INTRODUCTION: HIV replication leads to a change in lymphocyte phenotypes that impairs immune protection against opportunistic infections. We examined current HIV replication as an independent risk factor for tuberculosis (TB). METHODS: We included people living with HIV from 25 European cohorts 1983-2015. Individuals <16 years or with previous TB were excluded. Person-time was calculated from enrolment (baseline) to the date of TB diagnosis or last follow-up information. We used adjusted Poisson regression and general additive regression models. RESULTS: We included 272,548 people with a median follow-up of 5.9 years (interquartile range [IQR] 2.3-10.9). At baseline, the median CD4 cell count was 355 cells/μL (IQR 193-540) and the median HIV-RNA level 22,000 copies/mL (IQR 1,300-103,000). During 1,923,441 person-years of follow-up, 5,956 (2.2%) people developed TB. Overall, TB incidence was 3.1 per 1,000 person-years (95% confidence interval [CI] 3.02-3.18) and was four times higher in patients with HIV-RNA levels of 10,000 compared with levels <400 copies/mL in any CD4 stratum. CD4 and HIV-RNA time-updated analyses showed that the association between HIV-RNA and TB incidence was independent of CD4. The TB incidence rate ratio for people born in TB-endemic countries compared with those born in Europe was 1.8 (95% CI 1.5-2.2). CONCLUSIONS: Our results indicate that ongoing HIV replication (suboptimal HIV control) is an important risk factor for TB, independent of CD4 count. Those at highest risk of TB are people from TB-endemic countries. Close monitoring and TB preventive therapy for people with suboptimal HIV control is important.

• MeSH
• dospělí MeSH
• HIV infekce * epidemiologie   imunologie   komplikace   MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• počet CD4 lymfocytů MeSH
• replikace viru MeSH
• rizikové faktory MeSH
• RNA virová MeSH
• tuberkulóza * epidemiologie   imunologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Názvy látek
• RNA virová MeSH

Tuberculosis (TB) contact tracing and TB preventive treatment are key tools in preventing the transmission of TB with the aim of eliminating the disease. Our study seeks to demonstrate how the infection spread from an individual patient to the entire community and how proactive contact tracing facilitated prompt diagnosis and treatment. Our work was conducted as a retrospective analysis of the spread of TB infection within the Roma community in the Czech Republic, following the case of an index patient who succumbed to pulmonary TB. Several levels of care and preventive and treatment measures are outlined. Confirming the identity of the Mycobacterium tuberculosis strain was achieved using molecular methods. Among the 39 individuals examined, TB disease was detected in eight patients and TB infection was detected in six patients. The investigation of contacts within this group yielded positive results in 36% of cases, necessitating treatment. The study's findings provide evidence that actively tracing individuals at risk can lead to early detection of cases, prompt treatment, and prevention of further disease transmission. The study also indicates that the highest risk of infection occurs within the sick person's household and that young children under the age of 5 are most susceptible to falling ill.

• Klíčová slova
• BCG vaccination, Roma community, TB diagnostics, TB preventive therapy, contact tracing, public health, tuberculosis,
• MeSH
• latentní tuberkulóza * MeSH
• lidé MeSH
• plicní tuberkulóza * epidemiologie   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• Romové * MeSH
• trasování kontaktů metody   MeSH
• tuberkulóza * diagnóza   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: The war in Ukraine has led to significant migration to neighboring countries, raising public health concerns. Notable tuberculosis (TB) incidence rates in Ukraine emphasize the immediate requirement to prioritize approaches that interrupt the spread and prevent new infections. METHODS: We conducted a prospective genomic surveillance study to assess migration's impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia. RESULTS: Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p < 0.0001), also presents substantial obstacles to control endeavors. The genomic analysis identified the three highly related genomic clusters, indicating the recent TB transmission among migrant populations. The largest clusters comprised war refugees diagnosed in the Czech Republic, TB patients from various regions of Ukraine, and incarcerated individuals diagnosed with pulmonary TB specialized facility in the Kharkiv region, Ukraine, pointing to a national transmission sequence that has persisted for over 14 years. CONCLUSIONS: The data showed that most infections were likely the result of reactivation of latent disease or exposure to TB before migration rather than recent transmission occurring within the host country. However, close monitoring, appropriate treatment, careful surveillance, and social support are crucial in mitigating future risks, though there is currently no evidence of local transmission in EU countries.

