Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-17 (of 17 Records) |
Query Trace: Lobue PA[original query] |
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Second nationwide tuberculosis outbreak caused by bone allografts containing live cells - United States, 2023
Wortham JM , Haddad MB , Stewart RJ , Annambhotla P , Basavaraju SV , Nabity SA , Griffin IS , McDonald E , Beshearse EM , Grossman MK , Schildknecht KR , Calvet HM , Keh CE , Percak JM , Coloma M , Shaw T , Davidson PJ , Smith SR , Dickson RP , Kaul DR , Gonzalez AR , Rai S , Rodriguez G , Morris S , Armitige LY , Stapleton J , Lacassagne M , Young LR , Ariail K , Behm H , Jordan HT , Spencer M , Nilsen DM , Denison BM , Burgos M , Leonard JM , Cortes E , Thacker TC , Lehman KA , Langer AJ , Cowan LS , Starks AM , LoBue PA . MMWR Morb Mortal Wkly Rep 2024 72 (5253) 1385-1389 During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed. |
In reply
Castro KG , Marks SM , Hill AN , Chen MP , Miramontes R , Winston CA , LoBue PA . Int J Tuberc Lung Dis 2017 21 (1) 120-121 We agree with the excellent summary provided by Reves and Benjamin of the important, but insufficient, progress toward tuberculosis (TB) elimination (<1 case per million population) in the United States over the past two decades. Furthermore, we concur with the need to advance the argument in favor of additional investments required to eliminate TB by providing an estimate of future expected benefits. | | While we did not model future projected savings in our report,1 we have undertaken relatively simple retrospective modeling to estimate the reduction in TB cases and societal benefits had TB elimination been achieved in 1995 and sustained through 2014. From this we estimate that during 1995–2014 from 430 397 to 604 494 TB cases would have been averted (Figure 1), at estimated benefits of US $19.9 billion to $27.7 billion, including the value of deaths prevented and the costs to treat drug-resistant TB disease (Figure 2). Projected cases averted and cost savings for two decades into the future would also be anticipated to be substantial, although somewhat less, because even with a flat case rate the projected case counts for the next two decades would be less than those that actually occurred between 1995 and 2014. |
Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA
LoBue PA , Mermin JH . Lancet Infect Dis 2017 17 (10) e327-e333 Since 1989, the USA has been pursuing the goal of tuberculosis elimination. After substantial progress during the past two decades, the rate of tuberculosis cases in the USA each year has now levelled off and remains well above the elimination threshold. Both epidemiological data and modelling underline the necessity of addressing latent tuberculosis infection if further progress is to be made in eliminating the disease. In this Personal View we explore next steps towards elimination. Given the estimated prevalence of latent tuberculosis infection, compared with the limited testing and treatment that currently occur, a major new effort is required. This effort should consist of a surveillance system or registry to monitor progress, scale-up of targeted testing for latent tuberculosis infection in at-risk populations, scale-up of short-course treatment regimens, engagement of affected communities and medical providers who serve those communities, and increased public health staffing for implementation and oversight. Such an effort would benefit greatly from the development of new tools, such as tests that better indicate reactivation risk, and even shorter latent tuberculosis infection treatment regimens than currently exist. |
Comparison of sputum-culture conversion for Mycobacterium bovis and M. tuberculosis
Scott C , Cavanaugh JS , Silk BJ , Ershova J , Mazurek GH , LoBue PA , Moonan PK . Emerg Infect Dis 2017 23 (3) 456-462 Current US guidelines recommend longer treatment for tuberculosis (TB) caused by pyrazinamide-resistant organisms (e.g., Mycobacterium bovis) than for M. tuberculosis TB. We compared treatment response times for patients with M. bovis TB and M. tuberculosis TB reported in the United States during 2006-2013. We included culture-positive, pulmonary TB patients with genotyping results who received standard 4-drug treatment at the time of diagnosis. Time to sputum-culture conversion was defined as time between treatment start date and date of first consistently culture-negative sputum. We analyzed 297 case-patients with M. bovis TB and 30,848 case-patients with M. tuberculosis TB. After 2 months of treatment, 71% of M. bovis and 65% of M. tuberculosis TB patients showed conversion of sputum cultures to negative. Likelihood of culture conversion was higher for M. bovis than for M. tuberculosis, even after controlling for treatment administration type, sex, and a composite indicator of bacillary burden. |
Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of tuberculosis in adults and children
Lewinsohn DM , Leonard MK , LoBue PA , Cohn DL , Daley CL , Desmond E , Keane J , Lewinsohn DA , Loeffler AM , Mazurek GH , O'Brien RJ , Pai M , Richeldi L , Salfinger M , Shinnick TM , Sterling TR , Warshauer DM , Woods GL . Clin Infect Dis 2017 64 (2) 111-115 BACKGROUND: Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. METHODS: A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. CONCLUSIONS: These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances. |
Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades
Castro KG , Marks SM , Chen MP , Hill AN , Becerra JE , Miramontes R , Winston CA , Navin TR , Pratt RH , Young KH , LoBue PA . Int J Tuberc Lung Dis 2016 20 (7) 926-33 BACKGROUND: Following a concerted public health response to the resurgence of tuberculosis (TB) in the United States in the late 1980s, annual TB incidence decreased substantially. However, no estimates exist of the number and cost savings of TB cases averted. METHODS: TB cases averted in the United States during 1995-2014 were estimated: Scenario 1 used a static 1992 case rate; Scenario 2 applied the 1992 rate to foreign-born cases, and a pre-resurgence 5.1% annual decline to US-born cases; and a statistical model assessed human immunodeficiency virus and TB program indices. We applied the cost of illness to estimate the societal benefits (costs averted) in 2014 dollars. RESULTS: During 1992-2014, 368 184 incident TB cases were reported, and cases decreased by two thirds during that period. In the scenarios and statistical model, TB cases averted during 1995-2014 ranged from approximately 145 000 to 319 000. The societal benefits of averted TB cases ranged from US$3.1 to US$6.7 billion, excluding deaths, and from US$6.7 to US$14.5 billion, including deaths. CONCLUSIONS: Coordinated efforts in TB control and prevention in the United States yielded a remarkable number of TB cases averted and societal economic benefits. We illustrate the value of concerted action and targeted public health funding. |
Tuberculosis infection in the United States: prevalence estimates from the National Health and Nutrition Examination Survey, 2011-2012
Miramontes R , Hill AN , Yelk Woodruff RS , Lambert LA , Navin TR , Castro KG , LoBue PA . PLoS One 2015 10 (11) e0140881 BACKGROUND: Reexamining the prevalence of persons infected with tuberculosis (TB) is important to determine trends over time. In 2011-2012 a TB component was included in the National Health and Nutrition Examination Survey (NHANES) to estimate the reservoir of persons infected with TB. METHODS: Civilian, noninstitutionalized U.S. population survey participants aged 6 years and older were interviewed regarding their TB history and eligibility for the tuberculin skin test (TST) and interferon gamma release assay (IGRA) blood test. Once eligibility was confirmed, both tests were conducted. Prevalence and numbers of TST positive (10 mm or greater), IGRA positive, and both TST and IGRA positive were calculated by adjusting for the complex survey design after applying corrections for item nonresponse and digit preference in TST induration measurements. To examine TST positivity over time, data from NHANES 1999-2000 were reanalyzed using the same statistical methods. The TST was performed using Tubersol, a commercially available purified protein derivative (PPD), rather than PPD-S, which was the antigen used in NHANES 1999-2000. Prior patient history of TB vaccination was not collected in this study nor were patients examined for the presence of a Bacillus of Calmette and Guerin (BCG) vaccine scar. RESULTS: For NHANES 2011-2012, TST and IGRA results were available for 6,128 (78.4%) and 7,107 (90.9%) eligible participants, respectively. There was no significant difference between the percentage of the U.S. population that was TST positive in 2011-2012 (4.7% [95% CI 3.4-6.3]; 13,276,000 persons) compared with 1999-2000 (4.3%; 3.5-5.3). In 2011-2012 the percentage that was IGRA positive was 5.0% (4.2-5.8) and double TST and IGRA positivity was 2.1% (1.5-2.8). The point estimate of IGRA positivity prevalence in foreign-born persons (15.9%; 13.5-18.7) was lower than for TST (20.5%; 16.1-25.8) in 2011-2012. The point estimate of IGRA positivity prevalence in U.S.-born persons (2.8%; 2.0-3.8) was higher than for TST (1.5%; 0.9-2.6). CONCLUSIONS: No statistically significant decline in the overall estimated prevalence of TST positivity was detected from 1999-2000 to 2011-2012. The prevalence of TB infection, whether measured by TST or IGRA, remains lower among persons born in the United States compared with foreign-born persons. |
Is it time to replace the tuberculin skin test with a blood test?
