Welttuberkulosetag 2021: Infektionskontrolle gestern und heute – 125 Jahre Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK

Die COVID-19-Pandemie gefährdet weltweit die bisher erreichten Erfolge im Kampf gegen die Tuberkulose. Wie das Epidemiologische Bulletin 11/2021 anlässlich des Welttuberkulosetages ausführt, bleibt die Infektionskontrolle angesichts globaler Herausforderungen wie der immer noch unzureichenden Diagnosestellung und der damit verbundenen inadäquaten oder fehlenden Behandlung von Tuberkulose ein hochaktuelles Thema. „The Clock is Ticking“ – Die Uhr tickt

Tuberkuloseversorgung in Deutschland unter Pandemiebedingungen – eine Online-Umfrage des DZK im Öffentlichen Gesundheitsdienst

Seit Beginn der COVID-19-Pandemie kommt es in vielen Ländern zu einem Rückgang der gemeldeten Tuberkulosefälle. In Ländern mit geringem oder mitt¬lerem Einkommen werden vor allem Einschränkungen der allgemeinen Gesundheitsversorgung als Ursache diskutiert. Kurz- wie auch mittelfristigen könnte dies zu einem Anstieg sowohl der Tuberkulose-Todesfälle als auch der -Neuerkrankungen führen. In Deutschland, wo 2020 ein Rückgang von verschiedenen meldepflichtigen Erkrankungen be-obachtet wurde, stellt sich die Frage, ob eine Überlastung des Gesundheitswesens eine Rolle in der Tuberkulosekontrolle spielt. Um eine Einschätzung aus dem Öffentlichen Gesundheits¬dienst zur derzeitigen Versorgungssituation bei der Tuberkulose zu erhalten, führte das Deutsche Zentralkomitee zur Bekämpfung der Tuberkulose einen Survey durch.Peer Reviewe

Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study

BACKGROUND: Prevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease. METHODS: We created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs). FINDINGS: We included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31·3-48·0) of individuals with prevalent subclinical disease at baseline recover and 18% (13·3-24·0) die from tuberculosis, with 14% (9·9-19·2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40·0-59·1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38·3-52·2) die and 20% (15·2-25·8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30·5-45·4). INTERPRETATION: For people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected. FUNDING: TB Modelling and Analysis Consortium and European Research Council

Risk Assessment for Patients with Chronic Respiratory Conditions in the Context of the SARS-CoV-2 Pandemic Statement of the German Respiratory Society with the Support of the German Association of Chest Physicians

Assessing the risk for specific patient groups to suffer from severe courses of COVID-19 is of major importance in the current SARS-CoV-2 pandemic. This review focusses on the risk for specific patient groups with chronic respiratory conditions, such as patients with asthma, chronic obstructive pulmonary disease, cystic fibrosis (CF), sarcoidosis, interstitial lung diseases, lung cancer, sleep apnea, tuberculosis, neuromuscular diseases, a history of pulmonary embolism, and patients with lung transplants. Evidence and recommendations are detailed in exemplary cases. While some patient groups with chronic respiratory conditions have an increased risk for severe courses of COVID-19, an increasing number of studies confirm that asthma is not a risk factor for severe COVID-19. However, other risk factors such as higher age, obesity, male gender, diabetes, cardiovascular diseases, chronic kidney or liver disease, cerebrovascular and neurological disease, and various immunodeficiencies or treatments with immunosuppressants need to be taken into account when assessing the risk for severe COVID-19 in patients with chronic respiratory diseases

Gemeinsame Stellungnahme zur neuen Empfehlung der WHO zur Behandlung der multiresistenten und Rifampicin-resistenten Tuberkulose

Die Entwicklung von Medikamentenresistenz ist global derzeit eines der größten Hindernisse im Kampf gegen TB. Die Problematik resistenter TB ist auch in Deutschland präsent. Zwar sind die Resistenzraten in den letzten Jahren relativ stabil geblieben, die RKI-Surveillancedaten der letzten 10 Jahre zeigen jedoch, dass bei einem Großteil der Fälle multiresistenter TB (MDR-TB) mehr als nur die beiden wichtigsten TB-Medikamente Isoniazid und Rifampicin unwirksam sind. Um eine Ausbreitung von MDR-TB zu verhindern, sind rechtzeitige und sachgemäße Resistenztestungen sowie eine resistenzgerechte, individualisierte Behandlung durch Experten/-innen unabdingbar. Hierbei sind aktuelle Entwicklungen zur Diagnostik, Behandlungsmöglichkeiten und Medikamenten zu berücksichtigen. In Epidemiologischen Bulletin 11/12 2019 beschreiben Maurer et al. die von der WHO empfohlene Umstellung auf ein orales Behandlungsregime und betonen auch hier, dass die Möglichkeiten der Resistenztestung ausgeschöpft werden sollten.Peer Reviewe

The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis

Stages of tuberculosis disease can be delineated by radiology, microbiology, and symptoms, but transitions between these stages remain unclear. In a systematic review and meta-analysis of studies of individuals with untreated tuberculosis who underwent follow-up (34 cohorts from 24 studies, with a combined sample of 139 063), we aimed to quantify progression and regression across the tuberculosis disease spectrum by extracting summary estimates to align with disease transitions in a conceptual framework of the natural history of tuberculosis. Progression from microbiologically negative to positive disease (based on smear or culture tests) in participants with baseline radiographic evidence of tuberculosis occurred at an annualised rate of 10% (95% CI 6·2–13·3) in those with chest x-rays suggestive of active tuberculosis, and at a rate of 1% (0·3–1·8) in those with chest x-ray changes suggestive of inactive tuberculosis. Reversion from microbiologically positive to undetectable disease in prospective cohorts occurred at an annualised rate of 12% (6·8–18·0). A better understanding of the natural history of pulmonary tuberculosis, including the risk of progression in relation to radiological findings, could improve estimates of the global disease burden and inform the development of clinical guidelines and policies for treatment and prevention

Risk Assessment for Patients with Chronic Respiratory Conditions in the Context of the SARS-CoV-2 Pandemic Statement of the German Respiratory Society with the Support of the German Association of Chest Physicians

Assessing the risk for specific patient groups to suffer from severe courses of COVID-19 is of major importance in the current SARS-CoV-2 pandemic. This review focusses on the risk for specific patient groups with chronic respiratory conditions, such as patients with asthma, chronic obstructive pulmonary disease, cystic fibrosis (CF), sarcoidosis, interstitial lung diseases, lung cancer, sleep apnea, tuberculosis, neuromuscular diseases, a history of pulmonary embolism, and patients with lung transplants. Evidence and recommendations are detailed in exemplary cases. While some patient groups with chronic respiratory conditions have an increased risk for severe courses of COVID-19, an increasing number of studies confirm that asthma is not a risk factor for severe COVID-19. However, other risk factors such as higher age, obesity, male gender, diabetes, cardiovascular diseases, chronic kidney or liver disease, cerebrovascular and neurological disease, and various immunodeficiencies or treatments with immunosuppressants need to be taken into account when assessing the risk for severe COVID-19 in patients with chronic respiratory diseases