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  • 1.
    Hoffner, S
    et al.
    Swedish Institute Communicable Disease Control, Sweden .
    Angeby, K
    Karolinska University Hospital, Sweden .
    Sturegard, E
    University of and Regional Labs Regional Skåne, Sweden .
    Jonsson, B
    University of Gothenburg, Sweden .
    Johansson, A
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Sellin, M
    Umeå University, Sweden .
    Werngren, J
    Swedish Institute Communicable Disease Control, Sweden .
    Proficiency of drug susceptibility testing of Mycobacterium tuberculosis against pyrazinamide: the Swedish experience2013In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 17, no 11, p. 1486-1490Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pyrazinamide (PZA) is a key drug in the treatment of tuberculosis (TB), including multidrug-resistant TB. Drug susceptibility testing (DST) of Mycobacterium tuberculosis against PZA is not included in the World Health Organizations yearly proficiency testing. There is an increasing need to establish quality control of PZA DST. less thanbrgreater than less thanbrgreater thanOBJECTIVE: To evaluate the performance of PZA DST and to introduce a quality assurance system for the test in Sweden. less thanbrgreater than less thanbrgreater thanMETHOD: Panels with PZA-susceptible and -resistant isolates were used in three rounds of proficiency testing in all five Swedish clinical TB laboratories and our reference laboratory. All laboratories used the MGIT 960 system. Minimum inhibitory concentrations (MICs) were determined and the pncA gene was sequenced to further characterise the 52 panel strains. less thanbrgreater than less thanbrgreater thanRESULTS: Good agreement was seen between the phenotypic PZA DST and pncA sequence data, and MIC determination confirmed high levels of resistance. However, in contrast to other drugs, for which correct proficiency test results were observed, specificity problems occurred for PZA DST in some laboratories. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: In Sweden, using panel testing, differences were seen in the proficiency of TB laboratories in correctly identifying PZA susceptibility. Improved results were noted in the third round; PZA has therefore been included in yearly proficiency testing.

  • 2.
    Lange, C.
    et al.
    Res Ctr Borstel, Germany; Univ Lubeck, Germany; German Ctr Infect Res DZIF, Germany; Karolinska Inst, Sweden.
    Aarnoutse, R. E.
    Radboud Univ Nijmegen, Netherlands.
    Alffenaar, J. W. C.
    Univ Groningen, Netherlands.
    Bothamley, G.
    Homerton Univ Hosp, England; QMUL, England; London Sch Hyg and Trop Med, England.
    Brinkmann, F.
    Ruhr Univ Bochum, Germany.
    Costa, J.
    Ctr Hosp Leiria, Portugal; Ctr Innovat Technol and Hlth Care, Portugal.
    Chesov, D.
    Nicoale Testemitanu State Univ Med and Pharm, Moldova; Res Ctr Borstel, Germany.
    van Crevel, R.
    Radboud Univ Nijmegen, Netherlands; Univ Oxford, England.
    Dedicoat, M.
    Univ Hosp Birmingham, England.
    Dominguez, J.
    Univ Autonoma Barcelona, Spain.
    Duarte, R.
    Portuguese Natl TB Program, Portugal; Ctr Hosp Vila Nova de Gaia, Portugal; Univ Porto, Portugal; Univ Porto, Portugal.
    Grobbel, H. P.
    Res Ctr Borstel, Germany; Univ Lubeck, Germany; German Ctr Infect Res DZIF, Germany.
    Guenther, G.
    Res Ctr Borstel, Germany; Univ Namibia, Namibia.
    Guglielmetti, L.
    Hop Univ Pitie Salpetriere Charles Foix, France; Univ Pierre and Marie Curie 06, France.
    Heyckendorf, J.
    Res Ctr Borstel, Germany; Univ Lubeck, Germany; German Ctr Infect Res DZIF, Germany.
    Kay, A. W.
    Texas Childrens Hosp, TX 77030 USA; Baylor Coll Med, TX 77030 USA; Baylor Coll Med Childrens Fdn, Swaziland.
    Kirakosyan, O.
    MSF France OCP, Armenia.
    Kirk, O.
    Univ Copenhagen, Denmark; Univ Southern Denmark, Denmark.
    Koczulla, R. A.
    Philipps Univ Marburg, Germany; German Ctr Lung Res DZL, Germany.
    Kudriashov, G. G.
    St Petersburg State Res Inst Phthisiopulmonol, Russia.
    Kuksa, L.
    Riga East Univ Hosp, Latvia; Riga Stradins Univ, Latvia.
    van Leth, F.
    Univ Amsterdam, Netherlands.
    Magis-Escurra, C.
    Radboud Univ Nijmegen, Netherlands.
    Mandalakas, A. M.
    Texas Childrens Hosp, TX 77030 USA; Baylor Coll Med, TX 77030 USA.
    Molina-Moya, B.
    Univ Autonoma Barcelona, Spain.
    Peloquin, C. A.
    Univ Florida, FL USA.
    Reimann, M.
    Res Ctr Borstel, Germany; Univ Lubeck, Germany; German Ctr Infect Res DZIF, Germany.
    Rumetshofer, R.
    Otto Wagner Hosp Vienna, Austria.
    Schaaf, H. S.
    Stellenbosch Univ, South Africa.
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Kalmar Cty Hosp, Sweden.
    Tiberi, S.
    Barts Hlth NHS Trust, England; Queen Mary Univ, England.
    Valda, J.
    Otto Wagner Hosp Vienna, Austria.
    Yablonskii, P. K.
    St Petersburg State Res Inst Phthisiopulmonol, Russia; St Petersburg State Univ, Russia.
    Dheda, K.
    Univ Cape Town, South Africa.
    Management of patients with multidrug-resistant tuberculosis2019In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 23, no 6, p. 645-662Article in journal (Refereed)
    Abstract [en]