LoBue PA , Castro KG . JAMA 2012 308 (3) 241-2 Effective Diagnosis and Treatment of Latent Tuberculosis infection (LTBI) to prevent progression to tuberculosis (TB) disease is one of the priority strategies for control, prevention, and eventual elimination of TB in the United States. Recent mathematical TB transmission modeling has shown that substantial improvements in addressing LTBI will be needed to eliminate TB before the 22nd century.1 Effective management of LTBI has been hampered by limitations of both treatment regimens and diagnostic tools. The advent of medication regimens with much shorter durations (eg, 12 weekly doses of isoniazid and rifapentine) than the current standard of 9 months of isoniazid is likely to lead to higher rates of treatment completion. Efforts have also been directed at finding a replacement for the tuberculin skin test (TST), which despite its many limitations has been the mainstay of LTBI diagnosis. | Beginning in the 1990s, interferon-γ–release assays (IG-RAs) were developed to diagnose LTBI. Currently, 2 US Food and Drug Administration-approved IGRAs are commercially available, QuantiFERON TB Gold In-Tube (Cellestis/Qiagen) and T-SPOT.TB (Oxford Immunotec). These blood tests detect ex vivo interferon-γ production by peripheral blood mononuclear cells exposed to peptides designed to simulate Mycobacterium tuberculosis antigens. Interferon-γ–release assays offer several practical and theoretical advantages over TST. Interferon-γ–release assays require only 1 patient visit as opposed to 2 for TST (1 visit for placement and 1 visit for reading 48-72 hours later). Interferon-γ–release assays use an objective measurement of interferon-7 production as opposed to human measurement of induration for TST. Also, IGRAs use peptides simulating specific M tuberculosis antigens (early secretory antigenic target 6 [ESAT-6], culture filtrate protein 10 [CFP-10], TB7.7), whereas TST uses purified protein derivative. Purified protein derivative contains numerous M tuberculosis antigens that cross-react with bacille Calmette-Guérin (BCG) and many nontuberculous mycobacteria. ESAT-6, CFP-10, and TB7.7 are found in very few nontuberculous mycobacteria and not found in BCG. |
Unexpected decline in tuberculosis cases coincident with economic recession -- United States, 2009
Winston CA , Navin TR , Becerra JE , Chen MP , Armstrong LR , Jeffries C , Yelk Woodruff RS , Wing J , Starks AM , Hales CM , Kammerer JS , Mac Kenzie WR , Mitruka K , Miner MC , Price S , Scavotto J , Cronin AM , Griffin P , Lobue PA , Castro KG . BMC Public Health 2011 11 (1) 846 BACKGROUND: Since 1953, through the cooperation of state and local health departments, the U.S. Centers for Disease Control and Prevention (CDC) has collected information on incident cases of tuberculosis (TB) disease in the United States. In 2009, TB case rates declined -11.4%, compared to an average annual -3.8% decline since 2000. The unexpectedly large decline raised concerns that TB cases may have gone unreported. To address the unexpected decline, we examined trends from multiple sources on TB treatment initiation, medication sales, and laboratory and genotyping data on culture-positive TB. METHODS: We analyzed 142,174 incident TB cases reported to the U. S. National Tuberculosis Surveillance System (NTSS) during January 1, 2000-December 31, 2009; TB control program data from 59 public health reporting areas; self-reported data from 50 CDC-funded public health laboratories; monthly electronic prescription claims for new TB therapy prescriptions; and complete genotyping results available for NTSS cases. Accounting for prior trends using regression and time-series analyses, we calculated the deviation between observed and expected TB cases in 2009 according to patient and clinical characteristics, and assessed at what point in time the deviation occurred. RESULTS: The overall deviation in TB cases in 2009 was -7.9%, with -994 fewer cases reported than expected (P <.001). We ruled out evidence of surveillance underreporting since declines were seen in states that used new software for case reporting in 2009 as well as states that did not, and we found no cases unreported to CDC in our examination of over 5400 individual line-listed reports in 11 areas. TB cases decreased substantially among both foreign-born and U.S.-born persons. The unexpected decline began in late 2008 or early 2009, and may have begun to reverse in late 2009. The decline was greater in terms of case counts among foreign-born than U.S.-born persons; among the foreign-born, the declines were greatest in terms of percentage deviation from expected among persons who had been in the United States less than 2 years. Among U.S.-born persons, the declines in percentage deviation from expected were greatest among homeless persons and substance users. Independent information systems (NTSS, TB prescription claims, and public health laboratories) reported similar patterns of declines. Genotyping data did not suggest sudden decreases in recent transmission. CONCLUSIONS: Our assessments show that the decline in reported TB was not an artifact of changes in surveillance methods; rather, similar declines were found through multiple data sources. While the steady decline of TB cases before 2009 suggests ongoing improvement in TB control, we were not able to identify any substantial change in TB control activities or TB transmission that would account for the abrupt decline in 2009. It is possible that other multiple causes coincident with economic recession in the United States, including decreased immigration and delayed access to medical care, could be related to TB declines. Our findings underscore important needs in addressing health disparities as we move towards TB elimination in the United States. |
