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PubMed2005

Clinical and epidemiological aspects of smoking and tuberculosis: a study of 13,038 cases.

SETTING AND OBJECTIVE: Smoking habit and tuberculosis (TB) appear to have common epidemiological and clinical links. The present study was to evaluate risk factors in TB patients with and without a smoking habit. DESIGN: A cross-sectional observational study of cases (TB with smoking) and controls (TB without smoking) from the same registry. Data were retrieved from case notes and interviews of patients registered in the Tuberculosis Control Programme in Cataluuña, Spain, between 1 January 1996 and 31 December 2002. Statistical analyses included univariate and stepwise multiple logistic regression analyses. RESULTS: There were 13,038 recorded patients. Social factors associated with TB in smokers were male sex (adjusted odds ratio [aOR] 2.2), age <64 years, alcohol use >30 g/day (aOR 7.4) and intravenous drug use (aOR 1.5). Smokers developed more pulmonary disease (aOR 1.5) and more cavitary lesions (aOR 1.9), and were more likely to require hospitalisation (aOR 1.8) which was more protracted. Differences in mortality and delay in diagnosis did not reach statistical significance. CONCLUSIONS: Smoking leads to faster and more severe progression of TB. The cost of TB-related hospitalisation for smokers increases by approximately one million euros per year.

Adolescent↗
PubMed2003

[Informative value of the major component technique in the assessment of the epidemic tuberculosis situation].

The paper describes a method for comprehensive analysis of the epidemic situation which is based on the major component technique. The algorithm proposed for comprehensive assessment is highly effective in the retrospective analysis and in the analysis of the current material which includes a great deal of various characteristics that are at first sight occasionally unrelated. The use of the algorithm is shown by the example of analyzing 19 statistical variables that characterize the epidemic situation and different aspects of the work of a tuberculosis-controlling facility in 30 districts of the Novosibirsk Region in a period of 15 years (1985-1999). During processing, the variables fall into two groups: a group of variables that characterize the quality of antituberculosis work and a group of those reflecting the epidemic situation, which were used to divide the districts of the region into several groups.

Adolescent↗
PubMed1996

[Territorial jurisdiction of sanitary risk and demographic statistics: the "tuberculous buildings" of the unhealthy block of Saint-Gervais (1894-1930)].

The assumption of contagion is often employed as an argument for the demarcation of areas considered dangerous to public health. This article examines how it was used in the case of the insalubrious district of Saint Gervais (Paris). The district was identified thanks to statistics available from the health records of Parisian apartment houses, which have been kept since 1894. The author's main concern is the existence of "maisons meurtrières (deathtraps) denounced by contemporary documents although deaths from tuberculosis were progressively decreasing. The examination of statistics giving the number of inhabitants and fatalities from tuberculosis in each apartment building shows that, with the exception of those with furnished rooms, only a small proportion of these dwellings actually had a high death rate from tuberculosis between 1894 and 1930. It also shows that the delimitation of the insalubrious area was based on the idea that the illness was irreversible, allowing the "deathtraps" discovered in earlier stages to be added to those found in each subsequent check. This method made it possible to designate "infected districts" and to justify a policy of city planning.

France↗
PubMed2001

Connectivity patterns in tuberculosis and leprosy patients are indistinguishable from that of healthy donors.

Connectivity, the self-defined interactions between antigen-recognising molecules in a network system can in part be assessed by measuring the reactivity of a given serum against an ordered set of immunoglobulin (Ig)G F(ab')2 fractions, separated by means of isoelectric focusing so that, the serum reactivity against the whole set of fractions defines a characteristic pattern of connectivity. Deviations from the normal condition (healthy donors) have so far been documented for two autoimmune diseases: systemic lupus erythematosus (SLE) and pemphigus vulgaris, as well as for human immunodeficiency virus (HIV)-1 infection. We tested here if bacterial infections lead to alterations in connectivity. In addition, we wanted to test if two antigenically related bacteria would produce similar or otherwise distinctive connectivity patterns. Connectivity analysis was applied on the sera from tuberculosis and leprosy patients and the sera from healthy donors were used as control. No statistically significant differences between the three groups studied were found. These results have implications for theories that set the origin of autoimmune diseases in microbial infections. To the best of our knowledge, this is the first attempt to analyze the connectivity status in bacterial infections.

Adult↗
PubMed2002

Historical risks of tuberculin skin test conversion among non-physician staff at a large urban hospital.

BACKGROUND: Nosocomial transmission of Mycobacterium tuberculosis among workers at a 1000-bed inner-city hospital led to an extensive evaluation of this risk among workers with potential exposure to TB patients or laboratory specimens. METHODS: Retrospective cohort study to determine the incidence and risk of tuberculin skin test (TST) conversions among workers employed 1/1/90 to 9/30/92. RESULTS: Personal, community, and occupational risk factors were evaluated in 2,362 workers with potential M. tuberculosis exposure and 886 workers with no known exposure. The 33-month cumulative rate of TST conversion was 5.8% for potentially exposed workers and 2.0% for controls (RR 3.6; 95% CI; 2.2-5.8). Among workers with potential M. tuberculosis exposure, statistically significantly elevated risks were found for nurses, laboratory technicians, pharmacy workers, phlebotomists, housekeepers, clerks, emergency room workers, and emergency responders. CONCLUSIONS: Workers with patient contact and those employed in certain occupational groups were at increased risk for occupational M. tuberculosis infection.

