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Article ; Online: A cross-sectional study of patients with extrapulmonary tuberculosis and normal chest radiographs - what characteristics were associated with sputum culture positivity?

Le, Victoria / Pascopella, Lisa / Westenhouse, Janice / Barry, Pennan

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022

Abstract: Background: Recognizing pulmonary involvement in tuberculosis (TB) patients is necessary to prevent TB transmission. We describe frequency and characteristics of patients with extrapulmonary TB (EPTB), normal chest radiographs, and positive sputum ... ...

Abstract	Background: Recognizing pulmonary involvement in tuberculosis (TB) patients is necessary to prevent TB transmission. We describe frequency and characteristics of patients with extrapulmonary TB (EPTB), normal chest radiographs, and positive sputum culture. Methods: We analyzed data on patients ≥15 years old with EPTB reported to the California TB registry during 2011-2017 with cultured sputum and normal chest radiographs, using generalized linear modeling to estimate prevalence ratios associated with positive sputum culture. Demographic, behavioral, clinical characteristics, and testing were compared for patients with positive and negative sputum culture. Results: Of 1,634 patients with EPTB and normal chest radiographs, 936 (57%) had sputum culture performed, and 126 (13%) patients had positive results for M. tuberculosis complex. Patients with positive results were more likely to: be male, experience homelessness, use substances, have HIV, have >1 disease site. Among 85 HIV co-infected patients, 54% had positive culture results compared to 9.5% among 852 patients without HIV co-infection. Patients with EPTB in more than one site were also more likely to have a positive sputum culture. Conclusions: Culturing sputum from patients with EPTB identified pulmonary cases not detected by chest radiograph, particularly among patients with HIV or >1 disease site.
Language	English
Publishing date	2022-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac338
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Article ; Online: Response to IJTLD 11-18-0796 correspondence by J Brož, B Jarosova, S F A Salih, M Brabec, F M A Salih related to 'Association between diabetes mellitus and mortality among patients with tuberculosis in California, 2010-2014'.

Nguyen, C H / Pascopella, L / Barry, P M

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

2019 Volume 23, Issue 5, Page(s) 638–639

MeSH term(s)	California ; Diabetes Mellitus ; Humans ; Tuberculosis
Language	English
Publishing date	2019-05-17
Publishing country	France
Document type	Letter ; Comment
ZDB-ID	1385624-8
ISSN	1815-7920 ; 1027-3719
ISSN (online)	1815-7920
ISSN	1027-3719
DOI	10.5588/ijtld.18.0860
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Article ; Online: Association between diabetes mellitus and mortality among patients with tuberculosis in California, 2010-2014.

Nguyen, C H / Pascopella, L / Barry, P M

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

2018 Volume 22, Issue 11, Page(s) 1269–1276

Abstract: Setting: Studies of US populations have produced conflicting findings about the impact of diabetes mellitus (DM) on tuberculosis (TB) treatment outcomes.: Objective: To investigate the association between DM and all-cause mortality among patients on ... ...

Abstract	Setting: Studies of US populations have produced conflicting findings about the impact of diabetes mellitus (DM) on tuberculosis (TB) treatment outcomes. Objective: To investigate the association between DM and all-cause mortality among patients on anti-tuberculosis treatment in California, USA. Design: Using TB surveillance data, we conducted a retrospective analysis of California patients with culture-confirmed TB who started anti-tuberculosis treatment during 2010-2014. We used Cox proportional hazards models to estimate the association of DM with all-cause mortality and conducted a sensitivity analysis to estimate the attenuating effect of unmeasured confounding by body mass index. Results: Among 8461 patients with TB, 2124 (25.1%) had DM and 713 (8.4%) died during anti-tuberculosis treatment. A higher proportion of TB-DM patients died (13.1% vs. 6.8% TB-no DM). After adjusting for confounders, DM was associated with mortality (adjusted hazards ratio [aHR] 1.35, 95%CI 1.15-1.57). There was effect modification by human immunodeficiency virus (HIV) status, with HIV-positive patients having an aHR of 5.33 (95%CI 1.76-16.12). Conclusion: TB patients with DM had a greater hazard of death during anti-tuberculosis treatment than those without DM. Further investigation into the impact of HIV on the relation of DM to death is necessary.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/therapeutic use ; California/epidemiology ; Cause of Death ; Coinfection/drug therapy ; Coinfection/epidemiology ; Coinfection/mortality ; Comorbidity ; Diabetes Mellitus, Type 1/epidemiology ; Diabetes Mellitus, Type 2/epidemiology ; Female ; HIV Infections/epidemiology ; HIV Infections/mortality ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Risk Factors ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology ; Tuberculosis/mortality ; Young Adult
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2018-10-25
Publishing country	France
Document type	Journal Article ; Observational Study
ZDB-ID	1385624-8
ISSN	1815-7920 ; 1027-3719
ISSN (online)	1815-7920
ISSN	1027-3719
DOI	10.5588/ijtld.18.0011
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Article ; Online: Factors associated with extended treatment among tuberculosis patients at risk of relapse in California.