Multiple cytokines are released when blood from patients with tuberculosis is stimulated with Mycobacterium tuberculosis antigens
Kellar KL , Gehrke J , Weis SE , Mahmutovic-Mayhew A , Davila B , Zajdowicz MJ , Scarborough R , Lobue PA , Lardizabal AA , Daley CL , Reves RR , Bernardo J , Campbell BH , Whitworth WC , Mazurek GH . PLoS One 2011 6 (11) e26545 BACKGROUND: Mycobacterium tuberculosis (Mtb) infection may cause overt disease or remain latent. Interferon gamma release assays (IGRAs) detect Mtb infection, both latent infection and infection manifesting as overt disease, by measuring whole-blood interferon gamma (IFN-gamma) responses to Mtb antigens such as early secreted antigenic target-6 (ESAT-6), culture filtrate protein 10 (CFP-10), and TB7.7. Due to a lack of adequate diagnostic standards for confirming latent Mtb infection, IGRA sensitivity for detecting Mtb infection has been estimated using patients with culture-confirmed tuberculosis (CCTB) for whom recovery of Mtb confirms the infection. In this study, cytokines in addition to IFN-gamma were assessed for potential to provide robust measures of Mtb infection. METHODS: Cytokine responses to ESAT-6, CFP-10, TB7.7, or combinations of these Mtb antigens, for patients with CCTB were compared with responses for subjects at low risk for Mtb infection (controls). Three different multiplexed immunoassays were used to measure concentrations of 9 to 20 different cytokines. Responses were calculated by subtracting background cytokine concentrations from cytokine concentrations in plasma from blood stimulated with Mtb antigens. RESULTS: Two assays demonstrated that ESAT-6, CFP-10, ESAT-6+CFP-10, and ESAT-6+CFP-10+TB7.7 stimulated the release of significantly greater amounts of IFN-gamma, IL-2, IL-8, MCP-1 and MIP-1beta for CCTB patients than for controls. Responses to combination antigens were, or tended to be, greater than responses to individual antigens. A third assay, using whole blood stimulation with ESAT-6+CFP-10+TB7.7, revealed significantly greater IFN-gamma, IL-2, IL-6, IL-8, IP-10, MCP-1, MIP-1beta, and TNF-alpha responses among patients compared with controls. One CCTB patient with a falsely negative IFN-gamma response had elevated responses with other cytokines. CONCLUSIONS: Multiple cytokines are released when whole blood from patients with CCTB is stimulated with Mtb antigens. Measurement of multiple cytokine responses may improve diagnostic sensitivity for Mtb infection compared with assessment of IFN-gamma alone. |
No rebound in tuberculosis in the United States in 2010
Winston CA , Navin TR , Becerra JE , LoBue PA . Int J Tuberc Lung Dis 2011 15 (9) 1272 In a recent article in this Journal, Holland et al. correlate TB incidence in the United States since 1952 with time, immigration, and HIV in the late 1980s and early 1990s.1 The authors also correlate proportional decreases in TB incidence in 2008–2009 with increases in unemployment in 2009–2010 in a separate linear regression in which lagged unemployment explains about 10% of state variance in TB incidence (R2 = 0.10). Given the disparities in TB incidence trends comparing US-born versus foreign-born persons in the United States,2 these models may be enhanced by considering origin of birth as an explanatory or stratification variable. | Provisional national surveillance data as of 26 February 2011 show a continued decline in TB case counts, to 11 181 cases in 2010 compared with 11 531 cases in 2009.3 In provisional data, the proportion of all TB patients with cavitary disease was 26% in 2009 and 25% in 2010, while 2% of patients were dead at diagnosis in both years. Despite the aberrant decline in 2009, these data suggest no increase in the number or severity of cases in 2010. As the 2010 case count data are finalized, we continue to investigate and be vigilant for any resurgence in TB. To date, none has been observed. |
Human tuberculosis caused by Mycobacterium bovis in the United States, Latin America and the Caribbean
de Kantor IN , LoBue PA , Thoen CO . Int J Tuberc Lung Dis 2010 14 (11) 1369-73 Human tuberculosis (TB) caused by Mycobacterium bovis appears to be rare in most of the region of the Americas, although some localities have reported an unusually high prevalence of M. bovis among human TB cases (e.g., San Diego, CA, USA; parts of Mexico). As surveillance data are lacking in many countries, there is substantial uncertainty regarding actual incidence. M. bovis is most often not identified, as the diagnosis of TB is made by smear microscopy alone or using egg-containing culture media lacking pyruvate. Where human M. bovis cases have been studied in the region, they appear to be associated with ingestion of unpasteurized dairy products, or with airborne acquired infection in animal keepers and meat industry workers from countries where bovine TB remains a problem. Human-to-human transmission of M. bovis does occur, but appears to account for a very small proportion of cases. Efforts to eradicate M. bovis in humans in the Americas should therefore be directed at eradicating the disease in cattle, increasing pasteurization of dairy products and providing education about the dangers of consuming unpasteurized dairy products. |
Why has zoonotic tuberculosis not received much attention?
