Katarzyna Kruczak

Krakow Cardiovascular Research Institute

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Ewa Niżankowska‐Mogilnicka

University of the West Indies System

Mariusz Duplaga

Jagiellonian University

Marek Sanak

Jagiellonian University

Krzysztof Sładek

Krakow Cardiovascular Research Institute

Ivan Solovič

Catholic University in Ruzomberok

Raquel Duarte

Universidade do Porto

Dragica Pešut

University of Belgrade

Christoph Lange

Research Center Borstel - Leibniz Lung Center

Alena Skrahina

Republican Scientific and Practical Centre of Pulmonology and Tuberculosis

María Luiza de Souza-Galvão

Vall d'Hebron Hospital Universitari

Cooperative Institutions

Research Center Borstel - Leibniz Lung Center

Universitat Autònoma de Barcelona

National Center for Tuberculosis and Lung Disease

Jagiellonian University

Instituto de Salud Carlos III

Karolinska Institutet

Universitat de Barcelona

Sociedad Española de Neumología y Cirugía Torácica

Vall d'Hebron Hospital Universitari

University College London

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Tularaemia: a case report and review

Przeglad Epidemiologiczny (2021)

Filip Mejza Katarzyna Kruczak Krzysztof Sładek

ABSTRACT Tularaemia is a rare infectious disease caused by Francisella tularensis. In Poland, F. tularensis infections are caused by F. tularensis subspecies holarctica (type B). The disease is widespread among multiple animal species. Humans are usually infected via insect bites and less commonly by other routes (contact with animals, inhalation of contaminated aerosol or dust, or oral route). In recent years, the prevalence of tularaemia in Poland was slightly more than dozen cases per year. Depending on the route of infection, the disease has various clinical presentations, of which the most common is the ulceroglandular form. We present a typical case of this clinical form, along with information on epidemiology, clinical presentation, diagnosis, and treatment of this rare disease. Because of a low prevalence and miscellaneous clinical features, the diagnosis is often delayed. Tularaemia should be included in the differential diagnosis of fever with local lymph node enlargement as well as atypical cases of upper airway infections and pneumonia. STRESZCZENIE Tularemia jest rzadką chorobą zakaźną, powodowaną przez zakażenie Francisella tularensis. W Polsce zakażenia powoduje podgatunek F. tularensis subspecies holoarctica (typ B). Tularemia jest rozpowszechniona wśród wielu gatunków zwierząt. Do zakażenia ludzi dochodzi najczęściej wskutek przeniesienia bakterii przez ugryzienie owada, rzadziej innymi drogami (kontakt z zakażonym zwierzęciem, inhalacja zakażonego aerozolu lub pyłu albo drogą doustną). Częstość choroby w Polsce w ostatnich latach to około kilkunastu przypadków rocznie. W zależności od drogi zakażenia tularemia ma wiele postaci, z których najczęstsza to wrzodziejąco-węzłowa. W artykule opisano typowy przypadek tej postaci tularemii, jak również przedstawiono informacje na temat epidemiologii, postaci klinicznych, diagnostyki i leczenia tej rzadkiej choroby. Ze względu na małą częstość występowania i różnorodny obraz kliniczny rozpoznanie często bywa opóźnione, dlatego należy pamiętać o uwzględnieniu tularemii w diagnostyce różnicowej m.in. gorączki z lokalnym powiększeniem węzłów chłonnych, jak również atypowych infekcji górnych dróg oddechowych i płuc.

Rare disease

10.32394/pe.75.17

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The assessment of latent tuberculosis infection by QuantiFERON® TB Gold In Tube in risk groups for tuberculosis and in healthy population

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum (2011)

Katarzyna Kruczak

QuantiFERON

Gold standard (test)

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Comparison of IGRA tests and TST in the diagnosis of latent tuberculosis infection and predicting tuberculosis in risk groups in Krakow, Poland

Scandinavian Journal of Infectious Diseases (2014)