• Klíčová slova
• Control of tuberculosis, Migration, Refugees, Tuberculosis epidemiology,
• MeSH
• dospělí MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• molekulární epidemiologie * MeSH
• multirezistentní tuberkulóza epidemiologie   MeSH
• Mycobacterium tuberculosis * genetika   izolace a purifikace   MeSH
• osoby s přechodným pobytem a migranti * statistika a číselné údaje   MeSH
• ozbrojené konflikty MeSH
• prospektivní studie MeSH
• tuberkulóza * epidemiologie   přenos   MeSH
• uprchlíci * statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Slovenská republika epidemiologie   MeSH
• Ukrajina epidemiologie   MeSH

• MeSH
• incidence MeSH
• lidé MeSH
• tuberkulóza * epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Ukrajina epidemiologie   MeSH

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

• Klíčová slova
• TB, migrants, policy, prevention, refugees,
• MeSH
• incidence MeSH
• lidé MeSH
• průřezové studie MeSH
• tuberkulóza * diagnóza   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Somálsko MeSH

OBJECTIVE: Extrapulmonary tuberculosis (EPTB) in children globally represents a proportion of all cases of tuberculosis, reaching 20% according to published reports. Children are at a higher risk for disseminated TB and extrapulmonary forms. The most prevalent clinical presentations of EPTB in children worldwide are peripheral lymphadenitis and osteoarticular TB. Peritoneal, urogenital, or meningeal tuberculosis is less frequent, and their diagnosis is often difficult. The aim of the study was the determination of EPTB incidence in children in a low-prevalence region over 35 years. METHODS: Descriptive retrospective study of the incidence of EPTB in children and adolescents (aged 0-18 years) in the Czech Republic in the years 1987-2021 as reported in the tuberculosis register. RESULTS: Total amount of EPTB cases was 95. The most prevalent form was extrathoracic lymph node TB. The median age was 10 years. Most patients (84%) were Czechs. None of them died. The ratio of pulmonary and extrapulmonary TB was 79.8% to 20.2%. CONCLUSION: The low incidence of EPTB in Czech children is congruent with a low incidence of TB in the Czech Republic. Our study confirms that the most frequent form of EPTB is peripheral lymph node TB. Our study did not prove a significant change in the trend of EPTB after the cessation of the mandatory Bacillus Calmette-Guerin (BCG) vaccination programme.

• Klíčová slova
• TB peripheral lymphadenitis, extrapulmonary, osteoarticular TB, tuberculosis, uropoetic,
• MeSH
• dítě MeSH
• extrapulmonální tuberkulóza * MeSH
• incidence MeSH
• lidé MeSH
• mladiství MeSH
• retrospektivní studie MeSH
• tuberkulóza * epidemiologie   diagnóza   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Tuberculosis (TBC) in solid organ transplant recipients represents a severe complication. The incidence among transplant recipients is higher than in the general population, and the diagnosis and treatment remain challenging. We present a case of active disseminated tuberculosis in a kidney transplant recipient treated with an anti-CD40 monoclonal antibody, who had been previously exposed to an active form of the disease, but latent tuberculosis (LTBI) was repeatedly ruled out prior to transplantation. To the best of our knowledge, no other case has been reported in a patient treated with the anti-CD40 monoclonal antibody. CASE PRESENTATION: A 49-year-old patient, 1.5 years after primary kidney transplantation, presented with vocal cord problems, a dry irritating cough, and a sore throat. A detailed investigation, including a high-resolution chest CT scan, revealed the diagnosis of disseminated tuberculosis. The antituberculosis treatment consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol was started immediately. The patient's condition became complicated by relapsing diarrhoea. The colonoscopy revealed a circular stenosis above Bauhin's valve. Microscopical findings showed active colitis and vaguely formed collections of epithelioid macrophages without fully developed caseous granulomas and were consistent with the clinical diagnosis of tuberculosis. The antituberculosis treatment was subsequently enhanced by moxifloxacin and led to a great improvement in the patient's condition. CONCLUSION: In this case, false negativity of interferon-γ release assays and possibly higher risk for intracellular infections in patients on costimulatory signal blockers are discussed.

• Klíčová slova
• Case report, Costimulation, Iscalimab, Kidney transplantation, Tuberculosis,
• MeSH
• antituberkulotika terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• monoklonální protilátky terapeutické užití   MeSH
• příjemce transplantátu MeSH
• protinádorové látky * MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• tuberkulóza * diagnóza   farmakoterapie   epidemiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antituberkulotika MeSH
• monoklonální protilátky MeSH
• protinádorové látky * MeSH

