Determinants of tuberculosis in Lambaréné and barriers towards successful antituberculous treatment

BACKGROUND: The epidemiology of tuberculosis in the central African country Gabon is characterized by an alarmingly high incidence rate and low treatment success rate. The aim of the study was to assess local TB determinants including treatment outcomes and to better understand the barriers towards successful treatment. METHODS: In a prospective observational cohort study TB patients were clinically and microbiologically monitored during the course of their treatment in Lambaréné, Gabon. TB treatment outcome was evaluated and risk factors for unfavorable treatment outcome were identified. RESULTS: Between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up. The HIV co-infection rate was 42% in adults; 4/91 (4.4%) and 4/13 (30.8%) on new and previously treated TB patients had multidrug-resistant TB (MDR-TB), respectively. Risk factors for adverse treatment outcome were far distance to treatment center and clinical diagnosis of TB. DISCUSSION: In Lambaréné, TB epidemiology is determined by a high rate of TB/HIV co-infection and a high rate of MDR-TB among re-treatment patients, as well as a low treament success rate. Prerequisites for an effective TB control in Gabon are the implementation of DOTS, the access to diagnostic capacity for MDR-TB and second-line TB drugs as well as improved integration of TB/HIV care.HINTERGRUND: Das zentralafrikanische Gabun weißt eine beunruhigend hohe Inzendenzrate von Tuberkulosefällen sowie eine geringe Erfolgsquote in der Tuberkulosetherapie auf. Ziel der Studie war die prospektive Erfassung lokaler Determinanten der Tuberkulose und das Aufzeigen von Hindernissen einer erfolgreichen Tuberkulosetherapie. METHODEN: In einer prospektiven Beobachtungsstudie wurden Tuberkulose Patienten während ihrer Behandung in Lambaréné, Gabun klinisch und mikrobiologisch nachverfolgt. Therapieerfolgsraten wurden ausgewertet und Risikofaktoren für ausbleibenden Therapieerfolg identifiziert. ERGEBNISSE: Zwischen 2012 und 2014 wurden 201 erwachsene und pädiatrische Tuberkulosepatienten eingeschlossen und nachverfolgt. 42% der Erwachsenen waren HIV-koinfiziert, der Anteil an multiresistenter Tuberkulose (MDR-TB) betrug 4/91 (4,4%) und 4/13 (30,8%) der Erst- und Rezidiv-Fälle. Die MDR-TB Patienten ausgenommen betrug die Therapieerfolgsquote 55%. Risikofaktoren für ausbleibenden Behandlungserfolg waren große Distanz zum Behandlungszentrum und klinisch diagnostizierte Tuberkulose. SCHLUSSFOLGERUNGEN: Die Epidemiologie der Tuberkulose in Lambaréné wird durch einen hohen Anteil an HIV-Koinfektionen und einen hohen Anteil an MDR-TB unter Rezidiv-Patienten sowie eine niedrige Therapieerfolgsquote bestimmt. Voraussetzungen für die effektive Tuberkulosebekämpfung in Gabun sind die Umsetzung der DOTS-Strategie (Directly Observed Therapy, short course), sowie der Zugang zu Diagnostik von MDR-TB und Zweitrang-Medikamenten und eine verbesserte Vernetzung zwischen Tuberkulose –und HIV Therapie

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

A case series of children and young people admitted to a tertiary care hospital in Germany with COVID-19

Background!#!While our knowledge about COVID-19 in adults has rapidly increased, data on the course of disease and outcome in children with different comorbidities is still limited.!##!Methods!#!Prospective, observational study at a tertiary care children's hospital in southern Germany. Clinical and virology data from all paediatric patients admitted with SARS-CoV-2 infection at our hospital were prospectively assessed.!##!Results!#!Between March and November 2020, 14 patients were admitted with COVID-19. One patient was admitted a second time with COVID-19 6 months after initial disease. Among seven patients with severe underlying comorbidities, three developed multisystem inflammatory syndrome (MIS-C), two were admitted to the paediatric intensive care unit. One patient needed invasive ventilation. Another patient died shortly after discharge of COVID-19-related complications.!##!Conclusions!#!While COVID-19 generally causes mild disease in children, severe respiratory illness and MIS-C occur, in some cases with fatal outcome. Children with underlying diseases might be at special risk for severe disease