eHealth in TB clinical management Margineanu, I.; Louka, C.; Akkerman, O. ...
The international journal of tuberculosis and lung disease,
12/2022, Volume:
26, Issue:
12
Journal Article
Peer reviewed
Open access
BACKGROUND: The constant expansion of internet and mobile technologies has created new opportunities in the field of eHealth, or the digital delivery of healthcare services. This TB meta-analysis ...aims to examine eHealth and its impact on TB clinical management in order to formulate
recommendations for further development.METHODS: A systematic search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework in PubMed and Embase of articles published up to April 2021. Screening, extraction and quality assessment were
performed by two independent researchers. Studies evaluating an internet and/or mobile-based eHealth intervention with an impact on TB clinical management were included. Outcomes were organised following the five domains described in the WHO "Recommendations on Digital Interventions
for Health System Strengthening" guideline.RESULTS: Search strategy yielded 3,873 studies, and 89 full texts were finally included. eHealth tended to enhance screening, diagnosis and treatment indicators, while being cost-effective and acceptable to users. The main challenges
concern hardware malfunction and software misuse.CONCLUSION: This study offers a broad overview of the innovative field of eHealth applications in TB. Different studies implementing eHealth solutions consistently reported on benefits, but also on specific challenges. eHealth is
a promising field of research and could enhance clinical management of TB.
Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing ...fever caused by Borrelia recurrentis was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions in both patients. Physicians should be aware of the possibility of B. recurrentis infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.
INTRODUCTION: Therapeutic drug monitoring (TDM) could improve TB treatment outcomes by avoiding drug toxicity or underdosing. In this study, we describe the patient burden in three TB centres in ...Romania and Ukraine with a TDM indication, as per the current guidelines, in order
to estimate the feasibility of implementing TDM.METHODS: A retrospective multi-centre study was conducted at the Iasi Lung Hospital (Iasi, Romania), Bucharest Marius Nasta Institute (Bucharest, Romania) and Chernivtsi TB Centre (Chernivtsi, Ukraine) in adult hospitalised TB patients.RESULTS:
A total of 927 participants were admitted, of whom 37.8% had at least one indication for TDM, the most frequent being slow response to TB treatment (202/345, 58.6%); 55.5% had at least one cavity present on chest X-ray. Patients with a TDM indication stayed in the hospital for a median of
67 days and took on average 2 months more to reach a successful TB outcome.CONCLUSION: TDM could be a valuable tool to improve management of selected TB patients. The decision on whether to perform TDM is often delayed by 2 months due to waiting for culture results after treatment
initiation. A randomised control trial should be performed in order to define TDM’s precise role in TB therapy.
Objectives
Buruli ulcer (BU) is a tropical skin disease caused by infection with Mycobacterium ulcerans, which is currently treated with 8 weeks of streptomycin and rifampicin. The evidence to treat ...BU for a duration of 8 weeks is limited; a recent retrospective study from Australia suggested that a shorter course of antimicrobial therapy might be equally effective. We studied the outcomes of BU in a cohort of Ghanaian patients who defaulted from treatment and as such received less than 8 weeks of antimicrobial therapy.
Methods
A number of days of antimicrobial therapy and patient and lesion characteristics were recorded from charts from a cohort of BU patients treated at Nkawie‐Toase hospital between 2008 and 2012. Patients who defaulted from treatment were retrieved, and lesion characteristics and functional limitations were recorded.
Results
About 54% of patients defaulted from therapy or wound care. Forty‐seven defaulters with follow‐up completed had received <56 days of antibiotics. 84% of these patients healed after 32 days or less of antibiotics. There appeared to be an increased rate of healing in smaller lesions; 94% of WHO category I lesions had healed after 32 days or less of antibiotics.
Conclusion
Although numbers were small, and a potential for bias exists, our findings suggest that a reduction in the duration of antimicrobial therapy in BU in small, early lesions is feasible. These findings can serve as a basis for future well‐designed studies.
Objectifs
l'ulcère de Buruli (UB) est une maladie cutanée tropicale causée par l'infection à Mycobacterium ulcerans, actuellement traitée avec la streptomycine et la rifampicine pendant 8 semaines. Les éléments de preuve pour traiter l’UB pendant 8 semaines sont limités; une étude rétrospective récente de l'Australie suggère qu'un régime plus court du traitement antimicrobien pourrait être tout aussi efficace. Nous avons étudié les résultats de l’UB dans une cohorte de patients ghanéens qui ont abandonné le traitement et ayant ainsi reçu moins de 8 semaines de traitement antimicrobien.
Méthodes
Le nombre de jours de traitement antimicrobien et les caractéristiques des patients et des lésions ont été enregistrés à partir des carnets d'une cohorte de patients UB traités à l'hôpital Nkawie‐Toase entre 2008 et 2012. Les patients qui ont abandonné le traitement ont été retrouvés et les caractéristiques des lésions et les limitations fonctionnelles ont été enregistrées.
Résultats
54% des patients ont abandonné le traitement ou les soins des plaies. 47 défaillants avec un suivi complété avaient reçu moins de 56 jours d'antibiotiques. 84% de ces patients ont été guéris après 32 jours ou moins d'antibiotiques. Il semble y avoir un taux de guérison accru pour les plus petites lésions; 94% des lésions de catégorie I de l’OMS étaient guéris après 32 jours ou moins d'antibiotiques.
Conclusion
Bien que le nombre soit peu élevé et qu'un biais potentiel existe, nos résultats suggèrent qu'une réduction de la durée du traitement antimicrobien dans l’UB pour les petites lésions précoces est possible. Ces résultats pourraient servir de base pour de futures études bien conçues.
Objetivos
La úlcera de Buruli (UB) es una enfermedad tropical de la piel causada por una infección con Mycobacterium ulcerans, que actualmente se trata con 8 semanas de estreptomicina y rifampicina. La evidencia de que el tratamiento de la UB debe ser de 8 semanas es limitada; un estudio retrospectivo reciente en Australia sugiere que una terapia antimicrobiana más corta podría ser igualmente efectiva. Hemos estudiado los resultados de la UB en una cohorte de pacientes de Ghana que dejaron el tratamiento antimicrobiano y por ello recibieron menos de 8 semanas de tratamiento.
Métodos
Se recogieron el número de días de terapia antimicrobiana y se tomó nota de las características de la lesión y de las limitaciones funcionales.
Resultados
Un 54% de los pacientes dejaron la terapia o los cuidados de la herida. 47 de estos pacientes que completaron el seguimiento recibieron menos de 56 días de antibióticos. Un 84% de estos pacientes se curaron después de 32 días o menos de antibióticos. Parecía haber una mayor tasa de curación en lesiones más pequeñas; un 94% de las lesiones con una categoría I según la clasificación de la OMS, sanaron tras 32 días o menos de antibióticos.
Conclusión
Aunque los números eran pequeños y podría haber sesgo, nuestros hallazgos sugieren que una reducción en la duración de la terapia antimicrobiana en UB con lesiones pequeñas es posible. Estos hallazgos podrían servir como base para estudios futuros bien diseñados.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background Morbidity due to Buruli ulcer disease (BUD), a cutaneous infection caused by Mycobacterium ulcerans, has been increasingly recognized in rural West Africa. The source and mode of ...transmission remain unknown. Methods To identify BUD risk factors, we conducted a case-control study in 3 BUD-endemic districts in Ghana. We enrolled case patients with clinically diagnosed BUD and obtained skin biopsy specimens. M. ulcerans infection was confirmed by at least 1 of the following diagnostic methods: histopathologic analysis, culture, polymerase chain reaction, and Ziehl-Neelsen staining of a lesion smear. We compared characteristics of case patients with confirmed BUD with those of age- and community-matched control subjects using conditional logistic regression analysis. Results Among 121 case patients with confirmed BUD, leg lesions (49%) or arm lesions (36%) were common. Male case patients were significantly more likely than female case patients to have lesions on the trunk (25% vs. 6%; P = .009). Multivariable modeling among 116 matched case-control pairs identified wading in a river as a risk factor for BUD (odds ratio OR, 2.69; 95% confidence interval CI, 1.27–5.68; P = .0096). Wearing a shirt while farming (OR, 0.27; 95% CI, 0.11–0.70; P = .0071), sharing indoor living space with livestock (OR, 0.36; 95% CI, 0.15–0.86; P = .022), and bathing with toilet soap (OR, 0.41; 95% CI, 0.19–0.90; P = .026) appeared to be protective. BUD was not significantly associated with penetrating injuries (P = .14), insect bites near water bodies (P = .84), bacille Calmette-Guérin vaccination (P = .33), or human immunodeficiency virus infection (P = .99). Conclusions BUD is an environmentally acquired infection strongly associated with exposure to river areas. Exposed skin may facilitate transmission. Until transmission is better defined, control strategies in BUD-endemic areas could include covering exposed skin.
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BFBNIB, NUK, PNG, UL, UM, UPUK
Management of BU–HIV co‐infection O'Brien, D. P.; Ford, N.; Vitoria, M. ...
