Journal of Clinical Tuberculosis and Other Mycobacterial Diseases最新文献

{"title":"Isolation and identification of non-tuberculous mycobacteria from aquarium fish in Ilam, Iran","authors":"","doi":"10.1016/j.jctube.2024.100478","DOIUrl":"10.1016/j.jctube.2024.100478","url":null,"abstract":"<div><p>Non-tuberculous mycobacteria (NTM) are among the most important pathogens in wild, captive, marine, and freshwater fish species. So, it is important to consider fish as the primary source of infection for aquarium fish and humans. The present study analyzed the occurrence of NTM in aquarium fish in Ilam, west of Iran. In total, 50 samples of infected fish were collected from different aquariums. Following initial sample processing, sediment of each sample was inoculated into Lowenstein-Jensen and Herrold egg media. The positive colonies were investigated with, growth rate, pigmentation, colony morphology, niacin accumulation, nitrate reduction, catalase activity, urease activity, and arylsulfatase activity. Also, molecular identification was carried out by sequencing of heat shock protein 65 kD gene (<em>hsp65</em>) sequence analysis. According to our results, NTM were isolated from 13 samples (26%), comprising 6 (46.2%) rapid growing, and 7 (53.8%) slow growing mycobacteria. In addition, <em>Mycobacterium marinum</em> was the most common NTM isolated in ornamental fish, which is potentially dangerous for both fish and humans. In conclusion, the current study indicates that ornamental fish play a significant role as a source of NTM.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000652/pdfft?md5=b7bc321c40a22541121e5ed4e3017488&pid=1-s2.0-S2405579424000652-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive reprocessing of reusable bronchoscopes can reduce the false positive rate of Xpert MTB/RIF caused by nucleic acid residue","authors":"","doi":"10.1016/j.jctube.2024.100476","DOIUrl":"10.1016/j.jctube.2024.100476","url":null,"abstract":"<div><h3>Background/Purpose</h3><p>Tuberculosis remains a leading cause of infectious death worldwide, The potential for nucleic acid residue on bronchoscopes to cause false positive results in molecular diagnostic methods and subsequently lead to tuberculosis misdiagnosis has long perplexed clinical.</p></div><div><h3>Methods</h3><p>We utilized Xpert MTB/RIF to analyze the liquid collected after bronchoscope washing, employed by patients either with or without active pulmonary tuberculosis, and subjected to standard reprocessing (SR) or intensive reprocessing (IR) procedures. The IR procedure included specialized training and the provision of patient information to cleaning staff before the SR procedure, and repeated washing and suction of the bronchoscope with sterilized water post SR procedure.</p></div><div><h3>Results</h3><p>55 participants enrolled in the study were divided into three groups: SR group (n = 28), IR group(n = 14), and the control group(n = 13). Among the 55 enrolled patients, neither Mycobacterium tuberculosis nor contamination was detected by MIGT 960 liquid culture in the washing liquid. The positive rate of MTB/RIF in the SR group (12/28) was significantly higher than that in the IR group (1/14), with a statistically significant difference observed between them (42.86 % vs. 7.14 %, P=0.018).</p></div><div><h3>Conclusions</h3><p>Nucleic acid residue on reusable bronchoscopes cleaned via the SR procedure was found to potentially cause false positives in MTB/RIF tests. Reprocessing bronchoscopes via the IR procedure was effective in significantly reducing nucleic acid residue, although complete elimination was not achieved.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000639/pdfft?md5=3f8ddafd8f567849a17b648cc8c48070&pid=1-s2.0-S2405579424000639-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition and unsuccessful tuberculosis treatment among people with multi-drug resistant tuberculosis in Uganda: A retrospective analysis","authors":"","doi":"10.1016/j.jctube.2024.100477","DOIUrl":"10.1016/j.jctube.2024.100477","url":null,"abstract":"<div><h3>Rationale</h3><p>Multi-drug-resistant tuberculosis (MDR-TB) poses a significant public health challenge to the control and successful eradication of TB globally. Suboptimal treatment outcomes are common among persons with MDR-TB necessitating a need to understand the contextual factors.