The landscape of tuberculosis (TB) treatment is evolving rapidly, especially in the face of drug-resistant strains. This review explores the historical and contemporary developments in drug-susceptible TB (DS-TB) and multidrug-resistant TB (MDR-TB) therapies, with a focus on the emerging role of pan-TB strategies. Using a non-systematic literature review method, we analyzed peer-reviewed articles, clinical trial reports, and studies on DS-TB, MDR-TB, and pan-TB approaches published from January 2000 to December 2023. Our findings highlight significant advancements in TB therapies, including the WHO-endorsed four-month regimen for DS-TB and the all-oral BPaL/M regimen for MDR-TB. Pan-TB initiatives, such as the BPMZ regimen by TB Alliance and the Project to Accelerate New Treatments for Tuberculosis (PAN-TB), aim to develop universal regimens for both DS-TB and MDR-TB, showing promise in enhancing treatment efficacy and patient adherence. Continuous innovation and adaptable strategies are crucial in the fight against TB. Pan-TB approaches have the potential to effectively address both DS-TB and MDR-TB, and recent advancements underscore their importance. Future research should focus on extensive clinical trials to validate these strategies and explore innovative methods to improve treatment adherence and efficacy. This review provides valuable insights for clinicians and researchers, emphasizing the importance of developing and implementing effective, universally applicable pan-TB treatments, which are critical for improving patient outcomes and advancing global TB control efforts.
Background: Rabies is a fatal zoonotic disease, present in almost 150 countries. The “Zero by 30” initiative aims to eliminate human deaths from dog-mediated rabies globally by 2030. This systematic review investigates how viral sequencing can contribute to achieving the “Zero by 30” goal by improving understanding of viral circulation and the impact of rabies control measures. Methods: A comprehensive search of bibliographic databases was conducted focusing on research on rabies from regions with endemic dog-mediated rabies published between 2000 and 2023, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and synthesised to provide recommendations for further research and application to support rabies control. Results: 220 studies were identified to have documented rabies virus (RABV) sequences from 94 countries, primarily using first-generation technology to produce partial genomes and with sequencing predominantly conducted overseas rather than in-country. Dogs were identified to be the primary RABV reservoir in these regions, although some studies identified more localised wildlife reservoirs. Clade classifications were commonly based on host association or geographical location, however, lack of standardised methods and nomenclature for classifying lineages limited comparison at higher resolution. Cross-species transmission, and both local and long-distance transmission were identified, although quantitative inference was limited. Sequence data was particularly useful for identifying transboundary spread and incursions, investigating host shifts, and tracing sources of human rabies, with endemicity typically characterised by the identification of multiple co-circulating viral lineages. Conclusion: There is an urgent need for standardised classification methods and phylogeny-based nomenclature for RABVs, and for improved sequencing capacity in regions with endemic dog-mediated rabies, including proficiency in bioinformatics and phylogenetics. Our findings emphasise the critical need to foster international cooperation and coordinate rabies control efforts to reduce transboundary spread, limit reintroductions and maintain progress towards the 2030 target.
Aim: Venomous animals are responsible for 26.8% of all poisonings occurring in people registered in Brazil, reflecting serious economic, medical, and social public health issues in tropical countries. The objective of this work was to characterize the cases notified of accidents involving venomous animals in humans in a Public Regional Hospital located in Piauí state, Northeast Brazil. Methods: We analyzed the notification forms registered at the National Notifiable Diseases Information System (SINAN), provided by the Hospital Regional Manoel de Souza from July 2009 to December 2017. The data were organized in spreadsheets and were exported to SPSS v. 24 for statistical analysis. A linear regression analysis was performed, and variables were considered significant when the estimated regression model presented P ≤ 0.05. Results: From 2009 to 2017, 833 cases of accidents caused by venomous animals treated were reported on SINAN. Accidents caused by scorpions were the most frequent, accounting for 69.7% (n = 269) of cases, followed by snakes at 17.6% (n = 68) and insects at 12.7% (n = 49). The people most affected by venomous animals were men (53.9%; n = 208) between the ages of 20 and 39 (42.5%; n = 164). The most frequent bite site was on the extremities, with the feet being the most affected region at 39.3% (n = 235), followed by the hands at 25.8% (n = 154) and the legs at 8% (n = 48). The study showed that despite the Regional Hospital covering 18 cities, the municipality of Bom Jesus had the highest incidence of accidents caused by venomous animals, mainly scorpions. Therefore, this investigation is a starting point for understanding the spatial distribution of these accidents. The data show that there are still flaws in the SINAN information flow. In the serotherapy variable, for example, 51.1% of cases were not completed. Conclusion: It is necessary to provide guidance and carry out educational work in order to improve official data records, so that they can be incorporated into the care routine.
Aim: This study intends to assess the occurrence of multi-drug resistant (MDR) resistant pathogens among exotic pets from France (2017-2019). Methods: Isolates were identified using MALDI-TOF-MS. Antimicrobial susceptibility testing was conducted for 21 antimicrobials and was assayed by disk diffusion methods. Statistical analyses were carried out using GraphPad Prism® (version 9.4.1). Results: Isolates (n = 2,100) recovered from samples of 10 small mammals (n = 1,555), 23 birds (n = 287), and 18 reptiles (n = 208) species were identified as Enterobacterales (n = 634), Pseudomonadaceae (n = 176), Pasteurellacea (n = 276), Staphylococcaceae (n = 563) , Streptococcaceae (n = 259), and Enterococcaceae (n = 186). Consistent high resistance rates were observed among diverse genera and/or species to beta-lactams, tetracyclines, and macrolides. Notably, a significant prevalence of MDR bacteria was identified, with 22.8% (n = 479/2,100, P < 0.05). Furthermore, 23.5% (P < 0.05) of these MDR bacteria displayed resistance to all tested antimicrobials: E. faecalis (n = 47/49; 95.0%), E. coli (n = 19/52; 36.5%), Klebsiella spp. (n = 12/32; 37.5%), S. epidermidis (n = 7/25; 28.0%), Streptococcus spp. (n = 6/68; 8.8%), Enterococcus spp. (n = 6/23; 26.0%), Staphylococcus spp. (n = 4/51; 7.8%), Lactococcus spp. (n = 4/8; 50.0%), Citrobacter spp. (n = 3/7; 42.8%), Raoultella spp. (n = 2/3; 66.6%), Serratia spp. (n = 1/9; 11.1%), Pasteurella spp. (n = 1/14; 7.1%), and S. xylosus (n = 1/28; 3.5%). Conclusions: This study emphasizes exotic pets as an emergent reservoir of MDR bacteria, focusing on E. faecalis as a potential route of transmission of MDR bacteria to humans, other animal species and environment. Urgent measures, including the establishment of mandatory monitoring for antimicrobial resistance (AMR) and the enforcement of restrictive antibiotic use policies in exotic pets, should be implemented to mitigate the risk of further spread and safeguard public and animal health.