    The emergence of multidrug-resistant tuberculosis (MDR-TB; defined as resistance to at least rifampicin and isoniazid) represents a growing threat to public health and economic growth. Never before in the history of mankind have more patients been affected by MDR-TB than is the case today. The World Health Organization reports that MDR-TB outcomes are poor despite staggeringly high management costs. Moreover, treatment is prolonged, adverse events are common, and the majority of affected patients do not receive adequate treatment. As MDR-TB strains are often resistant to one or more second-line anti-TB drugs, in-depth genotypic and phenotypic drug susceptibility testing is needed to construct personalised treatment regimens to improve treatment outcomes. For the first time in decades, the availability of novel drugs such as bedaquiline allow us to design potent and well-tolerated personalised MDR-TB treatment regimens based solely on oral drugs. In this article, we present management guidance to optimise the diagnosis, algorithm-based treatment, drug dosing and therapeutic drug monitoring, and the management of adverse events and comorbidities, associated with MDR-TB. We also discuss the role of surgery, physiotherapy, rehabilitation, palliative care and smoking cessation in patients with MDR-TB. We hope that incorporating these recommendations into patient care will be helpful in optimising treatment outcomes, and lead to more MDR-TB patients achieving a relapse-free cure.

  • 3.
    Schulman, H.
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Niward, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Abate, E.
    Univ Gondar, Ethiopia; Ethiopian Publ Hlth Inst, Ethiopia.
    Idh, Jonna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Axenram, P.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bornefall, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
    Forsgren, S.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jakobsson, J.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Öhrling, C.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Kron, M.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Diro, E.
    Univ Gondar, Ethiopia.
    Kebede, A. Getachew
    Addis Ababa Univ, Ethiopia.
    Paues, Jakob
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Bruchfeld, J.
    Karolinska Inst, Sweden.
    Wejse, C.
    Indepth Network, Guinea Bissau; Aarhus Univ Hosp, Denmark; Aarhus Univ, Denmark.
    Stendahl, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
    Sedimentation rate and suPAR in relation to disease activity and mortality in patients with tuberculosis2019In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 23, no 11, p. 1155-1161Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE : To investigate how levels of the soluble urokinase plasminogen activator receptor (suPAR) and erythrocyte sedimentation rate (ESR) correlate with disease activity and prognosis in pulmonary tuberculosis (PTB). DESIGN: This was a retrospective analysis of patients with active PTB (n = 500) in Gondar, Ethiopia, for whom the suPAR (n = 301) and ESR (n = 330) were analysed at the start of treatment. Both biomarkers were available for 176 patients. Human immunodeficiency virus (HIV) status, chest X-ray (CXR) findings, classification according to the clinical TBscore and treatment outcome were all recorded. RESULTS : In a multivariable logistic regression analysis adjusted for age, sex and HIV status, surrogate markers of disease activity such as advanced CXR patterns correlated with increased levels of suPAR (adjusted OR [aOR] 8.24, Pamp;lt; 0.001) and of ESR (aOR 1.63, P = 0.030), whereas ESR only correlated significantly with a TBscore amp;gt;6 points. Increased levels of both suPAR and ESR were associated with unsuccessful treatment outcomes (aOR 2.93, P = 0.013; aOR 2.52, P = 0.025). The highest quartile of suPAR (aOR 13.3, P = 0.029) but not ESR levels correlated independently with increased mortality. CONCLUSION: SuPAR and ESR levels correlate with disease activity in PTB; however, the clinical role of these potentially prognostic biomarkers needs to be verified in prospective studies.

  • 4.
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
    The evaluation of routine immunological tests to estimate the risk of progression into active tuberculosis2019In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 23, no 11, p. 1127-1128Article in journal (Other academic)
    Abstract [en]

    n/a

  • 5.
    Schön, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    Elmberger, G
    KI.
    Negesse, Y
    Hernandez Pando, R
    Sundqvist, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    Britton, S
    KI.
    Local production of nitric oxide in patients with tuberculosis2004In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 8, no 9, p. 1134-1137Article in journal (Refereed)
    Abstract [en]

    Nitric oxide (NO), produced by the inducible nitric oxide synthase (iNOS), is important in host defence against Mycobacterium tuberculosis in rodents, but the presence of high-output NO production in human tuberculosis has been controversial. We investigated iNOS and nitrotyrosine (Ntyr) expression in pleural (n = 7), pulmonary (n = 5) and lymph node biopsies (n = 5) from untreated, newly diagnosed tuberculosis patients. Many iNOS and Ntyr reactive macrophages were observed in granulomas, including Langhans giant cells, indicating high-output NO production at the primary site of disease in tuberculosis.

1 - 5 of 5
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