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- WHO online guide on the use of digital technologies for tuberculosis programmesPublication . Akkerman, Onno W.; Falzon, Dennis; Migliori, Giovanni Battista; Konstantynovska, Olha; Eyuboglu, Fusun Oner; Sismanidis, Charalambos; Kanchar, Avinash; Duarte, RaquelExtract: In 2015, the World Health Organization (WHO)'s Global Tuberculosis Programme, the European Respiratory Society (ERS), and global experts released a collaborative agenda to enhance the use of digital technologies to end tuberculosis (TB) as a global public health threat, aligned to the United Nations Sustainable Development Goals and WHO's post-2015 End TB Strategy.
- The Invisible Face of COVID-19Publication . Duarte, Raquel; Aguiar, AnaExtract: The COVID-19 pandemic has left indelible marks on the global landscape, disrupting lives, economies, and health systems. The immediate, visible consequences of the pandemic include overwhelmed healthcare systems, with hospitals stretched beyond capacity, leading to delayed care and strained resources¹,². Staggering mortality rates became a grim hallmark as COVID-19 claimed millions of lives worldwide. Economically, global lockdowns disrupted supply chains, shuttered businesses, and caused massive job losses, plunging countless families into financial insecurity³. The urgency of vaccine development and distribution brought hope and highlighted disparities in access, underscoring systemic inequities between high- and low-income countries. While these visible effects dominated public discourse, they represent only part of the pandemic’s multifaceted impact. A significant portion of its impact remains hidden beneath the surface. These invisible damages, often overshadowed by immediate crises, have profound implications for public health and societal resilience. Understanding these hidden consequences is essential to formulating effective recovery strategies and building resilience against future crises. Addressing both visible and invisible impacts is crucial for constructing a comprehensive narrative of the pandemic’s effects and implementing holistic solutions.
- ERS Congress 2024: highlights from the Respiratory Infections AssemblyPublication . Jonckheere, Leander; Papadopoulou, Efthymia; Piedepalumbo, Federica; Akkerman, Onno W.; Duarte, Raquel; Premuda, ChiaraExtract: The 2024 European Respiratory Society (ERS) Congress in Vienna, Austria, brought together leading experts worldwide to address some of the most pressing challenges in respiratory medicine. In the field of respiratory infections, the congress highlighted notable advancements, particularly regarding pulmonary aspergillosis, tuberculosis (TB) and cystic fibrosis (CF), reflecting the rapidly evolving landscape in this area. This article aims to provide an overview of the key highlights from the congress in the field of respiratory infections, offering insights into the latest research, treatment innovations and ongoing challenges in managing these complex respiratory diseases.
- A multinational Delphi consensus on tuberculosis screening of migrants in EuropePublication . Pinheiro, Marina; Aguiar, Ana; Moreira, David N.; Akkerman, Onno W.; Al-Suwaidi, Zubaida; Alffenaar, Jan-Willem C.; Arandjelović, Irena; Brito, Ulisses; de Colombani, Pierpaolo; Curcic, Radmila; Garcia-Basteiro, Alberto L.; Goletti, Delia; Günther, Gunar; Ibraim, Elmira; Kapata, Nathan; Lange, Christoph; Lipman, Marc; Jankovic Makek, Mateja; Marais, Ben J.; Mariandyshev, Andrei; Magis-Escurra, Cecile; Migliori, Giovanni Battista; Sánchez Montalvá, Adrián; Nanovic, Zorica; Palmero, Domingo Juan; Priwitzer, Martin; Raviglione, Mario C. B.; Silva, Denise Rossato; Salzer, Helmut J.F.; Schwarzbach, Christian; Spruijt, Ineke; Winthrop, Kevin L.; Udwadia, Zarir; Vasankari, Tuula; Vilaplana, Cristina; Duarte, RaquelThe disproportionate burden of tuberculosis among migrants in the World Health Organization (WHO) European Region underscores the urgent need to address the public health challenges associated with global migration. Recommendations for screening of pulmonary tuberculosis (TB) and TB infection (TBI) are highly variable across European countries, highlighting the need for standardised practices and coordinated efforts to reduce TB risk more effectively. This study aims to produce a harmonised set of recommendations to contribute to elaboration for policy action using the Delphi method. It brings together a multidisciplinary panel of 33 TB experts from academia, healthcare, non-governmental organisations and government agencies across 22 countries to formulate consensus-based recommendations. The panel created 19 consensus statements and 36 recommendations for governments, health systems and other stakeholders. The recommendations span four key domains: 1) policy, 2) health systems and health professionals, 3) screening procedures and priority populations and 4) continued treatment and care. This study recommends a unified, evidence-based approach to TB screening in migrants, with free access to diagnosis and treatment, culturally sensitive care, use of digital tools and coordinated efforts across health systems to ensure effective and equitable TB control in Europe. Thus, the experts emphasised key recommendations that strike a balance between immediate health system interventions, screening procedures and cultural inclusivity to more effectively address TB among migrants. The findings of this study offer actionable policies to address gaps and weaknesses in Europe's response to tuberculosis among migrants, advancing efforts to eliminate TB as a public health threat.
