Factors Associated with Multidrugresistant Tuberculosis: Comparison of Patients Born Inside and Outside of the Czech Republic
|
|
- Reynard Hawkins
- 5 years ago
- Views:
Transcription
1 The Journal of International Medical Research 2010; 38: [first published online as 38(3) 26] Factors Associated with Multidrugresistant Tuberculosis: Comparison of Patients Born Inside and Outside of the Czech Republic V BARTU 1, E KOPECKA 2 AND M HAVELKOVA 3 1 Department of Respiratory Diseases, Medicon, Prague, Czech Republic; 2 Central Unit for MDR-TB, Department of Respiratory Diseases, 1st Medical School, Faculty Thomayer Hospital, Prague, Czech Republic; 3 Mycobacteriology Unit and National Reference Laboratory for Mycobacteria NIPH, WHO/IUATLD Supranational Reference Laboratory for Mycobacteria, Prague, Czech Republic Multidrug-resistant tuberculosis (MDR- TB) is defined as resistance of Mycobacterium tuberculosis complex (MTB) to at least isoniazid and rifampicin. The aim of this study was to evaluate and compare a cohort of 50 patients with MDR-TB according to birthplace, resistance type, clinical outcome, length of bacteriological positivity of sputum and length of hospitalization. Thirty-three of the patients were born in the Czech Republic (group A) and 17 were immigrants to the Czech Republic (group B). Patients in group B were significantly younger (mean [range] age 33 [19 56] years) than those in group A (mean [range] age 48 [33 80] years). Primary resistance was present in 16 (48%) cases in group A and in 13 (76%) cases in group B. There were 36 (72%) cured patients, five (10%) remained on treatment and nine (18%) died; no patients failed or transferred out of the study. The mean length of bacteriological positivity of sputum samples was 5.9 months and the mean length of hospitalization was 8.2 months. Resistance to capreomycin was an important predictor of poor outcome. KEY WORDS: MULTIDRUG-RESISTANT TUBERCULOSIS; RISK FACTORS; IMMIGRANTS; CZECH REPUBLIC; CLINICAL OUTCOME Introduction Tuberculosis (TB) remains one of the leading global infectious diseases. Multidrugresistant TB (MDR-TB) is characterized by resistance to the most potent anti-tb drugs, isoniazid and rifampicin, and contributes to rising morbidity and mortality rates for people with TB. 1 The most recent data, from 2006, show that the number of new cases of MDR-TB per annum is approaching half a million. 2 One of the priorities of TB management is monitoring the trends in drug resistance, in particular its impact on the incidence of MDR-TB. 3 In global terms, although there are some geographical differences, immigrants make up a substantial (and increasing) proportion of TB cases in the Western world. On average 1156
2 across western Europe, for example, 30% of the cases of TB occur in immigrants, although this figure is as high as 70% of cases in Norway, Sweden and The Netherlands; conversely, for southern Europe, immigrants make up only 15% of all TB cases. 4,5 The Czech Republic is a country with a favourable TB epidemiological situation: in 2008, 871 cases of TB were recorded, with an incidence of 8.4 per inhabitants; 153 of the cases (17.6%) were male immigrants. MDR-TB accounts for 2% of the overall TB prevalence and the number of cases has been stable in recent years. 6 The Czech Republic now represents a natural transit point for patients from eastern Europe or Asia who are aiming to live in a central or western European country. Consequently, authorities in the Czech Republic now pay much more attention to TB diagnosis and treatment in immigrants in order to prevent the further spread of TB, particularly its drug-resistant forms. The management of MDR-TB is complicated and the choice of an optimal therapeutic regimen may be controversial since few directly comparable published protocols exist. 7 In addition to first-line anti- TB therapies, MDR-TB requires sensitive second-line drugs (e.g. aminoglycosides, capreomycin, fluoroquinolones, ethionamid and para-aminosalicyclic acid [PAS]), which show lower efficacy and higher toxicity compared with first-line agents. 8 MDR-TB management should involve at least four sensitive drugs, 9 which are used over a long treatment period that varies between 18 and 24 months. 10 The aim of the present study was to evaluate and compare cohorts of patients with MDR-TB, born inside and outside of the Czech Republic, who were treated at the specialist unit for MDR-TB in Prague that serves the entire country. The study focused on demographic, clinical and epidemiological patient data. Patients and methods PATIENTS Patients with MDR-TB, who were treated at the Central Unit for MDR-TB, Department of Respiratory Diseases, 1st Medical School, Faculty Thomayer Hospital, Prague, Czech Republic, between 1 January 2001 and 30 June 2009, were enrolled sequentially into this retrospective study. Patients were monitored for between 6 and 24 months after completing treatment and were divided into two groups according to their birthplace: group A comprised patients born in the Czech Republic; and group B comprised immigrants to the Czech Republic. Each case of MDR-TB was identified according to World Health Organization (WHO) criteria for the management of resistant TB. 11 These criteria were also used to define resistance, record and evaluate treatment, and monitor outcome. An MDR-TB case was defined as a patient with disease where infectious Mycobacterium tuberculosis complex (MTB) isolates were resistant in vitro to at least isoniazid and rifampicin. Written informed consent was obtained for the initiation of MDR-TB treatment from all patients. The protocol was approved by the Ethics Review Committee of Faculty Thomayer Hospital. EPIDEMIOLOGICAL CLINICAL AND LABORATORY EVALUATIONS Epidemiological and clinical aspects of patients disease were evaluated. For each patient, the treating physician took anamnesis data and carried out a routine chest X-ray. TB resistance types and extent of MTB resistance, including its impact on the use of treatments classified as first- and 1157
3 second-line anti-tb drugs was assessed. Microbiological tests included repeated microscopic and culture examinations of sputum samples, the length of time to bacteriological conversion of sputum, identification of MTB isolates, and drug susceptibility testing. The results of susceptibility testing for firstline (isoniazid, ethambutol, streptomycin, pyrazinamide and rifampicin) and secondline (capreomycin, amikacin, kanamycin, ethionamid, ofloxacin, ciprofloxacin, cycloserine, clofazimin and PAS) anti-tb drugs were evaluated. All tests were confirmed with data for mycobacteria from the National Reference Laboratory for Mycobacteria (NRLM), and susceptibility testing was performed in accordance with recommended standard methods in microbiology for mycobacterial infections (National Health Institute NRLM, Prague, 1998) by Canetti s proportion method 12 (firstline anti-tb, kanamycin, ethionamid, cycloserine and PAS). For amikacin, rifabutin, ofloxacin, ciprofloxacin, clofazimin and capreomycin, a microdilution method was used to determine their minimum inhibition concentrations (mg/l). From 2004, the GenoType MTBDR test (Hain Lifescience, Nehren, Germany) confirmed that MTB with so-called marginal susceptibility to rifampicin or isoniazid was resistant to these drugs. In the entire cohort, the number of resistant first-line anti-tb drugs was evaluated in relation to microscopic and culture positivity of sputum. Clinical outcome and length of hospitalization were monitored; outcome was defined according to WHO definitions as cured, died, on treatment, failed and transferred out. Human immunodeficiency virus (HIV) serological testing was performed in all cases. TREATMENT PROCESS AND MONITORING All patients received individualized treatment regimens in accordance with WHO recommendations. 11 These regimens were based on the results of susceptibility testing conducted for the first- and secondline anti-tb treatments. Daily drug dosages were administered in accordance with the WHO recommendations. After sputum samples became negative, repeat testing was performed monthly and patients were considered cured after 18 months consecutive negative cultures. At this point, treatment ceased and they were discharged from care. Direct monitoring continued from the initial treatment phase, through hospitalization, and until the achievement of repeated bacteriological conversion of sputum. Routine laboratory monitoring including ions, liver function, urea and creatinine testing was performed monthly. After transferring patients to out-patient treatment regimens, direct therapeutic monitoring was not ensured in all people. During this period, patients were evaluated monthly with the focus on tolerance and undesirable treatment effects. STATISTICAL ANALYSIS Normally distributed data were analysed by analysis of variance and differences among groups were detected using the Tuke Kramer test. The Kruskal Wallis test and Kruskal Wallis Z-test were used in cases of nonnormal data distribution. A P value 0.05 was considered to be statistically significant. Results A total of 50 patients with MDR-TB, treated at the Central Unit for MDR-TB in Prague, Czech Republic, between 1 January 2001 and 30 June 2009, were enrolled into this 1158
4 retrospective study; 33 patients were born in the Czech Republic (group A) and 17 were immigrants to the Czech Republic (group B). Patients in group B originated from the Ukraine (n = 8), Russia (n = 3), Belarus (n = 2), Moldova (n = 1), Vietnam (n = 1), Korea (n = 1) and Croatia (n = 1). Table 1 shows the key demographic and clinical characteristics. A total of 37 patients (74%) had epidemiologically defined serious TB, with microscopic- and culture-positive sputum. All patients had pulmonary MDR-TB; none was diagnosed with non-pulmonary TB and none was HIV positive. The patients in group B were significantly younger than the patients in group A (P = ) (Table 1). Seventeen patients (52%) in group A, and four (24%) in group B, had anamnesis of previous TB treatments and had previously used anti-tb drugs for > 1 month, which corresponded to the resistance data obtained. Resistance to four of the five first-line anti-tb drugs (isoniazid, rifampicin, ethambutol, streptomycin) and possibly also to pyrazinamide was commonly found. In the whole cohort, such resistance was identified in 26 (52%) patients: 18 (55%) from group A and eight (47%) from group B. Resistance to three drugs was diagnosed in 13 (26%) patients: eight (24%) from group A and five (29%) from group B. Resistance to isoniazid and rifampicin was proven in only 11 (22%) of the whole cohort of patients; seven (21%) from group A and four (24%) from group B. Levels of resistance to second-line anti-tb drugs across the entire cohort are shown in Table 2; the four patients with capreomycinresistant disease died of MDR-TB. In addition, fluoroquinolone resistance was identified in 15 (30%) of the patients, of whom five (29%) were from group B. The number of drugs used in individual regimens was dependent on the results of in vitro drug susceptibility testing. Usually, aminoglycoside or capreomycin, fluoroquinolone, ethionamid, cycloserine or PAS were administered; the number of drugs used in combination are listed in Table 3. Treatment outcomes for patients in both study groups, according to WHO definitions, are listed in Table 4. In total, 36 (72%) of the patients were cured, five (10%) remained on treatment and nine (18%) patients died (all in group A). None of the patients required surgery during the study period. It was not necessary to interrupt therapy due to drug toxicity in any of the patients, although dyspeptic difficulties (nausea and loss of appetite) were present in two (4%) patients; there were no similarities in the treatment regimens for these two patients which might TABLE 1: Demographic and clinical characteristics of Czech Republic-born or immigrant patients (n = 50) with multidrug-resistant tuberculosis treated in Prague, Czech Republic Czech Republic-born Immigrants Demographic or characteristic (group A) (group B) Patients, n (%) 33 (66) 17 (34) Age, mean years (range) 48 (33 80) 33 (19 56) a Male sex, n (%) 28 (85) 13 (76) Primary resistance, n (%) 16 (48) 13 (76) Acquired resistance, n (%) 17 (52) 4 (24) Smear and culture positive, n (%) 23 (70) 14 (82) Only culture positive, n (%) 10 (30) 3 (18) a P = versus Czech Republic-born patients (Tuke Kramer test). 1159
5 TABLE 2: Resistance levels to second-line antituberculosis drugs in the cohort of patients (n = 50) with multidrug-resistant tuberculosis treated in Prague, Czech Republic Drug resistant combinations n (%) AMK 2 (4) AMK + CPX 4 (8) AMK + CPX + PAS 4 (8) AMK + CPX + PAS + CS 7 (14) AMK + CS + CL 5 (10) AMK + PAS + CL 7 (14) CM 4 (8) AMK, amikacin; CPX, ciprofloxacin; PAS, paraaminosalicylic acid; CS, cycloserin; CL, clofazimin, CM, capreomycin. TABLE 3: Number of antituberculosis drugs used in combination in the treatment of patients (n = 50) with multidrug-resistant tuberculosis treated in Prague, Czech Republic Drug combination n (%) Four drugs 13 (26) Five drugs 31 (62) Six drugs 6 (12) have accounted for the dyspeptic difficulties. Nine patients died, all males born in the Czech Republic (mean age [range] 52 [40 80] years), eight of whom had both microscopic- and culture-positive MDR-TB. Secondary resistance was proven in seven of the nine cases and seven of the deceased patients had resistance to four anti-tb drugs. All the deceased patients were smokers with concomitant medical