Isabelle Suárez1, Sarah Maria Fünger, Stefan Kröger, Jessica Rademacher, Gerd Fätkenheuer, Jan Rybniker. 1. Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Cologne; German Center for Infection Research, Cologne-Bonn, Partner Site Cologne; Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin; Department of Pneumonology, Hanover Medical School.
Abstract
BACKGROUND: Around 10 million people worldwide contract tuberculosis every year. According to the World Health Organization (WHO), approximately one-quarter of the world's population is latently infected with Mycobacterium tuberculosis. In Ger- many, the incidence of tuberculosis was in decline over several decades but rose in 2015 to 7.3 new cases per 100 000 persons. In 2018, a total of 5429 new cases were documented, corresponding to 6.5 new cases per 100 000 persons. METHODS: This article is based on literature retrieved by a selective search in PubMed and on the authors' clinical experience. RESULTS: Tuberculosis involves the lungs in almost 75% of patients but can generally involve any organ. In Germany, the majority of patients come from high-incidence countries. If a patient's differential diagnosis includes tuberculosis, the main tests for the detection of the pathogen in sputum and tissue samples are culture (the gold standard), microscopy, and nucleic acid amplification tests. Imaging studies are also used for diagnosis and follow-up. The standard treatment consists of a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide, followed by a combination of isoniazid and rifampicin only. Liver damage is one of the more common adverse effects of this treatment, arising in 2.4% of patients. Multidrug-resistant tuberculosis, which is rare in Germany (around 100 cases per year), should be treated in special- ized centers. CONCLUSION: Rapid diagnosis and targeted treatment are essential to prevent an unfavorable course of the disease as well as its transmission to other individuals. In patients presenting with unclear symptoms, tuberculosis should always be considered as a differential diagnosis. The diagnosis of latent tuberculosis and decision-making regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.
BACKGROUND: Around 10 million people worldwide contract tuberculosis every year. According to the World Health Organization (WHO), approximately one-quarter of the world's population is latently infected with Mycobacterium tuberculosis. In Ger- many, the incidence of tuberculosis was in decline over several decades but rose in 2015 to 7.3 new cases per 100 000 persons. In 2018, a total of 5429 new cases were documented, corresponding to 6.5 new cases per 100 000 persons. METHODS: This article is based on literature retrieved by a selective search in PubMed and on the authors' clinical experience. RESULTS:Tuberculosis involves the lungs in almost 75% of patients but can generally involve any organ. In Germany, the majority of patients come from high-incidence countries. If a patient's differential diagnosis includes tuberculosis, the main tests for the detection of the pathogen in sputum and tissue samples are culture (the gold standard), microscopy, and nucleic acid amplification tests. Imaging studies are also used for diagnosis and follow-up. The standard treatment consists of a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide, followed by a combination of isoniazid and rifampicin only. Liver damage is one of the more common adverse effects of this treatment, arising in 2.4% of patients. Multidrug-resistant tuberculosis, which is rare in Germany (around 100 cases per year), should be treated in special- ized centers. CONCLUSION: Rapid diagnosis and targeted treatment are essential to prevent an unfavorable course of the disease as well as its transmission to other individuals. In patients presenting with unclear symptoms, tuberculosis should always be considered as a differential diagnosis. The diagnosis of latent tuberculosis and decision-making regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.
Authors: Nils Wetzstein; Alena-Pauline Drummer; Annabelle Bockey; Eva Herrmann; Claus Philippe Küpper-Tetzel; Christiana Graf; Benjamin Koch; Udo Goetsch; Maria J G T Vehreschild; Lorenzo Guglielmetti; Berit Lange; Thomas A Wichelhaus; Christoph Stephan Journal: Infection Date: 2022-10-01 Impact factor: 7.455
Authors: Cristal Ribeiro Mesquita; Emilyn Costa Conceição; Lúcia Helena Martins Tavares Monteiro; Odinea Maria da Silva; Luana Nepomuceno Gondim Costa Lima; Rafael Aleixo Coelho de Oliveira; Artemir Coelho de Brito; Ricardo José de Paula Souza E Guimarães; Karla Valéria Batista Lima Journal: Int J Environ Res Public Health Date: 2021-02-02 Impact factor: 3.390
Authors: Maria Iovino; Martina Caruso; Antonio Corvino; Nicola Vargas; Federica Sandomenico; Andrea Cantelli; Maurizio Rispo; Vincenzo Pennacchio; Giuseppa Fernandes Journal: Radiol Case Rep Date: 2022-02-17