AIM: The aim is to characterize in more detail the group of HIV-positive persons in the Czech Republic diagnosed with tuberculosis (TB) in 2000-2020. MATERIAL AND METHODS: Data sources were mainly the national online TB register (RTBC), which is part of the information system of the Public Health Service, and the national electronic register of HIV-positive persons (RHIV) maintained by the National Reference Laboratory for HIV/AIDS of the National Institute of Public Health. RESULTS: Of 3,763 TB cases reported to the RHIV since 1985 and 16,212 TB cases reported to the RTBC since 2000, 91 occurred in 88 HIV-positive persons (69 males and 22 females) between 2000 and 2020. Sixty-five (74%) of the 88 HIV-positive persons were foreign born. Twenty-six per cent of TB cases were screened for HIV. The mean age of patients with TB/HIV coinfection was 35 years. The largest number of coinfected persons (35 cases) were from the capital city of Prague. Pulmonary TB was detected in 84 cases. Ninety-two per cent of the TB cases were bacteriologically confirmed, and 10 cases were multidrug-resistant TB. At the time of TB diagnosis, the median CD4+ lymphocyte count was 91.5 cells per mm3 of blood. TB was the most common reason for HIV testing in the analysed cohort (23 cases). The most common mode of HIV transmission was sexual intercourse (heterosexual in 39 cases and homosexual in 13 cases). Treatment success at 12-month follow-up was only recorded in 32% of cases of culture-positive pulmonary TB in HIV-positive patients. CONCLUSIONS: TB/HIV co-infection remains a serious health concern, especially in the foreign-born residents of the Czech Republic. Of foreign-born persons with TB, 42% were tested for HIV over the 21-year study period, with their percentage increasing over the years. Almost 6% of them tested HIV positive. The most relevant finding is that treatment success was only recorded for less than one third of HIV-positive persons with culture-positive pulmonary TB and that every fourth patient with TB/HIV died before or during TB treatment.

• Klíčová slova
• AIDS, Czech Republic, HIV, treatment outcome, tuberculosis,
• MeSH
• dospělí MeSH
• HIV infekce * komplikace   epidemiologie   MeSH
• incidence MeSH
• koinfekce * epidemiologie   MeSH
• lidé MeSH
• multirezistentní tuberkulóza * epidemiologie   MeSH
• plicní tuberkulóza * MeSH
• tuberkulóza * komplikace   epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Bacillus Calmette-Guérin (BCG) vaccination programs were introduced in Czechoslovakia more than 60 years ago under a quite different epidemiological situation than that of today. Compulsory mass BCG vaccination was abolished in November 2010 and changed to a selective vaccination program for infants at high risk of contracting tuberculosis (TB). METHODS: This work sets out to ascertain the risk of TB and nontuberculous mycobacterial (NTM) infection in the 10-year period following the change to the vaccination program and to compare this with the same period of time when mass BCG vaccination was compulsory. Descriptive study. Statistical analysis of the incidence of tuberculosis and non-tuberculous mycobacteriosis as reported in the TB register in years 2001-2020. CONCLUSIONS: The incidence trend of TB in children in both monitored time periods is identical and statistically significantly decreasing (P < 0.001). In the first monitored period, the incidence trend of NTM cervical lymphadenitis in children is degressive and is not statistically significant (P = 0.561). However, in the second monitored period, the trend increases and is statistically significant (P < 0.001); in every compared 2-consecutive year period, there is an increase of 8%. These findings indicate that the change from mass BCG vaccination to selective vaccination of high-risk newborns and the abolishment of BCG revaccination can be recommended, so long as a keen eye is kept on NTM caused lymphadenitis.

• Klíčová slova
• Bacillus Calmette–Guérin vaccination, incidence, nontuberculous mycobacteriosis, tuberculosis,
• MeSH
• Bacillus * MeSH
• BCG vakcína MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• očkovací programy MeSH
• tuberkulóza * epidemiologie   prevence a kontrola   MeSH
• vakcinace MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• BCG vakcína MeSH

AIM: Comparision of the incidence of cervical lymphadenitis caused by nontuberculous mycobacteria in two equal time periods before and after the ending of widespread calmetization (tuberculosis vaccination). Backgroung. From 2011 to 2018, 89 children were registered in the Tuberculosis Register with cervical lymphadenitis caused by nontuberculous mycobacteria, as confirmed by cultivation. In the majority of cases, the infection was caused by a mycobacterium belonging to the Mycobacterium avium complex. Only 7 cases of cervical lymphadenitis of the same etiology were registered during the same time interval between 2003 and 2010. The authors consider the ending of widespread calmetization (tuberculosis vaccination) in 2010 to be the main cause of the growing incidence. METHOD: A comparison of data for the period 2003-2018 about cases of the illness caused by atypical mycobacteria as reported in the Tuberculosis Register. RESULTS: The average incidence per year in the first interval was 0.04/100 000 children and in the second interval 0.53/100 000 children. During the second time interval, there was an increase from 0.14/100 000 children in 2011 to 1.40/100 000 children in 2018. While the incidence during the first time interval did not show any time trend (P=0.885), the year 2010 marks a significant turning point, with growth during the second interval being highly statistically significant (P<0.001).

• Klíčová slova
• Mycobacterium avium complex, calmetization, cervical lymphadenitis, nontuberculous mycobacterial infection (NTM),
• MeSH
• dítě MeSH
• incidence MeSH
• lidé MeSH
• lymfadenitida * MeSH
• Mycobacterium avium komplex MeSH
• tuberkulóza * epidemiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH