Clinical outcomes of new algorithm for diagnosis and treatment of Tuberculosis sepsis in HIV patients.
Kenneth C. Byashalira,Peter M. Mbelele,Hadija Semvua,Jaffu Chilongola,Seleman K Semvua,Alphonce Liyoyo,Blandina T. Mmbaga,Sayoki Mfinanga,Christopher L. Moore,Scott K. Heysell,Stellah G. Mpagama +10 more
TLDR
Investigation of a new algorithm for diagnosis and treatment of tuberculosis (TB) related sepsis among PLHIV presenting with life-threatening illness increased TB case detection in patients that could have been missed by Xpert MTB/RIF assay.Abstract:
Background: Despite effort to diagnose tuberculosis (TB) in the Human Immunodeficiency Virus (HIV) infected population, 45% of adults with HIV that had a previously unknown reason for death, demonstrated TB was the cause by autopsy examination. We aimed to assess the clinical outcomes of implementation a new algorithm for diagnosis and treatment of tuberculosis (TB) related sepsis among PLHIV presenting with life-threatening illness. Methods: This study is a prospective cohort conducted in three-referral hospitals in Kilimanjaro, recruited 97 PLHIV from February through June 2018. Patients provided urine and sputum samples for testing lateral flow – lipoarabinomannan (LF-LAM) and Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays, respectively. Anti-TB was prescribed to patients with positive LF-LAM or Xpert MTB/RIF or received broad-spectrum antibiotics but deteriorated. Results: Of 97 patients, 84 (87%) provided urine and sputa, and 13 (13%) provided only urine. The mean age (95% confidence interval) was 40 (38–43) years and 52 (54%) were female. In 84 patients, LF-LAM increased TB detection from 26 (31%) by Xpert MTB/RIF to 41 (55%) by both tests. Of 97 patients, 69 (71%) prescribed anti-TB, 67% (46/69) and 33% (23/69) had definitive and probable TB respectively. Sixteen (16.5%) patients died, of which one died before treatment, 73% (11/15) died within 7 days of admission. The 30-day survival was similar in both treatment groups (log rank = 0.1574). Mortality was significantly higher among hospitalized patients compared to outpatients (P ≤ 0.027). Conclusion: Implementation of new algorithm increased TB case detection in patients that could have been missed by Xpert MTB/RIF assay. Survival of PLHIV with confirmed or probable TB was comparable to those of PLHIV that were treated with broad-spectrum antibiotics alone. Further work should focus on the optimal timing and content of the immediate antimicrobial regimen for sepsis among PLHIV in TB-endemic settings.read more
Citations
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Journal ArticleDOI
Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis
Jerry S Zifodya,Jonah S Kreniske,Ian Schiller,Mikashmi Kohli,Nandini Dendukuri,Samuel G Schumacher,Eleanor A Ochodo,Eleanor A Ochodo,Frederick Haraka,Frederick Haraka,Alice Zwerling,Madhukar Pai,Karen R Steingart,David J. Horne +13 more
TL;DR: In this paper, the diagnostic accuracy of Xpert Ultra and Xpert MTB/RIF for the detection of pulmonary tuberculosis and detection of rifampicin resistance in adults with presumptive pulmonary tuberculosis was compared.
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Xpert MTB/RIF and Xpert Ultra assays for screening for pulmonary tuberculosis and rifampicin resistance in adults, irrespective of signs or symptoms
Adrienne E Shapiro,Jennifer M. Ross,Mandy Yao,Ian Schiller,Mikashmi Kohli,Nandini Dendukuri,Karen R Steingart,David J. Horne +7 more
TL;DR: The accuracy of Xpert MTB/RIF and Xpert Ultra for screening for pulmonary tuberculosis in adults, irrespective of signs or symptoms, in high-risk groups and in the general population is estimated using a Bayesian approach.
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Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study.
Stellah G. Mpagama,Kaushik Ramaiya,Troels Lillebaek,Blandina T. Mmbaga,Marion Sumari-de Boer,Nyanda E. Ntinginya,Jan-Willem C. Alffenaar,Scott K. Heysell,Ib C. Bygbjerg,Dirk L. Christensen +9 more
TL;DR: The ADEPT protocol with underpinned implementation and operational research on TB/DM is described, which aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study.
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Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania
Kenneth C. Byashalira,Nyasatu G Chamba,Yosra Alkabab,Peter M. Mbelele,Emmanuel A. Mpolya,Nyanda E. Ntinginya,PendoMartha J. Shayo,Kaushik Ramaiya,Troels Lillebaek,Scott K. Heysell,Blandina T. Mmbaga,Ib C. Bygbjerg,Stellah G. Mpagama,Dirk L. Christensen +13 more
TL;DR: Assessment of treatment outcomes including time to sputum conversion and death in TB participants with or without hyperglycaemia found diabetes mellitus to compromise TB treatment outcomes.
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Advanced HIV disease: A review of diagnostic and prophylactic strategies.
TL;DR: In this paper , a review of point-of-care (POC) diagnostics and treatment strategies that can facilitate OI screening and prophylaxis for persons living with AHD is presented.
References
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Catharina Boehme,Mark P. Nicol,Mark P. Nicol,Pamela Nabeta,Joy Sarojini Michael,Eduardo Gotuzzo,Rasim Tahirli,Ma Tarcela Gler,Robert Blakemore,William Worodria,Christen Gray,Laurence Huang,Tatiana Cáceres,Rafail Mehdiyev,Lawrence Raymond,Andrew Whitelaw,Andrew Whitelaw,Kalaiselvan Sagadevan,Heather Alexander,Heather Alexander,Heidi Albert,Frank Cobelens,Helen M Cox,David Alland,Mark D. Perkins +24 more
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Diagnosis of smear-negative pulmonary tuberculosis in people with HIV infection or AIDS in resource-constrained settings: informing urgent policy changes
TL;DR: It is proposed that the internationally recommended algorithm for the diagnosis of smear-negative pulmonary tuberculosis should be revised to include HIV status, severity of AIDS and tuberculosis, and early use of chest radiography in the decision tree.
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Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis.
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Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial.
Ben Andrews,Ben Andrews,Matthew W. Semler,Levy Muchemwa,Paul Kelly,Paul Kelly,Shabir Lakhi,Douglas C. Heimburger,Chileshe Mabula,Mwango Bwalya,Gordon R. Bernard +10 more
TL;DR: A protocol for early resuscitation with administration of intravenous fluids and vasopressors increased in-hospital mortality compared with usual care among adults with sepsis and hypotension in Zambian adults presenting to the emergency department at a 1500-bed referral hospital.
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