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1.
The European respiratory journal ; 2022.
Article in English | EuropePMC | ID: covidwho-1957906

ABSTRACT

Background COVID-19 social distancing measures led to a dramatic decline in non-COVID respiratory virus (RV) infections, providing a unique opportunity to study their impact on annual FEV1 decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR). Methods All FEV1 values of LTR transplanted between 2009-April 2020 were included. Annual FEV1 change was estimated with separate estimates for pre- social distancing (2009/2020) and the year with social distancing measures (2020/2021). Patients were grouped by individual TDLF frequency (frequent/infrequent). RV circulation was derived from weekly hospital-wide RV infection rates. Effect modification by TDLF frequency and RV circulation was assessed. CLAD and TDLF rates were analyzed over time. Results 479 LTR (12 775 FEV1 values) were included. Pre- social distancing annual change in FEV1 was −114 mL [95%CI;−133;−94], while during social distancing FEV1 did not decline: +5 mL [−38;48] (difference pre- versus during social distancing: p<0.001). The frequent TDLF subgroup showed faster annual FEV1 decline compared to infrequent TDLF (−150 mL [−181;−120] versus −90 mL [−115;−65] p=0.003). During social distancing, we found significantly lower odds for any TDLF (OR 0.53 [0.33;0.85], p=0.008) and severe TDLF (OR 0.34 [0.16;0.71] p=0.005) as well as lower CLAD incidence (OR 0.53 [0.27;1.02] p=0.060). Effect modification by RV circulation indicated a significant association between TDLF/CLAD and RVs. Conclusion During social distancing the strong reduction in RV circulation coincided with markedly less FEV1 decline, fewer TDLFs and possibly less CLAD. Effect modification by RV circulation suggests an important role for RVs in lung function decline in LTR.

2.
J Bras Pneumol ; 48(2): e20220087, 2022.
Article in English, Portuguese | MEDLINE | ID: covidwho-1819121

ABSTRACT

The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.


Subject(s)
COVID-19 , Influenza, Human , Tuberculosis , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Humans , Influenza, Human/epidemiology , Pandemics/prevention & control
3.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-331566

ABSTRACT

Background: Despite the fact that a number of therapeutic agents have been tested for the treatment of coronavirus disease 2019 (Covid-19), no antiviral agents have yet been proven to be effective. Objectives This study aims to evaluate the favorable clinical outcomes after remdesivir treatment in hospitalized patients with moderately severe COVID-19 disease in Pakistan. Methods A prospective study in hospitalized patients with moderately severe Covid-19 disease was conducted between January 2021- October 2021. The patients were divided into remdesivir-treated and control groups. The Remdesivir-treated group received 200mg IV, followed by 100mg once daily for four days. In addition to standard care, all patients received corticosteroid therapy. The clinical status of remdesivir patients was assessed after the 5th day of treatment, including proportion negative polymerase chain reaction test for COVID-19, length of hospitalization, improvement in oxygen demand, and effects on C-reactive protein (CRP) levels. Multivariate analysis and paired sample T-test were performed to evaluate a favorable response to remdesivir treatment and results were compared with a control group. Result In total, 328 patients were enrolled in the study, with 162 of them receiving IV remdesivir on the day of admission. The C-reactive protein level in the remdesivir treated group [median 22.0 (14.0–36.7)] was significantly lower (p < 0.001) than in the remdesivir naive group [median 79.1 (57.4–139.0)]. The number of days spent in the hospital was significantly different between the remdesivir-treated and remdesivir-naive groups [6.2 0.5] (p < 0.001). In the remdesivir-treated group, 36.7% of patients were discharged with a negative PCR, compared to 21.6% in the control group (p < 0.001). In comparison to the control group, the remdesivir treated group showed a significant improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (p < 0.001). Conclusion The remdesivir treatment was found to be superior to improve clinical outcomes among moderately severe Covid-19 disease patients.

