Challenging MDR-TB clinical problems - The case for a new Global TB Consilium supporting the compassionate use of new anti-TB drugs.

MDR-TB is a growing challenge worldwide, and an obstacle to TB elimination. It is apparent that TB is being replaced by small but growing number of resistant cases with an anticipated 2 million cases of MDR-TB within the next two decades. One of the potential causes of MDR-TB is iatrogenic and we risk losing our new drugs through inexperience and repetition of basic errors of adding single active drugs to failing regimens. Discussion of MDR-TB cases with senior colleagues is not only best practice; it is now embedded in the WHO and many national and local guidelines.TB Consilia act as gatekeepers to the new drugs, monitor guideline adherence and mandate active drug safety monitoring. TB Consilia are also excellent educational tools.TB Consilia are now recommended by funding bodies, the WHO and manufacturers of drugs available for compassionate use in the hope that these drugs will be protected and will continue to be useful in the future. This article briefly discusses Consilia, their origin and evolution and gives some examples of how they operate. Keywords: TB, MDR-TB, TB Consilium, Prevention, New TB drugs, Compassionate use, Alderott

Multidrug-Resistant Tuberculosis in Europe, 2010-2011

This study (TBNET #30) was supported by the European Commission Seventh Framework Programme (FP7/2007-2013) under grant agreement FP7-223681 and was part of the EU FP7–funded TBPANNET project (http://www.tbpannet.org). C.L. is supported by the German Center for Infection Research

Screening for Tuberculosis in Migrants: A Survey by the Global Tuberculosis Network

Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and-to a lesser degree TB infection (TBI)-is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a diverse group of international health professionals on TB management among migrants. Participants expressed their level of agreement using a six-point Likert scale with different statements in an online survey available in English, French, Mandarin, Spanish, Portuguese and Russian. The survey consisted of eight sections, covering TB and TBI screening and treatment in migrants. A total of 1055 respondents from 80 countries and territories participated between November 2019 and April 2020. The largest professional groups were pulmonologists (16.8%), other clinicians (30.4%), and nurses (11.8%). Participants generally supported infection control and TB surveillance established practices (administrative interventions, personal protection, etc.), while they disagreed on how to diagnose and manage both TB and TBI, particularly on which TBI regimens to use and when patients should be hospitalised. The results of this first knowledge, attitude and practice study on TB screening and treatment in migrants will inform public health policy and educational resources

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort

Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes

<i>Ips sexdentatus</i> Mass-Trapping: Mitigation of Its Negative Effects on Saproxylic Beetles Larger Than the Target

Research Highlights: We investigated the negative effects of bark beetle mass trapping, especially non-target catches among the target’s natural enemies. Slot traps modified with mesh screen and escape windows were tested to improve their selectiveness. Background and Objectives: Two of the main natural enemies of bark beetles, Thanasimus formicarius (L.) and Temnoscheila caerulea (Olivier), are frequently trapped in high numbers in Ips sexdentatus (Böerner) pheromone traps, along with other saproxylic insects; this may lead to much larger pest populations in the successive 4–20 beetle generations. From 2016–2019, during I. sexdentatus mass-trapping in a pine forest of Tuscany (Italy), non-target catches were tallied. Trap modifications were evaluated to mitigate non-target catches, especially those concerning bark beetles’ natural enemies. Materials and Methods: A total of 25 bark-beetle slot traps were placed about 75 m apart in a pine stand infested by I. sexdentatus. Traps were baited with I. sexdentatus aggregation pheromone, whose main components are ipsenol, ipsdienol, and 2-methyl-3-buten-2-ol. Catches were collected every 10 days from March to December. In 2019, 13 traps were modified by applying a 6-mm mesh screen on top of the collection container and by providing three 60 mm × 8 mm escape windows immediately above the screen. These “modified traps” and their captures were considered separately from the 12 remaining “standard traps.” All bark beetle species were recorded, as well as all beetle species > 8 mm. Results: Overall, target catches amounted for Orthotomicus erosus Wollaston. Trap modification allowed the escape of larger species, resulting in the reduction of the average size of caught specimens. Even though non-target catches among predators were still high, the proportion of major predators (T. formicarius and T. caerulea) to bark beetles showed a statistically significant reduction of predator catches in modified traps, an encouraging outcome. Conclusions: Trap modifications may mitigate the problem of non-target catches during mass trapping, especially reducing catches of beetle species larger than the target. However, the key is to schedule mass trapping only during those seasons when the target adults are more active than the main predator adults, thus limiting their catches and, consequently, the negative effects on pest management and biodiversity