Туберкулез

[Наталья П.]

TB Resources for the European Region
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What:

A new website with TB resources specifically for the European region—documents, web links, grant opportunities, conference and training calendars, and interactive discussion forums in English and Russian.

Who:

This is a resource for everyone interested in TB—program managers, doctors, nurses, community health workers/feldshers, nongovernmental organizations, policymakers, and people with TB.

Join Dr. Vaira Leimane from February 19-23, 2007 for an on-line discussion of MDR-TB.

[Annabella]

О, спасибо большое, я училась у доктора Леймане - и она была здесь в Петрозавосдке в прошлом году - оооооочень рекомендую - потрясающий специалист и очень интересный собеседник.

[Наталья П.]

"One-in-Ten" A 50-day on-line campaign on drug resistant TB ********************************************** (Friday 2nd February 2007) According to latest estimates, 10% of all new TB infections are resistant to at least one anti-TB drug. Multi-drug resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) are currently in the news following recent reports indicating rates of drug resistance may be far higher than previously thought. Drug-resistant TB poses a grave global public health threat, especially in populations with high rates of HIV, and requires an immediate and urgent global response. In the 50 days leading up to World TB Day (Saturday 24th March, 2007), Health and Development Networks and the AIDSCareWatch Campaign are organizing the One-in-Ten Campaign focusing on drug resistant TB. The campaign aims to increase awareness, bring front-line perspectives to current MDR- and XDR-TB discussions, and advocate for TB patients to receive the best possible care.
You can be part of the campaign by:
- Contributing to the on-line discussion on drug-resistant TB. You will have the opportunity to Speak-Your-World and describe your local/national drug resistant TB situation, as well as receiving background information on specific drug resistance topics and Key Correspondent articles on patients' and front-line health workers' experiences of TB drug resistance.
- Adding your name to a campaign sign-on appeal (more details to follow).
- Passing on this announcement to others you know who might be interested in the campaign.
- Being a One-in-Ten Campaign collaborator:
- Help inform your local network and media contacts about the campaign, and regularly update them as the campaign goes forward;
- Engage individuals and organizations in the Stop-TB eForum on-line discussion;
- Organize local advocacy initiatives around World TB Day and the 1-in-10 Campaign key messages.

If you are already a member of the Stop-TB eForum, do nothing.
To join, send an email here: [Ссылки доступны только зарегистрированным пользователям ] Or go to: [Ссылки доступны только зарегистрированным пользователям ]
For a campaign update or further information, and to give your suggestions how the One-in-Ten Campaign can be improved, please get in touch with us at the email below. Many thanks in advance for your commitment to raise awareness about the crucial front-line issues surrounding MDR-TB and XDR-TB. From the Campaign Team Email: [Ссылки доступны только зарегистрированным пользователям ] ***TB is Preventable and Curable. Fund the Global Plan to Stop TB*** ----- Health & Development Networks is a non-profit organization based in Thailand. Since its inception, HDN has strived to improve the quality of information and dialogue around the HIV & TB epidemics and related health and development issues ([Ссылки доступны только зарегистрированным пользователям ]).

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]
Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control.
London (UK): Royal College of Physicians; 2006

[Наталья П.]

Журнал "Оценка медицинских технологий", 2007
Health Technol Assess. 2007 Jan;11(3):1-314.

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection.
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Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, Drobniewski F, Lalvani A.

Wessex Institute for Health Research and Development, University of Southampton, UK.

