Universität zu Köln

Suarez, Isabelle, Fuenger, Sarah Maria, Jung, Norma, Lehmann, Clara, Reimer, Robert Peter, Mehrkens, Dennis ORCID: 0000-0002-8578-0290, Bunte, Anne, Plum, Georg, Jaspers, Natalie, Schmidt, Matthias, Faetkenheuer, Gerd and Rybniker, Jan (2019). Severe disseminated tuberculosis in HIV-negative refugees. Lancet Infect. Dis., 19 (10). S. E352 - 8. OXFORD: ELSEVIER SCI LTD. ISSN 1474-4457

Full text not available from this repository.

Abstract

In high-income countries, the presentation of tuberculosis is changing, primarily because of migration, and understanding the specific health needs of susceptible populations is becoming increasingly important. Although disseminated tuberculosis is well documented in HIV-positive patients, the disease is poorly described and less expected in HIV-negative individuals. In this Grand Round, we report eight HIV-negative refugees, who presented with extensively disseminated tuberculosis. We discuss the multifactorial causes, such as deprivations during long journeys, precarious living conditions, and the experience of violence, which might add to nutritional factors and chronic disorders, eventually resulting in a state of predisposition to immune deficiency. We also show that disseminated tuberculosis is often difficult to diagnose when pulmonary symptoms are absent. Communication difficulties between refugees and health-care workers are another major hurdle, and every effort should be made to get a valid patient history. This medical history is crucial to guide imaging and other diagnostic procedures to establish a definite diagnosis, which should be confirmed by a positive tuberculosis culture. Because many of these patients are at risk for multidrug-resistant tuberculosis, drug susceptibility testing is imperative to guide therapy. In the absence of treatment guidelines for this entity, clinicians can determine treatment duration according to recommendations provided for extrapulmonary tuberculosis and affected organs. Paradoxical expansion of tuberculous lesions during therapy should be treated with corticosteroids. In many cases, treatment duration must be individualised and might even exceed 12 months.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Suarez, Isabelle UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuenger, Sarah Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Jung, Norma UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehmann, Clara UNSPECIFIED UNSPECIFIED UNSPECIFIED Reimer, Robert Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Mehrkens, Dennis UNSPECIFIED orcid.org/0000-0002-8578-0290 UNSPECIFIED Bunte, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Plum, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Jaspers, Natalie UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Faetkenheuer, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Rybniker, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-133128
DOI:	10.1016/S1473-3099(19)30162-8
Journal or Publication Title:	Lancet Infect. Dis.
Volume:	19
Number:	10
Page Range:	S. E352 - 8
Date:	2019
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1474-4457
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACTIVE TUBERCULOSIS; ASYLUM SEEKERS; HEALTH-CARE; SYSTEM; EXPERIENCE; DIAGNOSIS; AMERICA; UPDATE; ASSAY; EYE Multiple languages Infectious Diseases Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13312