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New England Journal of Medicine 01/2013; 368(3):290. · 53.30 Impact Factor
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European Respiratory Journal 05/2012; 39(5):1057-9. · 5.89 Impact Factor
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The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 06/2011; 15 Suppl 2:S3-5. · 2.73 Impact Factor
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ABSTRACT: Resistance to antituberculosis drugs has been documented since the 1940s, when the first medicines for tuberculosis were introduced. Since the initiation in 1994 of a global project to monitor the development of drug-resistant tuberculosis, nearly 60% of all countries in the world have implemented surveillance activities. In the past 15 years, special surveys have been the most common approach to investigate the frequency and patterns of drug-resistant tuberculosis. The major obstacle to the expansion of routine surveillance activities has been the lack of laboratory capacity needed to detect resistance. We are now in a new era for antituberculosis drug resistance surveillance due to the advent of new diagnostic tools and global commitment towards universal access to care for all patients with tuberculosis, including those with drug-resistant disease. Routine surveillance linked to patient care, which represents the best approach to monitor drug resistance, now has the possibility of becoming a reality even in resource-limited countries.
Clinical Infectious Diseases 04/2011; 52(7):901-6. · 9.15 Impact Factor
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New England Journal of Medicine 09/2010; 363(11):1050-8. · 53.30 Impact Factor
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Tropical Medicine & International Health 05/2009; 14(4):376-8. · 2.80 Impact Factor
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ABSTRACT: The main thrust of the World Health Organization's global tuberculosis (TB) control strategy is to ensure effective and equitable delivery of quality assured diagnosis and treatment of TB. Options for including preventive efforts have not yet been fully considered. This paper presents a narrative review of the historical and recent progress in TB control and the role of TB risk factors and social determinants. The review was conducted with a view to assess the prospects of effectively controlling TB under the current strategy, and the potential to increase epidemiological impact through additional preventive interventions. The review suggests that, while the current strategy is effective in curing patients and saving lives, the epidemiological impact has so far been less than predicted. In order to reach long-term epidemiological targets for global TB control, additional interventions to reduce peoples' vulnerability for TB may therefore be required. Risk factors that seem to be of importance at the population level include poor living and working conditions associated with high risk of TB transmission, and factors that impair the host's defence against TB infection and disease, such as HIV infection, malnutrition, smoking, diabetes, alcohol abuse, and indoor air pollution. Preventive interventions may target these factors directly or via their underlying social determinants. The identification of risk groups also helps to target strategies for early detection of people in need of TB treatment. More research is needed on the suitability, feasibility and cost-effectiveness of these intervention options.
Social Science & Medicine. 01/2009; 68(12):2240-2246.
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ABSTRACT: It has long been evident that there is an association between alcohol use and risk of tuberculosis. It has not been established to what extent this association is confounded by social and other factors related to alcohol use. Nor has the strength of the association been established. The objective of this study was to systematically review the available evidence on the association between alcohol use and the risk of tuberculosis.
Based on a systematic literature review, we identified 3 cohort and 18 case control studies. These were further categorized according to definition of exposure, type of tuberculosis used as study outcome, and confounders controlled for. Pooled effect sizes were obtained for each sub-category of studies.
The pooled relative risk across all studies that used an exposure cut-off level set at 40 g alcohol per day or above, or defined exposure as a clinical diagnosis of an alcohol use disorder, was 3.50 (95% CI: 2.01-5.93). After exclusion of small studies, because of suspected publication bias, the pooled relative risk was 2.94 (95% CI: 1.89-4.59). Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies.
The risk of active tuberculosis is substantially elevated in people who drink more than 40 g alcohol per day, and/or have an alcohol use disorder. This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.
BMC Public Health 02/2008; 8:289. · 2.00 Impact Factor
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Cesar A Bonilla,
Aldo Crossa,
Hector O Jave,
Carole D Mitnick,
Ronal B Jamanca,
Cesar Herrera,
Luis Asencios,
Alberto Mendoza,
Jaime Bayona,
Matteo Zignol, Ernesto Jaramillo
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ABSTRACT: To describe the incidence of extensive drug-resistant tuberculosis (XDR-TB) reported in the Peruvian National multidrug-resistant tuberculosis (MDR-TB) registry over a period of more than ten years and present the treatment outcomes for a cohort of these patients.
From the Peruvian MDR-TB registry we extracted all entries that were approved for second-line anti-TB treatment between January 1997 and June of 2007 and that had Drug Susceptibility Test (DST) results indicating resistance to both rifampicin and isoniazid (i.e. MDR-TB) in addition to results for at least one fluoroquinolone and one second-line injectable (amikacin, capreomycin and kanamycin).
