Tuberc Lung Dis Research Articles

Knowledge domain and emerging trends in HIV-MTB co-infection from 2017 to 2022: A scientometric analysis based on VOSviewer and CiteSpace.

Co-infection with Mycobacterium tuberculosis (MTB) in human immunodeficiency virus (HIV)-infected individuals is one of the leading causes of death. Also, research on HIV and MTB (HIV-MTB) co-infection was found to have a downward trend. In this work, we performed the knowledge domain analysis and visualized the current research progress and emerging trends in HIV-MTB co-infection between 2017 and 2022 by using VOSviewer and CiteSpace. The relevant literatures in this article were collected in the Web of Science (WoS) database. VOSviewer and CiteSpace bibliometric software were applied to perform the analysis and visualization of scientific productivity and frontier. Among all the countries, USA was dominant in the field, followed by South Africa, and England. Among all the institutions, the University of Cape Town (South Africa) had more extensive collaborations with other research institutions. The Int J Tuberc Lung Dis was regarded as the foremost productive journal. Survival and mortality analysis, pathogenesis, epidemiological studies, diagnostic methods, prognosis improvement of quality of life, clinical studies and multiple infections (especially co-infection with COVID-19) resulted in the knowledge bases for HIV-MTB co-infection. The clinical research on HIV-MTB co-infection has gradually shifted from randomized controlled trials to open-label trials, while the cognition of HIV-TB has gradually shifted from cytokines to genetic polymorphisms. This scientometric study used quantitative and qualitative methods to conduct a comprehensive review of research on HIV-MTB co-infection published over the past 5 years, providing some useful references to further the study of HIV-MTB co-infection.

The Global Asthma Report 2022.

Published as a Supplement to the IJTLD, the 2022 Global Asthma Report (GAR), highlights the challenges of preventing and managing asthma, and reports on the gaps in asthma care in low- and middle-income countries. Cite as: The Global Asthma Report. Int J Tuberc Lung Dis 2022;26:S1-S102.

TUBERCULOUS TAMPONADE WITH A TWIST: A CASE OF TB AND COVID-19

TUBERCULOUS TAMPONADE WITH A TWIST: A CASE OF TB AND COVID-19

HIDING IN PLAIN SIGHT: DISSEMINATED PULMONARY TB

HIDING IN PLAIN SIGHT: DISSEMINATED PULMONARY TB

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

World Tuberculosis Day 2022: aligning COVID-19 and tuberculosis innovations to save lives and to end tuberculosis

The potential perils of a drug protection framework in tuberculosis

When bedaquiline was approved by stringent regulatory agencies for the treatment of drug-resistant tuberculosis in 2012, it was as the first novel agent for the treatment of tuberculosis to be developed in almost 50 years. 1 Zumla A Gillespie S Hoelscher M et al. New antituberculosis drugs, regimens, and adjunct therapies: needs, advances and future prospects. Lancet Infect Dis. 2014; 14: 327-340 Summary Full Text Full Text PDF PubMed Scopus (257) Google Scholar Given the gruelling therapeutic regimens being used for drug-resistant tuberculosis at the time—with success rates hovering at a dismal 50% globally—it would seem this novel medication would be embraced as a breakthrough and rapidly rolled out. 2 WHOGlobal TB Report 2012. https://www.who.int/tb/publications/global_report/gtbr12_main.pdfDate: 2012 Date accessed: August 14, 2021 Google Scholar However, data on bedaquiline use painted a different picture, with fewer than 20% of those in need of the medication actually receiving it by 2016. 3 Cox V Brigden G Crespo RH et al. Global programmatic use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2018; 22: 407-412 Crossref PubMed Scopus (32) Google Scholar Although multiple reasons were given for this low uptake of bedaquiline—including costs, safety concerns, and limited practical experience with its use—one often cited reason for denying people access to bedaquiline was fear of generating resistance to the medication. 4 Furin J Brigden G Lessem E et al. Global progress and challenges in the implementation of new medications for the treatment of multidrug-resistant tuberculosis. Emerg Infect Dis. 2016; 22e151430 Crossref PubMed Scopus (39) Google Scholar “We have to protect the drug” was a common mantra among those working in the field. In fact, so invested was the tuberculosis community in this framework of drug protection that early WHO recommendations on the use of bedaquiline specified it should only be given to people who had limited treatment options, either because of resistance or intolerance to other second-line medications 5 WHOThe use of bedaquiline in the treatment of multidrug-resistant tuberculosis: interim guidance. World Health Organization, Geneva2013 Google Scholar —a population vastly different from those included in the clinical trials that led to the purported evidence-based recommendations regarding how bedaquiline should be used. Assessment of epidemiological and genetic characteristics and clinical outcomes of resistance to bedaquiline in patients treated for rifampicin-resistant tuberculosis: a cross-sectional and longitudinal studyBedaquiline resistance was associated with poorer treatment outcomes. Rapid assessment of bedaquiline resistance, especially when patients were previously exposed to bedaquiline or clofazimine, should be prioritised at baseline or if patients remain culture-positive after 2 months of treatment. Preventing resistance by use of novel combination therapies, current treatment optimisation, and patient support is essential. Full-Text PDF

