The first Arctic Meeting on Clinical Tuberculosis took place in Umeå Sweden, the 25th – 26th of January. It was organized by researchers of Umeå University, Tuberculosis Center Arctic, Norrland’s University Hospital and TBnet. The meeting was supported by Marie Curie Actions, Norrland’s University Hospital, Arctic Research Center (ARCUM), Umea, and Umea Centre for Microbial Research (UCMR). Participants were from Sweden, Denmark, Moldova, Ireland, Russia, Ukraine, Spain and Germany. The aim of the meeting was to provide an agenda relevant for TB clinicians and TB researchers.
Andreas Winroth TB Center Arctic Umea,opened the clinical part of the conference with an epidemiological description of TB in Sweden. Sweden is amongst the top per capita receivers of refugees in the world and has today a larger part of the population born abroad (18%) than the USA. This is the reason that TB incidence has increased the last 15 years. Dr Winroth pointed to the fact that many of the patients had likely been infected quite recently. This may indicate that many of the refugees got infected on their way to Sweden and not in their home countries. In Västerbotten County, Sweden app. 80 % of the refugees are screened for TB at TB Center Arctic using health questionnaire andIGRA-test, usually within three month after arrival. Active TB, in this group, though seems tobreak out somewhat later.
Patterns of TB spread were touched upon by many speakers. Karen Björn Mortensen, Statens Serum Institut (SSI) Copenhagen, presented a study where it had been not possible to locate the source of infection for 53 % of the cases; this despite the fact that the study was done in a small and isolated community in eastern Greenland. The finding challenges the view that TB most of all spreads through close contact i.e. between members of the same family.Dr Mortensen stressed the fact that if awareness is lowered, especially in previously high-endemic areas, TB might return even decades after it was thought to be eliminated.
Christoph Lange, German Center for Infection Research (DZIF), pointed out that the traditional opinion, that MDR-TB arises in patients who don’t follow their treatment schedule, has to be changed. “With 10000 MDR-TB cases in Ukraine, 1400 in Moldavia, 1600 in Belorussia we have to appreciate that MDR-TB is now a community spread disease” prof. Lange said.
In the research oriented part of the conference Christer Larsson, Umeå University, presented a high throughput screening study in which he and his colleagues had found substances that, in vitro, blocked mycobacterial virulence.
Maria Lerm, Linköping University, focused on the relationship between the innate and the adaptive immune systems in TB infections. Dr Lerm pointed to recent research that shows that macrophages exposed to mycobacteria undergo epigenetic changes making them more efficient against mycobacteria at a second exposure. On the other hand, Dr Lerm said, there are findings showing that a strong response from the adaptive immune system actually seems to be helping TB bacteria to aggravate inflammation and enhance transmission. Maybe stimulation of the innate immune system is the key to a more potent strategy for TB prevention?
Henrik Antti, Umeå University, described the work of his group on the new method of distinguishing TB meningitis from other forms of meningitis - caused by other bacteria, viruses, or fungi. The method is based on analysis of numerous metabolites in cerebrospinal fluid and serum of patients and gives a specific multimetabolite-fingerprint for a specific type of meningitis.
Vacheslav Zhuravlev, Research Institute of Phthisiopulmonology, St. Petersburg, Russia reported about the algorithm of etiological diagnosis on the example of cases of tuberculosis spondylitis. He also presented modern methods of molecular genetic diagnosis and characteristics of mycobacterium tuberculosis and nontuberculous mycobacteria.
Ekaterina Chernyaeva, Theodosius Dobzhansky Center for Genome BioInformatics, St. Petersburg State University, Russia reported on applications of whole genome sequencing for comparative analysis of clinical M. tuberculosis strains from patients with pulmonary and extrapulmonary TB in Russia, giving a snapshot of genomic markers and population structure identified in studied strains.
The conference ended with case discussions with a panel of microbiologists and TB-physicians, focusing on severe adverse effects from MDR-TB treatment and TB-meningitis.
An important point from Deborah Fritiof and Maria Björmsjö, Dep. of Pediatrics, Umeå was that TB-treatment is different from treatment of other infectious diseases. The long, and sometimes very tough, treatment resembles cancer therapymore than anything else. They underlined that both the patients and health care staff has to be reminded that a TB treatment can be a very long and bitter fight for the patient.
Hopefully the first Arctic Meeting on Clinical Tuberculosis contributed to a broader knowledge of TB amongst both researchers and clinicians. Something that is important if more patients all over the world are to be victorious in their fight against TB.
Patrik Brännberg, Umeå
