5 курс / Пульмонология и фтизиатрия / Clinical_Tuberculosis_Friedman_Lloyd_N_,_Dedicoat

material from “maintenance” hosts. The main source of transmission of M. bovis infection is ingestion of infected milk or inhalation of aerosolized mycobacteria. In Scotland, selling of unpasteurized milk is illegal. This has not currently been achieved completely in England, as unpasteurized milk may currently be sold from certified “tuberculosis-free” herds. However, since the majority of herds across the United Kingdom began to sell pasteurized milk alone, the rate of human, cat, and dog infection has decreased.

Control of transmission via the aerosol route is an important consideration for farm workers, veterinary surgeons, or abattoir workers, who all have regular contact with cattle, and therefore the potential to inhale aerosolized droplets. This can be done most effectively by the use of personal protective clothing during animal and carcass handling and regular assessment of cattle as a source of infection.

Control in low income countries

There are many reasons to explain why it is difficult to implement standard control methods for tuberculosis in animals in HMICs in practice in low income countries. In low income countries, limiting steps to tuberculosis control may include a lack of knowledge about the disease prevalence and transmission, some degree of technical and financial limitation, lack of veterinary infrastructure, and cultural or geographical barriers to implementing a successful disease control strategy. In some areas of Ethiopia, some efforts to control bovine tuberculosis have been made on the Government State farms. At Mojo State Dairy Farm in Central Ethiopia in 1997, 55% of the positive reactor cattle were culled post-diagnosis, the farm was closed and healthy or negative cattle were transferred to other farms.112 These steps have helped to decrease the prevalence of bovine tuberculosis in these herds. Control methods, however, are generally not well practiced on small-holder farms. In Ethiopia, the mobility of the pastoralist or semi-pastoralist herds makes any control practices hard to implement, even without consideration of the social and economic factors involved. Therefore currently, a test and slaughter policy is not yet established.

Alaku55 has identified steps to be implemented as fundamental practice to initiate the control of bovine tuberculosis in Ethiopia. These steps can also be considered in other countries where there is currently no control programme for the disease.

1.Cattle over the age of 6 months should be permanently marked or identified using a systematic approach.

2.Hygiene and management practices should be implemented to increase biosecurity. Cattle should be kept further from human dwellings to decrease opportunities for transmission. Creation of legislation is necessary to register individual dairy farms, and notify vets of cattle purchases, sales, or transfers.

3.Regular testing and meat inspection practices are required to identify infected individuals. Ideally testing of infected herds should occur in a predetermined pattern to establish whether there are any changes in the rate of new infections, and biannual testing programs should be put in place for those herds that have gained disease-free status, to confirm that this disease-free status remains (Figure 22.2).

4.A system of insurance or initiation of a government policy to reimburse farmers for the loss of individual cattle will make it possible for a farmer to maintain their livelihood should an infected cow need to be removed from the herd. It is extremely rare to find such a system in low income countries, however, the current practice of condemnation in low income countries is not well studied or documented.

RISK TO HUMANS

The major risk to humans of mycobacterial infections from animals worldwide is the risk of infection with M. bovis. The most common transmission route of the mycobacteria from cattle to humans occurs due to ingestion of unpasteurized, infected milk. The important public health issue has ensured that M. bovis has been made a listed disease by the World Organization of Animal Health (OIE). In addition to the impact of illness on the human population, M. bovis has a significant economic impact on international trade of animals and animal products.18

As knowledge of the mycobacteria has increased over the last 100 years, control measures have been set in place in some countries to limit to the spread of the disease, and currently in the United Kingdom the risk to humans of infection with M. bovis from cattle is low.

Risk to humans is higher where no control mechanisms have been set in place or where there is a lack of public health education. In African countries such as Ethiopia, where the level of milk pasteurization is generally low, and certainly not generally regulated or controlled, infection of humans due to ingestion of infected milk remains high. In the United Kingdom, should a tuberculosisreactor cow be detected on farm, the Government Local Authority and State Veterinary Service offer verbal and written advice to avoid consumption of milk from reactor animals; however, there is no legal obligation for the farmer to follow this recommendation.

Risk of human infection by exposure to M. bovis or other zoonotic mycobacteria is heightened by the presence of any concurrent cause of immunosuppression such as HIV/AIDS infection, malnutrition, and concurrent disease, thus increasing the likelihood of developing clinical signs of disease.

Another group of individuals at risk are those who work regularly in close contact with infected cattle, for example, farm workers, abattoir workers, and veterinary surgeons. M. bovis bacilli can be aerosolized and infected particles be easily inhaled by humans or other cattle in close contact, in addition to oral transmission by infected milk.

The Health Protection Agency and Animal and Plant Health Agency in the United Kingdom are the bodies that are able to provide information about the incidence of confirmed human cases of M. bovis infections, and so are able to annually quantify the risk to humans in the United Kingdom from M. bovis infection. Consideration will be made as to the demographics of the diseased individual; older members of the population with a limited travel history are thought to have been exposed to the bacteria while drinking unpasteurized milk years previously, while the younger generation are more likely to be infected during travel abroad.