OBJECTIVES: To evaluate the effectiveness of available rapid diagnostic tests to identify tuberculosis (TB) infection. DATA SOURCES: Electronic databases were searched from 1975 to August 2003 for tests for active TB and to March 2004 for tests for latent tuberculosis infection (LTBI). REVIEW METHODS: Studies were selected and evaluated that (1) tested for LTBI, (2) compared tuberculin skin test (TST) and interferon-gamma assays based on ESAT-6 and CFP-10 antigens and (3) provided information on TB exposure or bacille Calmette-Guerin (BCG) vaccination or HIV status. For each test comparison, the sensitivity, specificity and 95% confidence intervals (CIs) were calculated. Sources of heterogeneity were investigated by adding covariates to the standard regression model. The authors examined whether interferon-gamma assays were more strongly associated with high versus low TB exposure than TST. Odds ratios (ORs) were calculated for the association between test results and exposures from each study along with their 95% CIs. Within each study, the OR value for one test was divided by that for another to produce a ratio of OR (ROR).
RESULTS: A total of 212 studies were included, providing 368 data sets. A further 19 studies assessing fully automated liquid culture were included. Overall, nucleic acid amplification test (NAAT) accuracy was far superior when applied to respiratory samples as opposed to other body fluids. The better quality in-house studies, were, for pulmonary TB, much better at ruling out TB than the commercial tests (higher sensitivity), but were less good at ruling it in (lower specificity), but it is not possible to recommend any one over another owing to a lack of direct test comparisons. The specificity of NAAT tests was high when applied to body fluids, for example for TB meningitis and pleural TB, but sensitivity was poor, indicating that these tests cannot be used reliably to rule out TB. High specificity estimates suggest that NAAT tests should be the first-line test for ruling in TB meningitis, but that they need to be combined with the result of other tests in order to rule out disease. Evidence for NAAT tests in other forms of TB and for phage-based tests is significantly less prolific than for those above and further research is needed to establish accuracy. There is no evidence to support the use of adenosine deaminase (ADA) tests for diagnosis of pulmonary TB; however, there is considerable evidence to support their use for diagnosis of pleural TB and to a slightly lesser extent for TB meningitis. Anti-TB antibody test performance was universally poor, regardless of type of TB. Fully automated liquid culture methods were superior to culture on solid media, in terms of their speed and their precision. In total, 13 studies were included. Assays based on RD1 specific antigens, ESAT-6 or CFP-10, correlate better with intensity of exposure, and therefore are more likely than TST/purified protein derivative (PPD)-based assays to detect LTBI accurately. An additional advantage is that they are more likely to be independent of BCG vaccination status and HIV status.
CONCLUSIONS: The NAAT tests provide a reliable way of increasing the specificity of diagnosis (ruling in disease) but sensitivity is too poor to rule out disease, especially in smear-negative (paucibacillary) disease where clinical diagnosis is equivocal and where the clinical need is greatest. For extra-pulmonary TB, clinical judgement has both poor sensitivity and specificity. For pleural TB and TB meningitis, adenosine deaminase tests have high sensitivity but limited specificity. NAATs have high specificity and could be used alongside ADA (or interferon-gamma) to increase sensitivity for ruling out disease and NAAT for high specificity to rule it in. All studies from low-prevalence countries strongly suggest that the RD1 antigen-based assays are more accurate than TST- and PPD-based assays for diagnosis of LTBI. If their superior diagnostic capability is found to hold up in routine clinical practice, they could confer several advantages on TB control programmes. Further research for active TB needs to establish diagnostic accuracy in a wide spectrum of patients, against an appropriate reference test, and avoiding the major sources of bias. For LTBI, research needs to address different epidemiological and clinical settings, to evaluate the performance of the main existing commercial assays in head-to-head comparison in both developed and developing countries, and to assess the role of adding more TB-specific antigens to try to improve diagnostic sensitivity.

Полный текст
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[Наталья П.]

Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research.


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Menzies D, Pai M, Comstock G.

McGill University, Montreal, Quebec, Canada. [Ссылки доступны только зарегистрированным пользователям ]