Level of Mycobacteria in Pre-Treatment Sputum and Susceptibility of M. tuberculosis Strains Isolated from Patients with non-Multidrug-Resistant Pulmonary Tuberculosis AFB (+) and Factors Influencing MGIT Results after the First 8 Weeks of Anti-Tuberculosi

Vietnam is among 30 high TB ​​burden countries even though the Vietnam National TB Program has made great efforts to detect and treat tuberculosis. Objectives: Assessment of Mycobacterial level in sputum before treatment, and susceptibility to the first line anti-TB drugs of M. tuberculosis strains isolated from TB patients with AFB (+) and non-multidrug-resistant. Moreover, factors influencing MGIT outcome after the first 8 weeks of first-line anti-TB drugs therapy in patients with pulmonary tuberculosis was also analysed. Methodology: An observational, analytical study was performed in 128 patients with non-multidrug-resistant pulmonary tuberculosis AFB (+) for evaluating the level of Mycobacteria in sputum before treatment by smear microscopy method; the susceptibility of M. tuberculosis isolated from sputum of the patient was analysed by Lowenstein - Jensen method. Factors affecting positive MGIT results after 2 months of treatment were determined by multivariate logistics regression. Results: The patients had AFB 3+ were 28% in new cases and 24,5% retreatment patients. The rate of M. tuberculosis strains was susceptible to the first line anti-TB drugs in new cases was higher than retreatment patients. The percentage of any anti-TB drug resistance in retreatment tuberculosis was 59,6%, higher than that of new case TB (23,6%). There was high rate of M. tuberculosis strains resistant to Streptomycin and Isoniazid (12,5% and 16,8% for new cases; 42,3% and 36,5% for retreatment cases, respectively). Large radiographic chest lesions and high AFB levels in pre-treatment sputum were factors associated with a positive MGIT result after the first 8 weeks of treatment. Conclusion: Most of TB patients had high level of Mycobacteria in sputum samples collected before treatment. The percentage of M. tuberculosis strains isolated from sputum of pulmonary non MDR-TB patients had any anti-TB drug resistance were high. High Mycobacteria level in pre-treatment sputum and radiographic chest lesions related to positive MGIT result after the first 8 weeks of treatment.
 Keywords
 Pulmonary tuberculosis, first-line anti-TB drugs, anti-TB drug resistance, susceptibility, M. tuberculosis.
 References
 [1] World Health Organization, Global Tuberculosis Report 2020. Tuberculosis profiles: Viet Nam (2020) Available: https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&entity_type=%22country%22&lan=%22EN%22&iso2=%22VN%22 (accessed 10 April 2020).[2] L.T. Luyen, N.V. Hung, Methods for Diagnosis in Tuberculosis, in Le Thi Luyen (Ed), Tuberculosis - Textbook for General Medical Students. Vietnam National University Press, Hanoi, 2020, pp: 47-69 (in Vietnamese).[3] Ministry of Health - National Tuberculosis Programme Guideline for Standard Operating Procedures of Microbiology Laboratory Methods for Mycobacteria. Vietnam National Tuberculosis Programme, Hanoi (2013) (in Vietnamese).[4] Ministry of Health (2018) Guideline for Management, Diagnosis and Treatment for Tuberculosis. (in Vietnamese) Available: https://kcb.vn/vanban/quyet-dinh-so-3216-qd-byt-ngay-23-5-2018-ve-viec-ban-hanh-huong-dan-chan-doan-dieu-tri-va-du-phong-benh-lao (Accessed 12 January 2019)[5] A.P. Ralph, M. Ardian, A. Wiguna et al. A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. Thorax 2010 Oct;65(10):863-869. https://doi.org/10.1136/thx.2010.136242[6] C.T. Minh, L.T. Luyen, N.T.L. Huong et al. Plasma concentration of anti-tubeculosis drugs in pulmonary tuberculosis patients, who treatment in National Tuberculosis and Lung Diseases Hospital 2008 Journal of Practical Medicine 651(2009) 50-53 (in Vietnamese).[7] N.V. Nhung, N.B. Hoa, D.N. Sy, C.M. Hennig, A.S. Dean (2015) The fourth national anti-tuberculosis drug resistance survey in Viet Nam. Int J Tuberc Lung Dis. Jun 2015 19(6) 670-675. https://doi.org/10.5588/ijtld.14.0785[8] N.T. Hang, S. Maeda, L.T. Lien, et al. Primary drug-resistant tuberculosis in Hanoi, Viet Nam: present status and risk factors. PloS one 8(8) (2013) e71867. https://doi.org/10.1371/journal.pone.0071867[9] R. Hafner, J.A. Cohn, D.J. Wright, et al. Early bactericidal activity of isoniazid in pulmonary tuberculosis. Optimization of methodology. The DATRI 008 Study Group. Am J Respir Crit Care Med 156 (1997) 918–923. https://doi.org/10.1164/ajrccm.156.3.9612016[10] A. Jindani, V.R. Aber, E.A. Edwards, D.A. Mitchison. The early bactericidal activity of drugs in patients with pulmonary tuberculosis. Am J Respir Crit Care Med. 121(1980)(6) 939-949. Available: https://www.atsjournals.org/doi/10.1164/arrd.1980.121.6.939 (Accessed 12 January 2019).[11] H.L. Rieder. Intervention for Tuberculosis Control and Elimination. International Union of Tuberculosis and Lung Diseases, Paris, France, 2002.

Tuberculosis care does not end at treatment completion— a perspective from tuberculosis survivors