Qin, F / Barry, P M / Pascopella, L

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

2016 Volume 20, Issue 3, Page(s) 363–369

Abstract: Setting: California, United States.: Objective: To determine the frequency of tuberculosis (TB) patients at risk for relapse who received at least 9 months of anti-tuberculosis treatment (extended treatment) and to identify factors associated with ... ...

Abstract	Setting: California, United States. Objective: To determine the frequency of tuberculosis (TB) patients at risk for relapse who received at least 9 months of anti-tuberculosis treatment (extended treatment) and to identify factors associated with not receiving extended treatment. Design: We analyzed characteristics of culture-confirmed pulmonary TB patients reported to the California TB Registry during 2004-2009. Patients with cavities on initial chest radiograph and delayed culture conversion (⩾70 days) were at 'high risk of relapse', and anti-tuberculosis treatment of ⩾270 days was 'extended treatment'. We used a generalized linear model to identify independent risk factors for absence of extended treatment in the high risk of relapse group. Results: Among 5680 TB patients, 483 (8.5%) were at high risk of relapse: 372 (77%) received extended treatment but 111 (23%) did not. Factors associated with absence of extended treatment included negative sputum smears (adjusted prevalence ratio [aPR] 2.62, 95%CI 1.69-4.05), residence in three specific counties (aPR 1.71, 95%CI 1.19-2.46) and Black race (aPR 1.56, 95%CI 1.03-2.38). Conclusions: Nearly a quarter of TB patients at high risk of relapse did not receive extended treatment. Increased efforts are needed to ensure that all patients who may benefit from extended anti-tuberculosis treatment receive it.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/therapeutic use ; California/epidemiology ; Child ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Mycobacterium tuberculosis/drug effects ; Mycobacterium tuberculosis/isolation & purification ; Prevalence ; Proportional Hazards Models ; Recurrence ; Risk Factors ; Sputum/microbiology ; Time Factors ; Treatment Outcome ; Tuberculosis, Pulmonary/diagnosis ; Tuberculosis, Pulmonary/drug therapy ; Tuberculosis, Pulmonary/epidemiology ; Young Adult
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2016-03
Publishing country	France
Document type	Journal Article
ZDB-ID	1385624-8
ISSN	1815-7920 ; 1027-3719
ISSN (online)	1815-7920
ISSN	1027-3719
DOI	10.5588/ijtld.15.0469
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Article ; Online: Epidemiology and Treatment Outcomes of Tuberculosis with Chronic Hepatitis B Infection-California, 2016-2020.

Bertumen, J Bradford / Pascopella, Lisa / Han, Emily / Glenn-Finer, Rosie / Wong, Robert J / Chitnis, Amit / Jaganath, Devan / Jewell, Mirna / Gounder, Prabhu / McElroy, Sara / Stockman, Lauren / Barry, Pennan

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2024

Abstract: Background: Improved epidemiologic and treatment data for active tuberculosis (TB) with chronic hepatitis B virus (cHBV) infection might inform and encourage screening and vaccination programs focused on persons at risk of having both conditions.: ... ...