problems: chronic obstructive pulmonary disease (COPD, n = 6), cardiovascular disease (n = 3), diabetes mellitus (n = 3), or hepatopathy (n = 4). In comparison with patients who were cured, those who died were significantly older (P = 0.05) and also resistant to more anti-tb drugs (although the difference in resistance did not reach statistical significance in this study [P = ]). The mean ± SD length of hospitalization was 8.2 ± 5.7 months, being slightly longer for group A (9.1 ± 5.9 months) and shorter for group B (6.5 ± 3.4 months); this difference was not statistically significant. The mean ± SD length of time that sputum remained microscopic- and culture-positive was 5.9 ± 5.2 months for the whole cohort (6.7 ± 3.6 months for group A and 4.5 ± 2.3 months for group B; not statistically significant). After sputum samples became negative, monthly testing was performed and patients were considered cured after 18 months consecutive negative cultures, whereupon treatment ceased and they were discharged. TABLE 4: Treatment outcomes, according to World Health Organization definitions, 11 for the Czech Republic-born or immigrant patients (n = 50) with multidrug-resistant tuberculosis treated in Prague, Czech Republic Czech Republic-born Immigrants Outcome (group A) (n = 33) (group B) (n = 17) Cured, n (%) 21 (64) 15 (88) On treatment, n (%) 3 (9) 2 (12) Died, n (%) 9 (27) 0 (0) Failed, n (%) 0 (0) 0 (0) Transferred out, n (%) 0 (0) 0 (0) No statistically significant between-group differences. 1160
6 Discussion Drug resistance in the treatment of TB is generally a man-made problem caused by unsuitable drug administration and poor patient adherence to treatment. These problems have led to an increase in the number of people with MDR-TB, which now comprises 5.3% of all TB cases. 13,14 In many countries, the number of immigrants who have TB is increasing. In the present study, 17 of the 50 patients (34%) with MDR-TB were from eastern Europe and Asia, which supports this international trend. It is unsurprising that people migrate from these countries to the Czech Republic as it has strong connections with both western and eastern Europe. Significant differences in clinical and epidemiological data were observed between patients born in the Czech Republic compared with those who were immigrants; e.g. immigrants with MDR-TB were significantly younger than patients born in the Czech Republic. Immigrants often come to the Czech Republic for employment opportunities and to enjoy the improved socioeconomic culture and are, therefore, likely to be younger. Similar to findings reported from Spain, 4 primary resistance to anti-tb drugs was higher among immigrants than among Czech Republic-born patients, although this did not reach statistical significance in the present study. The high incidence of drug resistance found among people who had previously received > 1 month s anti-tb treatment confirms systematic failures in the detection, treatment and isolation of people with resistant MTB. Such failures can easily contribute to the spread of TB and are key reasons for the ever-increasing global incidence in MDR-TB cases through the migration of infected people from countries with high epidemiological risk of drugresistant disease. 3 Aminoglycosides and fluoroquinolones play key roles in the success of treatment for MDR-TB. The most important predictor of resistance to a particular drug is its prior use as anti-tb therapy for > 1 month. 9 Resistance to capreomycin alone, but not to either kanamycin or amikacin alone, appears to be an indicator of poor prognosis. 19 In the four cases that were capreomycin-resistant in the present study, the patients all had further risk factors for unsuccessful clinical outcomes and all died of MDR-TB. Multidrug resistance to first-line anti-tb drugs decreases the number of suitable and efficient drugs for combination therapy. According to the latest recommendations, there should be at least four efficacious drugs. 9,11 One of the risk factors that can contribute to the development of secondary resistance is the uncontrolled and unsubstantiated prescribing of drugs that are not among those recommended for anti-tb therapy. This narrows the spectrum of the few sensitive drugs that are designed for the treatment of MDR-TB, in particular endangering the fluoroquinolones, which are in the third group of anti-tb drugs. Their prescription and use against Gram-positive and Gramnegative organisms is very common. In cases of undiagnosed TB, treatment with fluoroquinolones can lead to monoresistance, 8 and resistance to them develops very quickly. 20 In the cohort from the present study, fluoroquinolone resistance was identified in 15 (30%) of the patients, of whom five were immigrants. For the susceptibility testing of MTB isolates to firstand second-line anti-tb drugs, we observed the WHO recommendations and used at least four drugs in the treatment regimens with respect to their division into the five efficacy classes. 11 Although this involves a long-term therapeutic strategy and carries a 1161
7 risk of undesirable effects, treatment was not interrupted due to drug toxicity in any patient, which is similar to the study by Shin et al. 21 In the present cohort, MDR-TB was cured in 36 patients and five remained on treatment. More favourable results were found in the immigrants with MDR-TB, where 15 (88%) patients were cured compared with 21 (64%) in the Czech Republic-born group (no statistically significant difference). A strong connection between TB-related deaths and smoking was noted among Czech-born patients compared with those who were immigrants. Smoking is one of the risk factors for TB observed by Pai et al. 22 and is also a cause of significant comorbidity, in particular COPD and cardiovascular diseases, with the incidence of both increasing with age. The patients who died of MDR-TB were all Czech Republic-born males, all of whom were smokers. Other risk factors for death included older age, increased incidence of comorbidities and resistance to anti-tb drugs, particularly capreomycin where all four resistant patients died. Similar conclusions have been drawn by others. 23,24 The mean time to bacteriological conversion of sputum was 5.9 months, which corresponded to the seriousness of the disease and to the necessity of letting the initial treatment phase run for a 6-month period, as in the WHO recommendations. 9,11 The mean hospitalization time of 8.2 months corresponded with the period during which bacteriological conversion of sputum was confirmed and the patient continued with out-patient treatment. There were certain limitations to the present study, including a limited sample size. It is planned to evaluate a larger cohort in the future. Despite this, it was possible to show significant clinical and epidemiological differences between the immigrants and patients born in the Czech Republic, as shown in a previous study. 