- Safety, Efficacy, and Pharmacokinetics of Daily Optimized Doses of Rifampicin for the Treatment of Tuberculosis: A Systematic Review and Bayesian Network Meta-AnalysisPublication . Espinosa-Pereiro, Juan; Aguiar, Ana; Nara, Eva; Medina, Angelica; Molinas, Gladys; Tavares, Margarida; Tortola, Teresa; Ghimire, Samiksha; Alfenaar, Jan-Willem C.; Sturkenboom, Marieke G.G.; Magis-Escurra, Cecile; Sánchez-Montalva, Adrián; Barros, Henrique; Duarte, RaquelBackground: Higher than standard doses of rifampicin could improve the treatment outcome of drug-susceptible tuberculosis (TB) without compromising the safety of patients. Methods: We performed a systematic review of prospective clinical studies including adults with pulmonary and extrapulmonary TB receiving rifampicin doses above 10 mg/kg/day. We extracted the data on overall adverse events (AE), hepatic AE, sputum culture conversion (SCC) at week 8, recurrence, mortality, and pharmacokinetics. We performed a Bayesian network meta-analysis (NMA) using a random-effects model. Results: In 19 studies, 2033 out of 3654 participants received rifampicin doses higher than 10 mg/kg/day. The NMA showed an increased risk of overall and hepatic AE for the 40 mg/kg/day dose (risk ratio [RR] 4.8, 95% credibility interval [CrI]: 1.1, 25, and 15.00; 95% CrI: 1.1, 58.0, respectively), but no other doses, including 50 mg/kg/day showed such an increase. Increasing doses improved sputum culture conversion at week 8 (RR 1.3, 95% CrI: 1.1, 1.7 for SCC with 35 mg/kg/day). Conclusions: Optimal doses of rifampicin may be between 25 and 35 mg/kg/day, but should be tailored at the individual or, at least, at the population level.
- Exploring perspectives on the benefits of a tuberculosis short-treatment regimen: a cross-sectional study on treatment experiences and perceptionsPublication . Silva, Fernando Pereira da; Ramos, João Pedro; Barbosa, Pedro; Vieira, Mariana; Duarte, RaquelNo abstract available.
- Reply to Wilson: The 4-Month Isoniazid, Rifapentine, Moxifloxacin, and Pyrazinamide Treatment Regimen for Drug-Susceptible Pulmonary Tuberculosis: A Word of CautionPublication . Saukkonen, Jussi; Munsiff, Sonal; Winston, Carla; Duarte, Raquel; Mammen, ManojNo abstract available
- Mycobacterium appelbergii sp. nov., a Novel Species Isolated from a Drinking Water Fountain in a Rural CommunityPublication . Roxo, Inês Cravo; Alarico, Susana; Fonseca, Ana; Machado, Daniela; Maranha, Ana; Tiago, Igor; Duarte, Raquel; Empadinhas, NunoThree isolates of a novel, rapidly growing, non-pigmented Mycobacterium species were recovered from the water and runoff of a public fountain in a rural village in central Portugal, formerly used by the local population as a source of drinking water and not accessible to animals. High-quality draft genome sequencing, in silico DNA–DNA hybridization, and phylogenetic analyses confirmed that isolates 21AC1T, 21AC14, and 21AC21 represent a previously undescribed species within the genus Mycobacterium, forming a distinct phylogenetic lineage closely related to Mycobacterium wolinskyi, Mycobacterium goodii and Mycobacterium smegmatis. MALDI-TOF MS analysis of the type strain 21AC1T revealed a unique spectral profile. A comprehensive polyphasic characterization was performed, including chemotaxonomic analyses of fatty acid and mycolic acid composition, as well as an extensive biochemical characterization. Their susceptibility to 12 antimicrobials was also assessed. The identification and characterization of novel nontuberculous mycobacteria species are of increasing environmental and clinical relevance, as infections by these opportunistic pathogens are on the rise globally. Based on our findings, we propose that isolates 21AC1T, 21AC14, and 21AC21 represent a novel species, for which we propose the name Mycobacterium appelbergii sp. nov., with the type strain designated as 21AC1T (=BCCM/ITM 501212 = DSM 113570) and the additional two strains as 21AC14 (=BCCM/ITM 501447 = DSM 118402) and 21AC21 (=BCCM/ITM 501448 = DSM 118403).