Abstract	Background: Improved epidemiologic and treatment data for active tuberculosis (TB) with chronic hepatitis B virus (cHBV) infection might inform and encourage screening and vaccination programs focused on persons at risk of having both conditions. Methods: We matched the California Department of Public Health TB registry during 2016-2020 to the cHBV registry using probabilistic matching algorithms. We used chi-square analysis to compare the characteristics of persons with TB and cHBV with those with TB only. We compared TB treatment outcomes between these groups using modified Poisson regression models. We calculated the time between reporting of TB and cHBV diagnoses for those with both conditions. Results: We identified 8,435 persons with TB, including 316 (3.7%) with cHBV.- Among persons with TB and cHBV, 256 (81.0%) were non-U.S.-born Asian vs 4,186 (51.6%) with TB only (P <0.0001). End-stage renal disease (26 [8.2%] vs 322 [4.0%]; P <0.001) and HIV (21 [6.7%] vs 247 [3.0%]; P value = 0.02) were more frequent among those with TB and cHBV compared with those with TB only. Among those with both conditions, 35 (11.1%) had TB diagnosed >60 days before cHBV (median 363 days) and 220 (69.6%) had TB diagnosed >60 days after cHBV (median 3,411 days). Conclusion: Persons with TB and cHBV were found more frequently in certain groups compared with TB only, and infrequently had their conditions diagnosed together. This highlights an opportunity to improve screening and treatment of TB and cHBV in those at high risk for coinfection.
Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciae169
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Article ; Online: Discordant results of tests for tuberculosis reconsidered - Authors' reply.

Ho, Christine S / Feng, Pei-Jean / Narita, Masahiro / Stout, Jason E / Chen, Michael / Pascopella, Lisa / Garfein, Richard / Reves, Randall / Katz, Dolly J

The Lancet. Infectious diseases

2022 Volume 22, Issue 2, Page(s) 164–165

MeSH term(s)	Humans ; Tuberculosis/diagnosis
Language	English
Publishing date	2022-01-29
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(21)00805-7
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Article: Use of Nucleic Acid Amplification Tests in Tuberculosis Patients in California, 2010-2013.

Peralta, Gianna / Barry, Pennan / Pascopella, Lisa

Open forum infectious diseases

2016 Volume 3, Issue 4, Page(s) ofw230

Abstract: Background: Nucleic acid amplification tests (NAATs) have been used as a diagnostic tool for tuberculosis (TB) in the United States for many years. We sought to assess NAAT use in TB patients in California during a period of time when NAAT availability ... ...

Abstract	Background: Nucleic acid amplification tests (NAATs) have been used as a diagnostic tool for tuberculosis (TB) in the United States for many years. We sought to assess NAAT use in TB patients in California during a period of time when NAAT availability increased throughout the world. Methods: We conducted a retrospective review of surveillance data from 6051 patients with culture-confirmed pulmonary TB who were reported to the California TB registry during 2010-2013. Results: Only 2336 of 6051 (39%) TB patients had a NAAT for diagnosis before culture results. Although 90% (N = 2101) with NAAT had positive test results, 9% (N = 217) had falsely negative NAAT results, and 0.8% (N = 18) had indeterminate NAAT results. The median time from specimen collection to TB treatment initiation was shorter when NAAT was used (3 vs 14 days, Conclusions: Increased use of NAATs in diagnosis of pulmonary TB could decrease the time-to-treatment initiation and consequently decrease transmission. However, differential use and access to NAAT may prevent full realization of NAAT benefits in California.
Language	English
Publishing date	2016-12-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofw230
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Article ; Online: A systematic synthesis of direct costs to treat and manage tuberculosis disease applied to California, 2015.

Oh, Peter / Pascopella, Lisa / Barry, Pennan M / Flood, Jennifer M

BMC research notes

2017 Volume 10, Issue 1, Page(s) 434

Abstract: Background: The cost of treating and managing cases of active tuberculosis (TB) disease-from diagnosis to treatment completion-is needed by agencies working on public health budgets, resource allocation and cost-effectiveness analysis. Although ... ...