4 These findings may help in the implementation of programmes for TB screening and routine drug-susceptibility testing in immigrants, emphasizing the subsequent need for strict monitoring of their ongoing treatment. The rapid identification of patients with MDR-TB, their isolation for the period of infectiousness and the use of efficacious treatments can help to reduce the risk of the spread of this disease in the population. In conclusion, this study compared Czech Republic-born and immigrant patients with MDR-TB. The data reflected issues observed with MDR-TB as a worldwide health problem. The high prevalence of TB, including MDR-TB, in countries such as the former Soviet Union poses a high risk of primary resistance. Younger individuals infected with TB are likely to migrate from these eastern European countries to the Czech Republic in search of employment, where they subsequently receive treatment. Sociobehavioural factors are likely to be important in the development of MDR-TB and should be investigated in depth. To prevent further spread of TB and increases in cases of MDR-TB, it is necessary to undertake direct observations of treatment in all patients in order to ensure better treatment adherence. Acknowledgements Part of this study was carried out with the support of a EC 102 grant within the EEA Financial Mechanism and Norwegian Financial Mechanism. We thank the donors for their financial support. Conflicts of interest The authors had no conflicts of interest to declare in relation to this article. 1162
8 Received for publication 20 January 2010 Accepted subject to revision 25 January 2010 Revised accepted 15 April 2010 Copyright 2010 Field House Publishing LLP References 1 Masjedi MR, Tabarsi P, Chitsaz E, et al: Outcome of treatment of MDR-TB patients with standardised regimens, Iran, Int J Tuberc Lung Dis 2008; 12: Zignol M, Hosseini MS, Wright A, et al: Global incidence of multidrug-resistant tuberculosis. J Infect Dis 2006; 194: Cohen T, Colijn C, Wright A, et al: Challenges in estimating the total burden of drug-resistant tuberculosis. Am J Respir Crit Care 2008; 177: Diz S, López-Vélez R, Moreno A, et al: Epidemiology and clinical features of tuberculosis in immigrants at an infectious diseases department in Madrid. Int J Tuberc Lung Dis 2007; 11: Kan B, Berggren I, Ghebremichael S, et al: Extensive transmission of an isoniazid-resistant strain of Mycobacterium tuberculosis in Sweden. Int J Tuberc Lung Dis 2008; 12: Institution of Public Health Protection: The TB Registry: Tuberculosis and Respiratory Diseases. Prague: Institute of Health Information and Statistics of the Czech Republic, Caminero JA: Management of multidrugresistant tuberculosis and patients in retreatment. Eur Respir J 2005; 25: Jugheli L, Rigouts L, Shamputa IC, et al: High levels of resistance to second-line antituberculosis drugs among prisoners with pulmonary tuberculosis in Georgia. Int J Tuberc Lung Dis 2008; 12: Caminero JA: Treatment of multidrug-resistant tuberculosis: evidence and controversies. Int J Tuberc Dis 2006; 10: Shin S, Furin J, Alcántara F, et al: Hypokalemia among patients receiving treatments for multidrug-resistant tuberculosis. Chest 2004; 3: World Health Organization (WHO): Guidelines for the Programmatic Management of Drugresistant Tuberculosis. WHO/HTM/TB Geneva: WHO, Canetti G, Fox W, Khomenko A, et al: Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Organ 1969; 41: Reichman LB: Tuberculosis drug resistance comes full circle. Lancet 2008; 371: The WHO/IUATLD Global Project on Antituberculosis Drug Resistance Surveillance: Antituberculosis Drug Resistance in the World: Report No 4. Geneva: WHO, 2008 (available at: eport4_26feb08.pdf). 15 Schwartzman K: Them and us : the two worlds of tuberculosis? Am J Respir Crit Care Med 2007; 176: Yew WY, Leung CHCH: Update in tuberculosis Am J Respir Crit Care Med 2008; 177: Zevallos M, Justman JE: Tuberculosis in the elderly. Clin Geriatr Med 2003; 19: Schachter EN: Tuberculosis: a global problem at our doorstep. Chest 2004; 126: Migliori GB, Lange C, Centis R, et al for the TBNET Study Group:. Resistance to second-line injectables and treatment outcome in multidrug-resistant and extensively drugresistant tuberculosis cases. Eur Respir J 2008; 31: Ginsburg AS, Woolwine SC, Hooper N, et al: The rapid development of fluoroquinolone resistance in M. tuberculosis. N Engl J Med 2003; 349: Shin SS, Pasechnikov AD, Gelmanova IY, et al: Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia. Int J Tuberc Lung Dis 2007; 11: Pai M, Mohan A, Dheda K, et al: Lethal interaction: the colliding epidemics of tobacco and tuberculosis. Expert Rev Anti Infect Ther 2007; 5: Lefebvre N, Falzon D: Risk factors for death among tuberculosis cases: analysis of European surveillance data. Eur Respir J 2008; 31: Espinal MA, Laszlo A, Simonsen L, et al: Global trends in resistance to antituberculosis drugs. N Engl J Med 2001; 344: Author s address for correspondence Dr Vaclava Bartu Department of Respiratory Diseases, Medicon, Antala Staska 1670/80, Prague, Czech Republic. vaclava.bartu@mediconas.cz 1163
Multidrug- and extensively drug-resistant tuberculosis: a persistent problem in the European Union European Union and European Economic Area
Rapid communications Multidrug- and extensively drug-resistant tuberculosis: a persistent problem in the European Union European Union and European Economic Area C Ködmön (csaba.kodmon@ecdc.europa.eu)
More informationGlobal epidemiology of drug-resistant tuberculosis. Factors contributing to the epidemic of MDR/XDR-TB. CHIANG Chen-Yuan MD, MPH, DrPhilos
Global epidemiology of drug-resistant tuberculosis Factors contributing to the epidemic of MDR/XDR-TB CHIANG Chen-Yuan MD, MPH, DrPhilos By the end of this presentation, participants would be able to describe
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Günther G, Lange C, Alexandru S, et al. Treatment outcomes
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Mitnick CD, Shin SS, Seung KJ, et al. Comprehensive treatment
More informationEpidemiology and clinical management of XDR-TB: a systematic review by TBNET
Eur Respir J 2009; 33: 871 881 DOI: 10.1183/09031936.00168008 CopyrightßERS Journals Ltd 2009 REVIEW Epidemiology and clinical management of XDR-TB: a systematic review by TBNET G. Sotgiu, G. Ferrara,
More informationMultidrug-resistant Tuberculosis - World, Europe, Switzerland
Multidrug-resistant Tuberculosis - World, Europe, Switzerland Magglingen March 23, 2017 peter.helbling@bag.admin.ch Topics Definitions Epidemiology of TB and MDR-TB worldwide Treatment outcome results
More informationWhat can be done against XDR-TB?
