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Dedicoat, Martin
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Biography
Martin is a consultant infectious diseases physician with expertise in tuberculosis (TB) management and care. He holds dual appointments, working both at University Hospitals Birmingham NHS Foundation Trust (UHB) and the UK Health Security Agency's (UKHSA) TB Unit. His research interests include tuberculosis epidemiology and health care for underserved populations.
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Publication Metadata only Anti-tuberculosis drug-induced liver injury(BMJ Publishing Group, 2023-10-27) Lim, Wei Shen; Avery, Anthony; Kon, Onn Min; Dedicoat, Martin; Dedicoat, Martin; Dedicoat, Martin; Infectious Diseases; Medical and Dental; Dedicoat, MartinNone availablePublication Metadata only A cost comparison of amikacin therapy with bedaquiline, for drug-resistant tuberculosis in the UK.(W.B. Saunders, 2019-09-21) Manalan, Kavina; Green, Nathan; Arnold, Amber; Cooke, Graham S; Dedicoat, Martin; Lipman, Marc; Loyse, Angela; Harrison, Tom S; Kon, Onn Min; Dedicoat, Martin; Dedicoat, Martin; Infectious diseases; Medical and Dental; Dedicoat, MartinObjectives: Prioritisation of oral bedaquiline over the injectable agents in the treatment of multidrug-resistant Tuberculosis (MDR-TB) in the World Health Organisations (WHO) 2019 guidelines prompted this UK analysis of cost implications. The objective was to estimate the costs of amikacin versus bedaquiline in MDR TB treatment regimens using a historical cohort where the injectable agents were the standard of care. Methods: This was a retrospective study using a known cohort of UK patients treated with an injectable agent, with data available on resource use, costs for the use of amikacin were compared with those for bedaquiline, based on recommended monitoring for bedaquiline. Results: The estimated cost of treatment per patient had mean (sd) of £27,236 (4952) for the observed injectable group, £30,264 (3392) and 36,309 (3901) for the 6 and 8 month amikacin groups, and £31,760 (2092) for the bedaquiline group. The cost in the bedaquiline group was £30,772 (1855) with a 10% reduction and £27,079 (1234) with a 33% reduction in-patient stay. Conclusions: In most scenarios, bedaquiline is close to cost neutral compared with injectable therapy, especially if, as expected, some reduction in duration of admission is possible as a result of bedaquiline's more rapid culture conversion.Publication Metadata only Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study(Public Library of Science, 2023-08-17) Berrocal-Almanza, Luis C; Lima, Marcela; Piotrowski, Helen; Botticello, Julie; Badhan, Amarjit; Karnani, Nisha; Kaur, Hanna; Pareek, Manish; Haldar, Pranabashis; Dedicoat, Martin; Kon, Onn Min; Zenner, Dominik; Lalvani, Ajit; Dedicoat, Martin; Dedicoat, Martin; Infectious Diseases; General Medicine; Medical and Dental; Nursing and Midwifery Registered; Kaur, Hanna; Dedicoat, MartinBackground: Evidence on factors contributing to poor treatment outcome and healthcare priorities in vulnerable populations affected by tuberculosis (TB) in urban areas of England other than London is needed to inform setting-specific prevention and care policies. We addressed this knowledge gap in a cohort of TB patients and healthcare providers in Birmingham and Leicester, UK. Methods: A mixed-methods study was performed. Logistic regression was used to identify TB patients more likely to have poor treatment outcomes according to clinical and demographic characteristics and social risk factors (SRFs) in a 2013-18 cohort. 