Management of Tuberculosis: Are the Practices Homogeneous in High-Income Countries?

Frédéric Méchaï; Hugues Cordel; Lorenzo Guglielmetti; Alexandra Aubry; Mateja Jankovic; Miguel Viveiros; Miguel Santin; Delia Goletti; Emmanuelle Cambau

doi:10.3389/fpubh.2020.00443

Management of Tuberculosis: Are the Practices Homogeneous in High-Income Countries?

Front Public Health. 2020 Sep 4:8:443. doi: 10.3389/fpubh.2020.00443. eCollection 2020.

Authors

Frédéric Méchaï¹, Hugues Cordel¹, Lorenzo Guglielmetti^{2

3}, Alexandra Aubry^{2

3}, Mateja Jankovic⁴, Miguel Viveiros⁵, Miguel Santin⁶, Delia Goletti⁷, Emmanuelle Cambau^{2

8}

Affiliations

¹ APHP, Infectious Disease Unit, Avicenne Hospital, Université Paris 13, IAME, INSERM, Bobigny, France.
² APHP, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France.
³ Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, Paris, France.
⁴ Clinic for Lung Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia.
⁵ Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal.
⁶ Service of Infectious Diseases, Tuberculosis Unit, Bellvitge University Hospital-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
⁷ Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy.
⁸ AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France.

Abstract

Objectives: To evaluate and compare practices regarding the diagnosis, isolation measures, and treatment of tuberculosis (TB) in high-income countries and mainly in Europe. Materials and Methods: A survey was conducted from November 2018 to April 2019 within the European Society of Clinical Microbiology and Infectious Diseases Study Group for Mycobacterial Infections (ESGMYC). The practices observed were compared to the main international guidelines. Results: Among 136 ESGMYC members, 64 (17 countries) responded to the questionnaire. In their practice, two (20.7%) or three sputum samples (79.3%) were collected for the diagnosis of pulmonary TB, alternatively induced sputum (n = 37, 67.2%), bronchoscopy (34, 58.6%), and gastric aspirates (15, 25.9%). Nucleic acid amplification tests (NAATs) were performed by 41 (64%) respondents whatever the smear result and by 47 (73%) in case of smear-positive specimens. NAAT and adenosine deaminase measurement were used for extrapulmonary TB diagnosis in 83.6 and 40.4% of cases, respectively. For isolation duration, 21 respondents (42.9%) were keeping isolation until smear negativity. An initial treatment without ethambutol was offered by 14% (n = 9) of respondents. Corticosteroid therapy, cerebrospinal fluid opening pressure testing, and repeated lumbar puncture were carried out for central nervous system TB by 79.6, 51.9, and 46.3% of the respondents, respectively. For patients with human immunodeficiency virus-TB coinfection, the preferred antiretroviral therapy included dolutegravir 50 mg twice a day (56.8%). Comparing with the recommendations of the main guidelines, the practices are not totally consistent. Conclusion: This study shows heterogeneous practices, particularly for diagnosis, and isolation, although rapid molecular testing is implemented in most centers. More standardization might be needed.

Keywords: Europe; diagnosis; guidelines; harmonization; survey; treatment; tuberculosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Developed Countries
Europe
Humans
Sputum
Tuberculosis* / diagnosis
Tuberculosis, Pulmonary*