What can be done against XDR-TB? Dr Matteo Zignol Stop TB Dep. World Health Organization Geneva 16 th Swiss Symposium on tuberculosis Münchenwiler, 22 March 2007 XDR-TB Extensive Drug Resistance XDR =
More informationDiagnosis of drug resistant TB
Diagnosis of drug resistant TB Megan Murray, MD, ScD Harvard School of Public Health Brigham and Women s Hospital Harvard Medical School Broad Institute Global burden of TB 9 million new cases year 2 million
More informationTuberculosis in Greece: bacteriologically confirmed cases and anti-tuberculosis drug resistance,
Surveillance and outbreak reports Tuberculosis in Greece: bacteriologically confirmed cases and anti-tuberculosis drug resistance, 1995-2009 D Papaventsis (dpapaventsis@yahoo.gr) 1, S Nikolaou 1, S Karabela
More informationMULTIDRUG- RESISTANT TUBERCULOSIS. Dean Tsukayama Hennepin County Medical Center Hennepin County Public Health Clinic
MULTIDRUG- RESISTANT TUBERCULOSIS Dean Tsukayama Hennepin County Medical Center Hennepin County Public Health Clinic I have no relevant financial relationships. Discussion includes off label use of: amikacin
More informationEmergence of New Forms of Totally Drug-Resistant Tuberculosis Bacilli
CHEST Emergence of New Forms of Totally Drug-Resistant Tuberculosis Bacilli Original Research Super Extensively Drug-Resistant Tuberculosis or Totally Drug-Resistant Strains in Iran Ali Akbar Velayati,
More informationXDR-TB Extensively Drug-Resistant Tuberculosis. What, Where, How and Action Steps
XDR-TB Extensively Drug-Resistant Tuberculosis What, Where, How and Action Steps The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever
More informationXDR TUBERCULOSIS IN EUROPE EPIDEMIOLOGICAL ASPECTS. Enrico Girardi Unità di Epidemiologia Clinica INMI Spallanzani, Roma. Pag. 1
XDR TUBERCULOSIS IN EUROPE EPIDEMIOLOGICAL ASPECTS Enrico Girardi Unità di Epidemiologia Clinica INMI Spallanzani, Roma Pag. 1 TB estimated incidence in EUR, 2004 Russian Fed. 12 th among the 22 TB high-burden
More information11/3/2009 SECOND EDITION Madhukar Pai McGill University. ISTC Training Modules Introduction
SECOND EDITION 2009 Madhukar Pai McGill University Introduction 1 Purpose of ISTC ISTC Version 2: Key Points 21 Standards Differ from existing guidelines: standards present what should be done, whereas,
More informationThe Clinical Characteristics and Predictors of Treatment Success of Pulmonary Tuberculosis in Homeless Persons at a Public Hospital in Busan
Korean J Fam Med. 2012;33:372-380 http://dx.doi.org/10.4082/kjfm.2012.33.6.372 The Clinical Characteristics and Predictors of Treatment Success of Pulmonary Tuberculosis in Homeless Persons at a Public
More informationHIV and Tuberculosis in Eastern Europe
HIV and Tuberculosis in Eastern Europe Daria N. Podlekareva Meeting Standard of Care for HIV and Coinfections in Europe Rome, November 25-16 2014 TB notification rates (per 100.000) European region 2012
More informationTotally Drug-Resistant Tuberculosis (TDR-TB): An Overview
Human Journals Review Article August 2016 Vol.:1, Issue:3 All rights are reserved by Mr. Suraj Narayan Mali et al. Totally Drug-Resistant Tuberculosis (TDR-TB): An Overview Keywords: Totally Drug-resistant
More informationEpidemiology of drug-resistant tuberculosis among children and adolescents in South Africa
Epidemiology of drug-resistant tuberculosis among children and adolescents in South Africa 2005 2010 BK Moore 1, E Anyalechi 1, M van der Walt 2, S Smith 1, L Erasmus 3, J Lancaster 2, S Morris 1, N Ndjeka
More informationPrevalence of resistance to second-line tuberculosis drug among multidrugresistant tuberculosis patients in Viet Nam, 2011
Original Research Prevalence of resistance to second-line tuberculosis drug among multidrugresistant tuberculosis patients in Viet Nam, 2011 Hoa Binh Nguyen, ab Nhung Viet Nguyen, ac Huong Thi Giang Tran,
More informationBasic Overview of Tuberculosis Epidemiology in the Czech Republic in 2017
Centre for the development of technology platform used in registries of the National Health Information System, modernisation of data mining within these registries and extending their information capacity.
More informationThe authors assessed drug susceptibility patterns
Drug Resistance Among Tuberculosis Patients, 1991 and 1992 New York City, CYNTHIA R. DRIVER, RN, MPH THOMAS R. FRIEDEN, MD, MPH ALAN B. BLOCH, MD, MPH IDA M. ONORATO, MD All the authors are with the Division
More informationEffectiveness of the WHO regimen for treatment of multidrug resistant tuberculosis (MDR-TB)
Effectiveness of the WHO regimen for treatment of multidrug resistant tuberculosis (MDR-TB) M Bonnet, M Bastard, P du Cros, K Atadjan, K Kimenye, S Khurkhumal, A Hayrapetyan, A Telnov, C Hewison, F Varaine
More informationElizabeth A. Talbot MD Assoc Professor, ID and Int l Health Deputy State Epidemiologist, NH GEISELMED.DARTMOUTH.EDU GEISELMED.DARTMOUTH.
The image part with relationship ID rid2 was not found in the file. MDR TB Management Review of the Evolution (or Revolution?) Elizabeth A. Talbot MD Assoc Professor, ID and Int l Health Deputy State Epidemiologist,
More informationManaging Complex TB Cases Diana M. Nilsen, MD, RN
Managing Complex TB Cases Diana M. Nilsen, MD, RN Director of Medical Affairs NYC Department of Health & Mental Hygiene Bureau of TB Control Case #1 You are managing a patient who was seen at a private
More informationPredictors of poor treatment outcome in multi- and extensively drug-resistant pulmonary TB
Eur Respir J 2009; 33: 1085 1094 DOI: 10.1183/09031936.00155708 CopyrightßERS Journals Ltd 2009 Predictors of poor treatment outcome in multi- and extensively drug-resistant pulmonary TB K. Kliiman and
More informationNIH Public Access Author Manuscript Int J Tuberc Lung Dis. Author manuscript; available in PMC 2013 August 06.
NIH Public Access Author Manuscript Published in final edited form as: Int J Tuberc Lung Dis. 2013 May ; 17(5): 624 629. doi:10.5588/ijtld.12.0792. Outcomes of children treated for tuberculosis with second-line
More informationTreatment of Active Tuberculosis
Treatment of Active Tuberculosis Jeremy Clain, MD Pulmonary & Critical Care Medicine Mayo Clinic October 16, 2017 2014 MFMER slide-1 Disclosures No relevant financial relationships No conflicts of interest
More informationT uberculosis control aims to reduce mortality and morbidity
302 EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE Tuberculosis treatment outcome monitoring in England, Wales and Northern Ireland for cases reported in 2001 Delphine Antoine, Clare E French, Jane Jones,
More informationTB control and care. Curr Opin Pulm Med 16: ß 2010 Wolters Kluwer Health Lippincott Williams & Wilkins
Emerging epidemic of drug-resistant tuberculosis in Europe, Russia, China, South America and Asia: current status and global perspectives Giovanni Battista Migliori a, Rosella Centis a, Chris Lange b,
More informationManagement of Drug-resistant Tuberculosis (DR-TB)
Management of Drug-resistant Tuberculosis (DR-TB) Nitipatana Chierakul Division of Respiratory Disease & Tuberculosis Department of Medicine Faculty of Medicine Siriraj Hospital October 14 th, 2008 Tropical