BACKGROUND: Until recently, the tuberculin skin test was the only test for detecting latent tuberculosis (TB) infection, but 2 ex vivo interferon-gamma release assays (IGRAs) are now commercially licensed.
PURPOSE: To estimate sensitivity, specificity, and reproducibility of IGRAs (commercial or research versions of QuantiFERON [QFT] and Elispot) for diagnosing latent TB infection in healthy and immune-suppressed persons.
DATA SOURCES: The authors searched MEDLINE and reviewed citations of all original articles and reviews for studies published in English.
STUDY SELECTION: Studies had evaluated IGRAs using Mycobacterium tuberculosis-specific antigens (RD1 antigens) and overnight (16- to 24-h) incubation times. Reference standards had to be clearly defined without knowledge of test results.
DATA EXTRACTION AND QUALITY ASSESSMENT: Specific criteria for quality assessment were developed for sensitivity, specificity, and reproducibility.
DATA SYNTHESIS: When newly diagnosed active TB was used as a surrogate for latent TB infection, sensitivity of all tests was suboptimal, although it was higher with Elispot. No test distinguishes active TB from latent TB. Sensitivity of the tuberculin skin test and IGRAs was similar in persons who were categorized into clinical gradients of exposure. Pooled specificity was 97.7% (95% CI, 96% to 99%) and 92.5% (CI, 86% to 99%) for QFT and for Elispot, respectively. Both assays were more specific than the tuberculin skin test in samples vaccinated with bacille Calmette-Guerin. Elispot was more sensitive than the tuberculin skin test in 3 studies of immune-compromised samples. Discordant tuberculin skin test and IGRA reactions were frequent and largely unexplained, although some may be related to varied definitions of positive test results. Reversion of IGRA results from positive to negative was common in 2 studies in which it was assessed.
LIMITATIONS: Most studies used cross-sectional designs with the inherent limitation of no gold standard for latent TB infection, and most involved small samples with a widely varying likelihood of true-positive and false-positive test results. There is insufficient evidence on IGRA performance in children, immune-compromised persons, and the elderly.
CONCLUSIONS: New IGRAs show considerable promise and have excellent specificity. Additional studies are needed to better define their performance in high-risk populations and in serial testing. Longitudinal studies are needed to define the predictive value of IGRAs.

[Наталья П.]

The top twenty papers on tuberculosis

Which papers have provided the most interesting recent advances in tuberculosis research? Which new discoveries in pathogenesis, epidemiology, drug discovery or vaccine development have been the most important or are likely to have the highest impact to the field?

Nature Medicine - 13, 276 - 277 - March 2007, Volume 13 No 3
doi:10.1038/nm0307-276

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“…….Rather than relying on citations, we posed these questions directly to the tuberculosis community and asked TB researchers to identify what they perceived as the most important papers over the past 3 years. We received feedback from around 50 experts. Their responses were astonishingly diverse, no doubt reflecting the diverse expertise of the scientists we polled. The hot list—papers suggested by at least three experts—along with some comments, are presented…..”.

[Наталья П.]

Global tuberculosis control - surveillance, planning, financing

WHO Report 2007 - WHO/HTM/TB/2007.376, March 2007

Website: [Ссылки доступны только зарегистрированным пользователям ]

….The global tuberculosis (TB) epidemic has levelled off for the first time since the World Health Organization (WHO) declared TB a public health emergency in 1993. The Global Tuberculosis Control Report released today by WHO finds that the percentage of the world's population struck by TB peaked in 2004 and then held steady in 2005…..

“………This report draws four main conclusions about progress in TB control, based on routine monitoring and surveillance data:

The first is that NTPs worldwide narrowly missed the 2005 targets for case detection (60%/70%) and treatment success (84%/85%). However, both targets were met in the Western Pacific Region, and in 26 countries including China, the Philippines and Viet Nam.

Second, while the total number of patients diagnosed and treated under DOTS approached target levels in 2005, the numbers known to be HIV-positive or carrying drug-resistant bacteria (MDR-TB) were far fewer than anticipated by the Global Plan to Stop TB in 2006. Therefore a major effort is needed to step up collaborative TB/HIV activities and the management of MDR-TB.

Third, the global TB epidemic appears to be on the threshold of decline. The incidence rate (per capita) worldwide has evidently stabilized or begun to fall, following the earlier downturns in prevalence and mortality.1 The incidence rate is now stable or falling in all WHO regions, including Africa and Europe. This result, if robust, means that MDG target 8 was met before 2005, and more than 10 years before the target date of 2015. However, the total number of new TB cases was still rising slowly in 2005, and in the African, Eastern Mediterranean and South-East Asia regions. In some Asian countries that report high rates of case detection and treatment success, incidence has not apparently been reduced as quickly as expected, for reasons that are not fully understood.

This is linked to the fourth conclusion: that the global TB burden is not yet falling fast enough to satisfy the more demanding targets set by the Stop TB Partnership within the MDG framework. That is, at the current rate of progress, the 1990 prevalence and mortality rates will not be halved worldwide by 2015. The following sections discuss these conclusions in more detail…..”