25 semi-structured interviews were undertaken in purposely selected individuals (9 patients and 16 healthcare professionals) to glean insights on their healthcare priorities and the factors that contribute to poor treatment outcome. Results: The quantitative cohort comprised 2252 patients. Those who were ≥ 55 years of age, foreign-born from Central Europe, East Asia and Sub Saharan Africa and with MDR-TB were more likely to have poor treatment outcomes. According to patients and healthcare professionals, the factors that contribute to vulnerability to develop TB and poor treatment outcomes include poor working and living conditions, inadequate or absent welfare protection, poor primary healthcare responsiveness, treatment duration and side effects. These factors could be addressed by increased networking, partnership and integration between healthcare and social services and better integration between primary and secondary healthcare. Conclusions: In both cities, being ≥ 55 years of age, having MDR-TB and being of foreign-birth are predictors of unfavourable treatment outcome. Risk of poor treatment outcome and vulnerability seem to be multidimensional. A better understanding of specific vulnerabilities and how they affect patient care pathway is needed to design adequate support programmes.Publication Metadata only IgG glycosylation associates with risk of progression from latent to active tuberculosis(Elsevier, 2024-02-01) Burel, Julie G; Wang, Wenjun; Wuhrer, Manfred; Dedicoat, Martin; Fletcher, Thomas E; Cunningham, Adam F; O'Shea, Matthew K; Dedicoat, Martin; Dedicoat, Martin; Infectious Diseases; Pathology; Medical and Dental; Dedicoat, Martin; O'Shea, MatthewObjectives: Glycosylation motifs shape antibody structure, stability and antigen affinity and play an important role in antibody localization and function. Serum IgG glycosylation profiles are significantly altered in infectious diseases, including tuberculosis (TB), but have not been studied in the context of progression from latent to active TB. Methods: We performed a longitudinal study of paired bulk IgG glycosylation and transcriptomic profiling in blood from individuals with active TB (ATB) or latent TB infection (LTBI) before and after treatment. Results: We identified that a combination of two IgG1 glycosylation traits were sufficient to distinguish ATB from LTBI with high specificity and sensitivity, prior to, and after treatment. Importantly, these two features positively correlated with previously defined cellular and RNA signatures of ATB risk in LTBI, namely monocyte to lymphocyte ratio and the expression of interferon (IFN)-associated gene signature of progression (IFN-risk signature) in blood prior to treatment. Additional glycosylation features at higher prevalence in LTBI individuals with high expression of the IFN-risk signature prior to treatment included fucosylation on IgG1, IgG2 and IgG3. Conclusions: Together, our results demonstrate that bulk IgG glycosylation features could be useful in stratifying the risk of LTBI reactivation and progression to ATB.Publication Metadata only Disseminated: Mycobacterium abscessus with endocarditis(BMJ Publishing Group, 2024-03-13) Chue, Amy Louise; Braganza Menezes, Darryl; Bhabra, Moninder; Dedicoat, Martin; Dedicoat, Martin; Dedicoat, Martin; University Hospitals Birmingham NHS Foundation Trust; Infectious Diseases; Cardiac Surgery; Medical and Dental; Chue, Amy; Bhabra, Moninder; Dedicoat, MartinWe present an uncommon case of endocarditis caused by Mycobacterium abscessus in an immunocompetent patient following a caesarean section. We discuss her turbulent admission course leading to her diagnosis following persistent M. abscessus bacteraemia, medical and surgical management, including a splenectomy and valve resection and repair, and subsequent prolonged course of combination antimicrobials for 24 months post valve surgery. The patient is alive 9 months after completing her treatment and 36 months after her valve surgery. We emphasise the importance of a multidisciplinary team approach in the management of such a complex case.Publication Metadata only Drug-resistant tuberculosis treatments, the case for a phase III platform trial.