- Diagnostic accuracy and predictive value of the QuantiFERON-TB gold plus assay for tuberculosis in immunocompromised individuals: a prospective TBnet studyPublication . Sester, Martina; Altet-Gomez, Neus; Andersen, Åse Bengaard; Arias-Guillén, Miguel; Avsar, Korkut; Bakken Kran, Anne-Marte; Bothamley, Graham; Nordholm Breschel, Anne Christine; Brown, James; Chesov, Dumitru; Ciobanu, Nelly; Cirillo, Daniela Maria; Crudu, Valeriu; de Souza Galvao, Malu; Dilektasli, Asli Görek; Dominguez, José; Duarte, Raquel; Dyrhol-Riise, Anne Ma; Goletti, Delia; Hoffmann, Harald; Ibraim, Elmira; Kalsdorf, Barbara; Krawczyk, Marcin; Kunst, Heinke; Lange, Berit; Lipman, Marc; Matteelli, Alberto; Milkiewicz, Piotr; Neyer, David; Nitschke, Martin; Oral, Haluk Barbaros; Palacios-Gutiérrez, Juan José; Petruccioli, Elisa; Raszeja-Wyszomirska, Joanna; Ravn, Pernille; Rupp, Jan; Spohn, Hanna-Elisa; Toader, Corina; Villar-Hernandez, Raquel; Wagner, Dirk; van Leth, Frank; Martinez, Leonardo; Pedersen, Ole Skouvig; Lange, ChristophBackground: In low tuberculosis (TB)-endemic countries, tuberculosis preventive therapy (TPT) is recommended for immunocompromised individuals with a positive immunodiagnostic test. This study aimed to assess the performance of the QuantiFERON-TB Gold Plus (QFT+) assay and predictive power for future tuberculosis in immunocompromised individuals. Methods: In this prospective observational study, immunocompromised adults ≥18 years of age including people living with HIV (PLHIV), chronic renal failure, rheumatoid arthritis, solid-organ transplantation or stem-cell transplantation, and immunocompetent adults with and without TB-disease were recruited at 21 sites in 11 European countries and tested with the QFT+ assay. Individuals without TB-disease were followed up for the development of tuberculosis. TB incidence rates (IR) were calculated, stratified by QFT+ results and acceptance of TPT. This study is registered with Clinicaltrials.gov, NCT02639936. Findings: A total of 2663 individuals (1115 female, 1548 male) were enrolled from 03/11/2015 to 29/03/2019. Persons without tuberculosis were followed up for at least two years. Among 1758 immunocompromised individuals without active tuberculosis, 13.6% had positive QFT+ results. Sensitivity and specificity for TB-disease were 70.0% (52.1-83.3%) and 91.4% (89.6-92.9%), respectively, in immunocompromised, and 81.4% (76.6-85.3%) and 96.0% (92.5-97.9%), respectively, in immunocompetent individuals. During 2457 cumulative years of follow-up among 932 individuals with chronic renal failure, rheumatoid arthritis, solid-organ transplantation or stem-cell transplantation, including 83 persons with a positive QFT+ test without TPT, no-one developed active tuberculosis. In contrast, among 642 PLHIV without TPT, one with an indeterminate QFT+ and 3/30 individuals with a positive QFT+ developed active tuberculosis; all had detectable HIV-replication and low CD4 T-cell counts (incidence 4.1 (95% CI (1.3-12.4) per 100 person-years). No individuals receiving TPT developed active tuberculosis during 269 years of follow-up. Interpretation: In immunocompromised individuals in low TB-endemic countries, the 2-year-risk for active tuberculosis was highest among PLHIV with detectable HIV-replication and low CD4-counts. In this study, the QFT+ assay did not strongly predict progression to active tuberculosis, which emphasises the need to incorporate additional risk factors.
- Urgent request for pretomanid label expansion to align with WHO guidelines and improve treatment accessibility and efficacyPublication . Kuksa, L.; Andrejak, C.; Haecker, B.; Bothamley, G.; Calcagno, A.; Cirillo, D. M.; Duarte, Raquel; Fatima, R.; Ferlazzo, G.; Guglielmetti, L.; Günther, G.; Hewison, C.; Horsburgh, C.R.; Jäger, T.; Kalancha, Y.; Otto-Knapp, R.; Kranzer, K.; Lillebaek, T.; Marks, G.; Middelkoop, K.; Motta, I.; Rabinova, V.; Sommerfeld, P.; Tattevin, P.; Lange, C.Pretomanid is a key anti-TB drug included in the WHO list of essential medications. The current EMA-approved label for pretomanid restricts its use to the regimen comprising bedaquiline, pretomanid and linezolid (BPaL) and only for extensively drug-resistant-TB or multidrug-resistant TB, "when antibiotics used for the latter form of TB do not work or cause unacceptable side effects." This restricted use implies that the older, prolonged and poorly tolerated regimens remain the recommended treatment for most cases of drug-resistant TB. The authors, representing many respiratory groups and societies, call for the label expansion of pretomanid to align with global guidelines, allowing for broader use.
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