4.
Emerg Infect Dis ; 28(3): 660-671, 2022 03.
Article in English | MEDLINE | ID: covidwho-1736724

ABSTRACT

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011-2020. Among 283 patients, 153 (54.1%) were <5 years of age, and 226 (79.9%) had stage II or III TBM. Predictors of in-hospital death (n = 44 [15.5%]) were stage III TBM, hydrocephalus, male sex, low-income parents, seizures at admission, and lack of bacillus Calmette-Guérin vaccination. Predictors of postdischarge death (n = 18 [6.4%]) were hydrocephalus, tuberculoma, and lack of bacillus Calmette-Guérin vaccination. At treatment completion, 91 (32.1%) patients were documented to have survived, of whom 33 (36.3%) had severe neurologic sequelae and 118 (41.7%) had unknown outcomes. Predictors of severe neurologic sequelae were baseline temperature >38°C, stage III TBM, and baseline motor deficit. Despite treatment, childhood TBM in Indonesia causes substantial neurologic sequelae and death, highlighting the importance of improved early diagnosis, better tuberculosis prevention, and optimized TBM management strategies.


Subject(s)
Tuberculosis, Meningeal , Aftercare , Child , Hospital Mortality , Humans , Indonesia/epidemiology , Male , Patient Discharge , Retrospective Studies , Treatment Outcome , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/drug therapy , Tuberculosis, Meningeal/epidemiology
6.
Clin Pharmacokinet ; 60(6): 685-710, 2021 06.
Article in English | MEDLINE | ID: covidwho-1275007

ABSTRACT

Tuberculosis (TB) is still the number one cause of death due to an infectious disease. Pharmacokinetics and pharmacodynamics of anti-TB drugs are key in the optimization of TB treatment and help to prevent slow response to treatment, acquired drug resistance, and adverse drug effects. The aim of this review was to provide an update on the pharmacokinetics and pharmacodynamics of anti-TB drugs and to show how population pharmacokinetics and Bayesian dose adjustment can be used to optimize treatment. We cover aspects on preclinical, clinical, and population pharmacokinetics of different drugs used for drug-susceptible TB and multidrug-resistant TB. Moreover, we include available data to support therapeutic drug monitoring of these drugs and known pharmacokinetic and pharmacodynamic targets that can be used for optimization of therapy. We have identified a wide range of population pharmacokinetic models for first- and second-line drugs used for TB, which included models built on NONMEM, Pmetrics, ADAPT, MWPharm, Monolix, Phoenix, and NPEM2 software. The first population models were built for isoniazid and rifampicin; however, in recent years, more data have emerged for both new anti-TB drugs, but also for defining targets of older anti-TB drugs. Since the introduction of therapeutic drug monitoring for TB over 3 decades ago, further development of therapeutic drug monitoring in TB next steps will again depend on academic and clinical initiatives. We recommend close collaboration between researchers and the World Health Organization to provide important guideline updates regarding therapeutic drug monitoring and pharmacokinetics/pharmacodynamics.


Subject(s)
Pharmaceutical Preparations , Tuberculosis , Antitubercular Agents/therapeutic use , Bayes Theorem , Humans , Isoniazid , Tuberculosis/drug therapy
7.
Front Med (Lausanne) ; 7: 572485, 2020.
Article in English | MEDLINE | ID: covidwho-1186815

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a rapidly evolving, highly transmissible, and potentially lethal pandemic caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of June 11 2020, more than 7,000,000 COVID-19 cases have been reported worldwide, and more than 400,000 patients have died, affecting at least 188 countries. While literature on the disease is rapidly accumulating, an integrated, multinational perspective on clinical manifestations, immunological effects, diagnosis, prevention, and treatment of COVID-19 can be of global benefit. We aimed to synthesize the most relevant literature and experiences in different parts of the world through our global consortium of experts to provide a consensus-based document at this early stage of the pandemic.