Tuberculosis survivors need comprehensive care to increase their quality of life beyond the completion of tuberculosis treatment. Socioeconomic and medical challenges are faced by many patients after being cured from tuberculosis. 1 Allwood B Van der Zalm M Makanda G Mortimer K The long shadow post-tuberculosis. Lancet Infect Dis. 2019; 19: 1170-1171 Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar A systematic review and meta-analysis by Kamila Romanowski and colleagues 2 Romanowski K Baumann B Basham CA Ahmad Khan F Fox GJ Johnston JC Long-term all-cause mortality in people treated for tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2019; 19: 1129-1137 Summary Full Text Full Text PDF PubMed Scopus (51) Google Scholar found the force of mortality for tuberculosis survivors to be 2·91 (95% CI 2·21–3·84) times higher than in those who had never had tuberculosis. Post-tuberculosis lung damage negatively impacts many tuberculosis survivors' quality of life. 3 Meghji J Lesosky M Joekes E et al. Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study. Thorax. 2020; 75: 269-278 Crossref PubMed Scopus (20) Google Scholar , 4 Daniels KJ Irusen E Pharaoh H Hanekom S Post-tuberculosis health-related quality of life, lung function and exercise capacity in a cured pulmonary tuberculosis population in the Breede Valley district, South Africa. S Afr J Physiother. 2019; 751319 Crossref PubMed Scopus (9) Google Scholar Unfortunately, patient care often ends alongside treatment completion, with no follow-up consultations to evaluate mental wellbeing or lung damage. Meghji and colleagues 3 Meghji J Lesosky M Joekes E et al. Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study. Thorax. 2020; 75: 269-278 Crossref PubMed Scopus (20) Google Scholar documented that 246 (61%) of 405 tuberculosis survivors reported respiratory symptoms at the time of treatment completion and 113 (31%) of 368 reported respiratory symptoms 1 year after treatment completion. Mental health is also negatively affected for many tuberculosis survivors, emphasising the need for holistic care to support patients after tuberculosis. 5 Chin AT Rylance J Makumbirofa S et al. Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study. Int J Tuberc Lung Dis. 2019; 23: 203-211 Crossref PubMed Scopus (19) Google Scholar Quantifying the global number of tuberculosis survivors: a modelling studyThe number of tuberculosis survivors alive in 2020 is more than ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors. Full-Text PDF

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Building a tuberculosis-free world while responding to the COVID-19 pandemic

No time to waste: preventing tuberculosis in children

Tuberculosis takes the life of one in five children developing the disease. 1 WHOGlobal tuberculosis report: 2019. World Health Organization, Geneva2019 Google Scholar Data from the pre-chemotherapy era suggest very young children are at highest risk for tuberculosis after exposure, and highly susceptible to the most severe forms of the disease. 