We are pleased to inform you that the Division of Tuberculosis Elimination Molecular Detection of Drug Resistance (MDDR) service has received approval from the CDC Laboratory Safety Improvement Workgroup to resume operation and are able to transfer biological material from the BSL-3 into the BSL-2 laboratory space to perform clinical testing. For more information please see the document below.
The communication regarding the attached document involves a temporary moratorium from the CDC on the movement of biological material from biosafety level 3 (BSL-3) or BSL-4 facilities in any laboratory at CDC, in which the DTBE Laboratory Branch is temporarily unable to transfer crude DNA preparations from specified isolates or clinical sediments into the BSL-2 lab space. Please read the communication in full and contact Angela Starks, Laboratory Branch Chief (firstname.lastname@example.org), 404-639-3205 with any questions or concerns.
7th International Workshop on Clinical Pharmacology of Tuberculosis Drugs
5 September 2014, Washington DC, USA
Mayo Clinic Center for Tuberculosis is now on Facebook. We look forward to hearing your feedback, as well as posting relevant notifications and messages about Tuberculosis and our center. Please like us at:
On June 10, the National Society of TB Clinicians (NSTC) and the National TB Nurse Coalition (NTNC) will be holding their annual meetings. The annual meetings provide quality educational content and CE credits.
· For the latest agenda and registration information please visit: https://www.signup4.net/public/ap.aspx?EID=20141830E&OID=163
For the National TB Conference that follows Wednesday, June 11, to Friday, June 13, registration information for the conference is available online at https://www.signup4.net/Public/ap.aspx?EID=20141830E
We invite you to join the Mayo Clinic Center for Tuberculosis Breakout Session June 12, from 8:15-9:45 a.m.
All events will be held at the Grand Hyatt Atlanta in Buckhead, 3300 Peachtree Road, NE, Atlanta, GA 30305.
Announcement: Updated Guidelines on Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis
Morbidity and Mortality Weekly Report (MMWR)
March 28, 2014 / 63(12);272
Guidelines for managing pharmacologic interactions that can result when patients receive antiretroviral drugs for treatment of human immunodeficiency virus (HIV) infection together with rifamycin antibiotics for treatment of tuberculosis (TB) have been published previously (1–4). Newly updated guidelines, developed by CDC in collaboration with experts from other key national and international institutions, are now available athttp://www.cdc.gov/tb/publications/guidelines/tb_hiv_drugs/default.htm.
The updated guidelines include recommendations for use of newer antiretroviral drugs, including those in new classes, such as CCR5 receptor antagonists and integrase inhibitors. The new guidelines provide additional recommendations regarding use of rifampin with antiretroviral therapy; these recommendations are critical in regions where rifabutin is unavailable. New features of the guidelines include 1) summaries of clinical experience with use of specific antiretroviral regimens during TB treatment (in addition to pharmacokinetic data), 2) a table summarizing clinical experience with key antiretroviral regimens and providing recommended regimens, and 3) sections on treatment for special populations, including persons with latent TB infection, young children, pregnant women, and patients with drug-resistant TB. The online guidelines will be updated as necessary to provide clinicians with the latest information.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.
All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to email@example.com.
Autologous mesenchymal stromal cell infusion as adjunct treatment in patients with multidrug and extensively drug-resistant tuberculosis: an open-label phase 1 safety trial
A recent article in The Lancet Respiratory Medicine, early online publication from 9 January 2014, offers new insights into much-needed novel treatments for multi-drug resistant and extensively drug-resistant tuberculosis.
Aliaksandr Skrahin M.D., Raija K. Ahmed Ph.D., Giovanni Ferrara M.D., Lalit Rane M.Sc., Thomas Poiret M.Sc., Yanina Isaikina Ph.D., Alena Skrahina M.D., Alimuddin Zumla FRCP, Markus J Maeurer M.D.
Novel treatment options are urgently needed for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, which are associated with immune dysfunction and poor treatment outcomes. Mesenchymal stromal cells (MSCs) are immunomodulatory and adjunct autologous treatment with bone marrow-derived MSCs might improve clinical outcome by transforming chronic inflammation into productive immune responses. Our aim was to assess the safety of infusion of autologous MSCs as an adjunct treatment in patients with tuberculosis.
30 patients with microbiologically confirmed MDR or XDR tuberculosis were treated with single-dose autologous bone marrow-derived MSCs (aimed for 1×106 cells per kg), within 4 weeks of the start of antituberculosis-drug treatment in a specialist centre in Minsk, Belarus. Inclusion patients were those with pulmonary tuberculosis confirmed by sputum smear microscopy, culture, or both; MDR or XDR tuberculosis confirmed by drug-susceptibility testing to first-line and second-line drugs; age older than 21 years to 65 years or younger; and absence of lesion compatible with a malignant process or ongoing tuberculosis in organs other than the lungs and pleura. In addition to the inclusion criteria, patients were excluded if they were pregnant, coinfected with HIV, or infected with hepatitis B, C, or both. The primary endpoint was safety measured by MSC-infusion related events; any tuberculosis-related event within the 6 month observation period that related to a worsening of the underlying infectious disease, measured by conversion of Mycobacterium tuberculosis culture or microscopic examination; or any adverse event defined clinically or by changes in blood haematology and biochemistry variables, measured monthly for 6 months after MSC infusion per protocol. This study is registered with the German Clinical Trials Registry, number DRKS00000763.
The most common (grade 1 or 2) adverse events were high cholesterol levels (14 of 30 patients), nausea (11 of 30 patients), and lymphopenia or diarrhoea (ten of 30 patients). There were no serious adverse events reported. We recorded two grade 3 events that were transitory—ie, increased plasma potassium ion concentrations in one patient and a transitory grade 3 γ-glutamyltransferase elevation in another patient.
MSCs as an adjunct therapy are safe and can now be explored further for the treatment of patients with MDR or XDR tuberculosis in combination with standard drug regimens. Adjunct treatment with MSCs needs to be evaluated in controlled phase 2 trials to assess effects on immune responses and clinical and microbiological outcomes.
Review the extent and effects of the recurrent shortages of purified-protein derivative (PPD) tuberculin skin test antigen solutions in this new background piece by the Centers for Disease Control and Prevention, featured in its MMWR publication of Dec. 13, 2013. Download a pdf here.
Up-to-date information about shortages of biologic products, including PPD TST antigen solutions, is available from FDA online at www.fda.gov/biologicsbloodvaccines safetyavailability/shortages/ucm351921.htm.
June 11-13, 2014
National TB Conference "Sharing the Vision of TB Elimination", Grand Hyatt Atlanta in Buckhead
Atlanta, GA. Pre-meetings, June 10, 2014 and post-meetings June 13, 2014 (afternoon).
Conference agenda and hotel information will be released by early March.
For questions regarding the conference, please contact:
In the season of "scare" CDC says tuberculosis is the true ghoul
Guidelines for bedaquiline fumarate use and safety
“Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis”
CDC update on availability of assay for detecting Mycobacterium tuberculosis
“Availability of an Assay for Detecting Mycobacterium tuberculosis, Including Rifampin-Resistant Strains, and Considerations for Its Use — United States, 2013”