Thoen CO , LoBue PA , de Kantor I . Int J Tuberc Lung Dis 2010 14 (9) 1073-4 TUBERCULOSIS caused by Mycobacterium bovis | has been reported to cause disease in humans in widespread regions of the world. However, with few exceptions, the literature indicates that M. bovis accounts | for 1% or less of tuberculosis cases in humans.1–3 | Moreover, human-to-human transmission is rare and | is probably responsible for only a very small percentage of the cases.4 | The global picture of human tuberculosis caused | by M. bovis is, however, largely incomplete. Furthermore, it may be misleading to draw global conclusions | from the published literature on human M. bovis disease, which is mainly focused on high-income, lowtuberculosis burden countries.5,6 While reports indicate that M. bovis, including multidrug-resistant | M. bovis, has been isolated from some human immunodefi ciency virus (HIV) infected patients, the scope of | the problem has not been investigated in countries | where HIV infection is widespread.6,7 These countries | also tend to have large burdens of human tuberculosis. In addition, some may have substantial problems | with bovine tuberculosis and conditions that facilitate cattle-to-human transmission.8 For example, in | sub-Saharan Africa, where human tuberculosis and | HIV incidence are high and where no country has been | able to eradicate or effectively control bovine tuberculosis, half or more of the population may have direct contact with cattle, compared with less than 5% in | the United States.9 Routine or periodic surveillance of | M. bovis in cattle or humans in these high-tuberculosis | burden, high-HIV prevalence, low-resource settings | is not performed, and accurate information on the incidence of human M. bovis disease is not available |
Tuberculosis in humans and its epidemiology, diagnosis and treatment in the United States
Lobue PA , Enarson DA , Thoen TC . Int J Tuberc Lung Dis 2010 14 (10) 1226-1232 Tuberculosis (TB) is a pulmonary and systemic disease caused by Mycobacterium tuberculosis complex species. TB is spread from person to person by airborne transmission. Several factors determine the probability of transmission, including the infectiousness of the source patient and the nature of the environment where exposure occurs. This initial infection (primary TB) rapidly progresses to disease in some persons (especially children and immunocompromised persons), but resolves spontaneously in most individuals. This condition in which the organism lies dormant is known as latent TB infection (LTBI). In the United States, the diagnosis of LTBI is made with either the tuberculin skin test or an interferon-gamma release assay. LTBI is treated with isoniazid (INH; usually for 9 months) to prevent progression to TB disease. Up to 5% of immunocompetent persons will progress to TB disease at some time in the future, even decades after infection, if they are not treated for LTBI. Pulmonary TB disease is diagnosed using a combination of chest radiography and microscopic examination, culture and nucleic acid amplification testing of sputum. Treatment of drug-susceptible TB consists of at least 6 months of an INH and rifampin-containing regimen (with ethambutol and pyrazinamide for the first 2 months). In the United States, drug-resistant TB is relatively rare (approximately 1% of all patients), and is treated with an 18-24 month individualized regimen based on drug susceptibility test results. |
Tuberculosis in humans and animals: an overview
Lobue PA , Enarson DA , Thoen CO . Int J Tuberc Lung Dis 2010 14 (9) 1075-8 Tuberculosis (TB) is a significant disease for both humans and animals. Susceptibility to Mycobacterium tuberculosis is relatively high in humans, other primates and guinea pigs. Cattle, rabbits and cats are susceptible to M. bovis and are quite resistant to M. tuberculosis. Wild hoofed stock is generally susceptible to M. bovis, but few reports are available on the isolation of M. tuberculosis. Swine and dogs are susceptible to both M. bovis and M. tuberculosis. M. bovis accounts for only a small percentage of the reported cases of TB in humans; however, it