K Dheda

Summary

Affiliation: University of Cape Town
Country: South Africa

Publications

  1. Adams S, Ehrlich R, Baatjies R, Dendukuri N, Wang Z, Dheda K. Predictors of discordant latent tuberculosis infection test results amongst South African health care workers. BMC Infect Dis. 2019;19:131 pubmed publisher
    ..32; 95% CI 0.10-0.95). The marked TST-IGRA and IGRA-IGRA discordance in HIV-infected individuals suggest greater sensitivity of TSPOT.TB in immunocompromised persons or potential greater reactivity of TSPOT.TB in this population. ..
  2. Te Riele J, Buser V, Calligaro G, Esmail A, Theron G, Lesosky M, et al. Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis. Int J Infect Dis. 2019;79:65-71 pubmed publisher
    ..These data may have implications for clinical and programmatic decision-making and for evaluation of new regimens in clinical trials. ..
  3. Naidoo P, Esmail A, Peter J, Davids M, Fadul M, Dheda K. Does the use of adjunct urine lipopolysaccharide lipoarabinomannan in HIV-infected hospitalized patients reduce the utilization of healthcare resources? A post hoc analysis of the LAM multi-country randomized controlled trial. Int J Infect Dis. 2019;79:37-43 pubmed publisher
    ..However, given the limitations of the present study, further appropriately designed studies are required to determine the effect of adjunct urine LAM on the utilization of healthcare resources. ..
  4. Tomasicchio M, Semple L, Esmail A, Meldau R, Randall P, Pooran A, et al. An autologous dendritic cell vaccine polarizes a Th-1 response which is tumoricidal to patient-derived breast cancer cells. Cancer Immunol Immunother. 2019;68:71-83 pubmed publisher
    ..We have developed a DC vaccine that is cytotoxic to autologous breast cancer cells in vitro. The tools and technology generated here will now be applied to a phase I/IIa clinical trial. ..
  5. van Zyl Smit R, Naidoo J, Wainwright H, Said Hartley Q, Davids M, Goodman H, et al. HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting. BMC Pulm Med. 2015;15:38 pubmed publisher
    ..The diagnosis can often be made on transbronchial biopsy and is characterized by a predominant CD8 T cell infiltrate. No association with EBV antigen was found. ..
  6. Dheda K, Shean K, Zumla A, Badri M, Streicher E, Page Shipp L, et al. Early treatment outcomes and HIV status of patients with extensively drug-resistant tuberculosis in South Africa: a retrospective cohort study. Lancet. 2010;375:1798-807 pubmed publisher
    ..South African Medical Research Council, European Union Framework 7 program, and European Developing Countries Clinical Trials Partnership. ..
  7. Dheda K, Ruhwald M, Theron G, Peter J, Yam W. Point-of-care diagnosis of tuberculosis: past, present and future. Respirology. 2013;18:217-32 pubmed publisher
    ..We also discuss future applications, including the potential POC diagnosis of drug-resistant TB and presumed latent TB infection. Challenges to the development and roll-out of POC tests for TB are also reviewed. ..
  8. Dheda K, Schwander S, Zhu B, van Zyl Smit R, Zhang Y. The immunology of tuberculosis: from bench to bedside. Respirology. 2010;15:433-50 pubmed publisher
    ..An immunologically orientated approach to tackling TB can only succeed with concurrent efforts to alleviate poverty and reduce the global burden of HIV. ..
  9. Peter J, Theron G, Chanda D, Clowes P, Rachow A, Lesosky M, et al. Test characteristics and potential impact of the urine LAM lateral flow assay in HIV-infected outpatients under investigation for TB and able to self-expectorate sputum for diagnostic testing. BMC Infect Dis. 2015;15:262 pubmed publisher

More Information

Publications37

  1. Calligaro G, Theron G, Khalfey H, Peter J, Meldau R, Matinyenya B, et al. Burden of tuberculosis in intensive care units in Cape Town, South Africa, and assessment of the accuracy and effect on patient outcomes of the Xpert MTB/RIF test on tracheal aspirate samples for diagnosis of pulmonary tuberculosis: a prospective bur. Lancet Respir Med. 2015;3:621-30 pubmed publisher
    ..European and Developing Countries Clinical Trials Partnership, South African Medical Research Council, and the Discovery Foundation. ..
  2. Lehloenya R, Muloiwa R, Dlamini S, Gantsho N, Todd G, Dheda K. Lack of cross-toxicity between isoniazid and ethionamide in severe cutaneous adverse drug reactions: a series of 25 consecutive confirmed cases. J Antimicrob Chemother. 2015;70:2648-51 pubmed publisher
    ..Our findings strongly suggest that the risk of cross-reactivity of isoniazid and ethionamide in DRESS syndrome and SJS/TEN is low. These findings have implications for clinical management. ..
  3. Dheda K, van Zyl Smit R, Meldau R, Meldau S, Symons G, Khalfey H, et al. Quantitative lung T cell responses aid the rapid diagnosis of pulmonary tuberculosis. Thorax. 2009;64:847-53 pubmed publisher
    ..However, test utility in high-burden settings may be limited by the high proportion of inconclusive results. ..
  4. Dheda K, Barry C, Maartens G. Tuberculosis. Lancet. 2016;387:1211-26 pubmed publisher
  5. Mthiyane T, Rustomjee R, Pym A, Connolly C, Onyebujoh P, Theron G, et al. Impact of tuberculosis treatment and antiretroviral therapy on serial RD-1-specific quantitative T-cell readouts (QuantiFERON-TB Gold In-Tube), and relationship to treatment-related outcomes and bacterial burden. Int J Infect Dis. 2015;36:46-53 pubmed publisher
    ..As IGRAs do not correlate with 2- or 6-month culture conversion or with markers of bacillary burden, they are unlikely to be useful for the prognostication of treatment outcome in co-infected patients. ..
  6. Theron G, Peter J, Dowdy D, Langley I, Squire S, Dheda K. Do high rates of empirical treatment undermine the potential effect of new diagnostic tests for tuberculosis in high-burden settings?. Lancet Infect Dis. 2014;14:527-32 pubmed publisher
    ..Until such questions can be addressed, and empirical treatment is appropriately characterised, we postulate that the estimated population-level effect of new tests such as Xpert might be substantially overestimated. ..
  7. Sabur N, Esmail A, Brar M, Dheda K. Diagnosing tuberculosis in hospitalized HIV-infected individuals who cannot produce sputum: is urine lipoarabinomannan testing the answer?. BMC Infect Dis. 2017;17:803 pubmed publisher
    ..Our findings support the use of urine LAM testing in sputum-scarce hospitalized HIV-infected patients, and its incorporation into diagnostic algorithms for this patient population. ..
  8. Peter J, Theron G, Pooran A, Thomas J, Pascoe M, Dheda K. Comparison of two methods for acquisition of sputum samples for diagnosis of suspected tuberculosis in smear-negative or sputum-scarce people: a randomised controlled trial. Lancet Respir Med. 2013;1:471-8 pubmed publisher
    ..South African National Research Foundation, European Commission, National Institutes of Health, European and Developing Countries Clinical Trials Partnership, Discovery Foundation. ..
  9. Theron G, Peter J, Zijenah L, Chanda D, Mangu C, Clowes P, et al. Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study. BMC Infect Dis. 2015;15:253 pubmed publisher
    ..Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment. ..
  10. Dheda K, van Zyl Smit R, Badri M, Pai M. T-cell interferon-gamma release assays for the rapid immunodiagnosis of tuberculosis: clinical utility in high-burden vs. low-burden settings. Curr Opin Pulm Med. 2009;15:188-200 pubmed publisher
    ..Prospective studies are required in high-burden settings to confirm whether IFN-gamma responses are predictive of high risk of progression to active TB, particularly in HIV-infected individuals. ..
  11. Theron G, Venter R, Smith L, Esmail A, Randall P, Sood V, et al. False-Positive Xpert MTB/RIF Results in Retested Patients with Previous Tuberculosis: Frequency, Profile, and Prospective Clinical Outcomes. J Clin Microbiol. 2018;56: pubmed publisher
    ..These data inform clinical practice by highlighting the challenges in interpreting Xpert-positive results, underscore the need for culture, and have implications for next-generation ultrasensitive tests. ..
  12. Zijenah L, Kadzirange G, Bandason T, Chipiti M, Gwambiwa B, Makoga F, et al. Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe. BMC Infect Dis. 2016;16:20 pubmed publisher
    ..We recommend a combination of LAM and SSM for TB diagnosis in HIV-infected patients with low CD4 counts in HIV/TB co-endemic countries, where alternative methods are unavailable. ..
  13. Phelan J, Coll F, Bergval I, Anthony R, Warren R, Sampson S, et al. Recombination in pe/ppe genes contributes to genetic variation in Mycobacterium tuberculosis lineages. BMC Genomics. 2016;17:151 pubmed publisher
    ..This, the first comprehensive study of the pe and ppe genes, provides important insight into M. tuberculosis diversity and has significant implications for vaccine development. ..
  14. Calligaro G, Zijenah L, Peter J, Theron G, Buser V, McNerney R, et al. Effect of new tuberculosis diagnostic technologies on community-based intensified case finding: a multicentre randomised controlled trial. Lancet Infect Dis. 2017;17:441-450 pubmed publisher
    ..By contrast, urine LAM testing was not found to be useful for intensive case finding in this setting. European and Developing Countries Clinical Trials Partnership and South African Medical Research Council. ..
  15. Hoff S, Peter J, Theron G, Pascoe M, Tingskov P, Aggerbeck H, et al. Sensitivity of C-Tb: a novel RD-1-specific skin test for the diagnosis of tuberculosis infection. Eur Respir J. 2016;47:919-28 pubmed publisher
    ..tuberculosis infection. Sensitivity was reduced only in HIV-infected patients with severe immunosuppression. Further studies in different settings are required to validate the proposed 5 mm cut-point. ..
  16. Davids M, Pooran A, Pietersen E, Wainwright H, Binder A, Warren R, et al. Regulatory T Cells Subvert Mycobacterial Containment in Patients Failing Extensively Drug-resistant TB Treatment. Am J Respir Crit Care Med. 2018;: pubmed publisher
    ..Collectively, these data suggest that Tregs may be contributing to immune dysfunction, and bacterial persistence, in patients with XDR-TB. The relevant cellular pathways may serve as potential targets for immunotherapeutic intervention. ..
  17. Dheda K, Chang K, Guglielmetti L, Furin J, Schaaf H, Chesov D, et al. Clinical management of adults and children with multidrug-resistant and extensively drug-resistant tuberculosis. Clin Microbiol Infect. 2017;23:131-140 pubmed publisher
    ..This review informs on the prevention, diagnosis, and clinical management of MDR-TB and XDR-TB. ..
  18. Dheda K, Davids V, Lenders L, Roberts T, Meldau R, Ling D, et al. Clinical utility of a commercial LAM-ELISA assay for TB diagnosis in HIV-infected patients using urine and sputum samples. PLoS ONE. 2010;5:e9848 pubmed publisher
    ..However, even in this group sensitivity was modest. Future and adequately powered studies in a primary care setting should now specifically target patients with suspected TB who have advanced HIV infection. ..
  19. Engel N, Davids M, Blankvoort N, Dheda K, Pant Pai N, Pai M. Making HIV testing work at the point of care in South Africa: a qualitative study of diagnostic practices. BMC Health Serv Res. 2017;17:408 pubmed publisher
    ..These insights are crucial for understanding the contexts within which diagnostic devices and policies need to function. ..
  20. Pietersen E, Ignatius E, Streicher E, Mastrapa B, Padanilam X, Pooran A, et al. Long-term outcomes of patients with extensively drug-resistant tuberculosis in South Africa: a cohort study. Lancet. 2014;383:1230-9 pubmed publisher
    ..European and Developing Countries Clinical Trials Partnership, South African National Research Foundation (SARChI), and the South African Medical Research Council. ..
  21. Dheda K, van Zyl Smit R, Sechi L, Badri M, Meldau R, Meldau S, et al. Utility of quantitative T-cell responses versus unstimulated interferon-{gamma} for the diagnosis of pleural tuberculosis. Eur Respir J. 2009;34:1118-26 pubmed publisher
    ..The antigen-specific T-cell IGRAs were limited by suboptimal accuracy and the inability to isolate sufficient mononuclear cells to perform the assay...
  22. Dheda K, van Zyl Smit R, Sechi L, Badri M, Meldau R, Symons G, et al. Clinical diagnostic utility of IP-10 and LAM antigen levels for the diagnosis of tuberculous pleural effusions in a high burden setting. PLoS ONE. 2009;4:e4689 pubmed publisher
    ..Detection of LAM antigen has not previously been evaluated in pleural fluid...
  23. Dheda K, Theron G, Welte A. Cost-effectiveness of Xpert MTB/RIF and investing in health care in Africa. Lancet Glob Health. 2014;2:e554-6 pubmed publisher
  24. Gina P, Randall P, Muchinga T, Pooran A, Meldau R, Peter J, et al. Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection. BMC Infect Dis. 2017;17:339 pubmed publisher
    ..001). LF-LAM specificity was not determined. This proof of concept study indicates that EMU could improve the sensitivity of LF-LAM in hospitalised TB-HIV co-infected patients. These data have implications for clinical practice. ..
  25. Dheda K, Gumbo T, Maartens G, Dooley K, McNerney R, Murray M, et al. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. Lancet Respir Med. 2017;: pubmed publisher
  26. Dheda K, Limberis J, Pietersen E, Phelan J, Esmail A, Lesosky M, et al. Outcomes, infectiousness, and transmission dynamics of patients with extensively drug-resistant tuberculosis and home-discharged patients with programmatically incurable tuberculosis: a prospective cohort study. Lancet Respir Med. 2017;5:269-281 pubmed publisher
  27. Peter J, Zijenah L, Chanda D, Clowes P, Lesosky M, Gina P, et al. Effect on mortality of point-of-care, urine-based lipoarabinomannan testing to guide tuberculosis treatment initiation in HIV-positive hospital inpatients: a pragmatic, parallel-group, multicountry, open-label, randomised controlled trial. Lancet. 2016;387:1187-97 pubmed publisher
    ..European Developing Clinical Trials Partnership, the South African Medical Research Council, and the South African National Research Foundation. ..
  28. Theron G, Zijenah L, Chanda D, Clowes P, Rachow A, Lesosky M, et al. Feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing for tuberculosis in primary-care settings in Africa: a multicentre, randomised, controlled trial. Lancet. 2014;383:424-35 pubmed publisher
    ..We aimed to assess the feasibility, accuracy, and clinical effect of point-of-care Xpert MTB/RIF testing at primary-care health-care facilities in southern Africa...