Adolescent↗
PubMed1991

The annual tuberculosis infection rate, the tuberculin survey and the tuberculin test.

In the present stage of development where tuberculosis mortality has lost its statistical significance because of effective chemotherapy, it is generally recognized that the most reliable measure of the extent of the tuberculosis problem in a population is the "annual tuberculosis infection rate" or incidence of infection. In countries where infection with the bovine type of tubercle bacilli no longer exists, as is the case in the majority of low prevalence countries, the annual infection rate expresses that proportion of the population under study which will be primarily infected, or reinfected with tubercle bacilli from a human source in the course of one year. The annual tuberculosis infection rate is also the best measure for following the trend of the tuberculosis problem in a given population and for evaluating the total effects of organized efforts to control tuberculosis.

Age Factors↗
PubMed1979

[Which type of tuberculosis predominates in cases newly diagnosed during mass radiography? (author's transl)].

12.8 millions roentgenograms, 288,000 of which showed suspicious lesions, were made during the past 25 years by the Tuberculosis Committee of Rheinland-Westfalen. They were analysed with the view of finding whether and to what extent the features of tuberculosis had changed during this period. Although severe tertiary forms of the disease had not entirely disappeared, minimal asymptomatic lesions now tended to predominate when first diagnosed--evidence of the valuable contribution made by mass radiography towards the eradication of tuberculosis. However, the picture changes somewhat if the extent of the tuberculous process is related to the number of patients in need of treatment including cases of re-activation. These figures have remained remarkably constant, viz.: the percentage of cases of unilateral tuberculosis localized to one lobe was 50-54%, of bilateral tuberculosis confined to one lobe was 22-25%; the figures for unilateral and bilateral tuberculosis involving more than one lobe were 10-13 and 10-14% respectively. The type of tuberculosis discovered during voluntary mass radiography in Rheinland-Westfalen do not yet signal an end to the proven methods of tuberculosis control.

Adolescent↗
PubMed2003

[Phagocytosis and chemiluminescence of neutrophils in patients with pulmonary tuberculosis].

The study included 22 patients (15 males and 7 females) with tuberculosis (infected with Mycobacterium tuberculosis), aged from 14 to 70 years. Taking into account clinical status and inflammatory state indices (ESR, leucocytosis, neutrophil count) the following groups were identified: group I--all patients with tuberculosis (n = 22), with subgroup 1--patients with tuberculosis in serious condition (n = 13), subgroup 2--patients with tuberculosis in moderately serious condition (n = 9). The control group (group II) consisted of 16 healthy volunteers aged from 22 to 52 years (12 women and 4 men). In all patients the following parameters were measured: chemiluminescence (CLmax and CLarea) and phagocytosis of neutrophils (total phagocytic capacity (TPC), phagocytic index (PI), percent of phagocyting neutrophils %phag.), ESR, leukocyte count, neutrophil differential count in blood smear. No difference in CL was shown between patients with tuberculosis and healthy people. Significantly higher TPC values were observed in patients with tuberculosis (group I, subgroups 1 and 2) than in the control group. TPC was highest in subgroup 1. PI was slightly higher in patients with tuberculosis than in the control group. On the contrary, decreased %phag was observed in group I (both subgroups). ESR, total leukocyte count and differential neutrophil count were statistically significantly higher in group I than in group II. In patients from group I, together with a slight increase of CLmax, an elevation of TPC was observed. This dependence was not observed between CLarea and TPC. There was no dependence between CLmax and PI. Together with ESR increase, an increase of phagocytic properties of neutrophils was observed.

Adolescent↗
PubMed2002

[Effect of glutoxim in the combination with antitubercular agents of the second choice on the growth of drug resistant Mycobacteria tuberculosis in the cultured murine lung tissue].

It was demonstrated that glutoxim combination with second line drugs for tuberculosis treatment (cycloserine + rifabutine, cycloserine + protionamide) provided statistically significant decrease of intracellular mycobacteria growth in the murine lung tissue culture. The decrease rate when compared to the control group was 3-5 times. The investigated Mycobacterium tuberculosis strain was isolated from the patient and was multi-drug resistant (MDR). Glutoxim addition to the second line drugs combinations provided also decrease of the MDR bacteria microcolonies growth in the lung tissue culture. Glutoxim combination with second line antituberculosis drugs allowed to keep vitality and functional activity of lung tissue cells.

Animals↗
PubMed1990

Chromosome damage in untreated tuberculosis patients.

The frequency of chromosomal aberrations and sister chromatid exchanges (SCEs) were estimated in the lymphocytes of 95 untreated tuberculosis patients to evaluate the chromosomal damage with reference to bacterial invasion. The frequency of chromosomal aberrations was significantly higher in tuberculosis patients compared to controls (p less than 0.001) while the SCE frequency did not show any statistically significant differences. These findings indicate that the basic mechanism of formation of chromosomal aberrations and SCE are different and they suggest that the tubercle bacillus might be capable of inducing chromosome damage.

