Publications
42 results found
Meghji J, 2024, A scoping review of interventions to address TB associated respiratory disability, EClinicalMedicine, ISSN: 2589-5370
Meghji J, Gunsaru V, Chinoko B, et al., 2024, Screening for post-TB lung disease at TB treatment completion: are symptoms sufficient?, PLOS Global Public Health, Vol: 4, ISSN: 2767-3375
Pulmonary TB survivors face a high burden of post-TB lung disease (PTLD) after TB treatment completion. In this secondary data analysis we investigate the performance of parameters measured at TB treatment completion in predicting morbidity over the subsequent year, to inform programmatic approaches to PTLD screening in low-resource settings. Cohort data from urban Blantyre, Malawi were used to construct regression models for five morbidity outcomes (chronic respiratory symptoms or functional limitation, ongoing health seeking, spirometry decline, self-reported financial impact of TB disease, and death) in the year after PTB treatment, using three modelling approaches: logistic regression; penalised regression with pre-selected predictors; elastic net penalised regression using the full parent dataset. Predictors included demographic, clinical, symptom, spirometry and chest x-ray variables. The predictive performance of models were examined using the area under the receiver-operator curve (ROC AUC) values. Key predictors were identified, and their positive and negative predictive values (NPV) determined. The presence of respiratory symptoms at TB treatment completion was the strongest predictor of morbidity outcomes. TB survivors reporting breathlessness had higher odds of spirometry decline (aOR 20.5, 95%CI:3–199.1), health seeking (aOR 10.2, 2.4–50), and symptoms or functional limitation at 1-year (aOR 16.7, 3.3–133.4). Those reporting activity limitation were more likely to report symptoms or functional limitation at 1-year (aOR 4.2, 1.8–10.3), or severe financial impact of TB disease (aOR2.3, 1.0–5.0). Models were not significantly improved by including spirometry or imaging parameters. ROC AUCs were between 0.65–0.77 for the morbidity outcomes. Activity limitation at treatment completion had a NPV value of 78–98% for adverse outcomes. Our data suggest that whilst challenging to predict the development of post-TB morbidi
Meghji J, Kon OM, 2023, Opportunistic mycobacterial diseases, Medicine (United Kingdom), Vol: 51, Pages: 774-776, ISSN: 1357-3039
Non-tuberculous mycobacteria (NTM) are hardy environmental organisms: >190 species have been identified, with highly variable pathogenicity. NTM infection is usually acquired from the environment and can be asymptomatic or associated with pulmonary disease (NTM-PD), particularly in individuals with immunocompromise, chronic lung conditions or impaired mucociliary clearance. The incidence of NTM isolates and NTM-PD is rising in resource-rich settings. The diagnosis of NTM-PD requires positive microbiology and typical clinical and radiological features. Treatment typically requires multidrug therapy for at least 12 months, with a combination of oral, nebulized and intravenous antibiotics depending on the NTM species, severity of disease, drug resistance patterns and treatment response. Surgery can be used for localized refractory disease. Outcomes are highly variable and cure may not be possible. Disease should be managed in specialized multidisciplinary team settings where possible.
Meghji J, Kon OM, Ainley A, 2023, Clinical tuberculosis, Medicine (United Kingdom), Vol: 51, Pages: 768-773, ISSN: 1357-3039
In 1993 the World Health Organization declared tuberculosis (TB) a global public health emergency, and yet 26 years later it remains a significant public health issue globally and nationally within the UK. Although the overall incidence and mortality have improved, there remains considerable work needed to tackle both an underserved population who present unique and complex challenges, and the continuing threat from drug resistance. Within the UK and worldwide, numerous stakeholders have established networks, guidance and frameworks to facilitate a more targeted and standardized approach to detection, diagnosis and management. Novel diagnostic tools and treatments aim to reduce the burden of disease, with the ultimate aim of eradicating TB.
Smith DJF, Meghji J, Moonim M, et al., 2023, Sarcoidosis following COVID infection: A case series, RESPIROLOGY CASE REPORTS, Vol: 11, ISSN: 2051-3380
Menzies NA, Allwood BW, Dean AS, et al., 2023, Global burden of disease due to rifampicin-resistant tuberculosis: a mathematical modeling analysis., Nat Commun, Vol: 14
In 2020, almost half a million individuals developed rifampicin-resistant tuberculosis (RR-TB). We estimated the global burden of RR-TB over the lifetime of affected individuals. We synthesized data on incidence, case detection, and treatment outcomes in 192 countries (99.99% of global tuberculosis). Using a mathematical model, we projected disability-adjusted life years (DALYs) over the lifetime for individuals developing tuberculosis in 2020 stratified by country, age, sex, HIV, and rifampicin resistance. Here we show that incident RR-TB in 2020 was responsible for an estimated 6.9 (95% uncertainty interval: 5.5, 8.5) million DALYs, 44% (31, 54) of which accrued among TB survivors. We estimated an average of 17 (14, 21) DALYs per person developing RR-TB, 34% (12, 56) greater than for rifampicin-susceptible tuberculosis. RR-TB burden per 100,000 was highest in former Soviet Union countries and southern African countries. While RR-TB causes substantial short-term morbidity and mortality, nearly half of the overall disease burden of RR-TB accrues among tuberculosis survivors. The substantial long-term health impacts among those surviving RR-TB disease suggest the need for improved post-treatment care and further justify increased health expenditures to prevent RR-TB transmission.
