Marcel Behr

I thought it was going outside in winter without a hat....

Sihem Belhocine put this quote at the start of her thesis: "If many remedies are prescribed for an illness, you may be certain that the illness has no cure." Anton Chekhov, The Cherry Orchard, 1904 (the year he died of tuberculosis). Does this adage hold true in 2025?

Amazing thesis work led by Sarah Danchuk now submitted for review and posted as preprint: ssrn.com/abstract=51598…. Short summary: M. bovis & M. orygis manifest enhanced virulence compared to M. tuberculosis in natural host model (calves) and small animal model (mice).

Question to academics: I've been on several editorial boards before, but until now, never been asked by to sign a 16-page legal contract, including a section on my obligations. Unpaid role. Is this the new norm?

Hi Peter,
A further point. It's brilliant that UK publishes its M. Bovis data. Now that WHO and WOAH recognize that definition of zoonotic TB extends to M. Orygis as well, I would be curious to see the same type of data for M. Orygis cases. So far, just scattered case series, nothing systematic.

Thanks!

Hi Peter. I don't know about exposure. Harder to do in immigrants to e.g., Canada, Australia asking about exposure in country of birth. Maybe can be done in places where local exposure? Are there good data in the UK?

Compelling analysis suggesting that M:F difference in TB rates driven by differences in rates of Mtb infection. Consistent with old (2000) analysis of genotypic clustering (PMID: 10654640). But why do zoonotic TB series often have flipped ratios? doi: 10.1093/infdis/jiae124

I believe most isolates from pre-2020. Resistance developing or already established?

Agree with treating Legionella. Where are the best data on macrolide treatment and outcome of CAP due to Mycoplasma?

A diagram of the screening and randomization process for household contacts included in the trial.

In this report, investigators assessed the efficacy of levofloxacin for the prevention of secondary cases of tuberculosis among household contacts of persons with multidrug-resistant tuberculosis. Full VQUIN MDR trial results: nej.md/41BHEf5

#MedSky #IDSky

Recovery of Mycobacterium tuberculosis complex isolates including pre-XDR strains from Cattle at a Slaughterhouse in Chennai, India AbstractBackground. India has the highest global burden of human tuberculosis (TB) and the largest cattle herd with endemic bovine TB. However, the extent

Pre-XDR Mycobacterium tuberculosis in cattle. Plus some M. orygis academic.oup.com/ofid/advance...

Sarah Danchuk at PhD defense, presenting her favourite figure contrasting the host reservoirs of Mycobacterium tuberculosis complex.

Here is the reference for macrolide susceptibility of certain BCG strains PMID: 14693532

In addition to standard M. bovis drugs, 'late' BCG strains are macrolide susceptible because of deletion of rv1988, in the RD2 region. This gives another therapeutic option if it was oncoTice

In much of medicine, new drugs are twinned with companion diagnostics. Blood pressure monitoring for antihypertensives; bone densitometry for osteoporosis drugs, etc. How can we ensure drug susceptibility testing is developed and deployed for the next TB antibiotic?

Natural experiments, although imperfectly controlled, can be more creative, and therefore more informative, than the experiments we design in the lab. Agree/disagree/both?

They are also evaluated differently, generally using randomized responders rather than treat-through studies. Detailed in: www.gastrojournal.org/article/S001...

Do urine tests offer a useful sample in PWHIV because they have unrecognized renal TB? Or is there a DNAemia / LAMemia that is filtered through the glomeruli into the urine?

International observations consistent with what we saw across subgroups in San Francisco. But is it gender or sex or a bit of both? pubmed.ncbi.nlm.nih.gov/10654640/

Agree we need better data on infection. Will data drive the need for a test to distinguish cleared from current infection? Or is a test needed first to generate firm estimates? Would be ++ helpful in clinic to know who is infected today, before writing a prescription.

Read this amazing preprint today: ~2% (156M) of the world recently infected with #tb.

Between 4.9%~7.7% have viable infection.

But emphasises we need +++ data on Mtb infection
@aschwalbc.bsky.social @kchorton.bsky.social @petedodd24.bsky.social @reinhouben.bsky.social @hannahrickman.bsky.social

NGS can help make cryptic diagnoses. But to be clinically useful for CNS infections, there needs to be fast turnaround time. How long from lumbar puncture to report in different countries? Evenings and weekends included. Curious to hear your experiences.

Great to see this written up Alvaro. Good luck with the presentation in Bali. I'm curious to know how people respond to these estimates and their implications.

One of the indications to treat is 'during an epidemic'. Presumably for public health reasons, because disease should not be more severe? Is there evidence for treatment limiting community spread? Or is this recommendation based on different spectrum of disease during epidemics?

Got it! Did not expect such a low yield for simply obtaining sputum, but good to have this data point. Thanks!

Not all places have radiology. Should we be insisting on bringing in the machines (or sending people to the machines) or can we jump straight to sputum, which is sensitive and specific? Context dependent choices, perhaps?

In 2024, would this be done with Xpert? Xpert + CXR? Other?