2 WHOLatent tuberculosis infection: updated and consolidated guidelines for programmatic management. World Health Organization, Geneva2018 Google Scholar , 3 Marais BJ Gie RP Schaaf HS et al. The clinical epidemiology of childhood pulmonary tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004; 8: 278-285 PubMed Google Scholar As a result, tuberculosis control efforts among children in high-burden countries are focused on those below 5 years of age. 2 WHOLatent tuberculosis infection: updated and consolidated guidelines for programmatic management. World Health Organization, Geneva2018 Google Scholar One of the most important efforts is provision of tuberculosis preventive therapy after tuberculosis exposure, yet only one in four children below 5 years of age who might benefit from life-saving preventive therapy will receive it. 1 WHOGlobal tuberculosis report: 2019. World Health Organization, Geneva2019 Google Scholar In resource-constrained high-burden countries, fewer than 1% of children at least 5 years of age receive preventive therapy. 1 WHOGlobal tuberculosis report: 2019. World Health Organization, Geneva2019 Google Scholar The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysisThe risk of developing tuberculosis among exposed infants and young children is very high. Most cases occurred within weeks of contact investigation initiation and might not be preventable through prophylaxis. This suggests that alternative strategies for prevention are needed, such as earlier initiation of preventive therapy through rapid diagnosis of adult cases or community-wide screening approaches. Full-Text PDF

Revisiting the β-Lactams for Tuberculosis Therapy with a Compound-Compound Synthetic Lethality Approach.

The suboptimal effectiveness of β-lactam antibiotics against Mycobacterium tuberculosis has hindered the utility of this compound class for tuberculosis treatment. However, the results of treatment with a second-line regimen containing meropenem plus a β-lactamase inhibitor were found to be encouraging in a case study of extensively drug-resistant tuberculosis (M. C. Payen, S. De Wit, C. Martin, R. Sergysels, et al., Int J Tuberc Lung Dis 16:558-560, 2012, https://doi.org/10.5588/ijtld.11.0414). We hypothesized that the innate resistance of M. tuberculosis to β-lactams is mediated in part by noncanonical accessory proteins that are not considered the classic targets of β-lactams and that small-molecule inhibitors of those accessory targets might sensitize M. tuberculosis to β-lactams. In this study, we screened an NIH small-molecule library for the ability to sensitize M. tuberculosis to meropenem. We identified six hit compounds, belonging to either the N-arylindole or benzothiophene chemotype. Verification studies confirmed the synthetic lethality phenotype for three of the N-arylindoles and one benzothiophene derivative. The latter was demonstrated to be partially bioavailable via oral administration in mice. Structure-activity relationship studies of both structural classes identified analogs with potent antitubercular activity, alone or in combination with meropenem. Transcriptional profiling revealed that oxidoreductases, MmpL family proteins, and a 27-kDa benzoquinone methyltransferase could be the targets of the N-arylindole potentiator. In conclusion, our compound-compound synthetic lethality screening revealed novel small molecules that were capable of potentiating the action of meropenem, presumably via inhibition of the innate resistance conferred by β-lactam accessory proteins. β-Lactam compound-compound synthetic lethality may be an alternative approach for drug-resistant tuberculosis.