Kumar K, Ratnakumar R, Collin SM, et al., 2023, Chest CT features and functional correlates of COVID-19 at 3 months and 12 months follow-up., Clin Med (Lond), Vol: 23, Pages: 467-477
Long-term pulmonary sequelae of Coronavirus 2019 (COVID-19) remain unclear. Thus, we aimed to establish post-COVID-19 temporal changes in chest computed tomography (CT) features of pulmonary fibrosis and to investigate associations with respiratory symptoms and physiological parameters at 3 and 12 months' follow-up. Adult patients who attended our initial COVID-19 follow-up service and developed chest CT features of interstitial lung disease, in addition to cases identified using British Society of Thoracic Imaging codes, were evaluated retrospectively. Clinical data were gathered on respiratory symptoms and physiological parameters at baseline, 3 months, and 12 months. Corresponding chest CT scans were reviewed by two thoracic radiologists. Associations between CT features and functional correlates were estimated using random effects logistic or linear regression adjusted for age, sex and body mass index. In total, 58 patients were assessed. No changes in reticular pattern, honeycombing, traction bronchiectasis/bronchiolectasis index or pulmonary distortion were observed. Subpleural curvilinear lines were associated with lower odds of breathlessness over time. Parenchymal bands were not associated with breathlessness or impaired lung function overall. Based on our results, we conclude that post-COVID-19 chest CT features of irreversible pulmonary fibrosis remain static over time; other features either resolve or remain unchanged. Subpleural curvilinear lines do not correlate with breathlessness. Parenchymal bands are not functionally significant. An awareness of the different potential functional implications of post-COVID-19 chest CT changes is important in the assessment of patients who present with multi-systemic sequelae of COVID-19 infection.
Nightingale R, Carlin F, Meghji J, et al., 2023, Post-TB health and wellbeing, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 27, Pages: 248-+, ISSN: 1027-3719
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- Citations: 4
Rachow A, Walker NF, Allwood B, et al., 2023, The challenge of post-tuberculosis lung disease, ERS Monograph, Vol: 2023, Pages: 191-209, ISSN: 2312-508X
About half of microbiologically cured TB patients experience TB-related persistent respiratory health problems or residual lung pathology, which are summarised under the term post-TB lung disease (PTLD). The development of PTLD is complex and moderated by a multitude of host, pathogen and environmental risk factors. With regards to pathogenesis, two processes are likely to be important: 1) Mycobacterium tuberculosis infection-driven tissue damage, and 2) pathological tissue remodelling following active disease. The PTLD phenotype that is currently best described in the data is obstructive airways disease in adults. Other patterns of PTLD including bronchiectasis, other (non-obstructive) lung function abnormalities, such as low forced vital capacity or impaired diffusion capacity, and patterns of secondary morbidity, such as chronic pulmonary aspergillosis and pulmonary arterial hypertension, are less well described. In the absence of robust, evidence-based management guidelines for PTLD, clinical statements suggest a set of diagnostic and therapeutic “toolboxes” which must be adapted to the local and clinical context of PTLD patients.