Of 1,989 confirmed MDR-TB cases with second-line DSTs, 119(6.0%) XDR-TB cases were detected between January 1997 and June of 2007. Lima and its metropolitan area account for 91% of cases, a distribution statistically similar to that of MDR-TB. A total of 43 XDR-TB cases were included in the cohort analysis, 37 of them received ITR. Of these, 17(46%) were cured, 8(22%) died and 11(30%) either failed or defaulted treatment. Of the 14 XDR-TB patients diagnosed as such before ITR treatment initiation, 10 (71%) were cured and the median conversion time was 2 months.
In the Peruvian context, with long experience in treating MDR-TB and low HIV burden, although the overall cure rate was poor, a large proportion of XDR-TB patients can be cured if DST to second-line drugs is performed early and treatment is delivered according to the WHO Guidelines.
PLoS ONE 02/2008; 3(8):e2957. · 4.09 Impact Factor
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ABSTRACT: Tuberculosis, in all its forms, poses a serious, demonstrable threat to the health of countless individuals as well as to health as a public good. MDR-TB and, in particular, the emergence of XDR-TB, have re-opened the debate on the importance, and nature, of treatment supervision for basic TB control and the management of drug-resistant TB. Enforcing compulsory measures regarding TB patients raises questions of respect for human rights. Yet, international law provides for rights-limiting principles, which would justify enforcing compulsory measures against TB patients who refuse to have diagnostic procedures or who refuse to be monitored and treated once disease is confirmed. This article analyzes under what circumstances compulsory measures for TB patients may be enforced under international law. Compulsory measures for TB patients may, in fact, be justified on legal grounds provided that these measures are foreseen in the law, that they are used as a last resort, and that safeguards are in place to protect affected individuals. The deadly nature of the disease, its epidemiology, the high case fatality rate, and the speed at which the disease leads to death when associated with HIV are proven.
Health and Human Rights 01/2008; 10(2):121-6.
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ABSTRACT: In most of the world and particularly in Eastern Europe, China and India, drug resistance is increasingly seen as a major threat to tuberculosis (TB) control and even to public health and health security. What about in Africa? The conditions for creation of drug resistance exist in most, if not all, African countries, as a result of underinvestment in basic TB control, poor management of anti-TB drugs and virtual absence of infection control measures. The severity of drug resistance is increasing--following outbreaks all over the world of multi-drug resistant TB (MDR) in the 1990's, extensive drug resistant (XDR) TB has now been found in 37 countries, including South Africa. (MDR is, in essence, resistance to the most powerful first-line drugs, and XDR-TB is TB resistant to the most powerful second-line drugs as well.) Worse still, the impact of XDR-TB is magnified among those with HIV infection, giving rise to a remarkably high mortality, and exposing significant weaknesses in both HIV and TB control. In particular, the lack of laboratories capable of carrying out culture and drug susceptibility testing severely limits the capacity of countries even to detect the problem in Africa. This paper analyses the threat of TB drug resistance to health and to TB control in Africa, and puts forward measures to diminish this threat.
Ethiopian medical journal 11/2007; 45(4):399-404.
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ABSTRACT: Over the past decade, global and national tuberculosis (TB)-control programs, challenged with limited resources, have had to prioritize interventions to maximize impact. For this reason, patients with newly diagnosed cases of TB received more attention than did patients with a previous history of treatment. The recently launched STOP TB Strategy and Global Plan to STOP TB 2006-2015 now promote proper diagnosis and treatment of TB for all patients, without distinction of smear status, drug susceptibility, sex, or age, including all patients with a history of previous treatment. Previously treated patients are difficult to re-treat and represent an important source of disease transmission, as well as a serious threat to TB control worldwide, because of their higher rate of drug resistance.
Clinical Infectious Diseases 02/2007; 44(1):61-4. · 9.15 Impact Factor
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Eva Nathanson,
Catharina Lambregts-van Weezenbeek,
Michael L Rich,
Rajesh Gupta,
Jaime Bayona,
Kai Blöndal,
José A Caminero,
J Peter Cegielski,
Manfred Danilovits,
Marcos A Espinal,
Vahur Hollo, Ernesto Jaramillo,
Vaira Leimane,
Carole D Mitnick,
Joia S Mukherjee,
Paul Nunn,
Alexander Pasechnikov,
Thelma Tupasi,
Charles Wells,
Mario C Raviglione
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ABSTRACT: Evidence of successful management of multidrug-resistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings.
Emerging infectious diseases 10/2006; 12(9):1389-97. · 6.17 Impact Factor