More informationTransmission of MDR and XDR Tuberculosis in Shanghai, China
Transmission of MDR and XDR Tuberculosis in Shanghai, China Ming Zhao 1,2., Xia Li 2., Peng Xu 1,2, Xin Shen 1, Xiaohong Gui 1, Lili Wang 1, Kathryn DeRiemer 3, Jian Mei 1 *, Qian Gao 2 * 1 Department
More informationRecognizing MDR-TB in Children. Ma. Cecilia G. Ama, MD 23 rd PIDSP Annual Convention February 2016
Recognizing MDR-TB in Children Ma. Cecilia G. Ama, MD 23 rd PIDSP Annual Convention 17-18 February 2016 Objectives Review the definitions and categorization of drugresistant tuberculosis Understand the
More informationDRUG RESISTANCE IN TUBERCULOSIS CONTROL. A GLOBAL AND INDIAN SITUATION
JOURNAL OF PREVENTIVE MEDICINE 2008; 16(3-4): 3-9 Inviting Editorial DRUG RESISTANCE IN TUBERCULOSIS CONTROL. A GLOBAL AND INDIAN SITUATION Harshad Thakur Centre for Health Policy, Planning and Management,
More informationTuberculosis in Chicago 2007
City of Chicago Communicable Disease Information Department of Public Health Richard M. Daley, Mayor May 2008 Terry Mason, MD, FACS, Commissioner www.cityofchicago.org/health/ West Side Center For Disease
More informationMarch 24, 2007 will mark the 125th anniversary of Robert
Eur Respir J 2007; 29: 423 427 DOI: 10.1183/09031936.00001307 CopyrightßERS Journals Ltd 2007 EDITORIAL 125 years after Robert Koch s discovery of the tubercle bacillus: the new XDR-TB threat. Is science
More informationTUBERCULOSIS TREATMENT WITH MOBILE-PHONE MEDICATION REMINDERS IN NORTHERN THAILAND
Southeast Asian J Trop Med Public Health TUBERCULOSIS TREATMENT WITH MOBILE-PHONE MEDICATION REMINDERS IN NORTHERN THAILAND Piyada Kunawararak 1, Sathirakorn Pongpanich 2, Sakarin Chantawong 1, Pattana
More informationDiagnosis and Treatment of Tuberculosis, 2011
Diagnosis of TB Diagnosis and Treatment of Tuberculosis, 2011 Alfred Lardizabal, MD NJMS Global Tuberculosis Institute Diagnosis of TB, 2011 Diagnosis follows Suspicion When should we Think TB? Who is
More informationCompassionate use of bedaquiline in highly drug-resistant tuberculosis patients in Mumbai, India
AGORA RESEARCH LETTER Compassionate use of bedaquiline in highly drug-resistant tuberculosis patients in Mumbai, India To the Editor: Bedaquiline, a mycobacterial ATP synthase inhibitor [1], is the first
More informationStudy of Multi-Drug Resistance Associated with Anti-Tuberculosis Treatment by DOT Implementation Strategy in Pakistan
Journal of Basic & Applied Sciences, 2018, 14, 107-112 107 Study of Multi-Drug Resistance Associated with Anti-Tuberculosis Treatment by DOT Implementation Strategy in Pakistan Sana Saeed 1, Moosa Raza
More informationDRUG RESISTANCE IN TUBERCULOSIS
DRUG RESISTANCE IN TUBERCULOSIS INTRODUCTION Up to 50 million people may be infected with drug-resistant resistant TB.* Hot zones of MDR-TB such as Russia, Latvia, Estonia, Argentina and the Dominican
More informationWhat is the recommended shorter treatment regimen for MDR-TB?
DRTB STAT + TAG BRIEF Is shorter better? Is shorter better? Understanding the shorter regimen for treating drugresistant tuberculosis by Safiqa Khimani Edited by Vivian Cox, Mike Frick, Jennifer Furin,
More informationPrinciple of Tuberculosis Control. CHIANG Chen-Yuan MD, MPH, DrPhilos
Principle of Tuberculosis Control CHIANG Chen-Yuan MD, MPH, DrPhilos Estimated global tuberculosis burden 2015 an estimated 10.4 million incident cases of TB (range, 8.7 million 12.2 million) 142 cases
More informationBasic Overview of Tuberculosis Epidemiology in the Czech Republic in 2015
Centre for the development of technology platform used in registries of the National Health Information System, modernisation of data mining within these registries and extending their information capacity.
More informationThe emerging threat of multidrug resistant TB: Global and local challenges and solutions
Summary of IOM-ASSAf Workshop on: The emerging threat of multidrug resistant TB: Global and local challenges and solutions Salim S. Abdool Karim Pretoria - March, 2010 Why this workshop? Why is it on MDR
More information4/25/2012. The information on patterns of infection and disease can assist in: Assessing current and evolving trends in TB
Sindy M. Paul, MD, MPH, FACPM May 1, 2012 The information on patterns of infection and disease can assist in: Assessing current and evolving trends in TB morbidity, including resistance Identifying people
More informationModernizing Surveillance of Antituberculosis Drug Resistance: From Special Surveys to Routine Testing
VIEWPOINTS Modernizing Surveillance of Antituberculosis Drug Resistance: From Special Surveys to Routine Testing Matteo Zignol, Wayne van Gemert, Dennis Falzon, Ernesto Jaramillo, Léopold Blanc, and Mario
More informationLet s Talk TB. A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year
A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year Lancelot M. Pinto, MD, MSc Author Madhukar Pai, MD, PhD co-author and Series Editor Abstract Nearly 50% of patients with
More informationResearch Article Five-Year Assessment of Time of Sputum Smears Conversion and Outcome and Risk Factors of Tuberculosis Patients in Central Iran
Hindawi Publishing Corporation Tuberculosis Research and Treatment Volume 2015, Article ID 609083, 7 pages http://dx.doi.org/10.1155/2015/609083 Research Article Five-Year Assessment of Time of Sputum
More informationAnnual surveillance report 2016
Annual surveillance report 216 Acknowledgements The Public Health Agency Northern Ireland gratefully acknowledges all those who contributed to this report, including; physicians, nurses, microbiologists,
More informationSMEAR MICROSCOPY AS SURROGATE FOR CULTURE DURING FOLLOW UP OF PULMONARY MDR-TB PATIENTS ON DOTS PLUS TREATMENT
Original Article SMEAR MICROSCOPY AS SURROGATE FOR CULTURE DURING FOLLOW UP OF PULMONARY MDR-TB PATIENTS ON DOTS PLUS TREATMENT R. Sarin 1, R. Singla 2, P. Visalakshi 3, A. Jaiswal 4, M.M. Puri 4, Khalid
More informationDefinitions and reporting framework for tuberculosis 2013 revision. Dennis Falzon Global Forum of Xpert MTB/RIF Implementers Annecy 17 April 2013
Definitions and reporting framework for tuberculosis 2013 revision Dennis Falzon Global Forum of Xpert MTB/RIF Implementers Annecy 17 April 2013 2-year revision process WHO/HTM/TB/2013.2 2 www.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf
More informationFeasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru
Feasibility and cost-effectiveness of standardised second-line drug treatment for chronic tuberculosis patients: a national cohort study in Peru Pedro G Suárez, Katherine Floyd, Jaime Portocarrero, Edith
More informationAssessing the programmatic management of drug-resistant TB
Assessing the programmatic management of drug-resistant TB a. Review the programmatic management of drug-resistant TB patients with the TB manager. i. What is the size of MDR-TB problem locally? How many
More informationA tale of two settings: the role of the Beijing genotype in the epidemiology of MDR-TB.