Nightingale R, Chinoko B, Lesosky M, et al., 2022, Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study, THORAX, Vol: 77, Pages: 1131-1139, ISSN: 0040-6376
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- Citations: 7
Meghji J, Mortimer K, Mpangama S, 2022, TB and COPD in low-income settings: a collision of old foes, THORAX, Vol: 77, Pages: 1057-1058, ISSN: 0040-6376
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- Citations: 2
McCallum AD, Pertinez HE, Chirambo AP, et al., 2022, High Intrapulmonary Rifampicin and Isoniazid Concentrations Are Associated With Rapid Sputum Bacillary Clearance in Patients With Pulmonary Tuberculosis, CLINICAL INFECTIOUS DISEASES, Vol: 75, Pages: 1520-1528, ISSN: 1058-4838
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- Citations: 1
Kumar K, Ratnakumar P, Ricci P, et al., 2022, Recovering from COVID-19: lessons learnt from an intensive secondary care follow-up service, Future Healthcare Journal, ISSN: 2055-3331
Tomeny EM, Nightingale R, Chinoko B, et al., 2022, TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi, BMJ GLOBAL HEALTH, Vol: 7, ISSN: 2059-7908
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- Citations: 3
Karanja S, Malenga T, Mphande J, et al., 2022, Stakeholder perspectives around post-TB wellbeing and care in Kenya and Malawi., PLOS Glob Public Health, Vol: 2
BACKGROUND: There is growing awareness of the burden of post-TB morbidity, and its impact on the lives and livelihoods of TB affected households. However little work has been done to determine how post-TB care might be delivered in a feasible and sustainable way, within existing National TB Programmes (NTPs) and health systems, in low-resource, high TB-burden settings. In this programme of stakeholder engagement around post-TB care, we identified actors with influence and interest in TB care in Kenya and Malawi, including TB-survivors, healthcare providers, policy-makers, researchers and funders, and explored their perspectives on post-TB morbidity and care. METHODS: Stakeholder mapping was completed to identify actors with interest and influence in TB care services in each country, informed by the study team's local, regional and international networks. Key international TB organisations were included to provide a global perspective. In person or online one-to-one interviews were completed with purposively selected stakeholders. Snowballing was used to expand the network. Data were recorded, transcribed and translated, and a coding frame was derived. Data were coded using NVivo 12 software and were analysed using thematic content analysis. Online workshops were held with stakeholders from Kenya and Malawi to explore areas of uncertainty and validate findings. RESULTS: The importance of holistic care for TB patients, which addresses both TB comorbidities and sequelae, was widely recognised by stakeholders. Key challenges to implementation include uncertainty around the burden of post-TB morbidity, leadership of post-TB services, funding constraints, staff and equipment limitations, and the need for improved integration between national TB and non-communicable disease (NCD) programmes for care provision and oversight. There is a need for local data on the burden and distribution of morbidity, evidence-informed clinical guidelines, and pilot data on models of care. Op
Menzies NA, Quaife M, Allwood BW, et al., 2021, Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae, LANCET GLOBAL HEALTH, Vol: 9, Pages: E1679-E1687, ISSN: 2214-109X
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- Citations: 37
McCallum AD, Pertinez HE, Else LJ, et al., 2021, Intrapulmonary Pharmacokinetics of First-line Anti-tuberculosis Drugs in Malawian Patients With Tuberculosis, CLINICAL INFECTIOUS DISEASES, Vol: 73, Pages: E3365-E3373, ISSN: 1058-4838
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- Citations: 5
Meghji J, Mortimer K, Jayasooriya S, et al., 2021, Lung health in LMICs: tackling challenges ahead Reply, LANCET, Vol: 398, Pages: 490-490, ISSN: 0140-6736
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- Citations: 1
Allwood BW, Byrne A, Meghji J, et al., 2021, Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge, RESPIRATION, Vol: 100, Pages: 751-763, ISSN: 0025-7931
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- Citations: 53
Mallia P, Russell G, Meghji J, et al., 2021, Symptomatic, biochemical and radiographic recovery in patients with Covid-19, BMJ Open Respiratory Research, Vol: 8, ISSN: 2052-4439
Background: The symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described.Methods: Retrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness.Results: 75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge.Conclusions: Patients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.
Johnson C, Kumwenda M, Meghji J, et al., 2021, 'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi, BMC PUBLIC HEALTH, Vol: 21
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- Citations: 6
Meghji J, Gregorius S, Madan J, et al., 2021, The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting, THORAX, Vol: 76, Pages: 387-395, ISSN: 0040-6376
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- Citations: 19
Meghji J, Mortimer K, Agusti A, et al., 2021, Improving lung health in low-income and middle-income countries: from challenges to solutions, LANCET, Vol: 397, Pages: 928-940, ISSN: 0140-6736
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- Citations: 108
Meghji J, Brown J, Lipman M, 2021, Post-Tuberculosis Infections and Chronic Lung Disease, Essential Tuberculosis, Pages: 283-291, ISBN: 9783030667054
There is an increased awareness of the long-term physical, psychological and socioeconomic consequences that can follow apparently successful treatment for tuberculosis (TB). In this chapter, we describe the high burden of residual lung damage post-treatment for pulmonary tuberculosis, as well as the common associated respiratory infections. Patterns of post-TB lung disease (PTLD) are heterogenous, with no standardised tools for diagnosis or measurement. However, it is clear that the condition includes pleural, parenchymal and airway pathology, which may be particularly severe after multidrug resistant disease. Prospective data describing the long-term sequelae of PTLD are limited, but given the high burden of bronchiectasis, residual cavities and parenchymal destruction, these likely include infective exacerbations with bacterial or viral pathogens, and superimposed infection with aspergillus and non-tuberculous mycobacteria. There are few data reporting the incidence of post-TB infections amongst (an increasing number of) TB survivors in high-or low-income settings, but basic approaches to their diagnosis and management are described here. The importance of broad respiratory care, including tobacco cessation, and the need for further evidence for interventions to improve long-term respiratory outcomes after completing treatment for TB are highlighted.