</p></div><div><h3>Objective</h3><p>We determined the factors associated with unsuccessful TB treatment among persons with MDR-TB at a large TB Unit in Central Uganda.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed medical records for all persons with MDR-TB at Mubende Regional Referral Hospital MDR-TB Clinic in Central Uganda. The patients were treated with either second-line, modified second-line, or individualized anti-TB regimens and completed treatment between January 2012 and October 2023. The primary outcome was unsuccessful TB treatment defined as death, treatment failure, or loss to follow-up and measured as a binary outcome. We used a multivariable binary logistic regression analysis to determine the factors independently associated with unsuccessful TB treatment at a 5 % statistical significance level. We reported the adjusted odds ratio (aOR) and the 95 % confidence interval (CI).</p></div><div><h3>Measurements and results</h3><p>We analyzed data from 98 persons with MDR-TB who were aged 15–78 years (mean 36.4 ± 15.4 years). Of these, 40 (40.8 %) were cured, 25 (25.5 %) completed TB treatment, 1 (1.0 %) had treatment failure, 13 (13.3 %) died, and 19 (19.4 %) were lost to follow-up. Overall, 33 (33.7 %) participants had unsuccessful TB treatment which was associated with older age for a 1-year increase in age (aOR 1.05, 95 % CI 1.01–1.09), malnutrition—mid-upper arm circumference of &lt;12.5 cm (aOR 2.99, 95 % CI 1.16–7.98), and previous TB treatment (aOR 0.28, 95 % CI 0.10–0.77).</p></div><div><h3>Conclusion</h3><p>Unsuccessful TB treatment is high among persons with MDR-TB at this TB Unit. It is more likely as age advances and when persons with MDR-TB have malnutrition, but less likely when they have been previously treated for TB. Therefore, interventions to improve treatment outcomes may be beneficial for persons with MDR-TB who are older, malnourished, and those newly diagnosed with the disease. For example, routine nutritional assessment and counseling, including nutritional support for malnourished persons with MDR-TB may be needed to optimize their TB treatment success.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000640/pdfft?md5=dbc35999a5e1d0abc3b0e457d0979b7d&pid=1-s2.0-S2405579424000640-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced pulmonary tuberculosis in Alameda County: Ten-year incidence and risk factors","authors":"","doi":"10.1016/j.jctube.2024.100475","DOIUrl":"10.1016/j.jctube.2024.100475","url":null,"abstract":"<div><h3>Background</h3><p>Advanced pulmonary tuberculosis (APT) may reflect delays in tuberculosis (TB) diagnosis and contribute to ongoing disease transmission and poor outcomes. We characterized trends and factors associated with APT over ten years in a high TB-burden county within the United States.</p></div><div><h3>Methods</h3><p>We evaluated microbiologically and clinically confirmed TB cases reported to the Alameda County Public Health Department during 2010–2019. APT was defined as the presence of cavitation on chest imaging and positive acid-fast bacilli sputum smear. Over the ten-year period, we determined overall incidence and annual trends, and conducted multivariable logistic regression to identify sociodemographic and clinical factors associated with APT.</p></div><div><h3>Results</h3><p>We included 997 cases with pulmonary TB, of which 128 (12.8 %) had APT. The 10-year incidence of APT was 8.8 cases per 100,000, with no significant change in proportion over time. The median age of cases with APT were 50 years (IQR 32–61), 68 % were male, and 78.9 % were non-US-born. On multivariable assessment, APT cases were more likely than non-APT cases to use drugs in the past year (aOR 2.43, 95 % CI 1.10–35.09), to have diabetes (aOR 2.51, 95 % CI: 1.59–3.96), and be HIV negative (aOR 9.32 versus HIV positive, 95 % CI 1.87–169.77). While US nativity was not significantly associated with APT, it was an effect modifier. In stratified analysis, APT was more likely among those with drug-use in the last year among US-born, while diabetes was associated with APT among non-US-born individuals.