Katarzyna Kruczak Mariusz Duplaga Marek Sanak Adam Ćmiel Lucyna Mastalerz

Background: The objective of this study was to assess the prevalence of latent tuberculosis infection (LTBI) in risk groups in Krakow, using the QuantiFERON-TB Gold In-Tube (QFT-GIT) test and the tuberculin skin test (TST); we also sought to assess the rate of progression to active disease over 4–5 y of follow-up. Methods: QFT-GIT tests were performed on 785 subjects and the TST on 701 subjects from the risk groups of homeless persons, close contacts, periodic contacts, and residents of long-term care facilities (LTCFs), and subjects from a low risk group. Results: In homeless persons, close contacts, periodic contacts, LTCF residents, and low risk persons, a positive QFT-GIT was found in 36.7%, 27.2%, 27.0%, 21.1%, and 23.7% of subjects, respectively, while a positive TST was found in 55.8%, 47.4%, 47.6%, 43.2%, and 47.9%, respectively. Of 63 homeless subjects, 5 developed active TB over 248 person-y of follow-up (incidence rate (IR) 20 per 1000 person-y, 95% confidence interval (CI) 8.4–48.5); of 148 close contacts, 5 developed active TB over 740 person-y of follow-up (IR 7, 95% CI 2.8–16.2); of 145 periodic contacts, 2 developed active TB over 580 person-y of follow-up (IR 4, 95% CI 0.9–13.8). The IR per 1000 person-y (95% CI) among subjects with a positive QFT-GIT was 30 (9.0–86.1) for homeless subjects, 18 (5.7–54.7) for close contacts, and 13 (3.2–51.3) for periodic contacts. In Poland there is no policy for the provision of LTBI treatment to people with a positive QFT or TST; therefore, the estimated rates of disease progression were analysed amongst untreated subjects. Conclusions: The prevalence of positive QFT-GIT and TST was high in the study risk groups. The best predictor of active TB in the homeless and close contacts groups was a positive QFT-GIT together with a positive TST.

10.3109/00365548.2014.927955

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Risk Assessment of Tuberculosis in Contacts by IFN-γ Release Assays. A Tuberculosis Network European Trials Group Study

American Journal of Respiratory and Critical Care Medicine (2015)

Jean-Pierre Zellweger Giovanni Sotgiu Michael S. Block Simone Dore Neus Altet

Latent infection with Mycobacterium tuberculosis is defined by a positive IFN-γ release assay (IGRA) result in the absence of active tuberculosis. Only few, mostly monocentric studies have evaluated the role of IGRAs to predict the development of tuberculosis in recent contacts in low-incidence countries of tuberculosis.To analyze IGRA results and the effect of preventive chemotherapy on tuberculosis progression rates among recent contacts.Results from contact investigations at 26 centers in 10 European countries including testing for latent infection with M. tuberculosis by the QuantiFERON-TB Gold In-Tube (QFT) test or the T-SPOT.TB (TSPOT) were prospectively collected and analyzed.Among 5,020 contacts of 1,023 index cases, 25 prevalent secondary cases were identified at screening. Twenty-four incident cases occurred among 4,513 contacts during 12,326 years of cumulative follow-up. In those with a positive IGRA result, tuberculosis incidence was 0.2 (QFT) and 0 (TSPOT) per 100 patient-years when contacts received preventive chemotherapy versus 1.2 (QFT) and 0.8 (TSPOT) per 100 patient-years in those not treated (38 and 37 patients needed to be treated to prevent one case, respectively). Positive and negative predictive values were 1.9% (95% confidence interval [CI], 1.1-3.0) and 99.9% (95% CI, 99.7-100) for the QFT and 0.7% (95% CI, 0.1-2.6) and 99.7% (95% CI, 99.1-99.9) for the TSPOT.Tuberculosis rarely developed among contacts, and preventive chemotherapy effectively reduced the tuberculosis risk among IGRA-positive contacts. Although the negative predictive value of IGRAs is high, the risk for the development of tuberculosis is poorly predicted by these assays.

Contact tracing

QuantiFERON

Tuberculosis diagnosis

Interferon γ

10.1164/rccm.201502-0232oc

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Citations (102)

Infection control, genetic assessment of drug resistance and drug susceptibility testing in the current management of multidrug/extensively-resistant tuberculosis (M/XDR-TB) in Europe: A tuberculosis network European Trialsgroup (TBNET) study

Respiratory Medicine (2017)

Graham Bothamley Christoph Lange D. Albrecht Luis Anibarro Neus Altet Gómez

Extensively drug-resistant tuberculosis

10.1016/j.rmed.2017.09.007

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Interferon-gamma release assays and tuberculin skin testing for diagnosing latent Mycobacterium tuberculosis infection in at-risk groups in Poland

International Journal of Mycobacteriology (2015)

