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Front Immunol ; 11: 594572, 2020.
Article in English | MEDLINE | ID: covidwho-1083323


Mycobacterium tuberculosis (Mtb), the causative organism of pulmonary tuberculosis (PTB) now infects more than half of the world population. The efficient transmission strategy of the pathogen includes first remaining dormant inside the infected host, next undergoing reactivation to cause post-primary tuberculosis of the lungs (PPTBL) and then transmit via aerosol to the community. In this review, we are exploring recent findings on the role of bone marrow (BM) stem cell niche in Mtb dormancy and reactivation that may underlie the mechanisms of PPTBL development. We suggest that pathogen's interaction with the stem cell niche may be relevant in potential inflammation induced PPTBL reactivation, which need significant research attention for the future development of novel preventive and therapeutic strategies for PPTBL, especially in a post COVID-19 pandemic world. Finally, we put forward potential animal models to study the stem cell basis of Mtb dormancy and reactivation.

Bone Marrow Cells/microbiology , Mycobacterium tuberculosis/physiology , Tuberculosis, Pulmonary , Virus Activation/physiology , Virus Latency/physiology , COVID-19 , Humans , Mesenchymal Stem Cells/microbiology , SARS-CoV-2 , Stem Cell Niche/physiology , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/transmission
S Afr Med J ; 110(12): 1160-1167, 2020 11 05.
Article in English | MEDLINE | ID: covidwho-994150


The COVID-19 pandemic and phased nationwide lockdown have impacted negatively on individuals with tuberculosis (TB) and routine TB services. Through a literature review and the perspective of members of a national TB Think Tank task team, we describe the impact of the pandemic and lockdown on TB patients and services as well as the potential long-term setback to TB control in South Africa (SA). Strategies to mitigate risk and impact are explored, together with opportunities to leverage synergies from both diseases to the benefit of the National TB Programme (NTP). With the emergence of COVID-19, activities to address this new pandemic have been prioritised across all sectors. Within the health system, the health workforce and resources have been redirected away from routine services towards the new disease priority. The social determinants of health have deteriorated during the lockdown, potentially increasing progression to TB disease and impacting negatively on people with TB and their households, resulting in additional barriers to accessing TB care, with early reports of a decline in TB testing rates. Fewer TB diagnoses, less attention to adherence and support during TB treatment, poorer treatment outcomes and consequent increased transmission will increase the TB burden and TB-related mortality. People with TB or a history of TB are likely to be vulnerable to COVID-19. Modifications to current treatment practices are suggested to reduce visits to health facilities and minimise the risks of COVID-19 exposure. The COVID-19 pandemic has the potential to negatively impact on TB control in TB-endemic settings such as SA. However, there are COVID-19-related health systems-strengthening developments that may help the NTP mitigate the impact of the pandemic on TB control. By integrating TB case finding into the advanced screening, testing, tracing and monitoring systems established for COVID-19, TB case finding and linkage to care could increase, with many more TB patients starting treatment. Similarly, integrating knowledge and awareness of TB into the increased healthcare worker and community education on infectious respiratory diseases, behavioural practices around infection prevention and control, and cough etiquette, including destigmatisation of mask use, may contribute to reducing TB transmission. However, these potential gains could be overwhelmed by the impact of increasing poverty and other social determinants of health on the burden of TB.

COVID-19/prevention & control , Infection Control/methods , Telemedicine/methods , Tuberculosis, Pulmonary/prevention & control , Antitubercular Agents/therapeutic use , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Contact Tracing , Health Services Accessibility , Humans , Infection Control/organization & administration , Masks , Mass Screening , Retention in Care , SARS-CoV-2 , Social Determinants of Health , Social Stigma , South Africa , Telemedicine/organization & administration , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/prevention & control , Tuberculosis/transmission , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/transmission
Postgrad Med ; 132(7): 643-649, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-382140


INTRODUCTION: Recent respiratory infectious disease (RID) outbreaks of influenza and the novel coronavirus have resulted in global pandemics. RIDs can trigger nosocomial infections if not adequately prevented. OBJECTIVE: The objective of this study was to rate the adequacy of healthcare workers (HCWs) and hospital settings on RID prevention using unannounced standardized patients (USP) in clinical settings of hospital gateways. METHODS: Trained USPs visited 5 clinical settings: information desks, registration desks, two outpatient departments and the emergency departments in 10 hospitals across 3 cities of Inner Mongolia, China. USPs observed the hospital air ventilation and distance from the nearest hand-washing facilities to each clinical setting, then mimicked symptoms of either tuberculosis or influenza before observing the HCW's behavior. A total of 480 clinical-setting assessments were made by 19 USPs. RESULTS: The overall adequacy of triage services was 86.7% and for prevention of the spread of airborne droplets was 83.5%. Almost all hospitals offered adequate air ventilation. Compared to the information desk, adequacy of triage and preventing the spread of airborne droplets by physicians in the three clinical departments was less likely to be adequate. Triage services for USPs simulating symptoms of influenza were 2.6 times more likely to be adequate than for those simulating symptoms of tuberculosis but there was no significant difference in the prevention of the spread of airborne droplets. CONCLUSIONS: There is a need to improve respiratory infectious disease procedures in our study hospitals, especially in outpatient and emergency departments.

Emergency Service, Hospital , Health Personnel/standards , Infection Control/standards , Outpatient Clinics, Hospital , Patient Simulation , Respiratory Tract Infections/prevention & control , Betacoronavirus , COVID-19 , China , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Guideline Adherence , Hand Disinfection/standards , Hospitals , Humans , Influenza, Human/prevention & control , Influenza, Human/transmission , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Respiratory Tract Infections/transmission , SARS-CoV-2 , Triage/standards , Tuberculosis, Pulmonary/prevention & control , Tuberculosis, Pulmonary/transmission , Ventilation/standards