“…….Although incidence, prevalence and death rates now appear to be in decline, prevalence and death rates are not yet falling fast enough to achieve the MDGs globally by 2015. The decline will be accelerated by finding and curing more patients. The total number of patients diagnosed and treated in 2005 is in line with expectations for 2006, but the marked variations in case detection among WHO regions in 2005 will persist without remedial action. And there were major deficiencies in 2005 in the diagnosis and treatment of HIV-positive and MDR-TB patients, which are reflected in budgets for 2005–2007 (see Financing TB control). The present analysis leads to the conclusion that investment and implementation need to be stepped up especially, but not exclusively, in the African, Eastern Mediterranean and European regions….”

:: Table of contents
:: Key findings
:: Introduction
:: Methods
:: Results
:: Conclusions
:: Annex 1 - Profiles of high-burden countries
:: Annex 2 - Country data by WHO region

The key findings also available in different languages

:: Arabic :: Chinese :: French :: Russian :: Spanish

[Наталья П.]

Интерактивная основная программа обучения вопросам туберкулеза (Interactive Core Curriculum on Tuberculosis
) (на англ. яз)


Интерактивная программа обучения вопросам туберкулеза представляет клиницистам базовую информацию о туберкулезе (TB). Часы (кредиты) последипломного образования (ПДО) предлагаются различным профессиям бесплатно на основе, примерно, 5 часов инструктажа. С целью получения в зачет часов последипломного образования вам необходимо сдать экзамен и заполнить форму оценки курса. Нет минимальной суммы баллов, необходимой для получения в зачет часов ПДО. После успешного окончания курса, сдачи экзамена и заполнения формы оценки курса вам будут присвоены часы ПДО. Для того, чтобы вы могли немедленно распечатать свой сертификат, имеется простая форма в режиме online. Часы в зачет последипломного образования по этому курсу присваиваются до 19 октября 2007 г. .

[Ссылки доступны только зарегистрированным пользователям ]

[Наталья П.]

"Tuberculosis 2007" (687 pages, PDF, 8.3) is now available for download:

1. Download: [Ссылки доступны только зарегистрированным пользователям ]
2. YouTube Presentation (2:48 min): [Ссылки доступны только зарегистрированным пользователям ]
3. Text of the video presentation: [Ссылки доступны только зарегистрированным пользователям ]

The book was published for the Amedeo Tuberculosis Textbook Award
([Ссылки доступны только зарегистрированным пользователям ]).
The winner of the award is a team of 40 clinicians and researches guided by Juan Carlos Palomino, Sylvia Cardoso Leão, and Viviana Ritacco.

[Наталья П.]

Dear colleague,

Visit SciDev.Net's new online resource for a snapshot of tuberculosis (TB) today -- who it affects, where it might spread in the future and how it can be treated and controlled:

[Ссылки доступны только зарегистрированным пользователям ]

TB has always taken its toll on poor nations, but the way the epidemic is evolving -- the growing link between TB and HIV that threatens to overwhelm sub-Saharan Africa, and the drug-resistant strains that are making treatment harder -- means that understanding the changing face of the disease is more important than ever.

The collection includes:

* An introduction to TB and our online resource
[Ссылки доступны только зарегистрированным пользователям ]

* Facts & figures on the prevalence of TB in the developing world [Ссылки доступны только зарегистрированным пользователям ]

* Opinions - key stakeholder views on collaboration, treatment and diagnostics [Ссылки доступны только зарегистрированным пользователям ]

* A feature examining the threat of bovine TB to human health [Ссылки доступны только зарегистрированным пользователям ]

* Articles - all SciDev.Net's latest TB coverage
[Ссылки доступны только зарегистрированным пользователям ]

* Policy - summaries of relevant policy briefs
[Ссылки доступны только зарегистрированным пользователям ]

* Key documents - short summaries of significant publications [Ссылки доступны только зарегистрированным пользователям ]

* Links to key organisations relevant to TB treatment and control
[Ссылки доступны только зарегистрированным пользователям ]

* Definitions - a directory of terms used in TB research, treatment and control [Ссылки доступны только зарегистрированным пользователям ]

Please pass this information to friends and colleagues who will find it valuable. All our material is free to reproduce provided the organisation and author are credited.

Please accept our apologies if you have previously received this message through cross-posting. If you are already signed up with us and would like to update your details, or cancel your registration please go to [Ссылки доступны только зарегистрированным пользователям ].