TM & IH. Tropical medicine and international health/TM & IH. Tropical medicine & international health,
September 2014, Volume:
19, Issue:
9
Journal Article
Peer reviewed
Open access
Background
Buruli Ulcer (BU)–HIV co‐infection is an important emerging management challenge for BU disease. Limited by paucity of scientific studies, guidance for management of this co‐infection has ...been lacking.
Methods
Initiated by WHO, a panel of experts in BU and HIV management developed guidance principles for the management of BU–HIV co‐infection based on review of available scientific evidence, current treatment experience, and global recommendations established for management of HIV infection and tuberculosis.
Results
The expert panel agreed that all BU patients should be offered quality provider‐initiated HIV testing and counselling. In areas with high prevalence of malaria and/or bacterial infections, all patients with HIV co‐infection should be started on cotrimoxazole preventative therapy. Combination antibiotic treatment for BU should be commenced before starting antiretroviral therapy (ART) and provided for 8 weeks duration. The suggested combination is rifampicin (10 mg/kg daily up to a maximum of 600 mg/day) plus streptomycin (15 mg/kg daily). An alternative regimen is rifampicin plus clarithromycin (7.5 mg/kg twice daily up to a maximum of 1000 mg daily) although due to drug interactions with antiretroviral drugs this regimen should be used with caution. ART should be initiated in all BU–HIV co‐infected patients with symptomatic HIV disease (WHO clinical stage 3 or 4) regardless of CD4 cell count and in asymptomatic individuals with CD4 count ≤500 cells/mm3. If CD4 count is not available, BU–HIV co‐infected individuals with category 2 or 3 BU disease should be offered ART. For eligible individuals, ART should be commenced as soon as possible within 8 weeks after commencing BU treatment, and as a priority in those with advanced HIV disease (CD4 ≤ 350 cells/mm3 or WHO stage 3 or 4 disease). All co‐infected patients should be actively screened for tuberculosis before commencing BU treatment and before starting ART. Programmes should implement a monitoring and reporting system to document the outcomes of BU–HIV interventions.
Conclusions
Knowledge of the clinical and epidemiological interactions between BU and HIV disease is limited. While awaiting more urgently needed evidence, current management practice of both diseases has been useful to build simple ‘common sense’ preliminary guidance on how to manage BU–HIV co‐infection.
Contexte
La coinfection ulcère de Buruli (UB)‐VIH est un enjeu important émergent dans la prise en charge de l’UB. Limités par la rareté des études scientifiques, des conseils pour la prise en charge de cette coinfection font défaut.
Méthodes
Initié par l’OMS, un groupe d'experts dans la prise en charge de l’UB et du VIH a mis au point de principes de guidance pour la prise en charge de la coinfection UB‐VIH, fondés sur l'analyse des éléments de preuve scientifiques disponibles, l'expérience actuelle de traitement et les recommandations globales établies pour la prise en charge de l'infection VIH et de la tuberculose.
Résultats
Le groupe d'experts a convenu qu'un conseil et dépistage du VIH de qualité à l'initiative du prestataire devrait être offert à tous les patients UB. Dans les zones à forte prévalence du paludisme et/ou des infections bactériennes, tous les patients coinfectés par le VIH devraient être initiés à la thérapie préventive au cotrimoxazole. Le traitement antibiotique de combinaison pour l’UB devrait être introduit avant le début de l’ART et procuré pour une durée de 8 semaines. La combinaison suggérée est la rifampicine (10 mg/kg par jour, jusqu’à un maximum de 600 mg/jour) plus de la streptomycine (15 mg/kg par jour). Un régime alternatif consiste en la rifampicine (7,5 mg/kg deux fois par jour jusqu’à un maximum de 1000 mg par jour) plus la clarithromycine, mais en raison d'interactions avec les médicaments antirétroviraux ce régime devrait être utilisé avec prudence. L’ART devrait être instaurée chez tous les patients coinfectés UB‐VIH avec la maladie VIH symptomatique (stade clinique 3 ou 4 de l’OMS), quel que soit le nombre de cellules CD4 et chez les sujets asymptomatiques avec des CD4 ≤ 500 cellules/mm3. Si la numération des CD4 n'est pas disponible, l’ART devrait être offerte aux personnes coinfectées par l’UB et le VIH avec la catégorie 2 ou 3 de la maladie UB. Pour les personnes admissibles, l’ART devrait être débutée le plus tôt possible dans les 8 semaines après le début du traitement de l’UB, et en priorité chez ceux avec la maladie VIH avancée (CD4 ≤ 350 cellules/mm3 ou stade clinique 3 ou 4 de l’OMS). Tous les patients coinfectés devraient être dépistés activement pour la tuberculose avant le commencement du traitement UB et avant de commencer l’ART. Les programmes devraient mettre en œuvre un système de suivi et de report pour documenter les résultats des interventions UB‐VIH.