Establishing the Genotyping Method for NAT2 Polymorphism in Vietnamese Tuberculoma Patients

The metabolism of Isoniazid, one of the first-line antituberculosis drugs for TB treatment and prophylaxis, depends on the acetyltransferase 2 acetylation (NAT2) phenotype. Different phenotypes of NAT2 will lead to differences in drug concentration and the risk of uncontrolled side effects, such as hepatitis, peripheral neuropathy, gastrointestinal disorders (nausea, vomiting, and stomach pain). These risks are related to the presence of mutant NAT2 alleles such as NAT2*5 (c.341T> C), *6 (c.590G> A) and *7 (c.857G> A), that reduce the N- acetyltransferase activity. Therefore, the genotyping method for NAT2 polymorphism using RFLP and Sanger sequencing was established. The method was successfully applied to determine the polymorphism of 84 TB patients. This study provides a better tool for analyzing NAT2 gene to assist clinicians in treating isoniazid.
 Keywords
 Enzyme NAT2, isoniazid, single nucleotide polymorphism, RFLP, Sanger sequencing.
 References
 [1] U.A. Boelsterli, K.K. Lee, Mechanisms of isoniazid-induced idiosyncratic liver injury: emerging role of mitochondrial stress, J. Gastroenterol. Hepatol. 29 (2014) 678–687.[2] A. Zabost, S. Brzezinska, M. Kozinska, M. Blachnio, J. Jagodzinski, Z. Zwolska, E. Augustynowicz-Kopec, Correlation of N-acetyltransferase 2 genotype with isoniazid acetylation in Polish tuberculosis patients, Biomed Res Int. 2013 (2013) 1-5.[3] M. Kinzig-Schippers, D. Tomalik-Scharte, A. Jetter, B. Scheidel, V. Jakob, M. Rodamer, I. Cascorbi, O. Doroshyenko, F. Sorgel, U. Fuhr, Should we use N-acetyltransferase type 2 genotyping to personalize isoniazid doses? Antimicrob Agents Chemother. 49 (2005) 1733-8[4] K. Walker, G. Ginsberg, D. Hattis, D.O. Johns, K.Z. Guyton, B. Sonawane, Genetic polymorphism in N-Acetyltransferase (NAT): Population distribution of NAT1 and NAT2 activity, J Toxicol Environ Health B Crit Rev. 12 (2009) 440-472. [5] G. Ramachandran, S. Swaminathan, Role of pharmacogenomics in the treatment of tuberculosis: a review, Pharmgenomics Pers Med. 5 (2012) 89-98.[6] J. Azuma, M. Ohno, R. Kubota, S. Yokota, T. Nagai, K. Tsuyuguchi, Y. Okuda, T. Takashima, S. Kamimura, Y. Fujio, I. Kawase, Pharmacogenetics-based tuberculosis therapy research group, NAT2 genotype guided regimen reduces isoniazid-induced liver injury and early treatment failure in the 6-month four-drug standard treatment of tuberculosis: a randomized controlled trial for pharmacogenetics-based therapy, Eur J Clin Pharmacol. 69 (2013) 1091-1101.[7] P.S. Adole, P.S. Kharbanda, S. Sharma, N-acetyltransferase 2 (NAT2) gene polymorphism as a predisposing factor for phenytoin intoxication in tuberculous meningitis or tuberculoma patients having seizures - A pilot study, Indian J Med Res. 143 (2016) 581-590.[8] WHO Scientific Group on Pharmacogenetics and World Health Organization, Pharmacogenetics: report of a WHO scientific group,World Health Organization Technical Report Series. (1973)[9] T.D. Da Silva, A.V. Felipe, J.M. De Lima, C.T. Oshima, N.M. Forones, N-Acetyltransferase 2 genetic polymorphisms and risk of colorectal cancer, World J Gastroenterol. 17 (2011) 760-765. [10] E.Y. Lau, J.S. Felton, F.C. Lightstone, Insights into the o-acetylation reaction of hydroxylated heterocyclic amines by human arylamine N-acetyltransferases: a computational study, Chem Res Toxicol. 19 (2006) 182-1190.[11] Ensembl - EBI, http://asia.ensembl.org/Homo_sapiens/Variation/Population?db=core;r=8:18399844-18400844;v=rs1801280;vdb=variation;vf=1243314,2019 (Ensembl release 96 - April 2019).[12] I.B. Kuznetsov, M. McDuffie, R. Moslehi, A web server for inferring the human N-acetyltransferase-2 (NAT2) enzymatic phenotype from NAT2 genotype, Bioinformatics. 25 (2009) 1185-1186. [13] P. Wang, K. Pradhan, X.B. Zhong, X. Ma, Isoniazid metabolism and hepatotoxicity, Acta Pharm Sin B. 6 (2016) 384-392.[14] M. Ohno, I. Yamaguchi, I. Yamamoto, T. Fukuda, S. Yokota, Slow N-acetyltransferase 2 genotype affects the incidence of isoniazid and rifampicin-induced hepatotoxicity, Int J Tuberc Lung Dis. 4 (2000) 256-261. [15] G.M. Lower, T. Nilsson, C.E. Nelson, H. Wolf, T.E. Gamsky, G.T. Bryan, N-acetyltransferase phenotype and risk in urinary bladder cancer: approaches in molecular epidemiology. Preliminary results in Sweden and Denmark, Int J Epidemiol. 36 (2007) 11-18.
 