</p></div><div><h3>Conclusions</h3><p>APT remains a substantial proportion of TB cases. Efforts to increase awareness and access to care are needed for key risk groups including those with recent drug use or diabetes, with consideration of cultural and linguistic factors given differences by US nativity.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000627/pdfft?md5=935412d46d636ba3f6a985d0866e9f0b&pid=1-s2.0-S2405579424000627-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with tuberculosis drug resistance among presumptive multidrug resistance tuberculosis patients identified in a DRTB surveillance study in western Kenya","authors":"","doi":"10.1016/j.jctube.2024.100466","DOIUrl":"10.1016/j.jctube.2024.100466","url":null,"abstract":"<div><p>Multidrug-resistant tuberculosis (MDR-TB) is caused by <em>M. tuberculosis</em> (<em>Mtb</em>) with resistance to the first-line anti-TB medicines isoniazid (INH) and rifampicin (RIF). In Western Kenya, there is reported low prevalence of drug resistant strains among HIV tuberculosis patients, creating a need to determine factors associated with drug resistance patterns among presumptive MDR-TB patients. To determine factors associated with drug resistance patterns among presumptive MDR-TB patients in western Kenya. Three hundred and ninety (3<!--> <!-->9<!--> <!-->0) sputum sample isolates from among presumptive multidrug TB patients, were analyzed for TB drug resistance as per Ministry of Health (MoH) TB program diagnostic algorithm. Frequency and percentages were used to summarize categorical data while median and interquartile range (IQR) were used for continuous data. Multivariable logistic regression was carried out to identify factors associated with TB drug resistance. Out of 390 participants enrolled, 302/390 (77.4 %) were males, with a median age of 34 years. The HIV-infected were 118/390 (30.3 %). Samples included 322 (82.6 %) from presumptive patients, while 68/390 (17.4 %) were either lost to follow-up patients, failures to first-line treatment or newly diagnosed cases. A total of 64/390 (16.4 %) of the isolates had at least some form of drug resistance. Out of 390, 14/390 (3.6 %) had MDR, 12 (3.1 %) were RIF mono-resistance, 34 (8.7 %) had INH, while 4 (1 %) had ethambutol resistance. The category of previously treated patients (those who received or are currently on TB treatment) had a 70 % reduced likelihood of resistance (aOR: 0.30; 95 % CI: 0.13–0.70). In contrast, older age was associated with an increased likelihood of resistance to INH and RIF, with an adjusted odds ratio of 1.04 per year (95 % CI: 1.00–1.08). Prompt MDR-TB diagnosis is essential for appropriate patient care, management, and disease prevention and control. We recommend active surveillance on drug resistant TB in these regions to detect drug resistance patterns for rapid disease management.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000536/pdfft?md5=7b2b02de9f953b8195ed23b9e43f47c3&pid=1-s2.0-S2405579424000536-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance profile and prevalence of Mycobacterium tuberculosis complex in Western Iran using spoligotyping method","authors":"","doi":"10.1016/j.jctube.2024.100467","DOIUrl":"10.1016/j.jctube.2024.100467","url":null,"abstract":"<div><p>Tuberculosis (TB) is a chronic infectious disease with multiple manifestations and gradual progression that remains a major health problem and a leading cause of death worldwide. In recent years, a number of DNA fingerprinting techniques have been developed to identify strains of the <em>Mycobacterium tuberculosis</em> (MTB) complex. Spoligotyping is one of the first PCR-based genotyping methods. Information on the number and identification of common strains among MTB complex samples in clinical samples from Kermanshah city is needed to develop more effective therapeutic strategies.</p><p>This is a descriptive cross-sectional study of 41 sample patients with TB referred to Kermanshah Tuberculosis Centre between December 2021 and June 2022, including sputum, aspiration, urine, etc. First, the susceptibility of the developed bacteria to culture media was compared with that of isoniazid using the proportional method, and rifampin was determined according to the standard protocol. Demographic data of patients referred to the Centre for the Control of Lung Diseases were also recorded.</p><p>In the next step, spoligotyping was carried out using the standard method and each strain pattern was recorded as an OCTAL code and compared with the information available at the World Bank on spoligotyping and its strains. Forty-one patients with pulmonary TB were tested using spoligotyping. Four MTB strains were identified, including H4, CAS, T1 and H1.</p><p>The H4 strain also had the highest frequency with 16 samples (39%) among the MTB complex strains isolated using spoligotyping.</p><p>The highest frequency of strains isolated using spoligotyping was associated with the H4 strain. It can be concluded that spoligotyping is very cost effective, simple, repeatable and highly sensitive.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000548/pdfft?md5=76f39348ba153eeab2f14e31eca9d413&pid=1-s2.0-S2405579424000548-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial diversity in Buruli ulcer lesions in Ghana","authors":"","doi":"10.1016/j.jctube.2024.100468","DOIUrl":"10.1016/j.jctube.2024.100468","url":null,"abstract":"<div><h3>Background</h3><p>Previous studies have demonstrated secondary microbial infection of Buruli ulcer (BUD) lesions before, during and after treatment. However, there is limited data on the bacterial diversity across treatment and their influence on clinical outcome. The present study aimed to investigate the relationship between bacterial diversity within BUD lesions and clinical outcome in affected individuals.</p></div><div><h3>Methods</h3><p>We investigated the bacterial diversity within lesions of individuals with PCR confirmed BUD from 5 endemic districts within central Ghana. Samples were collected longitudinally from lesions over treatment period. Microbiological analyses including isolation of bacteria, and species identification were performed using the VITEK 2 compact.</p></div><div><h3>Results</h3><p>Out of 36 participants included, 80.5 % presented with ulcers on the lower limbs. Higher bacterial diversity was observed in ulcers compared to other clinical forms of BUD. There was a significant association between bacterial diversity and clinical outcome (<em>p</em> = 0.002). ESBL producing bacteria and MRSA were isolated in slow healing BUD lesions.</p></div><div><h3>Conclusion</h3><p>Higher diversity of secondary organisms colonizing BUD lesions may have an impact on clinical outcome in affected individuals. There is the need for the development of treatment guidelines for simultaneous management of <em>M. ulcerans</em> and other potential pathogens within lesions to improve clinical outcome.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240557942400055X/pdfft?md5=55e34dc847bb56aeef7a8458bb39dbc9&pid=1-s2.0-S240557942400055X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot use of a mycolactone-specific lateral flow assay for Buruli ulcer: A case report from Japan","authors":"","doi":"10.1016/j.jctube.2024.100469","DOIUrl":"10.1016/j.jctube.2024.100469","url":null,"abstract":"<div><p>Buruli ulcer, caused by <em>Mycobacterium (M.) ulcerans</em>, is a neglected tropical disease (NTD) characterized by necrosis of the cutaneous tissue, predominantly affecting the limbs. The pathogenesis of this disease is mainly attributed to mycolactone, a lipid toxin produced by <em>M. ulcerans</em>. Here, we report the case of a 7-year-old Japanese girl who presented with worsening ulceration on her left forearm, extending to the elbow, following antimicrobial treatment. To evaluate disease progression, we used a mycolactone-specific lateral flow assay. The test yielded positive results in the advancing necrotic area, aiding in determining the extent of necessary debridement. After undergoing two debridement surgeries and receiving 38 weeks of antimicrobial treatment followed by skin grafting, the patient achieved cure. Timely diagnosis is imperative in avoiding prolonged treatment, highlighting the importance of readily available diagnostic point-of-care tests for Buruli ulcer. Moreover, detection of mycolactone not only can serve as a diagnostic tool for Buruli ulcer but also enables prediction of lesion spread and assessment of cure.