TB and M/XDR-TB infection control in European TB reference centres: the Achilles’ heel?: Table 1–

Sotgiu, Giovanni; D’Ambrosio, Lia; Centis, Rosella; Bothamley, Graham; Cirillo, Daniela María; Lorenzo, Saverio De; Guenther, Gunar; Kliiman, Kai; Muetterlein, R.; Spînu, Victor; Villar, Miguęl; Jp, Zellweger; Sandgren, Andreas; Huitric, Emma; Lange, Christoph; Manissero, Davide; Migliori, Giovanni Battista

doi:10.1183/09031936.00029311

Cited by 52 publications

(45 citation statements)

References 10 publications

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“…Re-treatment patients need special attention because of the risk of inducing drug resistance. Rapid tests for DST should be used whenever available to ensure an appropriate treatment regimen from the beginning as well as adequate infection control management in a specialized MDR-TB Centre 18,19 . While awaiting DST results, these patients could be initially treated with an empiric regimen (i.e.…”

Section: Managing Drug-susceptible Tuberculosismentioning

confidence: 99%

Pulmonary Tuberculosis Management: 2015 Update

D’Ambrosio¹,

Centis²,

Mantero³

et al. 2015

BRN

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Section: Managing Drug-susceptible Tuberculosismentioning

confidence: 99%

Pulmonary Tuberculosis Management: 2015 Update

D’Ambrosio¹,

Centis²,

Mantero³

et al. 2015

BRN

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“…Moreover, pauci-bacillary active-TB cases [i.e., Acid Fast Bacilli (AFB)-negative subjects], although less effective in spreading MTB, are difficult to diagnose and might receive empirical treatment until culture and drug susceptibility test results are obtained, thus potentially contributing to MDR/XDR strain diffusion (8,9).…”

Section: Introductionmentioning

confidence: 99%

Performance of a lateral flow immunochromatography test for the rapid diagnosis of active tuberculosis in a large multicentre study in areas with different clinical settings and tuberculosis exposure levels

et al. 2016

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Background: Tuberculosis (TB) continues to cause an outsized burden of morbidity and mortality worldwide, still missing efficient and largely accessible diagnostic tools determining an appropriate control of the disease. Serological tests have the potentially to impact TB diagnosis, in particular in extreme clinical settings. Methods:The diagnostic performances of the TB-XT HEMA EXPRESS (HEMA-EXPRESS) immunochromatographic rapid test for active TB diagnosis, based on use of multiple Mycobacterium tuberculosis (MTB) specific antigens, have been evaluated in a large study multicentre TB case-finding study, in populations with different exposure level to TB. A total of 1,386 subjects were enrolled in the six participating centres in Peru: 290 active-TB and 1,096 unaffected subjects. Results:The TB prevalence (overall 20.5%) varied between 4.0% and 41.1% in the different study groups.Overall, the HEMA-EXPRESS test had 30.6% sensitivity (range 3.9-77.9%) and 84.6% specificity (range 51.6-97.3%). A significant inverse correlation between test accuracy (overall 73.5%, range 40.4-96.4%) and TB prevalence in the various study populations was observed (Pearson's r=−0.7985; P=0.05).Conclusions: HEMA-EXPRESS, is rapid and relatively inexpensive test suitable for routine use in TB diagnosis. In low TB prevalence conditions, test performance appears in line with WHO Target Product Profile for TB diagnostics. Performances appear suboptimal in high TB prevalence settings. Appropriate set-up in operative clinical settings has to be considered for novel serological tests for TB diagnosis, particularly for formats suitable for point-of-care use.

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“…addition of only one to two drugs to a failing regimen, or irrational use of available effective anti-TB drugs) or programmatic (no social support, no good approach to potential adverse drug reactions, no good adherence supporting initiatives, etc.) errors [26,27]. If this trend is not reversed, the chances of cure for TB patients will remain low, and the high costs of treating MDR-or XDR-TB may become unaffordable in low-income countries [28].…”

mentioning

confidence: 99%

Tuberculosis: are we making it incurable?

2013

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@ERSpublications With proper management all TB patients have a chance to be cured; it should never be thought that a TB case is incurable http://ow.ly/ksm5gTuberculosis (TB) is most probably the disease that has caused more damage to the human species throughout its history in terms of number of patients and, above all, death toll. There have been thousands of years spent fighting against Mycobacterium tuberculosis in which the human species could only rely on the efficiency of the immune system [1]. We must recall its importance as, in the pre-antibiotic era, the immune system alone could ensure important achievements such as: 1) only 50% of the people exposed to M. tuberculosis contract the infection [2]); 2) only 10% of those infected progress to active disease; and 3) up to 30% of patients with advanced TB disease heal spontaneously ( fig. 1) [3,4]. In spite of this, the fate of TB patients in the pre-chemotherapy period was very bleak, with a mortality of .50% within 5 years after the onset of disease [3,4]. For centuries, several empirical treatments were attempted to trying to change this fateful prognosis. Additionally, sanatoriums were built throughout the world for many decades ( fig. 2). However, all these interventions were not really effective, and none of them contributed significantly to improve the doom of TB patients [4]. Then, fortunately, their fate changed dramatically with the advent of the antibiotic era. The two decades from the discovery of streptomycin in 1943 to that of rifampicin in 1963 changed a devastating disease into a relatively easy to cure one. Not only were up to 11 different drugs with activity against M. tuberculosis discovered (streptomycin, p-aminosalicylate (PAS), thiacetazone, isoniazid (H), pyrazinamide, cycloserine, kanamycin, ethionamide, ethambutol, capreomycin and rifampicin (R)), but, based on multiple randomised clinical trials, the basic fundamentals of TB treatment were also established [4,5]. Probably the most essential of these was the need to combine at least two to three drugs to which the patient was sensitive, as M. tuberculosis can develop resistance to single drugs.The ability of M. tuberculosis to develop resistances to antibiotics was described in the very first randomised clinical trial conducted with streptomycin and published in 1948 [6]. The first great lesson learnt from early randomised clinical trials was that using TB drugs in monotherapy, or in poor combinations, would lead to the selection of resistance to these drugs [5]. Thus, as a result of the misuse of the available drugs, monoresistant TB started to develop, followed by poly-resistant TB (resistance to two or more drugs), multi-drug resistant (MDR)-TB (resistance to at least H+R), and extensively-drug resistant (XDR)-TB (defined as MDR-TB plus resistance to at least one fluoroquinolone (FQ) and one second-line injectable drug). The need for definitions beyond XDR-TB is a currently an issue of debate.The definitions in the field of anti-TB drug resistance should be based on two main fact...

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TB and M/XDR-TB infection control in European TB reference centres: the Achilles’ heel?: Table 1–

Cited by 52 publications

References 10 publications

Pulmonary Tuberculosis Management: 2015 Update

Pulmonary Tuberculosis Management: 2015 Update

Performance of a lateral flow immunochromatography test for the rapid diagnosis of active tuberculosis in a large multicentre study in areas with different clinical settings and tuberculosis exposure levels

Tuberculosis: are we making it incurable?

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