 

DIAGNOSING MILLIARY MYCOBACTERIUM BOVIS FROM THE PROSTATE OF AN IMMUNOCOMPETENT HOST

SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/09/2018 03:45 PM - 04:45 PM INTRODUCTION: Zoonotic infection from Mycobacterium Bovis remains an important consideration for tuberculous disease in the developing world. We present a challenging case of hematogenous Mycobacterial dissemination from an uncommon culprit. CASE PRESENTATION: A 53 year old Bacillus-Calmette-Guerin (BCG) vaccinated and otherwise healthy Mexican male presented with complaints of fever, productive cough, arthralgias and weight loss over the preceding 21 days. He had already completed two separate outpatient courses of oral antibiotics without improvement. He denied any travel outside of the continental United States over the last 13 years and denied any recent sick contacts. He also owned 2 pet parrots. His physical exam and initial laboratory work up was unremarkable. A Chest X-ray (Fig. 1) revealed diffuse, bilateral, micronodular opacities, warranting further evaluation with Computed Tomography (CT) (Fig. 2). Initial acid-fast bacilli (AFB) sputum stains, bronchoalveolar lavage stains, cytology brushings and trans-bronchial biopsies were all negative. Hypersensitivity pneumonitis and opportunistic fungal panels were obtained which were unremarkable. Interferon gamma release assay was positive however equivocal given patient's BCG vaccination status. CT Chest, Abdomen and Pelvis (Fig. 3) was performed, which incidentally revealed an enlarged, heterogeneous prostate with fluid collections. Ultrasound guided aspiration of the prostate yielded pus and a strongly positive AFB smear. Eventually, the AFB cultures from the initial BAL came back positive. The patient was started on RIPE therapy with symptomatic improvement. Final speciation returned as M. Bovis and accordingly, pyrazinamide was stopped. DISCUSSION: M. bovis disease was common in the industrialized world before the practice of pasteurization became widely implemented in the 1940s. Current estimates in the USA and Europe identify between 1.3%-1.6% of tuberculosis cases attributable to M. Bovis. Infections are typically contracted via ingestion of unpasteurized dairy products from infected livestock and may remain dormant for many years, as was likely the situation in this case. Given the oral inoculation route, most cases of M.bovis manifest primarily with extrapulmonary findings. Of note, M. Bovis has documented intrinsic resistance to pyrazinamide which necessitates modification of typical RIPE treatment strategy. CONCLUSIONS: Diagnosis of disseminated TB remains a challenge. Regarding M. Bovis, the mean time to diagnosis has increased among practitioners given the diminishing incidence of infection. Vigilance of the disseminated and often extra-pulmonary form of tuberculosis caused by M. Bovis continues to be warranted. Patients at particular risk for M.bovis are those from developing countries, with frequent exposure to livestock and/or the practice of unpasteurized dairy product consumption. Reference #1: Scott. C. Human Tuberculosis Caused by Mycobacterium bovis in the United States, 2006-2013. Clin Infect Dis. 2016 Sep 1;63(5):594-601. Reference #2: Sherman LF. Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999 Dec;3(12):1088-95. Reference #3: Majoor, C.J. Epidemiology of Mycobacterium bovis disease in humans, The Netherlands, 1993-2007. Emerg Infect Dis. 2011 Mar;17(3):457-63. DISCLOSURES: no disclosure on file for Christopher Barrios; No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Scott Maughan, source=Web Response No relevant relationships by Pujan Patel, source=Web Response