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000561/pdfft?md5=8c6a83841749ef713e3d49c6bfbae732&pid=1-s2.0-S2405579424000561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences in the introduction of bedaquiline pretomanid linezolid for drug-resistant tuberculosis in Kyrgyzstan","authors":"","doi":"10.1016/j.jctube.2024.100472","DOIUrl":"10.1016/j.jctube.2024.100472","url":null,"abstract":"<div><h3>Settings</h3><p>In Kyrgyzstan, drug-resistant tuberculosis poses a significant challenge. Recognizing the potential of the BPaL regimen, the World Health Organization recommended its use for selected drug-resistant TB cases under operational research conditions in 2020.</p></div><div><h3>Objective</h3><p>This report presents experiences and results from the BPaL operational research under the LIFT-TB project in Kyrgyzstan.</p></div><div><h3>Design</h3><p>Prospective cohort study.</p></div><div><h3>Results</h3><p>From August 2021 to June 2022, 50 patients were enrolled, achieving an 84 % treatment success rate. Although adverse events affected 11 patients (34.3 %), primarily linked to linezolid use (39 [78 %] patients started on 1200 mg linezolid daily), no unexpected adverse events occurred, and management was appropriate. The operational research emphasized proper patient inclusion, highlighting the crucial roles of psychological counselling support and active drug safety monitoring.</p></div><div><h3>Conclusion</h3><p>With insights gained, Kyrgyzstan is now nationwide implementing the BPaLM/BPaL regimens for a broader drug-resistant TB patient group. The experiences, successes, and lessons from the BPaL operational research, along with the programmatic introduction, offer valuable guidance for global drug-resistant TB control strategies. This initiative becomes a resource for countries with similar drug-resistant TB burdens, promoting a collaborative global approach to address drug-resistant TB challenges.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000597/pdfft?md5=4bbcce0a1369d915d702521507e820cd&pid=1-s2.0-S2405579424000597-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs of non-multidrug-resistant pulmonary tuberculosis and of preventive treatment in Germany – An update","authors":"","doi":"10.1016/j.jctube.2024.100473","DOIUrl":"10.1016/j.jctube.2024.100473","url":null,"abstract":"<div><h3>Background</h3><p>Only 4076 new cases of tuberculosis (TB) were reported in Germany in 2022; of those 184 were multidrug-resistant TB (MDR-/RR-TB).</p></div><div><h3>Methods</h3><p>Based on the current therapy guidelines of the German Central Committee against Tuberculosis and most recent renumeration data of the Statutory Health Insurances (SHI), this study estimates the mean in- and outpatient costs per adult infectious pulmonary non-MDR-TB patient, together with costs arising from Rifampicin (RIF)-based short-course options of tuberculosis preventive treatment (TPT) of their close contacts.</p></div><div><h3>Results</h3><p>From the insurance perspective, the mean inpatient cost (rounded) per adult case was 6138 EUR (SD±2810 EUR) for standard therapy; the cost of primary outpatient treatment only amounted to 1930 EUR and the cost of outpatient treatment post-hospital to 1093 EUR. The mean weighted cost was 6377 EUR (SD±2357 EUR), a drop of 27 % vs. 2019. This is mainly due to a decrease in hospitalizations of 5.6 %, and, given hospital treatment, by a 95 EUR decrease in the per-day reimbursement rate for TB patients who are hospitalized for at least 14 days. In contrast, the mean costs of TPT per person were 466 EUR (RIF solely over 4 months) and 423 EUR (RIF combined with Isoniazid over 3 months).</p></div><div><h3>Conclusion</h3><p>While costs for active non-MDR-TB treatment in Germany have clearly decreased thanks to increased engagement on the part of the private practice sector and lower reimbursement rates in hospital, the comparatively high costs of short-course TPT have surprisingly significant economic impact. This negative development can be countered through diligent selection of close contacts persons of infectious TB cases before using IGRA testing to detect latent TB, to minimize the number of those persons who are tested falsely determined to be at risk and needlessly undergo TPT.</p></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405579424000603/pdfft?md5=fa2f2be838585436e9ba77beff664486&pid=1-s2.0-S2405579424000603-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}