RESUMEN
BACKGROUND: Tuberculosis (TB) is a public health problem in Lithuania, among the 18 high-priority TB countries in the European region, and the most common AIDS-indicative disease with the highest proportion in the EU/EEA since 2015. The study aimed to identify socio-demographic, clinical characteristics and their relationship with TB outcomes in TB-HIV co-infected patients in Lithuania. METHODS: A retrospective chart review analysed the characteristics of TB-HIV co-infected adults registered in State Information System of Tuberculosis over 2008-2020. The factors associated with drug-resistant TB and unsuccessful treatment outcome were identified by multivariable logistic regression. RESULTS: The study included 345 cases in 311 patients (239 new, 106 previously treated cases), median age 40 years (IQR 35-45), 80.7% male. 67.8% patients knew their HIV-positive status before TB diagnosis, median time to TB diagnosis was 8 years (IQR 4-12). 83.6% were unemployed, 50.5%-anytime intravenous drug users (IDU), 34.9% abused alcohol. Drug-resistant TB rates in new and previously treated TB cases were 38.1% and 61.3%, respectively. In multivariable analysis, higher risk of drug-resistant TB was associated with imprisonment in new (aOR 3.35; 95%CI 1.17-9.57) and previously treated (aOR 6.63; 95%CI 1.09-40.35) cases. In 52.3% of new TB cases and in 42.5% previously treated TB cases the treatment outcomes were unsuccessful. In multivariable analysis of new TB cases, current imprisonment (aOR 2.77; 95%CI 1.29-5.91) and drug-resistant TB (aOR 2.18; 95%CI 1.11-4.28) were associated with unsuccessful treatment outcome. In multivariable analysis of previously treated TB cases, female gender (aOR 11.93; 95%CI 1.86-76.69), alcohol abuse (aOR 3.17; 95%CI 1.05-9.58), drug-resistant TB (aOR 4.83; 95%CI 1.53-15.28) were associated with unsuccessful treatment outcome. CONCLUSIONS: In the TB-HIV-infected adult cohort in Lithuania, unemployment, imprisonment, IDU, alcohol abuse, known to be risk factors for TB, were very frequent. Drug resistance was an undeniable risk factor for unsuccessful treatment outcome and imprisonment was associated with drug resistant TB.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Alcoholismo , Infecciones por VIH , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis , Adulto , Humanos , Masculino , Femenino , Estudios Retrospectivos , Lituania/epidemiología , Alcoholismo/complicaciones , Antituberculosos/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Factores de Riesgo , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/complicaciones , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , DemografíaRESUMEN
OBJECTIVE: A case-control study was conducted to assess seasonal influenza vaccine effectiveness (SIVE) during the 2015-2016 influenza season. METHODS: A study was performed in three departments in Lithuania between 1 December 2015 and 1 May 2016. Data on demographic and clinical characteristics including influenza vaccination status were collected from the patients recommended to receive the seasonal influenza vaccine. Influenza virus infection was confirmed by multiplex reverse transcription polymerase chain reaction (RT-PCR) . RESULTS: Ninety-one (56.4%) of the 163 included subjects were ≥65 years old. Fifteen (9.2%) subjects were vaccinated against influenza at least 2 weeks before the onset of influenza symptoms, 12 of them were ≥65 years old. Of the 72 (44.2%) influenza virus positive cases, 65 (39.9%) were confirmed with influenza A (including 50 cases of influenza A(H1N1)pdm09), eight (4.9%) were confirmed with influenza B and one was a co-infection. Unadjusted SIVE against any influenza, influenza type A and influenza A(H1N1)pdm09 was 57% (95% CI -41% to 87%), 52% (95% CI -57% to 85%) and 70% (95% CI -43% to 94%) respectively. CONCLUSION: Although SIVE estimates were not statistically significant the point estimates suggest moderate effectiveness against influenza type A.
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Virus de la Influenza A , Vacunas contra la Influenza , Gripe Humana/prevención & control , Estaciones del Año , Vacunación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Hospitales , Humanos , Subtipo H1N1 del Virus de la Influenza A , Virus de la Influenza B , Gripe Humana/virología , Lituania , Masculino , Persona de Mediana Edad , Embarazo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Due to scarce information on seasonal influenza vaccine effectiveness (SIVE) against severe clinical influenza outcomes in risk populations, we conducted a case-control study to assess its effects against laboratory-confirmed influenza in hospitalized patients during the 2012-2013 influenza season. METHODS: We conducted a test-negative case-control study among ≥18 years old patients with influenza-like illness (ILI) hospitalized in two Lithuanian hospitals. Cases were influenza A(H1N1), A(H3) or influenza B positive by RT-PCR, and controls were influenza negative. Additional demographic and clinical data to assess the role of confounding were collected. SIVE and its confidence intervals (95% CI) were estimated by using multivariate logistic regression as (1-OR)×100%. RESULTS: The sample consisted of 185 subjects. Seasonal influenza vaccine uptake was 5%. Among 111 (60%) influenza positive cases, 24.3% were A(H1N1), 10.8% were A(H3) and 24.3% were influenza B cases. Unadjusted SIVE was 79% (95% CI -6% to 96%) and after the adjustment it increased to 86% (95% CI 19% to 97%). CONCLUSIONS: Seasonal influenza vaccination in 2012-2013 was associated with reduced occurrence of laboratory-confirmed influenza, but due to low sample size the estimate of SIVE is imprecise. Given high prevalence of influenza in hospitalized ILI cases and low influenza vaccination coverage, there is a need to increase influenza vaccination rates.