(World Health Organization, 2024-09-01) Yates, Tom A; Barnes, Samara; Dedicoat, Martin; Kon, Onn Min; Kunst, Heinke; Lipman, Marc; Millington, Kerry A; Nunn, Andrew J; Phillips, Patrick Pj; Potter, Jessica L; Squire, S Bertel; Dedicoat, Martin; Dedicoat, Martin; Infectious Diseases; Medical and Dental; Dedicoat, MartinMost phase III trials in drug-resistant tuberculosis have either been underpowered to quantify differences in microbiological endpoints or have taken up to a decade to complete. Composite primary endpoints, dominated by differences in treatment discontinuation and regimen changes, may mask important differences in treatment failure and relapse. Although new regimens for drug-resistant tuberculosis appear very effective, resistance to new drugs is emerging rapidly. There is a need for shorter, safer and more tolerable regimens, including those active against bedaquiline-resistant tuberculosis. Transitioning from multiple regimen A versus regimen B trials to a single large phase III platform trial would accelerate the acquisition of robust estimates of relative efficacy and safety. Further efficiencies could be achieved by adopting modern adaptive platform designs. Collaboration among trialists, affected community representatives, funders and regulators is essential for developing such a phase III platform trial for drug-resistant tuberculosis treatment regimens.Publication Metadata only Practical management of suspected hypersensitivity reactions to anti-tuberculosis drugs(Blackwell Scientific Publications, 2022-02-23) Bermingham, William Hywel; Bhogal, Rashmeet; Arudi Nagarajan, Sowmya; Mutlu, Leman; El-Shabrawy, Reham Mohamed; Madhan, Ramesh; Krishnaswamy, Uma Maheswari; Murali, Mandakolathur Ramaswamy; Kudagammana, Sanath Thushara; Shrestha, Rajeev; Sumantri, Stevent; Christopher, Devasahayam Jesudas; Mahesh, Padukudru Anand; Dedicoat, Martin; Krishna, Mamidipudi Thirumala; Dedicoat, Martin; Dedicoat, Martin; University Hospitals Birmingham NHS Foundation Trust; Kanagaroo Care Paediatric Hospital; Zagazig University; JSS AHER; St Johns Medical College; Massachusetts General Hospital; University of Peradeniya; Teaching Hospital Peradeniya; Dhulikhel Hospital Kathmandu University Hospital; Universitas Pelita Harapan; Siloam Academic Hospital Lippo Village; Christian Medical College; University of Birmingham; Infectious Diseases; Medical and Dental; Dedicoat, MartinTuberculosis (TB) is the commonest cause of death by a single infectious agent globally and ranks amongst the top ten causes of global mortality. The incidence of TB is highest in Low-Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)-TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti-TB drugs occur in over 60% and 3%-4% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR-TB. HSRs to anti-TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T-cell mediated. Severe and systemic T-cell mediated HSRs and IgE mediated anaphylaxis to anti-TB drugs are relatively rare, but important to recognise and treat promptly. T-cell-mediated HSRs are more frequent amongst patients with co-existing HIV infection. Some patients develop multiple sensitisation to anti-TB drugs. Whilst skin tests, patch tests and in vitro diagnostics have been used in the investigation of HSRs to anti-TB drugs, their predictive value is not established, they are onerous, require specialist input of an allergist and are resource-dependent. This is compounded by the global, unmet demand for allergy specialists, particularly in low-income countries (LICs)/LMICs and now the challenging circumstances of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This narrative review provides a critical analysis of the limited published evidence on this topic and proposes a cautious and pragmatic approach to optimise and standardise the management of HSRs to anti-TB drugs. This includes clinical risk stratification and a dual strategy involving sequential re-challenge and rapid drug desensitisation. Furthermore, a concerted international effort is needed to generate real-time data on ADRs, HSRs, safety and clinical outcomes of these interventions.Publication Metadata only First use of Bedaquiline, Linezolid, and Pretomanid (BPaL) in a family cluster of multi-drug resistant (MDR) TB infection.