High Rates of Clinical and Subclinical Tuberculosis among HIV-Infected Ambulatory Subjects in Tanzania

Mtei, Lillian; Matee, Mecky; Herfort, Oliver; Bakari, Muhammad; Horsburgh, C. Robert; Waddell, Richard; Cole, Bernard F.; Vuola, Jenni M.; Tvaroha, Susan; Kreiswirth, Barry N.; Pallangyo, Kisali; Reyn, C. Fordham von

doi:10.1086/429825

Cited by 162 publications

(146 citation statements)

References 24 publications

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“…27 These treatment decisions were likely driven by data from SSA showing TB as a key cause of mortality after ART initiation 2,4,28 and high rates of prevalent TB in patients initiating ART in a high-burden setting. In this study, 6.5% of the screened patients had smear-positive TB before ART, slightly lower than previously reported rates of prevalent TB in HIV-infected patients in SSA (15-25% in South Africa 29,30 and 10-15% for other sub-Saharan African countries 23,31 ). However, 30.6% were diagnosed with smearnegative TB, corroborating an unusually high rate of empiric TB treatment initiation.…”

Section: Discussioncontrasting

confidence: 78%

“…21 However, TB unmasking often occurs in patients starting ART, suggesting that early reactivation or subclinical disease exists at the time of ART initiation. 22,23 In highly immunosuppressed patients, TB may be disseminated, smear-negative, and therefore difficult to diagnose with traditional clinical screening, including (sputum) smears. 24 In this trial in SSA, the primary objective was to assess the effect of presumptive anti-TB treatment on severely immunosuppressed, underweight, HIV-infected patients starting ART on 6-month mortality and to evaluate anti-TB medicationrelated toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Manabe

Worodria

Leth

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Early mortality after initiation of antiretroviral therapy (ART) occurs in 9-39% of patients in sub-Saharan Africa. A significant proportion of deaths are attributable to tuberculosis (TB). Low baseline CD4 T-cell count and low body mass index (BMI) are strongly associated with early mortality. We hypothesized that initiation of ART concurrent with presumptive anti-TB chemotherapy in high-risk patients would reduce mortality within the first 6 months by treating unrecognized TB. From October 2011 to December 2012, ART-naive, smear-negative participants with a CD4 T-cell count < 50 cells/μL and BMI < 18 kg/m 2 were randomly assigned to undergo either empiric four-drug anti-TB treatment followed 2 weeks later by efavirenz-based ART (N = 23) (ART + TB) or ART only (N = 20). This open-label, 1:1 randomized, controlled trial took place in Uganda, Mozambique, and Gabon and was stopped prematurely by the sponsor for slow recruitment. Overall, the 43 participants had a median CD4 of 22 (interquartile range [IQR]: 9-35) cells/μL and a median BMI of 17.5 (IQR: 16.6-18.0) kg/m 2 . The mortality was 14% (95% confidence interval [CI]: 5.3-27.9); two (10.0%) participants (ART-only group), and four (17.4%; ART + TB group). The associated hazard ratio (HR) for all-cause mortality was 1.6 (95% CI: 0.30-8.90). Despite limited enrollment, the study did not suggest that empiric TB treatment in severely immunosuppressed patients with low BMI decreased mortality and, had an HR in the opposite direction than expected. Notably, two participants in the ART + TB group died with autopsy-confirmed drug-induced hepatotoxicity. Improved TB diagnostics sensitive in immunosuppressed patients presenting late to care are urgently needed for more targeted interventions.

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Section: Discussioncontrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Manabe

Worodria

Leth

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…The subject's immunogical reactivity is very important in case of mycobacterial lymphadenopathy: the severity of mycobacterial lymphoadenitis in HIV positive patients is extensively described in the literature [13,14].…”

Section: Discussionmentioning

confidence: 99%

Head and neck mycobacterial infections in pediatric patients

Caruso

Passali

Salerni

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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Objective: Lymph nodal disease is one of the most common manifestations of head and neck tuberculosis and is particularly frequent in paediatric patients with an increasing incidence in the last decade. It may represent the manifestation of a systemic tuberculous disease or a clinical entity specific of the neck. Aim of this paper is to retrospectively analyse mycobacterial cervical adenopathies observed in two Paediatric European Centers between 1986 and 2004 and the outcomes of medical or surgical treatment. Methods: 353 children were examined for mycobacterial cervical lymphadenopaties since January 1986 to December 2004. Demografic data about the sample are showed. The retrospective evaluation of the sample underlined distribution according to etiologic patterns, head and neck adenopathies localization. Previous or simultaneous medical or surgical treatment were analyzed. Statistical analysis with Chi Square test was performed. Results: 281 (79.60%) cases showed a higher localization and 72 (20.40%) a lower localization. In relation to the etiological agent, 8 (2.27%) Mycobacterium tuberculosis (MTB) and 222 (62.89%) mycobacteria other than tuberculosis (MOTT) lymphadenopaties were observed in the upper localization as opposed to 21 (5.95%) MTB and 39 (11.05%) MOTT in the lower plane. Two (0.56%) were detected as upper lymph nodal tumefaction in the median line. In 86 (24.36%) cases at the MRI the so-called "iceberg effect" was noted. 163 (62.45%) patients underwent primary excisional biopsy whereas 74 (28.35%) underwent exeresis after other unsuccessfull therapies, 9 underwent only drainage, and 15 drainage with subsequent antibiotic therapy. Number of relapses after surgery was 16 (6.13%). Conclusions:A not homogeneous therapeutic approach to the mycobacterial cervical adenitis arises from literature and WHO guidelines does not give indications for the treatment of the cervical pattern.A therapeutic strategy based on the etiology is mandatory. In case of MBT adenopathy the therapy of choice includes the association, in variable way, of different chemotherapic drugs; surgery is reserved to advanced cases. Conversely, in cases of MOTT adenopathy, surgery is the treatment of choice.

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“…The sensitivity of such tests is very poor, especially for patients with HIV or extra pulmonary infection. [29,30]. Further in most high-burden countries, sputum smear microscopy remains the principal tool for diagnosing active disease; however, operationally, its sensitivity for pulmonary tuberculosis can be as low as 20% [31,32].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in Trinidad a Small Developing Country: Will we Reach the Millennium Development Goal 8 (MDG8) as we Countdown to 2015?

Mungrue

2014

J Anc Dis Prev Rem

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Aims: The aim of this study was to describe the epidemiological pattern of tuberculosis in Trinidad between 1993-2012, and use this data to answer three questions: (1) where as a developing country we stand in respect to MDG 8? What factors affect the rate of progress? Is it still possible to achieve these goals in the time remaining to 2015?Methods: We used a cohort study design in which all cases attending public facilities for diagnosis and treatment of tuberculosis were entered into a database and followed over time. Data on age and gender were recorded. Conclusion:We have not met MDG 8 and we are unlikely to meet this MDG by 2015, adequate resources to detect and treat TB are crucial to the future control and prevention of TB.

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High Rates of Clinical and Subclinical Tuberculosis among HIV-Infected Ambulatory Subjects in Tanzania

Cited by 162 publications

References 24 publications

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Head and neck mycobacterial infections in pediatric patients

Tuberculosis in Trinidad a Small Developing Country: Will we Reach the Millennium Development Goal 8 (MDG8) as we Countdown to 2015?

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