is a pathogen of significant economic importance in wild and domestic animals around the globe, especially in countries where little information is available on the incidence of M. bovis infection in humans. Unlike transmission of M. bovis from cattle to humans, the role of human-to-human airborne transmission in the spread of M. bovis has been somewhat controversial. Investigations are needed to elucidate the relative importance of M. bovis on TB incidence in humans, especially in developing countries. Efforts should be concentrated in countries where human immunodeficiency virus (HIV) infection is widespread, as HIV-infected individuals are more susceptible to mycobacterial disease. Eradication of M. bovis in cattle and pasteurisation of dairy products are the cornerstones of the prevention of human disease. |
Nontuberculous mycobacteria infections and anti-tumor necrosis factor-alpha therapy
Winthrop KL , Chang E , Yamashita S , Iademarco MF , Lobue PA . Emerg Infect Dis 2009 15 (10) 1556-61 Patients receiving anti-tumor necrosis factor-oc (anti-TNF-oc) therapy are at increased risk for tuberculosis and other granulomatous diseases, but little is known about illness caused by nontuberculous mycobacteria (NTM) in this setting. We reviewed the US Food and Drug Administration MedWatch database for reports of NTM disease in patients receiving anti-TNF-oc therapy. Of 239 reports collected, 105 (44%) met NTM disease criteria. Median age was 62 years; the majority of patients (66, 65%) were female, and most (73, 70%) had rheumatoid arthritis. NTM infections were associated with infliximab (n = 73), etanercept (n = 25), and adalimumab (n = 7); most patients were taking prednisone (n = 68, 65%) or methotrexate (n = 58, 55%) concurrently. Mycobacteria avium (n = 52, 50%) was most commonly implicated, and 9 patients (9%) had died at the time their infections were reported. A high rate of extrapulmonary manifestations (n = 46, 44%) was also reported. |
Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006
Peto HM , Pratt RH , Harrington TA , Lobue PA , Armstrong LR . Clin Infect Dis 2009 49 (9) 1350-7 BACKGROUND: Almost one-fifth of United States tuberculosis cases are extrapulmonary; unexplained slower annual case count decreases have occurred in extrapulmonary tuberculosis (EPTB), compared with annual case count decreases in pulmonary tuberculosis (PTB) cases. We describe the epidemiology of EPTB by means of US national tuberculosis surveillance data. METHODS: US tuberculosis cases reported from 1993 to 2006 were classified as either EPTB or PTB. EPTB encompassed lymphatic, pleural, bone and/or joint, genitourinary, meningeal, peritoneal, and unclassified EPTB cases. We excluded cases with concurrent extrapulmonary-pulmonary tuberculosis and cases of disseminated (miliary) tuberculosis. Demographic characteristics, drug susceptibility test results, and risk factors, including human immunodeficiency virus (HIV) status, were compared for EPTB and PTB cases. RESULTS: Among 253,299 cases, 73.6% were PTB and 18.7% were EPTB, including lymphatic (40.4%), pleural (19.8%), bone and/or joint (11.3%), genitourinary (6.5%), meningeal (5.4%), peritoneal (4.9%), and unclassified EPTB (11.8%) cases. Compared with PTB, EPTB was associated with female sex (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.7-1.8) and foreign birth (OR, 1.5; CI, 1.5-1.6), almost equally associated with HIV status (OR, 1.1; CI, 1.1-1.1), and negatively associated with multidrug resistance (OR, 0.6; CI, 0.5-0.6) and several tuberculosis risk factors, especially homelessness (OR, 0.3; CI, 0.3-0.3) and excess alcohol use (OR, 0.3; CI, 0.3-0.3). Slower annual decreases in EPTB case counts, compared with annual decreases in PTB case counts, from 1993 through 2006 have caused EPTB to increase from 15.7% of tuberculosis cases in 1993 to 21.0% in 2006. CONCLUSIONS: EPTB epidemiology and risk factors differ from those of PTB, and the proportion of EPTB has increased from 1993 through 2006. Further study is needed to identify causes of the proportional increase in EPTB. |
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