Little is known about the relationship between the COVID-19 and tuberculosis (TB). The aim of this study is to describe a group of patients who died with TB (active disease or sequelae) and COVID-19 ...in two cohorts.
Data from 49 consecutive cases in 8 countries (cohort A) and 20 hospitalised patients with TB and COVID-19 (cohort B) were analysed and patients who died were described. Demographic and clinical variables were retrospectively collected, including co-morbidities and risk factors for TB and COVID-19 mortality.
Overall, 8 out of 69 (11.6%) patients died, 7 from cohort A (14.3%) and one from cohort B (5%).
Out of 69 patients 43 were migrants, 26/49 (53.1%) in cohort A and 17/20 (85.0%) in cohort B.
Migrants: (1) were younger than natives; in cohort A the median (IQR) age was 40 (27–49) VS. 66 (46–70) years, whereas in cohort B 37 (27–46) VS. 48 (47–60) years; (2) had a lower mortality rate than natives (1/43, 2.3% versus 7/26, 26.9%; p-value: 0.002); (3) had fewer co-morbidities than natives (23/43, 53.5% versus 5/26–19.2%) natives; p-value: 0.005).
The study findings show that: (1) mortality is likely to occur in elderly patients with co-morbidities; (2) TB might not be a major determinant of mortality and (3) migrants had lower mortality, probably because of their younger age and lower number of co-morbidities. However, in settings where advanced forms of TB frequently occur and are caused by drug-resistant strains of M. tuberculosis, higher mortality rates can be expected in young individuals.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
BACKGROUND: Treatment outcomes in multidrug-resistant TB (MDR-TB) patients are suboptimal in several low-incidence countries.METHODS: The primary outcome measure was the proportion of successfully ...treated patients in Italy during an 18-year
period. Secondary outcomes were treatment outcomes in certain drug-containing regimens and the possibility for the WHO shorter MDR-TB regimen.RESULTS: In the 191 patients included (median age at admission: 33 years; 67.5% male, following drug-resistance patterns
were found: MDR-TB in 68.6%, pre-extensively drug-resistant TB (pre-XDR-TB) in 30.4% and XDR-TB in 1.1% patients. The most frequently prescribed drugs were fluoroquinolones in 84.6% cases, amikacin in 48.7%, linezolid in 34.6% and meropenem/clavulanic
acid in 29.5%. The median duration of treatment was 18 months. Treatment success was achieved in 71.2% patients, of whom, 44% were cured and 27.2% completed treatment. Treatment success rates did not statistically differ between the MDR- (68.8%) and pre-XDR-TB (77.6%)
groups (P = 0.26). Treatment success rates had large variability between North and South of Italy (81.3% vs. 53.3%). Only 22.5% of the cases would have been eligible for shorter MDR-TB regimensCONCLUSION: Our study highlights variability in treatment outcomes in MDR-
and pre-XDR-TB patients. Study findings confirmed the potential utility of linezolid and, for patients with limited oral options, meropenem/clavulanic acid and amikacin.
Background
Non-tuberculous mycobacteria (NTM) are generally free-living organism, widely distributed in the environment, with sporadic potential to infect. In recent years, there has been a ...significant increase in the global incidence of NTM-related disease, spanning across all continents and an increased mortality after the diagnosis has been reported. The decisions on whether to treat or not and which drugs to use are complex and require a multidisciplinary approach as well as patients’ involvement in the decision process.
Methods and Results
This review aims at describing the drugs used for treating NTM-associated diseases emphasizing the efficacy, tolerability, optimization strategies as well as possible drugs that might be used in case of intolerance or resistance. We also reviewed data on newer compounds highlighting the lack of randomised clinical trials for many drugs but also encouraging preliminary data for others. We also focused on non-pharmacological interventions that need to be adopted during care of individuals with NTM-associated diseases
Conclusions
Despite insufficient efficacy and poor tolerability this review emphasizes the improvement in patients’ care and the needs for future studies in the field of anti-NTM treatments.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The emergence of drug-resistant tuberculosis (TB) is a challenge to TB control in Europe. We evaluated second-line drug susceptibility testing in Mycobacterium tuberculosis isolates from patients ...with multidrug-resistant, pre-extensively drug-resistant (pre-XDR-TB) and XDR-TB
at 23 TBNET sites in 16 European countries. Over 30% of bacilli from patients with pre-XDR-TB showed resistance to any fluoroquinolone and almost 70% to any second-line injectable drug. Respectively >90% and >80% of the XDR-TB strains tested showed phenotypic resistance to pyrazinamide
and ethambutol. Resistance to prothionamide/ethionamide was high in bacilli from pre-XDR-TB patients (43%) and XDR-TB patients (49%).
BACKGROUND: Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union ...Standards for Tuberculosis Care (ESTC).METHODS: In 2017, we conducted an
audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability.RESULTS: Data from 122 patients, diagnosed
between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug-resistant TB (XDR-TB) (n = 11), pre-XDR-TB (n = 29) and drug-susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general
in agreement with the ESTC.CONCLUSION: Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient-centred
approaches.
Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in low incidence countries in Europe. The aim of this study was to attempt to have a better insight into the trends of ...MDR-TB in the metropolitan area of Rome, within the Italian and the foreign-born population, based on microbiological and demographic data.
We performed a prospective study, collecting microbiological data based on phenotypic drug-resistant testing (DST) of TB strains consecutively isolated in a referral hospital in Rome, the capital city of a low TB incidence country, over a 6-year period, and correlated them to the geographical origin of patients. This study was carried out in a referral hospital for patients with drug-resistant TB from the whole region.