8.
Eur Respir J ; 56(4)2020 10.
Article in English | MEDLINE | ID: covidwho-890060

ABSTRACT

Major epidemics, including some that qualify as pandemics, such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), HIV, influenza A (H1N1)pdm/09 and most recently COVID-19, affect the lung. Tuberculosis (TB) remains the top infectious disease killer, but apart from syndemic TB/HIV little is known regarding the interaction of viral epidemics and pandemics with TB. The aim of this consensus-based document is to describe the effects of viral infections resulting in epidemics and pandemics that affect the lung (MERS, SARS, HIV, influenza A (H1N1)pdm/09 and COVID-19) and their interactions with TB. A search of the scientific literature was performed. A writing committee of international experts including the European Centre for Disease Prevention and Control Public Health Emergency (ECDC PHE) team, the World Association for Infectious Diseases and Immunological Disorders (WAidid), the Global Tuberculosis Network (GTN), and members of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC) was established. Consensus was achieved after multiple rounds of revisions between the writing committee and a larger expert group. A Delphi process involving the core group of authors (excluding the ECDC PHE team) identified the areas requiring review/consensus, followed by a second round to refine the definitive consensus elements. The epidemiology and immunology of these viral infections and their interactions with TB are discussed with implications for diagnosis, treatment and prevention of airborne infections (infection control, viral containment and workplace safety). This consensus document represents a rapid and comprehensive summary on what is known on the topic.


Subject(s)
Respiratory Tract Infections/epidemiology , Tuberculosis/epidemiology , Virus Diseases/epidemiology , BCG Vaccine/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Epidemics , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/immunology , Humans , Influenza A Virus, H1N1 Subtype , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Influenza, Human/immunology , Lung/immunology , Middle East Respiratory Syndrome Coronavirus , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Public Health , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/immunology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/drug therapy , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/immunology , Tuberculosis/diagnosis , Tuberculosis/immunology , Tuberculosis/prevention & control , Virus Diseases/diagnosis , Virus Diseases/drug therapy , Virus Diseases/immunology
9.
Emerg Infect Dis ; 26(11): 2709-2712, 2020 11.
Article in English | MEDLINE | ID: covidwho-762400

ABSTRACT

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.


Subject(s)
Continuity of Patient Care/trends , Coronavirus Infections/epidemiology , Facilities and Services Utilization/trends , Global Health/trends , Pneumonia, Viral/epidemiology , Tuberculosis/therapy , Betacoronavirus , COVID-19 , Humans , Pandemics , SARS-CoV-2 , Tuberculosis/epidemiology
10.
Eur Respir J ; 56(1)2020 07.
Article in English | MEDLINE | ID: covidwho-382158
11.
Am J Transplant ; 20(12): 3529-3537, 2020 12.
Article in English | MEDLINE | ID: covidwho-361387

ABSTRACT

Respiratory tract infection with pneumoviruses (PVs) and paramyxoviruses (PMVs) are increasingly associated with chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTRs). Ribavirin may be a treatment option but its effectiveness is unclear, especially with respect to infection severity. We retrospectively analyzed 10 years of PV/PMV infections in LTRs. The main end points were forced expiratory volume in 1 second (FEV1 ) at 3 and 6 months postinfection, expressed as a percentage of pre-infection FEV1 and incidence of new or progressed CLAD 6 months postinfection. A total of 139 infections were included: 88 severe infections (63%) (defined as >10% FEV1 loss at infection) and 51 mild infections (37%) (≤10% FEV1 loss). Overall postinfection CLAD incidence was 20%. Associations were estimated on postinfection FEV1 for ribavirin vs no ribavirin (+13.2% [95% CI: 7.79; 18.67]) and severe vs mild infection (-11.1% [95% CI: -14.76; -7.37]). Factors associated with CLAD incidence at 6 months were ribavirin treatment (odds ratio (OR [95% CI]) 0.24 [0.10; 0.59]), severe infection (OR [95% CI] 4.63 [1.66; 12.88]), and mycophenolate mofetil use (OR [95% CI] 0.38 [0.14; 0.97]). These data provide valuable information about the outcomes of lung transplant recipients with these infections and suggests possible associations of ribavirin use and infection severity with long-term outcomes. Well-designed prospective trials are needed to confirm these findings.


Subject(s)
Lung Transplantation , Metapneumovirus , Respiratory Syncytial Virus Infections , Respiratory Tract Infections , Antiviral Agents/therapeutic use , Humans , Lung , Lung Transplantation/adverse effects , Prospective Studies , Respiratory Syncytial Virus Infections/drug therapy , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/etiology , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/etiology , Retrospective Studies , Ribavirin/therapeutic use , Transplant Recipients
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