Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, Dec 1, 2022
BackgroundOverseas screening for tuberculosis (TB) has sought to reduce the burden of active TB i... more BackgroundOverseas screening for tuberculosis (TB) has sought to reduce the burden of active TB in the United States. The duration of time between two unchanged, or stable, chest X-rays (CXRs) taken four to six months apart has been considered clinically useful in the evaluation of suspected pulmonary TB disease, but this relationship has not been previously quantified.ObjectiveTo investigate the association between pre-treatment CXR stability duration and future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB in San Diego, California, USA.MethodsThis retrospective record review included County of San Diego TB clinic patients with abnormal CXR results who were started on treatment between 2012 and 2017; multivariable logistic regression was used to analyze the clinical data.ResultsPre-treatment CXR stability duration of at least four months was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.83; 95 % confidence interval [CI], 0.20–3.48), nor was pre-treatment CXR stability duration of at least six months (AOR, 0.97; 95 % CI, 0.30–3.10). Similar results were obtained when four-to-six-month stability was considered (AOR, 0.78; 95 % CI, 0.16–3.89). Patients screened overseas (B1 notification) were less likely to develop Class 3 TB (unadjusted OR, 0.15; 95 % CI 0.05–0.44).ConclusionPre-treatment chest X-ray stability duration was not associated with excluding Class 3 pulmonary TB in this setting, and CXR stability duration cut points may not be as clinically informative as previously understood, but overseas screening is likely an important step in reducing active TB disease burden in the U.S.
Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% aged ≥65 years) developed... more Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% aged ≥65 years) developed moderate/severe adverse events that required treatment interruption (34.8%), first-line drug discontinuation (26.2%, primarily pyrazinamide), second-line drug initiation (30.0%), and treatment duration up to 3.8 months longer. More safe and effective options are needed, including for the elderly.
Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% of patients ≥65 years) de... more Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% of patients ≥65 years) developed moderate/severe adverse events requiring treatment interruption (34.8%), first-line drug discontinuation (26.2%, primarily pyrazinamide), second-line drug initiation (30.0%) and treatment duration up to 3.8 months longer. More safe and effective options are needed, including in the elderly.
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial an... more Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was si...
Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary se... more Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis. Case records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame. Review of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pl...
Background : In Mozambican hospitals, HIV drives transmission of tuberculosis (TB). This study em... more Background : In Mozambican hospitals, HIV drives transmission of tuberculosis (TB). This study employs active case finding along with latent TB infection (LTBI) and HIV screening to identify health workers (HW) at high risk for active TB. Methods : HW at Maputo Central Hospital (MCH) completed a symptom screen, chest X-ray, tuberculin skin- (TST), HIV- and Quantiferon TB-gold (QFT) testing. Sputum samples for acid-fast smear, mycobacterial culture and GeneXpert were solicited from symptomatic patients and those with suspicious X-ray findings. A logistic multivariate analysis with adjusted odds ratios is reported. Results : In 690 enrolled HW, 4 cases of active TB were diagnosed. 425 (62%) LTBI cases were identified, 284 (67%) were classified as high-risk LTBI (Fig 1), 186 are on INH preventive therapy. 12% of HW were HIV+ with no significant difference between those with and without TB infection including LTBI (p=0.3). The TST had a positive predictive value for QFT positivity of 82...
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, Dec 1, 2022
BackgroundOverseas screening for tuberculosis (TB) has sought to reduce the burden of active TB i... more BackgroundOverseas screening for tuberculosis (TB) has sought to reduce the burden of active TB in the United States. The duration of time between two unchanged, or stable, chest X-rays (CXRs) taken four to six months apart has been considered clinically useful in the evaluation of suspected pulmonary TB disease, but this relationship has not been previously quantified.ObjectiveTo investigate the association between pre-treatment CXR stability duration and future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB in San Diego, California, USA.MethodsThis retrospective record review included County of San Diego TB clinic patients with abnormal CXR results who were started on treatment between 2012 and 2017; multivariable logistic regression was used to analyze the clinical data.ResultsPre-treatment CXR stability duration of at least four months was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.83; 95 % confidence interval [CI], 0.20–3.48), nor was pre-treatment CXR stability duration of at least six months (AOR, 0.97; 95 % CI, 0.30–3.10). Similar results were obtained when four-to-six-month stability was considered (AOR, 0.78; 95 % CI, 0.16–3.89). Patients screened overseas (B1 notification) were less likely to develop Class 3 TB (unadjusted OR, 0.15; 95 % CI 0.05–0.44).ConclusionPre-treatment chest X-ray stability duration was not associated with excluding Class 3 pulmonary TB in this setting, and CXR stability duration cut points may not be as clinically informative as previously understood, but overseas screening is likely an important step in reducing active TB disease burden in the U.S.
Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% aged ≥65 years) developed... more Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% aged ≥65 years) developed moderate/severe adverse events that required treatment interruption (34.8%), first-line drug discontinuation (26.2%, primarily pyrazinamide), second-line drug initiation (30.0%), and treatment duration up to 3.8 months longer. More safe and effective options are needed, including for the elderly.
Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% of patients ≥65 years) de... more Of 373 patients treated for drug-susceptible tuberculosis, 35.4% (46.2% of patients ≥65 years) developed moderate/severe adverse events requiring treatment interruption (34.8%), first-line drug discontinuation (26.2%, primarily pyrazinamide), second-line drug initiation (30.0%) and treatment duration up to 3.8 months longer. More safe and effective options are needed, including in the elderly.
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial an... more Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was si...
Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary se... more Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis. Case records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame. Review of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pl...
Background : In Mozambican hospitals, HIV drives transmission of tuberculosis (TB). This study em... more Background : In Mozambican hospitals, HIV drives transmission of tuberculosis (TB). This study employs active case finding along with latent TB infection (LTBI) and HIV screening to identify health workers (HW) at high risk for active TB. Methods : HW at Maputo Central Hospital (MCH) completed a symptom screen, chest X-ray, tuberculin skin- (TST), HIV- and Quantiferon TB-gold (QFT) testing. Sputum samples for acid-fast smear, mycobacterial culture and GeneXpert were solicited from symptomatic patients and those with suspicious X-ray findings. A logistic multivariate analysis with adjusted odds ratios is reported. Results : In 690 enrolled HW, 4 cases of active TB were diagnosed. 425 (62%) LTBI cases were identified, 284 (67%) were classified as high-risk LTBI (Fig 1), 186 are on INH preventive therapy. 12% of HW were HIV+ with no significant difference between those with and without TB infection including LTBI (p=0.3). The TST had a positive predictive value for QFT positivity of 82...
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