RESUMEN
SETTING: Seven tuberculosis (TB) clinics in South Africa. OBJECTIVE: As both purified protein derivative (PPD) and a Mycobacterium tuberculosis-specific skin test (C-Tb) contain region of difference 1 (RD1) antigens, we conducted a study to evaluate whether there was any interaction between the two during concomitant and separate administration in patients with newly diagnosed culture-positive TB. DESIGN: Adult patients with active TB (n = 456, 20% human immunodeficiency virus infected) were randomised to receive only C-Tb, only PPD, or concomitant injection of both C-Tb and PPD using the Mantoux technique. Indurations were read after 48-72 h. QuantiFERON®-TB Gold In-Tube (QFT) was performed in tandem. RESULTS: Of the 456 study participants, 154 simultaneously received both C-Tb and PPD, 153 only C-Tb and 149 only PPD. There was no effect of concomitant injection of PPD on the mean C-Tb induration (19 mm, 95%CI 17-22 vs. 18 mm, 95%CI 16-21; P = 0.91). In patients with active TB, C-Tb sensitivity (78%) was similar to PPD (81%) and QFT (84%; excluding 82/429 [19%] indeterminate results). All tests showed reduced sensitivity in participants with CD4 <100 cells/µl. CONCLUSION: In patients with active TB, there was no interaction between C-Tb and PPD during concomitant injection of both agents. Sensitivities were similar for PPD and C-Tb.
Asunto(s)
Prueba de Tuberculina/métodos , Tuberculina/administración & dosificación , Tuberculosis/diagnóstico , Adolescente , Adulto , Anciano , Vacuna BCG/administración & dosificación , Reacciones Cruzadas , Método Doble Ciego , Femenino , Infecciones por VIH/complicaciones , Humanos , Ensayos de Liberación de Interferón gamma/métodos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Sensibilidad y Especificidad , Sudáfrica , Tuberculosis/complicaciones , Adulto JovenRESUMEN
BACKGROUND: The BCG vaccine's ability to prevent Mycobacterium tuberculosis infection (MTI) remains highly debated. In Greenland, BCG vaccination was introduced in 1955, but was temporarily discontinued (1991-1996) due to nationwide policy changes. The study aimed to use the transient stop in BCG vaccination to evaluate the effect of vaccination on MTI prevalence and TB incidence. METHODS: MTI study: A cross-sectional study (2012), comprising East Greenlanders born during 1982-2006, evaluated the effect of BCG vaccination on MTI prevalence; a positive interferon γ release assay defined an MTI case. Associations were estimated using logistic regression. TB study: a cohort study covering the same birth cohorts with follow-up until 2012 evaluated the vaccine's effect on TB incidence. A personal identifier allowed for follow-up in the TB notification system. Associations were estimated using Cox regression. RESULTS: MTI study: Included 953 participants; 81% were BCG-vaccinated; 29% had MTI, 23% among vaccinated and 57% among non-vaccinated. BCG vaccination reduced the odds of MTI, OR 0.52 (95% CI 0.32 to 0.85), p=0.01. Vaccine effectiveness against MTI was 20%. TB study: Included 1697 participants followed for 21,148 person-years. 6% were notified with TB, 4% among vaccinated and 11% among non-vaccinated. BCG vaccination reduced the risk of TB, HR 0.50 (95% CI 0.26 to 0.95), p=0.03, yielding a vaccine effectiveness of 50%. CONCLUSIONS: BCG vaccination was effective in reducing both MTI and TB disease among children and young adults in a TB high-endemic setting in Greenland.
Asunto(s)
Adyuvantes Inmunológicos , Vacuna BCG , Mycobacterium tuberculosis , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/prevención & control , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Estudios de Seguimiento , Groenlandia/epidemiología , Humanos , Incidencia , Ensayos de Liberación de Interferón gamma , Masculino , Prevalencia , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
During the past decade, a number of studies have established that there is a considerable pharmacologic advantage to direct intraperitoneal instillation of chemotherapy for treatment of cancer confined to the abdominal cavity. This article explores the history, present status, and future directions of intraperitoneal chemotherapy. The therapeutic advantages, various chemotherapeutic agents used, delivery systems, administration procedures, toxic effects, and nursing management are addressed.