Veronika Polcova

Multidrug-resistant tuberculosis in Europe, 2010-2011.

Ongoing transmission, high levels of drug resistance, and poor diagnostic

Treatment Outcomes in Multidrug-Resistant Tuberculosis

Multidrug-resistant tuberculosis is a major global challenge. This report examines the definition of treatment success and its effect on determining cure.

Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries

&NA; Rationale: Multidrug‐resistant tuberculosis (MDR‐TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR‐TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR‐TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR‐TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high‐incidence countries compared with low‐incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high‐incidence countries. Simplified outcome definitions that include 1 year of follow‐up after the end of treatment showed similar frequency of relapse‐free cure in low‐ (58.3%), intermediate‐ (55.8%), and high‐incidence (57.1%) countries, but highest frequency of failure in high‐incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR‐TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR‐TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.

Treatment outcomes of MDR-TB and HIV co-infection in Europe

The ongoing HIV epidemic and the increasing number of patients with drug-resistant tuberculosis (TB) are seriously hampering global TB-control activities, including those in the World Health Organization (WHO) Region Europe. Overall, the prevalence of HIV co-infection in TB patients increased from 3.4% in 2008 to 8% in 2014 in the region [1]. The prevalence of multidrug-resistant (MDR)-TB (drug resistance against at least isoniazid and rifampicin) reported for Europe – 15% in newly diagnosed TB patients and 48% in previously treated TB patients – is the highest in the world [1]. HIV-positive patients with MDR-TB demonstrate a very low proportion of relapse-free cure http://ow.ly/r9sk30bqLBP

Tuberculosis and latent tuberculosis in patients with inflammatory bowel disease treated with biologic agents

Souhrn: Pa cienti léčení preparáty anti-TNF-α jsou obecně ohroženi infekčními komplikacemi vč. tuberkulózy. Tuberkulóza je třetí nejrozšířenější infekční onemocnění na světě. Ročně tuberkulózou onemocnění 8– 9 mil. lidí a 1,5 mil. lidí na ni zemře. Každý třetí obyvatel planety je tuberkulózou infikován. Infekce většinou probíhá latentně, ale u 5– 10 % jedinců dojde k manifestaci onemocnění, nejčastěji do 5 let po infekci. Rozvoji tuberkulózy z latentní tuberkulózní infekce lze do jisté míry předejít preventivní léčbou. Proto je vyhledávání a léčba latentní tuberkulózní infekce u rizikových skupin považována za jednu z hlavních metod eliminace tuberkulózy v zemích s nízkou incidencí tuberkulózy, mezi které ČR patří. V přehledném článku se autoři věnují problematice dia gnózy a léčby latentní tuberkulózní infekce vč. aktivní tuberkulózy spojené s podáváním bio logické terapie. Reaktivace latentní tuberkulózní infekce je hlavním rizikem pa cientů léčených preparáty anti-TNF-α, proto autoři zmiňují nutnost screeningového vyšetření před zahájením terapie. Na základě výsledků screeningových vyšetření je doporučen další postup. Úvod článku je věnován základním informacím o tuberkulóze. Součástí článku jsou odkazy na doporučené postupy dia gnostiky a léčby latentní tuberkulózní infekce a aktivní tuberkulózy používané v ČR.

Can IL-4Ralpha and PAR-2 in bronchoalveolar lavage fluid serve as biomarker of fibroproliferative healing in interstitial lung diseases?

Aims: Prognosis and therapeutic approach to interstitial lung diseases (ILDs) depend on their tendency to fibroproliferative healing. In our previous works we proved a relationship of IL-4 gene polymorphisms and IL-4 receptor alpha (IL-4Ralpha) and proteinase activated receptor (PAR-2) expression in lung tissue in fibrotic idiopathic interstitial pneumonias (fIIPs) and increased values of IL-4Ralpha and PAR-2 in bronchoalveolar lavage fuid (BALF) in chronic hypersensitivity pneumonitits(HP). Thus we aimed to compare the PAR-2 and IL-4Ralpha BALF values in different ILDs to test whether these molecules might serve as biomarkers of fibroproliferative healing. Methods: BALF samples of 46 patients with ILDs (8 sarcoidosis (SARC), 15 HP, 13 fIIPs and 10 ILDs within connective tissue diseases (ILD-CTD)) were investigated by ELISA method to detect PAR-2 and IL-4Ralpha values. The Kruskal-Wallis test with multivariate comparisons was used to compare the PAR-2 and IL-4Ralpha values between the ILDs subgroups. Results: There was no significant difference of BALF IL-4Ralpha values between the ILDs (P=0.2729,NS). For PAR-2 we found significantly lower BALF concentrations in SARC compared to other ILDs (mean values in pg/ml: HP 19.93;fIIPs 26.0;ILD-CTD 27.5;SARC 9.3; P=0.007). In multivariate comparison the PAR-2 values in the HP, fIIPs and ILD-CTD groups differed significantly from SARC and on the contrary SARC differed significantly from all (p Conclusion: We hypothesize that PAR-2 in BALF might be a potential biomarker of fibroproliferative healing and can help in differential diagnosis of ILDs with/without progressive fibroproliferative healing.