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Action on social determinants is a main component of the World Health Organization End Tuberculosis (TB) Strategy. The aim of the study was to collect information on socioeconomic characteristics and biomedical risk factors in migrant TB patients in Italy and compare it with data collected among Italian TB patients. A cross-sectional study was conducted among TB patients aged 18 years over a 12-months enrolment period in 12 major Italian hospitals. Information on education, employment, housing and income was collected, and European Union Statistics on Income and Living Conditions index was used to assess material deprivation. Among migrants, we also analyzed factors associated with severe material deprivation. Migrants were compared with younger (18–64 years) and older (65+ years) Italians patients. Out of 755 patients enrolled (with a median age of 42 years, interquartile range: 31–53), 65% were migrants. Pulmonary, microbiologically confirmed, and new cases were 80%, 73%, and 87% respectively. Prevalence of co-morbidities (i.e. diabetes, chronic kidney disease, neoplastic diseases and use of immunosuppressive drugs) was lower among migrants compared to Italian TB patients, while indicators of socioeconomic status, income and housing conditions were worst in migrants. Forty-six percent of migrants were severely deprived vs. 9% of Italians (p

In vitro diagnosis of MTB-infection uses MTB-proteins coded for by genes of the region of differentiation 1 (RD1) of the MTB genome. This study wants to test if proteins preferentially expressed during MTB-intracellular growth might provide new targets for the diagnosis of MTB-infection. To this end seventy-five multiepitopic HLA-promiscuous MTB-peptides were designed by quantitative implemented peptide-binding motif analysis from 3 MTB-protein genes expressed in activated human macrophages (MA), 4 genes expressed during growth in non-activated human macrophages (MN-A), 12 housekeeping genes (HKG) and 6 genes of the RD1 region (RD1) as control. ELISpot for IFN-was performed to measure the responses of PBMCs deriving from 45 patients affected by active tuberculosis and 34 controls. In active-TB patients, the mean response to RD1-derived peptides was higher than that to either MA (p

Summary Background Functional alterations of the autonomic nervous system have been described in relation to chronic hypoxemia in chronic obstructive pulmonary diseases. Aim of the present study was to investigate the occurrence of neuro-vegetative dysfunction during active tuberculosis in the absence of hypoxemia. Materials and methods Fifteen patients affected by pulmonary tuberculosis under standard therapy and 17 matched controls were enrolled. Activation of the sympathetic system was induced by the tilt-up test. Systolic and diastolic arterial pressures and the R–R interval were monitored for 15 min by Finapres and ECG. The baroreflex sensitivity was evaluated by the spontaneous sequences method. Results Systolic and diastolic pressures were significantly higher at basal conditions and showed a less increase during the tilt test in tuberculosis patients compared to healthy controls. The basal R–R interval was shorter and its reduction during the tilt test was less evident in patients. The baroreflex sensitivity was decreased in patients at basal conditions and its reduction during the tilt test was less evident than in controls. Conclusions Our preliminary results suggest the presence in tuberculosis patients of an altered autonomic cardiovascular regulation, which is a reduced function of the baroreflex control of the sinus node.

Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04-0.21) for infants, 0.38% (95% CI 0.01-1.60) for children, 0.09% (95% CI 0.02-0.22) for adults and 0.00% (95% CI 0.00-0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 - 2.02) for infants, 0.9% (95% CI 0.40-1.60) for children, 4.32% (95% CI 1.43-8.67) for adults and 2.62% (95% CI 1.05-4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.

Summary Massive haemoptysis is a life-threatening emergency requiring prompt and highly specialized intervention to identify the site of haemorrhage, protect the airways and stop bleeding. A wide variety of lung diseases may cause haemoptysis, including tuberculosis. The most common sources of pulmonary bleeding are bronchial (90%) and non-bronchial systemic arteries (5%). Aberrant bronchial vessels have also been described. We report the case of a patient affected by cavitary pulmonary tuberculosis who presented with massive haemoptysis from an aberrant bronchial artery originating from the sovrascapular branch of the left thyrocervical trunk. Successful embolization was performed by means of superselective arteriography.

The use of Infliximab in the treatment of patients with rheumatoid diseases unresponsive to conventional therapies has been reported to be complicated by opportunistic infections. We report the case of a 56-yr old female rheumatoid arthritis patient complaining of fever and respiratory symptoms 9 months after commencing Infliximab, who received no ethiologic diagnosis for the six months before admission. Tuberculosis was suspected upon chest radiographic pictures and empirical treatment for miliary tuberculosis instated in the wake of microbiological confirmation. The case typifies the difficulties of diagnosing miliary tuberculosis in the immunocompromised as well as in the immunocompetent patient.

Erratum to ‘‘Design of immunogenic peptides from Mycobacterium tuberculosis genes expressed during macrophage infection’’ [Tuberculosis 89 (3) (May 2009) 210–217] Fouad Seghrouchni *, Silvia Contini , Roumiana Markova , Roumiana Drenska , Khalid Sadki , Larbii Baassi , Yana Todorova , Velislava Terzieva , Marialuisa Bocchino , Giulia Cappelli , Alfonso Maria Altieri , Mario Giuseppe Alma , Abdelaziz Benjouad , Francesca Mariani , Bogdan Petrunov , Vittorio Colizzi , Rajae El Aouad , Cesare Saltini , Massimo Amicosante a Department of Internal Medicine, University of Rome ‘‘Tor Vergata’’, Via Montpellier 1, 00133 Rome, Italy b Laboratory of Cellular Immunology, Department of Immunology–Virology, National Institute of Hygiene, 27, Avenue Ibn Battouta, Agdal, P.B: 769, P.C.:11400 Rabat, Morocco c Laboratory of Mediators of Inflammation and Immunity, Department of Immunology and Allergy, National Center of Infectious and Parasitic Diseases, Yanko Sakazov Boulevard 26, P.C.:1504 Sofia, Bulgaria d Laboratory of Infectious Diseases, INMM-C.N.R., Area Ricerca ‘‘Tor Vergata’’, Via del Fosso del Cavaliere 100, I-00133 Rome, Italy e IV Medical Division of Respiratory Disease, ‘‘S. Camillo-Forlanini’’ Hospital, Circonvallazione Gianicolense, 87, P.C.:00152 Rome, Italy f Laboratory of Biochemistry–Immunology, Department of Biology, University ‘‘Mohamed V-Agdal’’, Av Ibn Battouta, P.C.: 10000, P.B.:1014 Rabat, Morocco Department of Biology, University of Rome ‘‘Tor Vergata’’, Via della Ricerca Scientifica, 00133 Rome, Italy