CONCLUSION

M. bovis infection remains an economically important disease across the world. Although efforts to eradicate the disease have been successful in several countries including Australia, France and the majority of the United States, across many countries of the world the disease remains endemic in the cattle population. Successful disease control requires a thorough understanding of the epidemiology and transmission of the disease within and between the human, domestic and wild animal population. Tailoring a range of control methods using a multipronged approach is the sole route by which complete eradication of bovine tuberculosis can and will be achieved.

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Index

A

AADAC, see Arylacetamide deacetylase AAP, see American Academy of

Pediatrics

Abdominal tuberculosis, 353; see also Childhood tuberculosis and Extrapulmonary tuberculosis

ACH, see Air changes per hour Acid fast bacilli (AFB), 52, 244, 251

drug susceptibility testing, 354–355 ACOG, see American College of

Obstetrics and Gynecology Acquired immune deficiency

syndrome (AIDS), 12; see also Tuberculosis and Human Immunodeficiency Virus coinfection

syndemics of, 267

ACTG, see AIDS Clinical Trials Group Study

Acute respiratory distress syndrome (ARDS), 146, 239

ADA, see Adenosine deaminase Adenosine deaminase (ADA), 252 aDNA, see Ancient DNA

AFB, see Acid fast bacilli

AIDS, see Acquired immune deficiency syndrome

AIDS Clinical Trials Group Study (ACTG), 278

Air changes per hour (ACH), 101, 106 Alanine transaminase (ALT), 382 ALT, see Alanine transaminase

American Academy of Pediatrics (AAP), 343

American College of Obstetrics and Gynecology (ACOG), 364

American Thoracic Society (ATS), 243, 254

Treatment guidelines, 393–398 Amikacin (AMK), 184; see also

Anti-tuberculosis drugs, aminoglycosides

Aminoglycosides, 183–184; see also Anti-tuberculosis drugs

AMK, see Amikacin

AMP-activated protein kinase (AMPK), 210

AMPK, see AMP-activated protein kinase Ancient DNA (aDNA), 4

Animal tuberculosis, 415, 431 bovine TB in Great Britain, 417 control, 427–430

diagnostic tests, 423–426 direct contacts, 416 epidemiology, 418–420, 422 etiology, 417

genetic work, 424–425 histopathology, 425–426 history, 415–417 interferon-gamma test, 424 laboratory culture, 424

livestock production systems, 419 pathogenesis and transmission, 417–418 postmortem examination, 424

Ring Vaccination, 429 risk to humans, 430

single intradermal comparative cervical tuberculin test, 423–424

Spillover hosts, 419, 429–430 transmission by ingestion, 420–423 treatment, 426–427

tuberculin testing of cattle, 431 Anterior mediastinotomy, 328–329;

see also Surgical management and complications

Anthrax bacillus, 41 Antifungal agents, 336 Antiretrovirals (ARVs), 313

Antiretroviral therapy (ART), 23, 64, 118, 218, 244, 313, 365, 376

Anti-tuberculosis drugs, 175 aminoglycosides, 183–184 bedaquiline, 189–190 capreomycin, 184–185 carbapenems, 192–193 for children, 356–357 clarithromycin, 191–192 clofazimine, 188–189

cycloserine and terizidone, 187 delamanid, 190–191 ethambutol, 179–180 isoniazid, 176–177 levofloxacin, 182–183 linezolid, 187–188 moxifloxacin, 181–182

para-aminosalicylic acid, 185–186

pyrazinamide, 178–179 pretomanid, see Pretomanid rifabutin, 180–181 rifampicin, 177–178 rifapentine, 181 thiacetazone, 192 thioamides, 186–187

Antitumor necrosis factor (aTNF), 375 ARDS, see Acute respiratory distress

syndrome

Area under the curve (AUC), 176 time–concentration curve, 209

ARVs, see Antiretrovirals Arylacetamide deacetylase(AADAC), 177 Aspartate transaminase (AST), 376 Aspergilloma, 240; see also Pulmonary

tuberculosis

AST, see Aspartate transaminase ATB, see Active TB

aTNF, see Antitumor necrosis factor ATS, see American Thoracic Society Atypical mycobacteriosis, 147; see also

Radiology of mycobacterial disease

bronchiectasis, 149 cystic bronchiectasis, 149 endobronchial mass, 147 hilar adenopathy, 147

HIV with reconstituted immunity, 149

massive neck swelling, 148 progressive middle lobe

consolidation, 148 tree-in-bud pattern, 150

AUC, see Area under the curve

B

Bacille Calmette-Guérin vaccine (BCG vaccine), 12, 24, 154, 217, 275, 354; see also Vaccines

boosting with subunit vaccine, 223–224 development of, 217

effect on tuberculin skin test, 218 efficacy, 218 –220

primary attenuation, 45

reasons for efficacy variability, 220 replacing BCG, 222–223

safety of, 217–218

prevent, 407–408

projecting impact of increased TB case finding, 406

rapid declines in TB case rates, 402 search, 404–406

supporting patients through TB treatment, 407

TB elimination policy discussion, 402 treat, 406–407

Control of Substances Hazardous to Health (COSHH), 423

COPD, see Chronic obstructive pulmonary disease

Core genome MLST (cgMLST), 82 Corticosteroids, 244, 360, 374, 378 COSHH, see Control of Substances