Katarzyna Kruczak Lucyna Mastalerz Krzysztof Sładek

The diagnostics of latent tuberculosis infection in Poland using the tuberculin skin test is challenging due to the obligatory Bacillus Calmette-Guérin vaccinations. Interferon-gamma release assays are still very rarely used for diagnostics. We compared the tuberculin skin test and the QuantiFERON-TB Gold In-Tube test to evaluate the degree of latent tuberculosis infection in at-risk groups for tuberculosis (homeless, close contacts, periodic contacts, nursing-home attendees) and in healthy individuals.QuantiFERON-TB Gold In-Tube tests were carried out on 785 individuals from the homeless (n=150), close contacts (n=171), periodic contacts (n=163), nursing-home attendees (n=152), and healthy individuals (n=149). The tuberculin skin test was performed on 129, 156, 147, 148, and 121 participants, respectively. We evaluated the (a) correlation between serum concentrations of interferon gamma and the tuberculin-skin-test induration diameter; (b) between the number of QuantiFERON-TB Gold In-Tube-positive results and the tuberculin-skin-test diameter in the studied groups; and (c) agreement between both tests and the kappa coefficient using the tuberculin-skin-test diameters of 5, 10, and 15mm.Larger tuberculin-skin-test induration diameters were associated with elevated serum concentrations of interferon gamma. We found a positive correlation between the number of positive QuantiFERON-TB Gold In-Tube screening results and the tuberculin-skin-test induration diameter. The agreement between QuantiFERON-TB Gold In-Tube and tuberculin-skin-test screening results improved with increasing tuberculin-skin-test induration diameter.Based on measures of tuberculin-skin-test induration diameter alone, it is difficult to diagnose latent tuberculosis infection with certainty. The agreement of the QuantiFERON-TB Gold In-Tube test increases with the tuberculin-skin-test diameter. Tuberculin-skin-test diameters larger than 15mm are more likely to be associated with active infection.

Skin test

Tuberculosis diagnosis

QuantiFERON

10.1016/j.ijmyco.2015.10.004

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Citations (8)

Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire – a TBNET study

SpringerPlus (2014)

Dragica Pešut Bogdana Bursuc Milica Bulajić Ivan Solovič Katarzyna Kruczak

How patients relate to the experience of their illness has a direct impact over their behavior. We aimed to assess illness perception in patients with pulmonary tuberculosis (TB) by means of the Brief Illness Perception Questionnaire (BIPQ) in correlation with patients' demographic features and clinical TB score. Our observational questionnaire based study included series of consecutive TB patients enrolled in several countries from October 2008 to January 2011 with 167 valid questionnaires analyzed. Each BIPQ item assessed one dimension of illness perceptions like the consequences, timeline, personal control, treatment control, identity, coherence, emotional representation and concern. An open question referred to the main causes of TB in each patient's opinion. The over-all BIPQ score (36.25 ± 11.054) was in concordance with the clinical TB score (p ≤ 0.001). TB patients believed in the treatment (the highest item-related score for treatment control) but were unsure about the illness identity. Illness understanding and the clinical TB score were negatively correlated (p < 0.01). Only 25% of the participants stated bacteria or TB contact as the first ranked cause of the illness. For routine clinical practice implementation of the BIPQ is convenient for obtaining fast and easy assessment of illness perception with potential utility in intervention design. This time saving effective personalized approach may improve communication with TB patients and contribute to better behavioral strategies in disease control.

Concordance

10.1186/2193-1801-3-664

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Multidrug Resistance Tuberculosis—Current Problems

Advances in respiratory medicine (2009)

Katarzyna Kruczak Ewa Niżankowska‐Mogilnicka

The rising occurrence of multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, is a serious worldwide problem. The treatment of MDR-TB with alternative chemotherapy is difficult due to side-effects and treatment duration. It is also very expensive and sometimes unsuccessful. DOTS and DOTS-Plus strategy are necessary to achieve a good tuberculosis control.

Directly Observed Therapy

10.5603/arm.27809

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Citations (2)

Genotyping Methods vs Standard Epidemiological Investigations in Tuberculosis (TB) Transmission in Cracow (Poland).

Katarzyna Kruczak Ewa Augustynowicz‐Kopeć Zofia Zwolska Ewa Niżankowska‐Mogilnicka

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a5275

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QuantiFERON-TBGIT (QFT) vs TST in Diagnosis of Latent Tuberculosis (TB) Infection (LTBI) in Vaccinated Population in Poland.

Katarzyna Kruczak Ewa Niżankowska‐Mogilnicka Marek Sanak

QuantiFERON

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a5925

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