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Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Adulto , Estudios de Casos y Controles , Factores de Confusión Epidemiológicos , Femenino , Hospitales , Humanos , Subtipo H1N1 del Virus de la Influenza A , Virus de la Influenza B , Gripe Humana/epidemiología , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Vacunación/estadística & datos numéricosRESUMEN
UNLABELLED: The objective of this study was to identify case characteristics and clinical course of the disease in patients hospitalized with 2009 pandemic influenza A (H1N1) infection during the first wave of the pandemic and to identify risk factors associated with the complicated course of illness. MATERIAL AND METHODS: A retrospective study of adult cases of the laboratory-confirmed 2009 pandemic influenza A (H1N1) virus admitted to three hospitals in Kaunas between November 1, 2009, and March 15, 2010, was carried out. The main outcome measures were clinical characteristics, risk factors for complicated disease, treatment, and clinical course of the disease. RESULTS: The study enrolled 121 of the 125 patients hospitalized due to 2009 pandemic influenza A (H1N1) virus infection. The median age was 31 years (range, 18-83); 5% of the patients were aged more than 65 years. Pregnant and postpartum women comprised 26% of all hospitalized cases. Nearly half (49.5%) of those who underwent chest radiography had findings consistent with pneumonia, which was bilateral in one-third of cases. The risk to have pandemic influenza complicated by pneumonia increased significantly with one-day delay from symptom onset to antiviral treatment (OR, 2.241; 95% CI, 1.354-3.710). More than half (57%) of the patients received antiviral treatment. In 45% of the treated patients, antiviral drugs were administered within 48 hours from symptom onset. Intensive care was required in 7.4% of the cases. The overall mortality was 5% (6/121). The median age of the patients who died was 43.5 years (range, 23-62); 4 patients had been previously healthy, 1 patient suffered from chronic lympholeukemia, and 1 patient was a pregnant woman. CONCLUSION: The 2009 pandemic influenza A (H1N1) caused considerable morbidity in a significant proportion of hospitalized adults. The main risk factor associated with the complicated course of illness was delayed antiviral treatment.
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Hospitalización , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gripe Humana/virología , Pandemias , Adulto , Anciano , Femenino , Humanos , Gripe Humana/complicaciones , Gripe Humana/terapia , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
This article presents a clinical case of late diagnosis of cerebral toxoplasmosis and cytomegalovirus retinitis of right eye in a 32-year-old patient who was unaware of her HIV status. In addition, this article reviews the literature reflecting clinical, diagnostic, and treatment issues of some opportunistic infections in AIDS.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Síndrome de Inmunodeficiencia Adquirida , Toxoplasmosis Cerebral/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adulto , Retinitis por Citomegalovirus/epidemiología , Femenino , Hospitalización , Humanos , Uveítis/epidemiología , Agudeza VisualRESUMEN
UNLABELLED: Infection with high-risk human papillomaviruses is a significant risk factor of various benign and malignant human lesions in the upper respiratory tract, skin and the genital tract. The identification of particular human papillomaviruses types is important for identifying patients with premalignant lesions who are at risk of progression to malignancy. Our aim was to establish the prevalence of human papillomaviruses infection in the upper respiratory tract of patients with laryngeal papillomatosis, to identify viral types, to evaluate the relationship between some risk factors and persistence of human papillomaviruses in the upper respiratory tract and to determine the pattern of human papillomaviruses infection. MATERIAL AND METHODS: The group of 36 patients with laryngeal papillomatosis and control group of 108 persons without any complains of respiratory system was examined. Epidemiologic characteristics and objective data were analyzed and routine laryngological examination was performed. Pharyngeal swabs of all persons and laryngeal biopsies of 17 patients were taken and analyzed for the presence of human papillomaviruses DNA. Viral typing using the polymerase chain reaction was performed. RESULTS: Human papillomaviruses DNA was detected in all except one case of laryngeal papillomatosis; then only 23.15% of persons without complaints of respiratory system were found human papillomaviruses positive. Human papillomaviruses 6, 11 types were predominant (in 88.9% of patients and 19.4% of persons from control group). High-risk human papillomaviruses were detected in 52.78% of laryngeal papillomatosis cases and in 9.26% of control cases. Risk factors were noted statistically significantly more often in human papillomaviruses positive cases. CONCLUSIONS: The prevalence of human papillomaviruses infection in the upper respiratory tract of patients with laryngeal papillomatosis is high; human papillomaviruses 6, 11 types are predominant. High-risk human papillomaviruses were noted statistically significantly more often in the group of patients with laryngeal papillomatosis. Inclination to diseases of respiratory system, dental caries, smoking, low living standard are statistically significantly related to human papillomaviruses persistence in the upper respiratory tract.