Hazardous to Health

Cough aerosol sampling system (CASS), 98 Council for Scientific and Industrial

Research (CSIR), 108 CPR, see Capreomycin

CR1, see Complement receptor 1 C-reactive protein (CRP), 353 CRISPR, see Clustered regularly

interspaced short palindromic repeats

CRP, see C-reactive protein

CRyPTIC, see Comprehensive Resistance Prediction for Tuberculosis: An International Consortium

CS, see Cycloserine

CSF, see Cerebrospinal fluid

CSIR, see Council for Scientific and Industrial Research

CT, see Computed tomography CTL, see Cytolytic T lymphocytes CTS, see Canadian Thoracic Society

Culture filtrate protein-10 (CFP-10), 154, 222

Culture-negative TB, 244, 398 CXR, see Chest radiograph Cycloserine (CS), 187; see also

Anti-tuberculosis drugs CYP, see Cytochrome P450 Cytochrome P450 (CYP), 281 Cytokines, 251

Cytolytic T lymphocytes (CTL), 61 Cytomegalovirus (CMV), 220

D

DALYs, see Disability-adjusted life years DARQs, see Diarylquinolines

DDIs, see Drug−drug interactions DEFRA, see Department for the

Environment, Food and Rural Affairs

Dehydropeptidase-1 (DHP-1), 193; see also Anti-tuberculosis drugs

Delamanid (DLD), 190–191, 359; see also Anti-tuberculosis drugs

Delayed-type hypersensitivity (DTH), 57 Delpazolid, 206

Department for the Environment, Food and Rural Affairs (DEFRA), 427

DHP-1, see Dehydropeptidase-1 Diabetes mellitus (DM), 380 Diagnosis of pulmonary tuberculosis,

115, 124 bronchoscopy, 120

chest radiography, 118–119 diagnosis in public health context,

115–116

drug resistance, 123–124 four-symptom rule, 118 guiding principles of diagnosis,

116–117

history and physical examination, 117–118

lipoarabinomannan assays, 124 mycobacterial culture, 121 non-sputum tests, 124

nucleic acid amplification testing, 121–123

sensitivity and specificity diagnostic tests, 117

specimen collection, 119–120 sputum expectoration, 119–120 sputum induction, 120

sputum smear microscopy, 120–121 sputum tests, 120–124

Diagnosis of latent tuberculosis infection, 153

CD4+ T-cell subset cytokine profiles with clinical correlates, 164

cell-mediated immunity-based tests of TB infection, 153–154

children, 156

findings from latency antigens, 163 high-TB burden setting, 158–159 by IGRA, 155

immunocompetent adults, 155 immunocompromised subjects,

155–156 immunodiagnostics tools, 153–154

kinetics of IGRA responses over time, 159–161

limitations of, 159

low-TB burden settings, 157–158 policy and guidelines for IGRA use,

161

predictive power of IGRAs, 157–161 risk factors for progression, 153

skin test, 154, 159

specificity of IGRAs in diagnosis, 156–157

T-cell signatures, 164–166 treatment, 373–374

unmet clinical need in LTBI diagnostics, 161–166 Diarylquinolines (DARQs), 203

Differentiated service delivery (DSD), 290, 292–293

Direct contacts, 416

Directly observed therapy (DOT), 243, 277, 356

Directly observed therapy, short course (DOTS), 17

Direct repeat (DR), 43 Disability-adjusted life years

(DALYs), 26 DLD, see Delamanid DM, see Diabetes mellitus

Dolutegravir (DTG), 281, 282 DOT, see Directly observed therapy

DOTS, see Directly observed therapy, short course

DPRE1 inhibitors, 205; see also Drug treatment developments

DR-TB, see Drug-resistant tuberculosis Drug classes, 203

Drug−drug interactions (DDIs), 209 Drug-resistant tuberculosis (DR-TB),

301, 359, 383 compassionate treatment, 316 diagnosis of MDR-TB, 304–307 epidemiological findings using

genotyping tools, 303 epidemiology, 302–304 extensive drug-resistance, 395 genotypic testing, 305–307 isoniazid monoresistant TB, 394

MDR tuberculosis, 307–316, 394–395, 396

medical management principles, 309 molecular epidemiological

genotyping methods, 304 new XDR-TB regimen, 395, 397 next-generation sequencing, 307 palliative care, 316–317 person-centered care, 316–317 phenotypic DST, 305

quantitative assessment of sputum, 316

research priorities, 317 response to therapy, 315–316

rifampin monoresistant TB, 395, 397 rights-based approaches to, 316 second-line anti-tuberculous

drugs, 310