ERJ Express. Published on September 13, 2013 as doi: 10.1183/09031936.00140513 A tale of two settings: the role of the Beijing genotype in the epidemiology of MDR-TB. Helen R. Stagg a,b,c, *, Ted Cohen
More information2016 Annual Tuberculosis Report For Fresno County
206 Annual Tuberculosis Report For Fresno County Cases Rate per 00,000 people 206 Tuberculosis Annual Report Fresno County Department of Public Health (FCDPH) Tuberculosis Control Program Tuberculosis
More informationGlobal, National, Regional
Epidemiology of TB: Global, National, Regional September 13, 211 Edward Zuroweste, MD Chief Medical Officer Migrant Clinicians Network Assistant Professor of Medicine Johns Hopkins School of Medicine Epidemiology
More informationAuthors Malhotra, S; Zodpey, S P; Chandra, S; Vashist, R P; Satyanaryana, S; Zachariah, R; Harries, A D
MSF Field Research Should Sputum Smear Examination Be Carried Out at the End of the Intensive Phase and End of Treatment in Sputum Smear Negative Pulmonary TB Patients? Authors Malhotra, S; Zodpey, S P;
More informationMultidrug-Resistant and Extensively Drug-Resistant Tuberculosis in Multi-Ethnic Region, Xinjiang Uygur Autonomous Region, China
Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis in Multi-Ethnic Region, Xinjiang Uygur Autonomous Region, China Ying-Cheng Qi 1., Mai-Juan Ma 2., Dong-Jun Li 3, Mei-Juan Chen 1, Qing-Bin
More informationMultidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment
Multidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment L. P. Ormerod Chest Clinic, Blackburn Royal Infirmary, Blackburn, Lancs BB2 3LR, and Postgraduate School of Medicine and
More informationTuberculosis in NSW,
EPIREVIEW Tuberculosis in NSW, 2003 2007 Bridget A. O Connor, Lindy L. Fritsche, Amanda J. Christensen and Jeremy M. McAnulty Communicable Diseases Branch, NSW Department of Health Tuberculosis (TB) has
More informationGlobal, National, Regional
Epidemiology of TB: Global, National, Regional September 13, 211 Edward Zuroweste, MD Chief Medical Officer Migrant Clinicians Network Assistant Professor of Medicine Johns Hopkins School of Medicine Epidemiology
More informationAnnual surveillance report 2015
Annual surveillance report 215 Acknowledgements The Public Health Agency Northern Ireland gratefully acknowledges all those who contributed to this report, including; physicians, nurses, microbiologists,
More informationTreatment outcomes and survival based on drug resistance patterns in multidrug-resistant
Treatment outcomes and survival based on drug resistance patterns in multidrug-resistant tuberculosis Doh Hyung Kim, Hee Jin Kim, Seung-Kyu Park, Suck-Jun Kong, Young Sam Kim, Tae-Hyung Kim, Eun Kyung
More informationShort Course Treatment for MDR TB
Objectives Short Course Treatment for MDR TB Barbara J Seaworth M.D. Medical Director Heartland National TB Center Professor of Medicine, University of Texas Health Northeast Participants will utilize
More informationSputum culture results to monitor MDR-TB patients during treatment: How many do we
JCM Accepts, published online ahead of print on 5 December 2012 J. Clin. Microbiol. doi:10.1128/jcm.02837-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 3 4 Sputum culture
More informationTB and MDR/XDR-TB in European Union and European Economic Area countries: managed or mismanaged?
Eur Respir J 2012; 39: 619 625 DOI: 10.1183/09031936.00170411 CopyrightßERS 2012 TB and MDR/XDR-TB in European Union and European Economic Area countries: managed or mismanaged? G.B. Migliori*, ***, G.
More informationTHE WORLD HEALTH ORGANIZAtion
ORIGINAL CONTRIBUTION Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis Outcomes in 6 Countries Marcos A. Espinal, MD, DrPH Sang Jae Kim, ScD Pedro G. Suarez, MD Kai Man Kam, MB Alexander
More informationDrug Resistant Tuberculosis Biology, Epidemiology and Control Dr. Christopher Dye
Director of Health Information World Health Organization Geneva 1 1. Why TB patients are treated with drugs 2 Natural history and control of TB Fast 5/1 Slow 5/1 Uninfected Latent Active 1 1 infection/case
More informationTuberculosis. New TB diagnostics. New drugs.new vaccines. Dr: Hussein M. Jumaah CABM Mosul College of Medicine 23/12/2012
Tuberculosis New TB diagnostics. New drugs.new vaccines Dr: Hussein M. Jumaah CABM Mosul College of Medicine 23/12/2012 Tuberculosis (TB )is a bacterial disease caused by Mycobacterium tuberculosis (occasionally
More informationA review of Outcomes of Treatment among 29 cases of Extensively Drug Resistant Tuberculosis in Johannesburg
A review of Outcomes of Treatment among 29 cases of Extensively Drug Resistant Tuberculosis in Johannesburg Ntambwe Malangu 1 and Mame Dieynaba DIA-DIOP 2 Abstract The purpose of this study was to describe
More informationDrug susceptibility testing for tuberculosis KRISTEN DICKS, MD, MPH DUKE UNIVERSITY MEDICAL CENTER
Drug susceptibility testing for tuberculosis KRISTEN DICKS, MD, MPH DUKE UNIVERSITY MEDICAL CENTER Outline Drug resistant TB: definitions and epidemiology How does TB become resistant? Current drug susceptibility
More informationTUBERCULOSIS. Presented By: Public Health Madison & Dane County
TUBERCULOSIS Presented By: Public Health Madison & Dane County What is Tuberculosis? Tuberculosis, or TB, is a disease caused by a bacteria called Mycobacterium tuberculosis. The bacteria can attack any
More informationTB: A Supplement to GP CLINICS
TB: A Supplement to GP CLINICS Chapter 10: Childhood Tuberculosis: Q&A For Primary Care Physicians Author: Madhukar Pai, MD, PhD Author and Series Editor What is Childhood TB and who is at risk? India
More informationSurgery for MDR/XDR Tuberculosis
Surgery for MDR/XDR Tuberculosis John D. Mitchell, M.D. Davis Endowed Chair in Thoracic Surgery Professor and Chief, General Thoracic Surgery Department of Surgery University of Colorado School of Medicine
More informationDosage and Administration
SIRTURO product information for healthcare providers 2 WARNINGS: An increased risk of death was seen in the SIRTURO (bedaquiline) treatment group (9/79, 11.4%) compared to the placebo treatment group (2/81,
More informationMDR, XDR and Untreatable Tuberculosis and Laboratory Perspectives. Martie van der Walt TUBERCULOSIS EPIDEMIOLOGY & INTERVENTION RESEARCH UNIT
TUBERCULOSIS EPIDEMIOLOGY & INTERVENTION RESEARCH UNIT MDR, XDR and Untreatable Tuberculosis and Laboratory Perspectives Martie van der Walt IOM Meeting 15-17 January 2013 introduction 1 min 150 words
More informationPredicting outcomes and drug resistance with standardised treatment of active tuberculosis
