Training Protocol on the Natural History of Tuberculosis

Study Overview
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Brief Summary
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Background: - Tuberculosis (TB) is an infectious disease that affects numerous people worldwide. Researchers are interested in actively recruiting individuals with TB for research and treatment studies. Objectives: - To collect blood and other samples to study the natural history of tuberculosis. Eligibility: - Individuals 2 years of age and older who have either active or latent tuberculosis. Design: Latent TB patients: Participants will have a single study visit with a physical examination and medical history, and will provide blood samples for testing. Active TB patients: Participants will have an initial visit with a physical examination and medical history, and will provide blood samples for testing. Participants will also provide sputum samples if required, and may have an optional skin punch biopsy to collect a sample of skin tissue for study. Treatment for active TB will be provided as part of this protocol. Active TB participants may be asked to return for study visits every 1-2 months while receiving treatment....

Detailed Description
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Mycobacterium tuberculosis (MTB) is a slow-growing bacterium that establishes latent infection in millions of persons worldwide, but only leads to disease in 10% or less of these individuals. It typically causes pneumonia, however dissemination to almost any other organ is possible. Drug resistance of the organism, co-infection with HIV, and paradoxical reactions upon treatment are all factors that may complicate treatment. Host defense against mycobacterial infections is important. Specific defects within the innate immune system lead to Mendelian susceptibility to mycobacterial infections. HIV infected individuals and persons treated with anti-tumor necrosis factor antibodies are highly susceptible to tuberculosis (TB) infection. Genetic influence on susceptibility to TB disease is complex and does not seem to be confined to a single gene or pathway. Advancement in molecular techniques has expanded our understanding of the pathogenesis and epidemiology of MTB. Identification of gene mutations that confer antibiotic resistance are being exploited as alternatives to conventional drug susceptibility testing. The natural history of all forms of TB disease (including co-infection with HIV and other infections) will be followed, and MTB isolates and blood from 100 infected patients will be obtained in order to study organism virulence and host immune function and genetic/epigenetic factors. While it is recognized that the number of TB cases that occur in the Washington, DC area and nationally is low, it is imperative that a mechanism is in place to evaluate and treat these patients at the NIH Clinical Center. This protocol will also allow NIH infectious diseases trainees to manage challenging cases of TB.

Official Title
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Natural History of Tuberculosis

Conditions
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Mycobacterium Infections, Tuberculosis, Multidrug-Resistant, Latent Tuberculosis, Tuberculosis, Extensively Drug-Resistant Tuberculosis

Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: FOR ALL PATIENTS Patients may be included in this study who: Have or are suspected to have TB infection. Are aged 2 years or older. Have a primary care physician, infectious diseases physician, pulmonologist, or TB specialist outside of the NIH who can provide care of his or her TB infection outside the NIH, provide directly observed therapy (DOT) if necessary, and monitor for side effects and toxicity of TB medications. Are willing to consent to storage of specimens for future research. Able to provide informed consent for themselves or, if they lack the capacity to provide informed consent, have an appropriate Legally Authorized Representative (LAR; the study team will comply with NIH Human Research Protection Program [HRPP] Policy 403). FOR PATIENTS WITH LATENT TB In addition to the above-described inclusion criteria for all patients, patients may be included in the Latent TB part of this protocol who: -Have documented evidence of a positive purified protein derivative (PPD) skin test or Interferon-gamma Release Assays (IGRA) test meeting American Thoracic Society (ATS)/CDC guidelines for latent TB; conversion can have occurred at any time. FOR PATIENTS WITH ACTIVE TB In addition to the above-described inclusion criteria for all patients, patients may be included in the Active TB part of this protocol who: Have active TB of any drug susceptibility pattern and any site of infection as determined by smear, culture, or biopsy. Have appropriately documented clinically suspicious active TB without definitive microbiology confirmation. EXCLUSION CRITERIA: Patients will be excluded from this study who: Are incarcerated. Have been ordered by a court to take TB medications. Are unwilling or unable to comply with prescribed therapy. Are pregnant.

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active TB<br>subjects with active TB as determined by smear, culture, or biopsy or have appropriately documented clinically suspicious active TB without definitive microbiology confirmation | |
| Latent TB<br>subjects with documented evidence of a positive PPD skin test or Interferon Gamma Release Assays (IGRA) test meeting American Thoracic Society (ATS)/CDC guidelines for latent TB | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increase in the number of TB patients being actively followed at the NIH CC to provide information on TB patients with DS and drug-resistant disease for hypothesis generation and hands-on experience in the management of TB | increased number of TB patients being actively followed at the NIH CC | ongoing | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determination of subsets of lymphoid populations during various points in the treatment of TB | subsets of lymphoid populations during various points in treatment of TB | ongoing | 
| Description of whole genome sequences and their possible relationship to TB infection | possible relationship of whole genome sequences to TB infection | ongoing | 
| Collection of MTB specimens for studies of the organism and its pathogenesis | collection of MTB specimens | ongoing | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TB, Mycobacterium Tuberculosis, Active Tuberculosis, Latent Tuberculosis, MDR TB, Natural History, Tuberculosis