Getting bang for buck in the latent tuberculosis care cascade

An important component of the strategy to reduce and eliminate tuberculosis, as outlined by WHO in their post-2015 strategy, is to target preventative therapy at those with presumed latent tuberculosis infection at high risk of future active tuberculosis. 1 Dheda K Barry 3rd, CE Maartens G Tuberculosis. Lancet. 2016; 387: 1211-1226 Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar In low-burden settings it makes sense to target some groups for screening such as close contacts of index cases with active tuberculosis, immigrants from high-burden countries, and other vulnerable subpopulations who are high risk of infection. 1 Dheda K Barry 3rd, CE Maartens G Tuberculosis. Lancet. 2016; 387: 1211-1226 Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar Indeed, reactivation of latent tuberculosis infection could account for more than 80% of incident cases in such settings. 2 Cain KP Haley CA Armstrong LR et al. Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination. Am J Respir Crit Care Med. 2007; 175: 75-79 Crossref PubMed Scopus (112) Google Scholar By contrast, in high-burden settings, identification and treatment of infectious active tuberculosis cases remains the priority, and the sheer burden of disease and limitation of resources mean that only certain groups at high risk for progression, such as children and people with HIV, are targeted for preventative therapy. 1 Dheda K Barry 3rd, CE Maartens G Tuberculosis. Lancet. 2016; 387: 1211-1226 Summary Full Text Full Text PDF PubMed Scopus (375) Google Scholar Nevertheless, uptake of screening and preventative therapy in HIV-infected people from tuberculosis-endemic countries has been poor 3 Gupta S Granich R Date A et al. Review of policy and status of implementation of collaborative HIV-TB activities in 23 high-burden countries. Int J Tuberc Lung Dis. 2014; 18: 1149-1158 Crossref PubMed Scopus (34) Google Scholar despite recommendations that tuberculin skin testing (TST) not be a prerequisite for preventative therapy, even though it enables better targeting of treatment. 4 WHOGuidelines on the management of latent tuberculosis infection. World Health Organization, Geneva2015 Google Scholar Thus, in both high-burden and low-burden settings, targeted preventative treatment is an important strategy for tuberculosis control. However, once identified, what proportion of this target population undergo medical evaluation, are tested for latent tuberculosis, return for initiation of preventative therapy, and complete therapy; and how much attrition occurs at each step and throughout the process? The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysisWe identify major losses at several steps in the cascade of care for latent tuberculosis infection. Improvements in management of latent tuberculosis will need programmatic approaches to address the losses at each step in the cascade. Full-Text PDF

Innovations in pneumonia diagnosis and treatment: a call to action on World Pneumonia Day, 2013.

