1,721,038 research outputs found
Paediatric tuberculosis in Europe: Lessons from Denmark and inclusive strategies to consider
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Overview of fever of unknown origin in adult and paediatric patients
No full textFever of unknown origin (FUO) can be caused by a wide group of diseases, and can include both benign and serious conditions. Since the first definition of FUO in the early 1960's, several updates to the definition, diagnostic and therapeutic approaches have been proposed. This review outlines a case report of an elderly Italian male patient with high fever and migrating arthralgia who underwent many procedures and treatments before a final diagnosis of Adult-onset Still's disease was achieved. This case report highlights the difficulties in diagnosing certain causes of FUO that requires a very high index of suspicion. The main causes of FUO in paediatric and adult patients will be reviewed here, underlying the fact that a physician should also consider the possibility that a patient with FUO may have a monogenic autoinflammatory disease (AID). The identification of AIDs requires a careful evaluation of both history and clinical details that may reveal important clues to identify the correct aetiology. We also provide a comprehensive account of specific signs and symptoms that could suggest possible diagnoses and guide the work-up of FUO and non-genetic periodic fevers in children
A new free-cost e-service supporting clinicians to manage their difficult-to-treat TB cases: The ERS-WHO TB consilium
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Crossborder travel and multidrugresistant tuberculosis (MDRTB) in Europe
No full textThe number of international migrants worldwide has continued to grow rapidly over the past fifteen years and the trend is expected to continue, making the health matters associated with migration a crucial public health challenges faced by governments and societies. Multidrug-resistant tuberculosis is a paradigm of transmissible diseases that do not respect borders and poses a multifaceted and complex challenge on migrant health. The guiding principles for the health response are the respect of equity and human rights as well as the accurate analysis of epidemiological trends and determinants of TB in migrants. The action framework "Towards tuberculosis elimination: an action framework for low-incidence countries" includes regulations for cross border migration among the top eight interventions for TB elimination in low incidence countries. Political commitment is the essential requirement, and currently, the limiting factor, to draft regulations for cross-border collaboration, establish cross-border referral systems with contact tracing and information sharing. The e-platform TB Consilium hosted by European Respiratory Society in collaboration with World Health Organization - Euro is an example of a tool that can be used to exchange information for clinical management and surveillance
Compassionate and optimum use of new tuberculosis drugs
No full textCaitlin Reed and colleagues' description of a severe case of extensively drug-resistant tuberculosis emphasises the emerging issue of access to newly developed second-line drugs for difficult-to-treat or even untreatable tuberculosis cases1 and 2 from the perspective of both affected patients and health-care providers.
As the authors correctly point out, the potential benefits of accessing effective treatment go beyond the individual, and extend to public health because of the risk of transmission of a potentially lethal strain. Our understanding is that the reason for denial of delamanid to a patient already treated with bedaquiline was based on existing policies on the rational use of new drugs.3 and 4 Recent WHO guidance stated that there are no data on the simultaneous use of bedaquiline and delamanid in the same patient and that until such data become available, no recommendation on their joint administration is possible. However, the policy guidance, although accounting for the potential additive cardiac toxic effects, and aimed at minimising harms to those treated within a public health perspective, did not forbid the combined use of the two drugs in individual cases.
We recall that when a similar discussion took place about allowing procurement of second-line antituberculosis drugs at discounted prices via the Green Light Committee in the context of the risk of increasing the prevalence of drug resistance, important organisations were against it. Once again, we need to balance the patient's right to access a new, potentially life-saving drug against the risk of unknown, potentially life-threatening, adverse events, which might severely affect its future use.
Similar cases,2 although sporadic, will probably appear again in the future. In our opinion, since the rational use of new drugs (aimed at protecting both the patient and the drug) is an internationally agreed milestone, the simultaneous use of delamanid and bedaquiline might be considered if several conditions are met: an effective treatment cannot be designed by using only one new drug in addition to the optimised background regimen, the clinical centre is qualified, informed consent and pharmacovigilance are in place, and new drug use is supported by expert opinio
A new free-cost e-service supporting clinicians to manage their difficult-to-treat tuberculosis cases:The European Respiratory Society-World Health Organization tuberculosis Consilium
Full text linkThe pandemic of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB), respectively, defined as resistance to isoniazid and rifampicin, and to at least one fluoroquinolone and one injecTable second-line anti-TB drug in addition to isoniazid and rifampicin, is attracting more and more interest1,2,3.
Over 480,000 cases of MDR-TB (and 100,000 of rifampicin-resistant TB)1 are challenging physicians all over the world, as treating these cases is long, expensive and clinically complicated2,3,4,5,6,7,8,9,10. Furthermore, the results are still largely suboptimal with success rates in the order of 50 per cent in MDR-TB patients, which become as low as 20 per cent (with 15% failure/relapse and 35% death rates)2,3,10 in cases harbouring Mycobacterium tuberculosis strains with resistances beyond XDR2,3
Liver transplantation during anti-TB treatment
No full textBackground:Management of tuberculosis (TB) in patients undergoing organ transplantation represents a critical challenge, as induced immunosuppression correlates with bad outcomes and high mortality. Therefore, candidates to organ transplantation diagnosed with TB are generally excluded from transplant waiting list until they complete anti-TB treatment. However, in case of end-stage liver disease, liver transplantation (LT) is the unique life-saving option. Moreover anti-TB treatment may contribute to rapid impairment of liver function, that makes LT even more essential. Therefore, in selected cases, LT may still be considered.
Methods:
We report two cases of successful LT performed in patients affected by pulmonary TB.
Results:
CASE 1: A 14-year-old boy from Philippine was diagnosed with pulmonary TB and started on standard anti-TB regimen. Three weeks after he presented fever, nausea and rash; treatment was immediately stopped. Due to the rapid deterioration of clinical conditions and liver function, a liver biopsy was performed revealing fulminant hepatitis. Few days later, about 5 weeks after anti-TB therapy start, a LT was performed. Anti-TB treatment was reintroduced immediately after LT, opting for moxifloxacin, ethambutol and linezolid to reduce the risk of hepatoxicity. A month later p-aminosalicylic acid was added. Later linezolid was replaced by terizidone, due to linezolid-induced neuropathy. Treatment has been continued for 18 months, with clinical and radiological improvement. CASE 2: A 50-year old Ukrainian woman with an alcohol-related liver cirrhosis was diagnosed with pulmonary TB. To avoid hepatotoxic drugs, she was started on levofloxacin, linezolid, amoxicillin/clavulanate and ethambutol. After 3 weeks, a LT was necessary due to acute liver failure. The same anti-TB treatment was gradually reintroduced immediately after LT. A month later linezolid was replaced by isoniazid, considering the recovery of liver function. One year later she completed the treatment, showing clinical and radiological resolution.
Conclusion:
Both patients underwent successful LT and achieved positive outcome of TB treatment. Our cases suggest that TB is not an absolute contraindication to organ transplantation and case-by-case decision is necessary, especially if transplantation represents the only life-saving opportunity. However, the correct anti-TB treatment strategy in the post-transplant period is still under debate and should be further explored
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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