Eur Respir J 21; 36: 87 877 DOI: 1.1183/931936.15179 CopyrightßERS 21 Predicting outcomes and drug resistance with standardised treatment of active tuberculosis O. Oxlade*,#, K. Schwartzman*,#, M. Pai*,#,
More informationAntimycobacterial drugs. Dr.Naza M.Ali lec Dec 2018
Antimycobacterial drugs Dr.Naza M.Ali lec 14-15 6 Dec 2018 About one-third of the world s population is infected with M. tuberculosis With 30 million people having active disease. Worldwide, 9 million
More informationTB IN EMERGENCIES. Disease Control in Humanitarian Emergencies (DCE)
TB IN EMERGENCIES Department of Epidemic and Pandemic Alert and Response (EPR) Health Security and Environment Cluster (HSE) (Acknowledgements WHO Stop TB Programme WHO/STB) 1 Why TB? >33% of the global
More informationMSF Field Research. Diagnosis and management of drug-resistant tuberculosis. South African adults. Hughes, J; Osman, M
MSF Field Research Diagnosis and management of drug-resistant tuberculosis in South African adults Authors Citation DOI Publisher Journal Rights Hughes, J; Osman, M Diagnosis and management of drug-resistant
More informationInformation Note. WHO call for patient data on the treatment of multidrug- and rifampicin resistant tuberculosis
Information Note WHO call for patient data on the treatment of multidrug- and rifampicin resistant tuberculosis In order to ensure that the upcoming comprehensive revision of WHO policies on treatment
More informationMultidrug-/ rifampicinresistant. (MDR/RR-TB): Update 2017
Multidrug-/ rifampicinresistant TB (MDR/RR-TB): Update 2017 The global TB situation (1) Estimated incidence, 2016 Estimated number of deaths, 2016 All forms of TB HIV-associated TB Multidrug- / rifampicin-resistant
More informationLet s Talk TB A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year
Let s Talk TB A Series on Tuberculosis, A Disease That Affects Over 2 Million Indians Every Year Lancelot M. Pinto, MD, MSc Author Madhukar Pai, MD, PhD co-author and Series Editor Lancelot Pinto is a
More informationCronicon EC BACTERIOLOGY AND VIROLOGY RESEARCH. Research Article Multidrug Resistant Tuberculosis Cure Predictors
Cronicon OPEN ACCESS EC BACTERIOLOGY AND VIROLOGY RESEARCH Research Article Multidrug Resistant Tuberculosis Cure Predictors Vinod Namana 1,2 * and Pankaj Mathur 3 1 Department of Cardiology, Maimonides
More informationTUBERCULOSIS CONTROL IN THE WHO WESTERN PACIFIC REGION In the WHO Western Pacific Region 2002 Report
TUBERCULOSIS CONTROL IN THE WHO WESTERN PACIFIC REGION 2000 Tuberculosis Control In the WHO Western Pacific Region 2002 Report World Health Organization Office for the Western Pacific Region iii TUBERCULOSIS
More informationRapid Diagnosis and Detection of Drug Resistance in Tuberculosis
Rapid Diagnosis and Detection of Drug Resistance in Tuberculosis YAM Wing-Cheong 任永昌 Department of Microbiology The University of Hong Kong Tuberculosis Re-emerging problem in industrialized countries
More informationTreatment outcomes of multidrug-resistant tuberculosis in Switzerland
Published 4 December 04, doi:0.444/smw.04.405 Cite this as: Swiss Med Wkly. 04;44:w405 Treatment outcomes of multidrug-resistant tuberculosis in Switzerland Peter Helbling a, Ekkehardt Altpeter a, Jean-Marie
More informationM ultidrug resistant (MDR) tuberculosis (TB) has
1106 ORIGINAL ARTICLE Culture confirmed multidrug resistant tuberculosis: diagnostic delay, clinical features, and outcome H S Schaaf, K Shean, P R Donald... See end of article for authors affiliations...
More informationCMH Working Paper Series
CMH Working Paper Series Paper No. WG5 : 8 Title Interventions to reduce tuberculosis mortality and transmission in low and middle-income countries: effectiveness, cost-effectiveness, and constraints to
More informationThe European Union standards for tuberculosis care: do they need an update?
EDITORIAL EU STANDARDS FOR TB CARE The European Union standards for tuberculosis care: do they need an update? Marieke J. van der Werf 1, Andreas Sandgren 1, Lia D Ambrosio 2, Francesco Blasi 3 and Giovanni
More informationDrug resistance TB in People Living with HIV: research questions and priorities.
Drug resistance TB in People Living with HIV: research questions and priorities. Haileyesus Getahun, MD, PhD. Stop TB Department World Health Organisation Geneva, Switzerland Outline of presentation Definition
More informationUpdate on Management of
Update on Management of DR TB Definitions Presumptive MDR-TB A patient suspected of drug-resistant TB, based on RNTCP criteria for submission of specimens for drug-susceptibility testing MDR-TB Case A
More informationDrug-resistant Tuberculosis
page 1/6 Scientific Facts on Drug-resistant Tuberculosis Source document: WHO (2008) Summary & Details: GreenFacts Context - Tuberculosis (TB) is an infectious disease that affects a growing number of
More informationWhy can t we eliminate tuberculosis?
Why can t we eliminate tuberculosis? Neil W. Schluger, M.D. Professor of Medicine, Epidemiology and Environmental Health Sciences Columbia University Chief Scientific Officer World Lung Foundation Current
More informationTreatment of Tuberculosis in South Kazakhstan: Clinical and Economical Aspects
:335-40 335 Treatment of Tuberculosis in South Kazakhstan: Clinical and Economical Aspects Talgat Maimakov 1, Laura Sadykova 1, Zhanna Kalmataeva 1, Kural Kurakpaev 2, Kastytis Šmigelskas 3 1 Kazakhstan
More informationTreatment of Tuberculosis
TB Clinical i l Intensive Seattle Treatment of Tuberculosis June 16, 2016 Masa Narita, MD Public Health Seattle & King County; Firland Northwest TB Center, University of Washington Outline Unique features
More informationAnalysis of treatment outcome in multi-drug resistant tuberculosis patients treated under programmatic conditions
International Journal of Research in Medical Sciences Deepak S et al. Int J Res Med Sci. 2017 Jun;5(6):2401-2405 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172122
More informationTherapeutic drug monitoring (TDM) is the process. Use of Therapeutic Drug Monitoring for Multidrug-Resistant Tuberculosis Patients*
Use of Therapeutic Drug Monitoring for Multidrug-Resistant Tuberculosis Patients* Jiehui Li, MBBS, MS; Joseph N. Burzynski, MD, MPH; Yi-An Lee, MPH; Debra Berg, MD; Cynthia R. Driver, RN, MPH; Renee Ridzon,
More informationSoedarsono Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Hospital
Soedarsono Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Hospital MDR-TB is a public health crisis 480 000 people developed MDR-TB in
More information