(Ulster Medical Society, 2024-12-11) Pratt, Marcus; McNicol, Mark; Hunter, Michael; Dedicoat, Martin; Dedicoat, Martin; Dedicoat, Martin; Infectious Diseases; Medical and Dental; Dedicoat, MartinNo abstract available.Publication Metadata only Previously treated latent tuberculosis infection is associated with less severe acute COVID-19: a cohort study(BMJ Publishing Group Ltd & British Thoracic Society, 2025-10-13) Scandrett, Katie; Pallett, Scott; Takwoingi, Yemisi; Cunningham, Adam F; Dedicoat, Martin; O'Shea, Matthew K; Infection; Medical and Dental; Dedicoat, MartinIntroduction There is significant potential for respiratory infections, such as tuberculosis (TB) and COVID-19, to overlap but little is known about such co-infection. We aimed to study the impact of active TB and latent TB on the incidence of severe COVID-19 in a large cohort of individuals in a setting of low TB endemicity. Methods Clinical data of patients admitted to hospital with acute SARS-CoV-2 were merged with a database of patients with a history of previous or current active TB, latent TB or healthy controls. We assessed the incidence of COVID-19 in these groups, length of hospital stay, admission to the intensive care unit (ICU) and in-hospital mortality. Results COVID-19 incidence among individuals with current active TB was 6.2% (12/194) and previous active TB 0.67% (30/4496). In contrast, the incidence in previously treated latent TB was 0.09% (4/4542) and among TB contacts 0.24% (34/13 391). There were similar rates of ICU admission and mortality among individuals with COVID-19 and current active TB, TB contacts and other patients. No individuals with previously treated latent TB and COVID-19 were admitted to the ICU or died. Conclusions Individuals with a history of latent TB seem to be at reduced risk of severe COVID-19 and have better outcomes than those with active TB and even uninfected controls. Further studies are required to understand the mechanistic basis of this observation.Publication Metadata only The effect of M. tuberculosis lineage on clinical phenotype.(Public Library of Science, 2023-12-20) Du, Duc Hong; Geskus, Ronald B; Zhao, Yanlin; Codecasa, Luigi Ruffo; Cirillo, Daniela Maria; van Crevel, Reinout; Pascapurnama, Dyshelly Nurkartika; Chaidir, Lidya; Niemann, Stefan; Diel, Roland; Omar, Shaheed Vally; Grandjean, Louis; Rokadiya, Sakib; Ortitz, Arturo Torres; Lân, Nguyễn Hữu; Hà, Đặng Thị Minh; Smith, E Grace; Robinson, Esther; Dedicoat, Martin; Nhat, Le Thanh Hoang; Thwaites, Guy E; Van, Le Hong; Thuong, Nguyen Thuy Thuong; Walker, Timothy M; Dedicoat, Martin; Dedicoat, Martin; Infectious Diseases; Medical and Dental; Dedicoat, MartinSix lineages of Mycobacterium tuberculosis sensu stricto (which excludes M. africanum) are described. Single-country or small observational data suggest differences in clinical phenotype between lineages. We present strain lineage and clinical phenotype data from 12,246 patients from 3 low-incidence and 5 high-incidence countries. We used multivariable logistic regression to explore the effect of lineage on site of disease and on cavities on chest radiography, given pulmonary TB; multivariable multinomial logistic regression to investigate types of extra-pulmonary TB, given lineage; and accelerated failure time and Cox proportional-hazards models to explore the effect of lineage on time to smear and culture-conversion. Mediation analyses quantified the direct effects of lineage on outcomes. Pulmonary disease was more likely among patients with lineage(L) 2, L3 or L4, than L1 (adjusted odds ratio (aOR) 1.79, (95% confidence interval 1.49-2.15), p<0.001; aOR = 1.40(1.09-1.79), p = 0.007; aOR = 2.04(1.65-2.53), p<0.001, respectively). Among patients with pulmonary TB, those with L1 had greater risk of cavities on chest radiography versus those with L2 (aOR = 0.69(0.57-0.83), p<0.001) and L4 strains (aOR = 0.73(0.59-0.90), p = 0.002). L1 strains were more likely to cause osteomyelitis among patients with extra-pulmonary TB, versus L2-4 (p = 0.033, p = 0.008 and p = 0.049 respectively). Patients with L1 strains showed shorter time-to-sputum smear conversion than for L2. Causal mediation analysis showed the effect of lineage in each case was largely direct. The pattern of clinical phenotypes seen with L1 strains differed from modern lineages (L2-4). This has implications for clinical management and could influence clinical trial selection strategies.