ABSTRACT
BACKGROUND: Preventive treatment may avoid future cases of tuberculosis among asylum seekers. The effectiveness of preventive treatment depends in large part on treatment completion. METHODS: In a prospective cohort study, asylum seekers of two of the Swiss Canton Vaud migration centres were screened with the Interferon Gamma Release Assay (IGRA). Those with a positive IGRA were referred for medical examination. Individuals with active or past tuberculosis were excluded. Preventive treatment was offered to all participants with positive IGRA but without active tuberculosis. The adherence was assessed during monthly follow-up. RESULTS: From a population of 393 adult migrants, 98 (24.9%) had a positive IGRA. Eleven did not attend the initial medical assessment. Of the 87 examined, eight presented with pulmonary disease (five of them received a full course of antituberculous therapy), two had a history of prior tuberculosis treatment and two had contraindications to treatment. Preventive treatment was offered to 75 individuals (4 months rifampicin in 74 and 9 months isoniazid in one), of whom 60 (80%) completed the treatment. CONCLUSIONS: The vulnerability and the volatility of this population make screening and observance of treatment difficult. It seems possible to obtain a high rate of completion using a short course of treatment in a closely monitored population living in stable housing conditions.
Subject(s)
Antitubercular Agents/therapeutic use , Isoniazid/therapeutic use , Latent Tuberculosis/prevention & control , Medication Adherence/statistics & numerical data , Refugees/statistics & numerical data , Rifampin/therapeutic use , Adult , Africa/ethnology , Asia/ethnology , Balkan Peninsula/ethnology , Chemoprevention/statistics & numerical data , Cohort Studies , Female , Humans , Interferon-gamma Release Tests , Latent Tuberculosis/diagnosis , Latent Tuberculosis/drug therapy , Male , Mass Screening , Prospective Studies , SwitzerlandABSTRACT
Shrinking lung syndrome (SLS) is an uncommon feature of systemic lupus erythematosus (SLE) characterized by dyspnea, pleuritic chest pain, diaphragmatic elevation, restrictive ventilatory defect and reduced respiratory muscle strength as measured by volitional tests. We report the case of a 28-year-old woman with overlapping features of SLE and Sjögren syndrome who developed severe SLS while receiving corticosteroids and azathioprine for severe polyarthritis. She was treated with a combination of rituximab and cyclophosphamide, which led to a dramatic improvement in her clinical condition and respiratory function tests. The increase in vital capacity was one of the highest among 35 published cases of SLS. Thus, restoring a near-normal lung function is an achievable goal in SLS, and the use of rituximab, with or without concomitant cyclophosphamide, certainly deserves further study in this setting.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/administration & dosage , Cyclophosphamide/administration & dosage , Lung Diseases , Lupus Erythematosus, Systemic , Respiratory Function Tests/methods , Sjogren's Syndrome , Adult , Antirheumatic Agents/administration & dosage , Chest Pain/etiology , Chest Pain/physiopathology , Drug Monitoring/methods , Drug Therapy, Combination , Dyspnea/etiology , Dyspnea/physiopathology , Female , Humans , Lung Diseases/drug therapy , Lung Diseases/etiology , Lung Diseases/physiopathology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/physiopathology , Pleura/physiopathology , Pleurisy/drug therapy , Pleurisy/etiology , Pleurisy/physiopathology , Respiratory Muscles/physiopathology , Rituximab , Severity of Illness Index , Sjogren's Syndrome/complications , Sjogren's Syndrome/drug therapy , Sjogren's Syndrome/physiopathology , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the yield of contact tracing after exposure to active tuberculosis (TB) cases in a low incidence area for TB as well as completion rate and tolerance to treatment for latent TB infection (LTBI). METHODS: Retrospective study based on a database including all patients evaluated in Geneva during contact tracing procedures; review of medical records of contacts for whom treatment of LTBI was indicated. RESULTS: 3582 subjects were screened over 10 years (on average 4.3 contacts per index case); 8 (0.2%) had active TB. LTBI was detected in 28% of subjects screened. Foreign origin, exposure and contagiousness of index case were predictive of LTBI. Of the 996 subjects with LTBI, files of 705 subjects followed at our centre were reviewed: treatment was indicated in 571 (81%). Side-effects led to interruption of treatment for LTBI in 32 cases (6.9% of subjects treated); 227 subjects eligible for treatment (40%) either refused or stopped treatment, or were lost to follow-up. Completion rate was 67%. CONCLUSIONS: In a low-incidence environment for TB, contact tracing procedures had a very low yield for detection of active TB cases; acceptance and completion rates for LTBI therapy were in agreement with recent studies..