Abstract	Background: The cost of treating and managing cases of active tuberculosis (TB) disease-from diagnosis to treatment completion-is needed by agencies working on public health budgets, resource allocation and cost-effectiveness analysis. Although components of TB costs have been published in the United States (US), no recent study has assessed overall costs for TB care and potential gaps. To systematically review the US literature for costs of treating and managing cases of active TB disease, adjust these costs to current (2015) values, and assess gaps. We quantified total direct costs-from the perspective of the health care payer-of the treatment and case management of active TB disease. Estimates were based on published figures in the US, and operational data of the California Department of Public Health. Result: The average direct cost of treating and managing a TB case was $34,600 in 2015. The average cost of a multidrug-resistant TB case was $110,900. Health care spending for treating and case managing TB patients in California amounted to approximately $75.6 million for the 2133 new cases reported in 2015. Most published cost estimates were based on data from the 1990s. Conclusion: TB is resource-intensive to treat and manage. Our synthesis provides inputs for budgets and economic analyses. New studies to provide original cost data are needed to better reflect current clinical and public health practices.
Language	English
Publishing date	2017-08-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2413336-X
ISSN	1756-0500 ; 1756-0500
ISSN (online)	1756-0500
ISSN	1756-0500
DOI	10.1186/s13104-017-2754-y
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Article ; Online: Comparison of three tests for latent tuberculosis infection in high-risk people in the USA: an observational cohort study.

Ho, Christine S / Feng, Pei-Jean I / Narita, Masahiro / Stout, Jason E / Chen, Michael / Pascopella, Lisa / Garfein, Richard / Reves, Randall / Katz, Dolly J

The Lancet. Infectious diseases

2021 Volume 22, Issue 1, Page(s) 85–96

Abstract: Background: Treatment of latent tuberculosis infection is an important strategy to prevent tuberculosis disease. In the USA, three tests are used to identify latent tuberculosis infection: the tuberculin skin test (TST) and two IFN-γ release assays (T- ... ...

Abstract	Background: Treatment of latent tuberculosis infection is an important strategy to prevent tuberculosis disease. In the USA, three tests are used to identify latent tuberculosis infection: the tuberculin skin test (TST) and two IFN-γ release assays (T-SPOT.TB and QuantiFERON). To our knowledge, few large studies have compared all three tests among people at high risk of latent tuberculosis infection or progression to tuberculosis disease. We aimed to assess test agreement between IFN-γ release assays and TST to provide guidance on their use in important risk groups. Methods: In this observational cohort study, we enrolled participants at high risk of latent tuberculosis infection or progression to tuberculosis disease at ten US sites with 18 affiliated clinics, including close contacts of infectious tuberculosis cases, people born in countries whose populations in the USA have high (≥100 cases per 100 000 people) or moderate (10-99 cases per 100 000 people) tuberculosis incidence, and people with HIV. Participants were interviewed about demographics and medical risk factors, and all three tests were administered to each participant. The primary endpoints for this study were the proportions of positive test results by test type stratified by risk group and test concordance by risk group for participants with valid results for all three test types. The study is registered at ClinicalTrials.gov, NCT01622140. Findings: Between July 12, 2012, and May 5, 2017, 26 292 people were approached and 22 131 (84·2%) were enrolled in the study. Data from 21 846 (98·7%) participants were available for analysis, including 3790 (17·3%) born in the USA and 18 023 (82·5%) born outside the USA. Among non-US-born participants overall, the RR comparing the proportions of TST-positive results (7476 [43·2%] of 17 306 participants) to QuantiFERON-positive results (4732 [26·5%] of 17 882 participants) was 1·6 (95% CI 1·6-1·7). The risk ratio (RR) for the comparison with the proportion of T-SPOT.TB-positive results (3693 [21·6%] of 17 118 participants) was 2·0 (95% CI 1·9-2·1). US-born participants had less variation in the proportions of positive results across all tests. The RRs for the proportion of TST-positive results (391 [10·9%] of 3575 participants) compared with the proportion of QuantiFERON-positive results (445 [12·0%] of 3693 participants) and T-SPOT.TB-positive results (295 [8·1%] of 3638 participants) were 0·9 (95% CI 0·8-1·0) and 1·3 (1·2-1·6), respectively. 20 149 (91·0%) of 21 846 participants had results for all three tests, including 16 712 (76%) non-US-born participants. Discordance between TST and IFN-γ release assay results varied by age among non-US-born participants and was greatest among the 848 non-US-born children younger than 5 years. 204 (87·2%) of 234 non-US-born children younger than 5 years with at least one positive test were TST-positive and IFN-γ release assay-negative. The proportion of non-US-born participants who were TST-negative but IFN-γ release assay-positive ranged from one (0·5%) of 199 children younger than 2 years to 86 (14·5%) of 594 participants aged 65 years and older (p Interpretation: Our findings support the preferential use of IFN-γ release assays for the diagnosis of latent tuberculosis in high-risk populations, especially in very young and older people born outside the USA. Funding: US Centers for Disease Control and Prevention.
MeSH term(s)	Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Infant ; Interferon-gamma Release Tests/standards ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/epidemiology ; Latent Tuberculosis/microbiology ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Reagent Kits, Diagnostic/standards ; Reproducibility of Results ; Risk Factors ; Surveys and Questionnaires ; Tuberculin Test/standards ; United States/epidemiology ; Young Adult
Chemical Substances	Reagent Kits, Diagnostic
Language	English
Publishing date	2021-09-06
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Observational Study ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(21)00145-6
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Article ; Online: Residential urban tree canopy is associated with decreased mortality during tuberculosis treatment in California.