Meghji J, Kon OM, 2021, TB Treatment Complications, Tuberculosis in Clinical Practice, Pages: 263-278, ISBN: 9783030755089
The aims of TB drug treatment are to rapidly reduce bacillary load to achieve clinical improvement, to remove persistor organisms to prevent relapse, to avoid drug resistance. Stard first-line treatment for drug sensitive PTB EPTB disease in both HIV-positive -negative adults requires quadruple therapy with RIF, INH, PZA ETH. Drug therapy is typically provided for 6-months (2 RHZE/4 RH) with extension of the continuation phase in the treatment of TB meningitis, ocular TB disease, possibly in those with a high initial bacillary load. Adjunctive treatments including pyridoxine (all patients), corticosteroids (TB meningitis) may be required. Drugs can be provided individually or in fixed-dose preparations, but practitioners must be aware of common/severe side effects of these medications. Treatment programmes must have capacity for pre-treatment assessment of patient risk, monitoring of patients during treatment, management of complications.
Harlow CF, Meghji J, Martin L, et al., 2020, Republished: Rifampicin induced shock during re-exposure for treatment of latent tuberculosis., Drug Ther Bull, Vol: 58, Pages: 157-159
Allwood B, van der Zalm M, Amaral A, et al., 2020, Post-tuberculosis lung health: perspectives from the firstInternational symposium, International Journal of Tuberculosis and Lung Disease, Vol: 24, Pages: 820-828, ISSN: 1027-3719
Tuberculosis, although curable, frequently leaves the individual with chronic physical and psycho-social impairment, yet these consequences have to-date been largely neglected. The 1st International Post-Tuberculosis Symposium was devoted entirely to impairment after tuberculosis, and covered a number of multi-disciplinary topics. Using the Delphi process, consensus was achieved for the terms “post-tuberculosis”, “post-tuberculosis lung disease/s (PTLD)”, and “post-tuberculosis economic, social and psychological well-being” (Post-TB ESP)”, to overcome the historical challenge of varied terminology in the literature. A minimum case-definition was proposed by consensus for PTLD in adults and children. Lack of sufficient evidence hampered definitive recommendations in most domains, including prevention and treatment of PTLD, but highlighted the dire need for research and priorities were identified. The heterogeneity of respiratory outcomes and previously employed research methodologies complicates the accurate estimation of disease burden. However, consensus was reached proposing a toolkit for future PTLD measurement, and on PTLD patterns to be considered. The importance of extra-pulmonary consequences and progressive impairment throughout the life-course was identified, including tuberculosis recurrence and increased mortality. Patient advocates emphasised the need for addressing the psychological and social impacts post tuberculosis, and called for clinical guidance. Increased awareness and more research addressing post-tuberculosis complications is urgently needed.
Meghji J, Kon OM, 2020, Opportunistic mycobacterial diseases, Medicine (United Kingdom), Vol: 48, Pages: 363-365, ISSN: 1357-3039
Non-tuberculous mycobacteria (NTM) are hardy environmental organisms: >200 species have been identified, with highly variable pathogenicity. NTM infection is usually acquired from the environment and can be asymptomatic or associated with pulmonary disease (NTM-PD), particularly in patients with immunocompromise, chronic lung conditions or impaired mucociliary clearance. The incidence of NTM isolates and NTM-PD is rising in resource-rich settings. Diagnosis of NTM-PD requires both positive microbiology and typical clinical and radiological features. Treatment typically requires multidrug therapy for at least 12 months, with a combination of oral, nebulized and intravenous antibiotics depending on the NTM species, severity of disease, drug resistance patterns and treatment response. Surgery can be used for localized refractory disease. Outcomes are highly variable and cure may not be possible. Disease should be managed in specialized multidisciplinary team settings where possible.
Nightingale R, Jary H, Meghji J, et al., 2020, Non-communicable respiratory disease in Malawi: a systematic review and meta-analysis, MALAWI MEDICAL JOURNAL, Vol: 32, Pages: 64-73, ISSN: 1995-7262
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- Citations: 1
Meghji J, Lesosky M, Joekes E, et al., 2020, Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study, THORAX, Vol: 75, Pages: 269-278, ISSN: 0040-6376
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- Citations: 72
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