Drug-resistance data from 926 patients with a microbiological diagnosis of TB from 2011 to 2016 show a 5.5% rate of MDR-TB, mostly occurring in patients born in a single East European country, that has a high incidence of MDR-TB. The strains isolated from these patients frequently carry additional resistances, leading to an increased risk of developing extensively drug-resistant (XDR) TB.
In the great metropolitan area of Rome, MDR-TB more frequently occurs in patients who were born in a single country from Eastern Europe known to have high rates of MDR-TB and long-time residents in Italy. Recent immigrants from non-European countries do not appear to contribute to the rates of MDR-TB reported in this article. This knowledge of local TB trends could help improve the measures of surveillance and prevention of disease.
SETTING: A tuberculosis (TB) referral centre in Rome, Italy.OBJECTIVE: To identify demographic and epidemiological characteristics associated with diabetes mellitus (DM) among patients with TB and to ...compare the clinical presentation of TB and TB-DM in the light of the growing worldwide
burden of DM.DESIGN: We performed a retrospective study of TB cases diagnosed from 2007 to 2012.RESULTS: Among 971 TB patients, 723 were foreign-born and 63 (6.5%) had DM. DM prevalence was 12.7% (8/63) among those born in countries with DM prevalence 8%, 4.7% (31/660) among patients
from countries with DM prevalence <8% and 9.7% among Italian patients (24/248). In multivariable analysis, DM was independently associated with older age, and with being born in countries other than Italy, compared to Italians; this latter association was stronger in older patients. DM
patients were also significantly more likely to be male and less likely to test positive for the human immunodeficiency virus. The presence of cavities was significantly associated with DM.CONCLUSIONS: As individuals born in high TB incidence and high DM prevalence countries emerge as
a vulnerable population, greater attention to bidirectional low-cost screening in people from these countries is needed.
Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower.
To document the ...management and treatment outcome in patients with MDR-TB in Europe.
We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET).
A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%).
Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
The ongoing HIV epidemic and the increasing number of patients with drug-resistant tuberculosis (TB) are seriously hampering global TB-control activities, including those in the World Health ...Organization (WHO) Region Europe. Overall, the prevalence of HIV co-infection in TB patients increased from 3.4% in 2008 to 8% in 2014 in the region 1. The prevalence of multidrug-resistant (MDR)-TB (drug resistance against at least isoniazid and rifampicin) reported for Europe – 15% in newly diagnosed TB patients and 48% in previously treated TB patients – is the highest in the world 1.
According to the World Health Organization (WHO), successful treatment outcome from pulmonary TB includes patients who meet the criteria for cure and treatment completion (1). ...WHO-defined ...definitions for cure and failure in patients with non-MDR-TB are frequently not met in many European countries, as necessary investigations are not performed. Martin J. Dedicoat· Heart of England Foundation Trust Birmingham, United Kingdom and University of Warwick Coventry, United Kingdom Gunar Gunther· Research Center Borstel Borstel, Germany and University of Namibia School of Medicine Windhoek, Namibia Valeriu Crudu Institute of Phthisiopneumology Chisinau, Republic of Moldova and National TB Reference Laboratory Chisinau, Republic of Moldova Raquel Duarte Porto University Porto, Portugal Gina Gualano National Institute for Infectious Diseases "L, Spallanzani" Rome, Italy Cecile Magis-Escurra Radboud University Medical Centre Nijmegen/Groesbeek, the Netherlands Rudolf Rumetshofer Otto Wagner Hospital Vienna, Austria Alena Skrahina Republican Research and Practical Centre for Pulmonology and Tuberculosis Minsk, Belarus Victor Spinu Marius-Nasta-Institut Bucharest, Romania Simon Tiberi AOVV E. Morelli Reference Hospital for MDR and HIV-TB Sondalo, Italy and Barts Health NHS Trust London, United Kingdom Piret Viiklepp National Institute for Health Development Tallinn, Estonia Frank van Leth· University of Amsterdam Amsterdam, the Netherlands and Amsterdam Institute for Global Health and Development Amsterdam, the Netherlands Christoph Lange· Research Center Borstel Borstel, Germany German Center for Infection Research (DZIF) Borstel, Germany University of Lubeck Lubeck, Germany and Karolínska Institute Stockholm, Sweden for TBNET4 *M.J.D., G.G., F.v.L., and C.L. contributed equally to this work. Additional collaborators of the TBNET MDR-TB hospital collaboration are (in alphabetical order): Sofia Alexandru, Institute of Phthisiopneumology, Chisinau, Republic of Moldova; Neus Altet, Unitat de Tuberculosis Vall d'Hebron-Drassanes, DOTS clinic "Servicios Clinicos," Barcelona, Spain; Korkut Avsar, Asklepios Klinik Gauting, Gauting, Germany; Didi Bang, Statens Serum Institut, Copenhagen, Denmark; Raisa Barbuta, Balti Municipal Hospital, Balti, Republic of Moldova; Graham Bothamley, Homerton University Hospital, London, United Kingdom; Ana Ciobanu, Institute of Phthisiopneumology, Chisinau, Republic of Moldova; Manfred Danilovits, Tartu University Lung Hospital, Tartu, Estonia; Heinke Kunst, Heart of England Foundation Trust, Birmingham, United Kingdom, and Queen Mary University, London, United Kingdom; Wiel de Lange, University Medical Center Groningen, Groningen, the Netherlands; Vaira Leimane, Riga East University Hospital, Riga, Latvia; Anne-Marie McLaughlin, St James's Hospital, Dublin, Ireland; Inge Muylle, University Medical Center St. Pieter, Brussels, Belgium; Veronika Polcova, Thomayer University Hospital, Prague, Czech Republic; Cristina Popa, Marius-Nasta-Institut, Bucharest, Romania; and Varvara Solodovnikova, Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
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