Innovations in pneumonia diagnosis and treatment: a call to action on World Pneumonia Day, 2013.

Higher prevalence of breathlessness in elderly exposed to indoor aldehydes and VOCs in a representative sample of French dwellings

The purpose of this study was to explore respiratory health effects of indoor exposures to aldehydes and volatile organic compounds (VOCs) in elderly living in a population-based representative sample of French dwellings and to compare them to the rest of the occupants of the dwellings. Twenty VOCs were objectively measured in 490 main dwellings. The respiratory conditions were assessed through a standardized questionnaire in 1012 inhabitants aged over 15 years, 144 of whom were aged over 65 years. Generalized estimating equations (GEE) were used to model the relationship between respiratory health outcomes and air pollutants concentrations using the median value of the distribution to define elevated exposure. Similar levels of indoor air pollutants were found in elderly and others. However, associations between breathlessness and living in dwellings with elevated concentrations of toluene and o-xylene respectively were statistically significant in elderly but not in the rest of the population (adjusted odds ratios (AOR(95% confidence interval)=3.36(1.13, 9.98) and 2.85(1.06, 7.68) in elderly vs. 0.91(0.59, 1.39) and 0.79( 0.47, 1.34) in the others respectively). A more pronounced effect of n-decane on past year breathlessness was observed in case of poor ventilation in the dwellings. Our results showed a higher risk of breathlessness in elderly exposed to indoor air pollution than in the rest of the exposed population. Further investigations are needed to confirm whether this is related to frailty in elderly.

Errata.

IN THE ARTICLE entitled 'Trends in the annual risk of tuberculous infection in India' by V. K. Chadha, R. Sarin, P. Narang, K. R. John, K. K. Chopra, R. Jitendra, D. K. Mendiratta, V. Vohra, A. N. Shashidhara, G. Muniraj, P. G. Gopi, P. Kumar (Int J Tuberc Lung Dis 2013; 17(3): 312-319; http://dx.doi.org/10.5588/ijtld.12.0330), the affiliation for G. Muniraj should have read Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu.

Errata.

IN THE ARTICLE entitled 'Time to act to prevent and control tuberculosis among inmates' by M. Dara, S. S. Chadha, N. V. Melchers, J. van den Hombergh, E. Gurbanova, H. Al-Darraji, J. B. W. van der Meer (Int J Tuberc Lung Dis 2013; 17(1): 4-5; http://dx.doi.org/10.5588/ijtld.12.0909), the name of author N. V. Melchers should have read N. V. S. Vinkeles Melchers, and her affiliation should have read: Academic Medical Center, Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.

Erratum to ‘An evaluation of “Ribolola”: a household tuberculosis contact tracing programme in North West Province, South Africa’

IN THE ARTICLE entitled 'An evaluation of "Ribolola": a household tuberculosis contact tracing programme in North West Province, South Africa' by Thind D, Charalambous S, Tongman A, Churchyard G, Grant AD (Int J Tuberc Lung Dis 2012; 16(12): 1643-1648; http://dx.doi.org/10.5588/ijtld.12.0074), two errors occurred:On page 1644, paragraph 3, 'Those aged >5 years who were already on TBPT were nonetheless screened' should have read: 'Those aged ≥5 years who were already on TBPT were nonetheless screened'.And on page 1645, paragraph 6, 'All were aged <5 years' should have read: 'All were aged 5 years'.

Translating evidence into policy: the case for INH prophylaxis programs for health care personnel in India

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