Blount, Robert J / Pascopella, Lisa / Barry, Pennan / Zabner, Joseph / Stapleton, Emma M / Flood, Jennifer / Balmes, John / Nahid, Payam / Catanzaro, Donald G

The Science of the total environment

2019 Volume 711, Page(s) 134580

Abstract: Trees can sequester air pollutants, and air pollution is associated with poor tuberculosis outcomes. However, the health impacts of urban trees on tuberculosis patients are unknown. To elucidate the effects of urban tree canopy on mortality during ... ...

Abstract	Trees can sequester air pollutants, and air pollution is associated with poor tuberculosis outcomes. However, the health impacts of urban trees on tuberculosis patients are unknown. To elucidate the effects of urban tree canopy on mortality during tuberculosis treatment, we evaluated patients diagnosed with active tuberculosis in California from 2000 through 2012, obtaining patient data from the California tuberculosis registry. Our primary outcome was all-cause mortality during tuberculosis treatment. We determined percent tree cover using 1 mresolution color infrared orthoimagery categorized into land cover classes, then linked tree cover to four circular buffer zones of 50-300 m radii around patient residential addresses. We used the Kaplan-Meier method to estimate survival probabilities and Cox regression models to determine mortality hazard ratios, adjusting for demographic, socioeconomic, and clinical covariates. Our cohort included 33,962 tuberculosis patients of median age 47, 59% male, 51% unemployed, and 4.9% HIV positive. Tuberculosis was microbiologically confirmed in 79%, and 1.17% were multi-drug resistant (MDR). Median tree cover was 7.9% (50 m buffer). Patients were followed for 23,280 person-years with 2370 deaths during tuberculosis treatment resulting in a crude mortality rate of 1018 deaths per 10,000 person-years. Increasing tree cover quintiles were associated with decreasing mortality risk during tuberculosis treatment in all buffers, and the magnitude of association decreased incrementally with increasing buffer radius: In the 50 m buffer, patients living in neighborhoods with the highest quintile tree cover experienced a 22% reduction in mortality (HR 0.78, 95%CI 0.68-0.90) compared to those living in lowest quintile tree cover; whereas for 100, 200, and 300 m buffers, a 21%, 13%, and 11% mortality risk reduction was evident. In conclusion, urban tree canopy was associated with decreased mortality during tuberculosis treatment even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that trees might play a role in improving tuberculosis outcomes.
MeSH term(s)	Adult ; Aged ; Air Pollutants ; Air Pollution ; California/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Residence Characteristics ; Trees ; Tuberculosis/mortality ; Urban Health Services
Chemical Substances	Air Pollutants
Language	English
Publishing date	2019-11-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	121506-1
ISSN	1879-1026 ; 0048-9697
ISSN (online)	1879-1026
ISSN	0048-9697
DOI	10.1016/j.scitotenv.2019.134580
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