[Наталья П.]

Recommended readings on Delays in accessing tuberculosis diagnosis and treatment

Anti-tuberculosis drug resistance in the world
Authors: A. Wright; M. Zignol
Publisher: World Health Organization , 2008

This report presents survey and surveillance data collected between 2002 and 2006 on drug resistance in tuberculosis (TB). It includes drug susceptibility test results from over 91,000 patients from 81 countries. New data are available from several high TB burden countries including: India, China, Russian Federation, Indonesia, Ethiopia, Vietnam, and Tanzania. The data records the highest ever prevalence of multi-drug resistant tuberculosis (MDR-TB). There are nearly half a million new cases of MDR-TB a year, with the highest rate recorded in Baku in Azerbaijan. Further, extensively drug-resistant tuberculosis (XDR-TB), a virtually untreatable form of TB, has been recorded in 45 countries.
The report argues that countries and the international community need to address TB drug resistance aggressively. In addition to specifically confronting drug-resistant TB and saving lives, programmes worldwide must immediately improve their performance in diagnosing all TB cases rapidly and treating them until cured as this is the best way to prevent the development of drug resistance. Approximately US$ 4.8 billion is needed for overall TB control in low- and middle-income countries in 2008, with US$ 1 billion for MDR-TB and XDR-TB.
Available online at: [Ссылки доступны только зарегистрированным пользователям ]

[Наталья П.]

From CDC HIV/Hepatitis/STD/TB Prevention News Update Monday, July 27, 2009

"Phone Gadget to Diagnose Disease"
BBC (07.22.09)
US researchers report that they have built a mobile phone-mounted light microscope with a resolution of just over one micron that can be used to identify TB in samples. The "snap-on" CellScope fluorescence microscope could be particularly useful in the developing world, where mobile phone access and coverage are common.
CellScope is made with conventional microscope optics and uses a cheap, commercial-grade light-emitting diode for its light source. While attached to a standard Nokia mobile phone with a 3.2 megapixel camera, CellScope's economical optical filters isolate the light coming from fluorescent "tagging" molecules that are designed to latch onto TB or other diseases.
Typical fluorescence microscopes are bulky and expensive.
"There are other people who have been working on developing portable fluorescent microscopes," said David Breslauer, a University of California-Berkeley researcher and the study's lead author. "The innovation on our front is that we've integrated that with a cell phone rather than just making a standalone microscope."
The mobile phone "gives us access to the computational power of the phone as well as the mobile communication aspect," Breslauer said. Image analysis software could be built into an application that runs on the phone, he said.
"In many developing world and rural areas, you could be hundreds of miles from hospitals or miles away from power, but the mobile infrastructure is well established and pretty much blanketing the globe," said Breslauer.
"So if you can have a portable, battery-operated system to take these images, analyze, and transfer them, you're creating a portable health care clinic. Your doctor can see your samples without actually having to be present."

The full report, "Mobile Phone Based Clinical Microscopy for Global Health Applications," was published in Public Library of Science ONE (2009;4(7):e6320).

Free full text at
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[Наталья П.]

eForums on HIV and TB
A toolkit for launching, moderating and managing a high quality eforum
[Ссылки доступны только зарегистрированным пользователям ]

"eForums are email discussion forums for information sharing, networking and dialogue on HIV, AIDS, TB, and related health and development issues.
Health & Development Networks (HDN) conceptualised and launched the first eForum in 1996 and since then has established regional, national, and issue-based forums to facilitate more unified, grounded action for change.
This toolkit was created to document best practice for developing and utilising eForums, informed by over a decade of cumulative experience.This toolkit is an instructive resource for civil society organisations working in the HIV and TB fields, but has the potential to be applied to a range of health and development issues. It is intended for international, regional and national civil society organisations recognising the power of information and the significance of a transparent, broad-based communication mechanism that enhances civil society responses to HIV and TB"

[Наталья П.]

Self-Study Modules on Tuberculosis
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The CDC course is a series of educational modules designed to provide information about TB in a self-study format. The series consists of a total of nine modules that are separated into two courses.
The first course, Modules 1-5, provides basic information on TB.
The second course, Modules 6-9, provides more specific TB programmatic information.