Conclusions
Les connaissances sur les interactions cliniques et épidémiologiques entre l’UB et le VIH sont limitées. En attendant des preuves plus urgemment nécessaires, la pratique actuelle de la prise en charge de ces deux maladies a été utile pour développer une guidance préliminaire simple de «bon sens» sur la façon de gérer la coinfection UB‐VIH.
Antecedentes
La coinfección con úlcera de Buruli (UB) y VIH es un importante reto emergente en el manejo de la enfermedad de la UB. Con limitaciones por la escasez de estudios científicos, hacen falta guías sobre el manejo clínico de esta coinfección.
Métodos
Iniciado por la OMS, un panel de expertos en el manejo de la UB y el VIH desarrollaron una guía para el manejo de la coinfección UB‐VIH, basándose en la revisión de la evidencia científica disponible, de experiencias actuales sobre el tratamiento y de recomendaciones globales establecidas para el manejo de la infección por VIH y tuberculosis.
Resultados
El panel de expertos estuvo de acuerdo en que a los pacientes con UB se les debería ofrecer el aconsejamiento y prueba para VIH con un proveedor de calidad. En áreas con una alta prevalencia de malaria y/o infecciones bacterianas, todos los pacientes coinfectados con VIH deberían comenzar una terapia preventiva con cotrimoxazol. El tratamiento para la UB con una combinación de antibióticos debería iniciarse antes de comenzar el TAR y suministrarse durante 8 semanas. La combinación sugerida es de rifampicina (10 mg/kg al día y hasta máximo 600 mg/día) más estreptomicina (15 mg/kg día). Un régimen alternativo es el de rifampicina más claritromicina (7. 5 mg/kg dos veces al día, y máximo 1000 mg al día) aunque debido a la interacción con los antirretrovirales, este régimen debería utilizarse con precaución. El TAR se debería iniciar en todos los pacientes con coinfección UB‐VIH con síntomas de VIH (estadíos clínicos de la OMS 3 o 4) independientemente del conteo de células CD4, y en individuos asintomáticos con conteos de CD4 ≤500 células/mm3. Si no hay medios para realizar un conteo de CD4, a los individuos coinfectados con UB‐VIH, con una UB de categoría 2 o 3, se les debería ofrecer TAR. Para individuos elegibles, se debería comenzar con el TAR lo antes posible dentro de las 8 semanas siguientes al comienzo del tratamiento para la UB, y como prioridad entre aquellos con una enfermedad avanzada por VIH (CD4 ≤350 células/mm3 o estadíos de la OMS de 3 o 4). A todos los pacientes coinfectados se les debería realizar el despistaje para tuberculosis antes de comenzar el tratamiento para la UB y antes de comenzar el TAR. Los programas deberían implementar sistemas de monitorización y reportes para documentar los resultados de las intervenciones para UB‐VIH.
Conclusiones
El conocimiento de las interacciones clínicas y epidemiológicas entre la UB y el VIH es limitado. A la espera de contar con una mayor evidencia, la cual se necesita urgentemente, las prácticas actuales en el manejo de ambas enfermedades podrían ser útiles para construir una guía preliminar basada en el “sentido común” sobre cómo manejar la coinfección UB‐VIH.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Tularemia is thought to be rare in the Netherlands. Here we describe a cluster of two patients who contracted tularaemia after field dressing of a hare found dead. Additionally, infection from the ...same source is suggested in three animals.
Similar to other mycobacterial diseases, susceptibility to Buruli ulcer (Mycobacterium ulcerans infection) may be determined by host genetic factors. We investigated the role of SLC11A1 (NRAMP1) in ...Buruli ulcer because of its associations with both tuberculosis and leprosy. We enrolled 182 Buruli ulcer patients (102 with positive laboratory confirmation) and 191 healthy neighbourhood-matched controls in Ghana, and studied three polymorphisms in the SLC11A1 gene: 3' UTR TGTG ins/del, D543N G/A, and INT4 G/C. Finger prick blood samples from study subjects were dried on filter papers (FTA) and processed. D543N was significantly associated with Buruli ulcer: the odds ratio (adjusted for gender, age, and region of the participant) of the GA genotype versus the GG genotype was 2.89 (95% confidence intervals (CI): 1.41-5.91). We conclude that a genetic polymorphism in the SLC11A1 gene plays a role in susceptibility to develop Buruli ulcer, with an estimated 13% population attributable risk.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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