Adolescent↗
PubMed2005

A case-control study for multidrug-resistant tuberculosis: risk factors in four European countries.

The aim of this study was to detect risk factors for multidrug resistance in patients with pulmonary tuberculosis in four European Union countries: France, Germany, Italy, and Spain. A prospective epidemiological case control study was conducted, made up of patients with clinically diagnosed and microbiologically confirmed pulmonary tuberculosis in the four countries between 1997 and 2000. A total of 138 cases and 276 controls were studied. Considering the four countries as a whole, the most statistically significant risk factors were as follows: intravenous drug use (OR 4.68); asylum-seeker support (OR 2.55) as income factor; living in a nursing home (OR 2.05); previous tuberculosis (OR 2.03) with pulmonary location; prison (OR 2.02); known tuberculosis contacts (OR 2.01); immunosuppression other than human immunodeficiency virus (HIV) (OR 1.96); acquired immunodeficiency syndrome (AIDS) (OR 1.96); current tuberculosis with pulmonary location (OR 1.77); and health-care worker (OR 1.69). These risk factors will have to be taken into account in the European Union as a whole, as well as in each individual country, to establish a health policy of monitoring and control for these cases of multidrug resistance. Although rare, their seriousness makes them particularly important.

Adolescent↗
PubMed2005

A note on variance estimation in random effects meta-regression.

For random effects meta-regression inference, variance estimation for the parameter estimates is discussed. Because estimated weights are used for meta-regression analysis in practice, the assumed or estimated covariance matrix used in meta-regression is not strictly correct, due to possible errors in estimating the weights. Therefore, this note investigates the use of a robust variance estimation approach for obtaining variances of the parameter estimates in random effects meta-regression inference. This method treats the assumed covariance matrix of the effect measure variables as a working covariance matrix. Using an example of meta-analysis data from clinical trials of a vaccine, the robust variance estimation approach is illustrated in comparison with two other methods of variance estimation. A simulation study is presented, comparing the three methods of variance estimation in terms of bias and coverage probability. We find that, despite the seeming suitability of the robust estimator for random effects meta-regression, the improved variance estimator of Knapp and Hartung (2003) yields the best performance among the three estimators, and thus may provide the best protection against errors in the estimated weights.

Analysis of Variance↗
PubMed1995

Antibodies to the 65 kDa mycobacterial stress protein in west Africans with rheumatoid arthritis, tuberculosis and malaria.

We have studied IgG antibodies to recombinant mycobacterial 65 kDa heat-shock protein in West African rheumatoid arthritis (RA) patients and local control groups, including those with tuberculosis or malaria. Mean levels were higher among the patients with RA than among healthy controls, but did not achieve statistical significance. Our findings may relate to the level of mycobacterial exposure in West Africa.

Africa, Western↗
PubMed2001

The effect of adjuvant steroid treatment on serial cerebrospinal fluid changes in tuberculous meningitis.

Three recent studies found that corticosteroids improve clinical outcome and mortality in tuberculous meningitis (TBM), although the exact mechanism of action of the drug remains speculative. A number of reports on the effect of corticosteroids on cerebrospinal fluid (CSF) findings in TBM have been published, often with conflicting results regarding serial cell counts and protein levels. As part of a controlled, randomized trial on the effect of oral prednisone on outcome in childhood TBM at our institution, CSF was collected and analysed weekly during the 1st month of treatment. We found no significant difference in serial CSF cell counts between the steroid and non-steroid groups in the study. However, the steroid group had significantly lower CSF protein and globulin levels after the 1st month of treatment, and a more steady rise in CSF glucose levels than the non-steroid group. Knowledge of the different CSF responses during the course of anti-tuberculosis therapy is important in clinical decision-making.

Adenylate Kinase↗
PubMed2001

Patterns and implications of naturally acquired immune responses to environmental and tuberculous mycobacterial antigens in northern Malawi.

Interferon (IFN)-gamma responsiveness to 12 purified protein derivative (PPD) and new tuberculin antigens from 9 species of mycobacteria was assessed, using a whole blood assay, in 616 young adults living in northern Malawi, where Mycobacterium bovis bacille Calmette-Guérin (BCG) vaccination provides no protection against pulmonary tuberculosis. The prevalence of IFN-gamma responsiveness was highest for PPDs of M. avium, M. intracellulare, and M. scrofulaceum (the MAIS complex). Correlations between responsiveness paralleled genetic relatedness of the mycobacterial species. A randomized, controlled trial was carried out, to assess the increase in IFN-gamma responsiveness to M. tuberculosis PPD that can be attributed to M. bovis BCG vaccination. The BCG-attributable increase in IFN-gamma response to M. tuberculosis PPD was greater for individuals with low initial responsiveness to MAIS antigens than for those with high initial responsiveness. Although not statistically significant, the trend is consistent with the hypothesis that prior exposure to environmental mycobacteria interferes with immune responses to BCG vaccination.

Antigens, Bacterial↗