Multidrug resistance tuberculosis - current problems

Wzrastająca zapadalność na gruźlicę wielolekooporną, czyli gruźlicę z opornością co najmniej na rifampicynę i izoniazyd, jest poważnym światowym problemem. Leczenie gruźlicy wielolekoopornej lekami drugiego wyboru jest związane z wieloma efektami ubocznymi i długim okresem terapii; jest też bardzo drogie i niejednokrotnie kończy się niepowodzeniem. W celu osiągnięcia dobrej kontroli gruźlicy niezbędne jest postępowanie zgodnie ze strategią DOTS i DOTS-Plus.The rising occurrence of multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, is a serious worldwide problem. The treatment of MDR-TB with alternative chemotherapy is difficult due to side-effects and treatment duration. It is also very expensive and sometimes unsuccessful. DOTS and DOTS-Plus strategy are necessary to achieve a good tuberculosis control

Nowe możliwości diagnostyki utajonego zakażenia prątkiem gruźlicy

So far the only metod of diagnostic assessment of tubercle bacillus infection was a skin tuberculin reaction - but it has low specificity and sensitivity. The article discusses the new tests in the diagnosis of a latent phase of tuberculosis infection and the active form of the disease based on the measurement of interferon gamma (IFN-γ) released by lymphocyte T after the stimulation by antigens which are specific for M. tuberculosis: ESAT-6, CFP-10. The sensitivity and specificity of QuantiFERON-TB Gold and T-SPOT.TB tests in diagnosis of infection as well as in active form of disease, comparison between the results of tuberculin skin test and the results obtained by the new tests, and problem of incompatibility of results obtained thanks to those tests are discussed.Dotychczas jednym z ważnych narzędzi diagnostycznych zakażenia prątkiem gruźlicy był skórny odczyn tuberkulinowy - jest on jednak mało swoisty i mało czuły. W niniejszym artykule omówiono nowe testy w diagnostyce utajonej infekcji gruźliczej oraz czynnej postaci choroby. Zasada ich działania opiera się na pomiarze interferonu gamma (IFN-γ) wydzielanego przez limfocyty T po stymulacji przez antygeny swoiste dla prątka gruźlicy: ESAT-6, CFP-10. Omówiono czułość i swoistość testów QuantiFERON-TB Gold oraz T-SPOT.TB zarówno w zakażeniu, jak i w czynnej postaci choroby, porównanie ich z tuberkulinowym testem skórnym oraz problem niezgodności wyników otrzymanych za pomocą tych testów

Society and labour 6 : Back Cover

Zmiany płucne w przebiegu starczej amyloidozy z niezmutowanej transtyretyny są rzadko opisywane. Opisywany przypadek dotyczy współistnienia gammapatii monoklonalnej typu MGUS oraz amyloidozy z niezmutowanej transtyretyny z rozległym zajęciem miąższu płucnego. Sześćdziesięciosiedmioletnia kobieta została przyjęta na ddział z objawami duszności, osłabienia, utraty masy ciała oraz zmianami rozsianymi w płucach. W badaniu HRCT obecne były obszary wypełnień pęcherzykowych, pogrubienie linii przegrodowych oraz cechy nadciśnienia płucnego. W ECHO serca stwierdzono cechy znacznego nadciśnienia płucnego, badaniem elektromiograficznym czuciowo-ruchową polineuropatię z uszkodzeniem aksonu i mieliny. Wykazano złogi amyloidu w formie guzków w ścianach oskrzeli oraz zrębie płuca, barwienie na czerwień Congo było dodatnie, ujemne dla białek AA, AL, beta2-mikroglobuliny, dodatnie dla transtyretyny. Amyloidozę potwierdzono również ze śluzówki jelita (ujemne barwienie dla białek AA, AL., beta2-mikroglobuliny, dodatnie dla transtyretyny). Trepanobiopsja szpiku wykazała gammapatię monoklonalną typu MGUS z dodatnim barwieniem na czerwień Congo. U chorej postawiono rozpoznanie amyloidozy z transtyretyny z zajęciem naczyń, w szczególności połączeń tętniczo-żylnych, w tym także płucnych z niewielką ilością białka AL (najpewniej była to wtórna imbibicja z surowicy krwi). Nie stwierdzono mutacji w egzonie 1, 2, 3, 4 dla genu transtyretyny. Pacjentka była leczona metyloprednisolonem, melfalanem oraz cyklofosfamidem. Zdjęcie przeglądowe klatki piersiowej wykonane 1 i 2 miesiące po rozpoczęciu terapii wykazało progresję zmian. Pacjentka zmarła w szpitalu rejonowym – sekcji zwłok nie wykonano.Pulmonary involvement in the course of systemic senile amyloidosis caused by non-mutated transthyretin is rarely described. We report on concomitant monoclonal gammapathy of undermined significance (MGUS) and amyloidosis with non-mutated transthyretin with diffuse lesions in lung parenchyma. A female patient, 67 years old, was admitted with dyspnoea, malaise, weight loss, and disseminated radiological lesions in the lungs. On lung HRCT, signs of pulmonary hypertension, alveolar and interstitial involvement, with thickening of septal lines were found. Echocardiography revealed severe pulmonary hypertension, and electromyography revealed sensoromotoric polyneuropathy with axon and myelin damage. Pathological assessment of lung specimens revealed nodular deposits of amyloid in the bronchial walls and lung parenchyma Congo red staining was positive. Specimens of colon mucosa confirmed amyloidosis. Stainings for AA, AL and beta2-microglobulin were negative but were positive for transthyretin. Bone marrow trepanobiopsy indicated monoclonal gammapathy of MGUS type; Congo red staining was positive. Transthyretin amyloidosis with vascular involvement, particularly of arteriovenous anastomoses, including pulmonary vessels and an insignificant amount of AL protein (perhaps secondary imbibition with AL protein from serum) was diagnosed in amyloid deposits. No mutations of the transthyretin gene (exon 1,2,3,4) were found. The patient was treated with methylprednisolone, melphalan and then with cyclophosphamide. Radiological examinations performed 1 and 2 month/s after initiation of therapy showed progression of pulmonary lesions. The patient died one month later; an autopsy was not performed

Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire : a TBNET study

How patients relate to the experience of their illness has a direct impact over their behavior. We aimed to assess illness perception in patients with pulmonary tuberculosis (TB) by means of the Brief Illness Perception Questionnaire (BIPQ) in correlation with patients’ demographic features and clinical TB score. Our observational questionnaire based study included series of consecutive TB patients enrolled in several countries from October 2008 to January 2011 with 167 valid questionnaires analyzed. Each BIPQ item assessed one dimension of illness perceptions like the consequences, timeline, personal control, treatment control, identity, coherence, emotional representation and concern. An open question referred to the main causes of TB in each patient’s opinion. The over-all BIPQ score (36.25 ± 11.054) was in concordance with the clinical TB score (p ≤ 0.001). TB patients believed in the treatment (the highest item-related score for treatment control) but were unsure about the illness identity. Illness understanding and the clinical TB score were negatively correlated (p < 0.01). Only 25% of the participants stated bacteria or TB contact as the first ranked cause of the illness. For routine clinical practice implementation of the BIPQ is convenient for obtaining fast and easy assessment of illness perception with potential utility in intervention design. This time saving effective personalized approach may improve communication with TB patients and contribute to better behavioral strategies in disease control

Interferon-gamma release assays and tuberculin skin testing for diagnosing latent Mycobacterium tuberculosis infection in at-risk groups in Poland

AbstractObjective/BackgroundThe diagnostics of latent tuberculosis infection in Poland using the tuberculin skin test is challenging due to the obligatory Bacillus Calmette–Guérin vaccinations. Interferon-gamma release assays are still very rarely used for diagnostics. We compared the tuberculin skin test and the QuantiFERON-TB Gold In-Tube test to evaluate the degree of latent tuberculosis infection in at-risk groups for tuberculosis (homeless, close contacts, periodic contacts, nursing-home attendees) and in healthy individuals.MethodsQuantiFERON-TB Gold In-Tube tests were carried out on 785 individuals from the homeless (n=150), close contacts (n=171), periodic contacts (n=163), nursing-home attendees (n=152), and healthy individuals (n=149). The tuberculin skin test was performed on 129, 156, 147, 148, and 121 participants, respectively. We evaluated the (a) correlation between serum concentrations of interferon gamma and the tuberculin-skin-test induration diameter; (b) between the number of QuantiFERON-TB Gold In-Tube-positive results and the tuberculin-skin-test diameter in the studied groups; and (c) agreement between both tests and the kappa coefficient using the tuberculin-skin-test diameters of 5, 10, and 15mm.ResultsLarger tuberculin-skin-test induration diameters were associated with elevated serum concentrations of interferon gamma. We found a positive correlation between the number of positive QuantiFERON-TB Gold In-Tube screening results and the tuberculin-skin-test induration diameter. The agreement between QuantiFERON-TB Gold In-Tube and tuberculin-skin-test screening results improved with increasing tuberculin-skin-test induration diameter.ConclusionBased on measures of tuberculin-skin-test induration diameter alone, it is difficult to diagnose latent tuberculosis infection with certainty. The agreement of the QuantiFERON-TB Gold In-Tube test increases with the tuberculin-skin-test diameter. Tuberculin-skin-test diameters larger than 15mm are more likely to be associated with active infection

Multidrug Resistance Tuberculosis—Current Problems

The rising occurrence of multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, is a serious worldwide problem. The treatment of MDR-TB with alternative chemotherapy is difficult due to side-effects and treatment duration. It is also very expensive and sometimes unsuccessful. DOTS and DOTS-Plus strategy are necessary to achieve a good tuberculosis control

Tuberculosis transmission in the population of patients from the Krakow Region (Poland) based on the epidemiological and molecular methods

Background: The transmission of tuberculosis may affect the incidence rate of the disease in Poland. Genetic methods are of assistance in tracing the infection transmission, identifying its sources, determining the risk groups, and focusing on the preventive actions. Objectives: The objectives of this study lie in an assessment of tuberculosis transmission by genetic methods with the assistance of the standard epidemiologic interview. Methods: The genome DNA of 275 Mycobacterium tuberculosis (Mtb) strains from tuberculosis patients, inhabitants of the city of Krakow, was subjected to a genetic analysis via the spoligotyping method and the IS6110-Mtb1–Mtb2 polymerase chain reaction (PCR) method. If the DNA profiles were identical in both of the PCRs, they were considered identical and classified within one molecular family. Results: Among 275 strains, 104 genetic patterns (spoligotypes) were identified. Two hundred and three strains were divided into 66 molecular families (clusters) and analyzed with the IS6110- Mtb1–Mtb2 PCR method. Eighteen clusters were separated. In the Mtb1–Mtb2 clusters, 21 patients were in the risk groups (the homeless, prisoners, and nursing home residents). We did not confirm any direct or temporary contacts between the patients constituting the Mtb1–Mtb2 clusters (apart from the risk groups). However, the patients in these clusters often lived in the same parts of Krakow. Conclusions: The standard epidemiologic interview in tuberculosis patients should be combined with genetic methods. Active transmission of tuberculosis occurs largely among the individuals maintaining probably periodic contacts. The patients who are in the risk groups may play an important role in the transmission of tuberculosis