberculosis infection among HIV-infected people but the potential for non-compliance with treatment and the risk that drug resistance will develop exist. Confidential HIV testing plus counseling and condom promotion decreased the incidence of HIV infection and gonorrhea among women living in Kigali, Rwanda. There has been successful counseling of discordant couples with HIV infection in Kigali, Rwanda, and Kinshasa, Zaire. HIV testing in the most cost-beneficial way should be done for both members of a steady couple at the same time. HIV tests should be more available in developing countries, and national guidelines for HIV testing should be set.

Drug-Resistant Tuberculosis after Gastrectomy: Double Jeopardy?

Although an increased incidence of Mycobacterium tuberculosis infection is found in patients after subtotal gastrectomy, to my knowledge, the potential for gastrectomy to alter the course and outcome of typical mycobacterial disease has not been noted. I report the case of a patient who developed tuberculosis after a Billroth II subtotal gastrectomy, malabsorbed his antibiotics, and subsequently manifested infection with a drug-resistant strain of M tuberculosis. Altered drug pharmacokinetics should be considered as an important metabolic consequence of subtotal gastrectomy.