PubMed Health⌕ Search

Biomedical subjects

A W Sturm

Publications and source records attributed to A W Sturm.

97 records · Page 6Linked to original sources
PubMedDate not supplied

Resistance to antituberculosis drugs in rural South Africa: rates, patterns, risks, and transmission dynamics.

This study describes the rate, pattern, and transmission dynamics of, and risk factors for, isolates of Mycobacterium tuberculosis resistant to antituberculosis drugs in a rural South African health district. Twenty-one of 254 (7.6%; 95% confidence interval [CI] 4.8-11.4) isolates from incident cases were resistant to at least one drug (isoniazid, rifampicin, streptomycin, ethambutol). A random sample of 28 otherwise susceptible isolates and all 21 resistant isolates were susceptible to pyrazinamide. There was one case of combined isoniazid/rifampicin resistance. The rate of initial resistance was 8.1% (95% CI 4.9-12.4) and of acquired resistance 6.2% (95% CI 1.9-14.2). Age, sex, known human immunodeficiency virus status, and previous treatment history were not associated with drug resistance. Restriction fragment length polymorphism (RFLP) analysis of 13 of the 21 resistant specimens showed 12 different banding patterns. Rates of drug resistance were low in this representative sample of patients from a defined geographical area. Previous treatment history was probably not a risk factor because of the use of multiple drug regimens, directly observed therapy, and high completion rates in those previously treated. Although limited in number, the RFLP data suggested that recent local transmission of resistant strains was not occurring to a significant extent.

Adult↗
PubMedDate not supplied

Diagnosing tuberculosis in a resource-poor setting: the value of sputum concentration.

Diagnosis of tuberculosis in resource-poor settings is hampered by the insensitivity of the direct Ziehl-Neelsen (ZN) smear. Liquefaction and concentration of sputum before preparing a ZN smear has been proposed as a way of increasing diagnostic sensitivity. A field trial of this technique was done in a district hospital in South Africa among 166 consecutive tuberculosis suspects. Correlation between the 2 types of smear was high, but the extra cases diagnosed after concentration was offset by a similar number that, initially positive, were negative after concentration. Overall diagnostic sensitivity of smear microscopy was not increased by sputum liquefaction and concentration. The value of this technique may lie in combining it with direct microscopy. Limiting specimen examination to one per patient and making an initial direct smear with subsequent concentration only if the direct smear was negative increased sensitivity from 43% to 55% without any reduction in specificity. However, overall diagnostic sensitivity remained disappointing.

Humans↗
PubMedDate not supplied

Diagnosing tuberculosis in a resource-poor setting: the value of a trial of antibiotics.

Diagnosis of smear-negative but culture-positive pulmonary tuberculosis in resource-poor settings is difficult. To determine the value of assessing response to a trial of antibiotics in the identification of patients with positive cultures but negative Ziehl-Neelsen (ZN) smears, we compared clinicians' diagnoses with culture in 334 consecutive adults with suspected tuberculosis in rural South Africa; 142 patients (43%) had culture-positive pulmonary tuberculosis. Diagnosis by ZN smear alone was insensitive (61%) but highly specific (94%). Only half of the smear-negative but culture-positive cases were correctly identified by failing to respond to a broad spectrum antibiotic. The remainder responded to therapy and were discharged. Diagnostic sensitivity therefore increased to 80%, but specificity fell to 78%. A more rigorous algorithm may improve diagnosis of smear-negative pulmonary tuberculosis in resource-poor settings.

Adult↗
PubMedDate not supplied

Efficacy of twice weekly treatment for tuberculosis given under direct observation in Africa.

The efficacy of a 6 months course of twice weekly therapy with 4 drugs for tuberculosis, preceded by a 2-3 weeks intensive daily phase, is unknown. Implementation of this regime as community-based directly observed therapy in Africa is highly effective (85% completion rate); it is important to estimate the efficacy of the regime before advocating its widespread use and before conducting prospective trials. We retrospectively evaluated 109 consecutive adults with culture-positive pulmonary tuberculosis who had documented completion of treatment; 84 (77%) were traced and in 15 (14%) a history was obtained from a close relative; 10 (9%) had left the area. Nineteen patients were producing sputum and 4 of these were culture-positive for Mycobacterium tuberculosis, giving an estimated cure rate of 95% (95% confidence interval, 89-98%). Follow-up specimens revealed no acquired drug resistance and restriction fragment length polymorphism analysis of patient-paired specimens showed them to be nearly identical, indicating that treatment had failed or there had been early relapse. This preliminary study suggested that generally twice weekly 4-drug treatment for tuberculosis, given under direct observation, is curative in an acceptable proportion of patients. Prospective trials are indicated.

Adult↗