MHF TOP PICKS FOR August
Every month, we at the Mueller Health Foundation like to showcase interesting news and updates in the field of tuberculosis. Below are our top 3 picks for August:
- Sytematic Review and Meta-Analsysis of Infant BCG Vaccination and Risk of Pulmonary and Extrapulmonary Tuberculosis throughout the Life Course
A group of international researches funded by the National Institutes of Health (NIH) identified 14,927 original records from their database searches and included participant-level data from 26 cohort studies done in 17 countries in the meta-analysis. From this analysis, the researchers estimated the overall effectiveness of BCG vaccination against all tuberculosis to be approximately 18%. However, the research showed that when stratified by age, BCG vaccination only significantly protected against all tuberculosis in children younger than 5 years. Overall, the results suggest that BCG vaccination at birth is effective at preventing tuberculosis in young children but is ineffective in adolescents and adults. Additional resources should therefore be invested in research that provides new methods for boosting immunoprotection in older populations. To learn more about the research, you can access the full article at: https://www.thelancet.com/action/showPdf?pii=S2214-109X%2822%2900283-2
- Creation of Data Compendium Associating Genomes of 12,289 TB Isolates with Quantitative Resistance Phenotypes to 13 Antibiotics
The study describes the collection and analysis of 15,211 M. tuberculosis isolates from CRyPTIC (Comprehensive Resistance Prediction for Tuberculosis: an International Consortium) partners in Asia, Europe, Africa, and South America. From this collection, 12,289 isolates belonging to the four main M. tuberculosis lineages were sequenced and had susceptibility to 13 different anti-tubercular drugs measured to capture their genotypic and phenotypic profile. Of the 12,289 isolates tested, 6,814 (55.4%) were resistant to at least one drug, including 4,685 that were resistant to the first-line drug rifampicin or were multidrug-resistant (RR/MDR). Of the RR/MDR isolates, 3% were extensively drug-resistant (XDR), and 38.8% were pre-XDR. The drugs with the highest percentage of resistant isolates were the first-line drugs isoniazid (49%) and rifampicin (38.7%). Resistance was low for the newer and repurposed TB drugs, like bedaquiline (0.9%), clofazimine (4.4%), delaminid (1.6%), and linezolid (1.3%). The main contribution of this study is that it provides an unparalleled view of resistance and resistance patterns among the panel of 13 anti-tubercular compounds studied. To learn more, you can read the paper here: https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001721
- Genome-Wide Association Studies of Global TB Resistance to 13 Antimicrobials in 10,228 Genomes Identify New Resistance Mechanisms
CRyPTIC (Comprehensive Resistance Prediction for Tuberculosis: an International Consortium) researchers analyzed the genomes of 10,228 M. tuberculosis isolates and investigated the association between resistance mechanisms and the minimum inhibitory concentration (MIC) for 13 TB drugs. MIC is a measurement of the lowest concentration needed of a drug to inhibit growth of bacteria.
DID YOU KNOW?
Throughout history, tuberculosis has had a major impact on many famous works created by prominent writers, painters, and musicians. Many of these artists often suffered from tuberculosis themselves or had family and loved ones that were afflicted by the disease. Below are a few short stories of how tuberculosis shaped our literature, art, and music:
- While it is unclear whether the American Poet Edgar Allen Poe ever was afflicted with tuberculosis himself, the loss of his father, mother, adoptive mother, and wife Virginia to tuberculosis greatly influenced his poetry and writings. He wrote one of his most famous poems “Annabel Lee” for his beloved wife shortly after her death. The haunting phrase “…the wind came out of a cloud by night, chilling and killing my Annabel Lee” remains as a stark reminder of his wife’s untimely death from the disease, which plunged him into a deep depression.
- The Czech writer Franz Kafka struggled with having tuberculosis throughout most of his life. During his lifetime, there was no cure for the disease, only palliative care and he was very much aware that the disease would ultimately end his life. In his diaries he often refers to himself as a “non-born, condemned to die, without having lived.” While tuberculosis is never mentioned explicitly in his works, several characters embody his sentiment and feelings about suffering from tuberculosis: Many of his protagonists are condemned to death, but carry on completely ignorant of their fate and just like him they suffered but continued on their way, not caring and incurable.
- The Dutch painter Rembrandt, while not having suffered tuberculosis himself, was deeply affected by the death of his wife Saskia and young son Titus, who both were afflicted by tuberculosis. The portraits of his wife that he painted during her lifetime clearly show the progression of the disease. It was only the last portrait of his wife that he completed after her death that shows her as healthy and beautiful with a sprig of rosemary in her hand, which served as a symbol of remembrance. It was his final gift as an artist to his wife to remember her in her youthfulness and paint away her sufferance from tuberculosis.
- Tuberculosis not only had a major influence on literature and art, but is often reflected in famous operas and musicals. The death of Mimi from consumption in La Bohème by Puccini is perhaps one of the most moving scenes in all of opera. In the musical Les Misérables, the character of Fantine also dies of tuberculosis. Similarly in the musical Moulin Rouge, the main protagonist Satine dies of tuberculosis, leaving the love of her life behind to tell her story.