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PubMed1994

Prevalence of drug resistance in Thai human immunodeficiency virus seropositive tuberculosis patients.

The emergence of drug resistant tuberculosis has been reported from many countries which have had epidemics of human immunodeficiency virus (HIV) infection. This study was conducted at the Central Chest Hospital, Thailand in order to determine the prevalence of drug resistance before treatment in Thai HIV-infected tuberculosis patients. From the Statistics and Registration Unit, pulmonary tuberculosis patients with HIV seropositivity were matched in terms of age and gender with control cases who attended the tuberculosis clinic on the same day. Results of sensitivity test were obtained from record cards in the Microbiology Section. The method for determining the sensitivity test was absolute concentration. During the study period from January 1988 to December 1993, 798 patients were registered as having tuberculosis and HIV infection. Only 406 sensitivity tests were available before treatment and resisted to Isoniazid 56 (13.8%), rifampicin 36 (8.9%), ethambutol 6 (1.5%), streptomycin 64 (15.8%) and Multidrug resistant (MDR)- TB 11 (2.7%). In the control group, 475 tests were available and resisted to isoniazid 61 (12.8%), rifampicin 52 (10.9%), ethambutal 2 (0.4%), streptomycin 46 (9.7%) and MDR-TB 13 (2.7%). The prevalence of resistance to each drug was not significantly different except for streptomycin. We concluded that the prevalence of antituberculous drug resistance among Thai HIV-infected tuberculosis patients was not higher than among general tuberculosis patients.

Adolescent↗
PubMed1979

[Indices of tuberculosis and nonspecific respiratory diseases a contribution to the surveillance of these diseases (author's transl)].

The epidemiology of tuberculosis and nonspecific respiratory diseases in GDR is reviewed. For tuberculosis an exact survey on its development in the course of the last 30 years is possible by reason of compulsory registration. The program of tuberculosis control has been pushed on consequently from the very beginning; all indices of tuberculosis epidemiology (annual infection rate, incidence and prevalence of morbidity, mortality) have favourably developed. Till 1982 tuberculosis is expected to be eliminated as a special problem of public health in GDR. The assessment and statistic evaluation of the nonspecific respiratory diseases is much more difficult. There is no compulsory registration or notification; acute respiratory diseases are very common; the chronic pulmonary diseases clinically and prognostically important are insufficiently defined and, therefore, patients can be delimited only badly from the by far greater number of persons with chronic cough and sputum defined on the base of epidemiological aspects. The informative significance of secondary statistics (temporary disabelement, dismissals from hospital, invalidity- social parameters) is analyzed regarding their value for an evaluation of these diseases. Acute respiratory diseases have serious consequences on the sickness absence rate due to the percentage of case and duration of absenteeism (20--35% of all cases) of the considerable portion of hospital dismissals. In periods of epidemics disablement is still by far higher.

Adolescent↗
PubMed2004

Adjunctive thalidomide therapy for childhood tuberculous meningitis: results of a randomized study.

Childhood tuberculous meningitis is associated with serious long-term sequelae, including mental retardation, behavior disturbances, and motor handicap. Brain damage in tuberculous meningitis results from a cytokine-mediated inflammatory response, which causes vasculitis and obstructive hydrocephalus. Thalidomide, a potent tumor necrosis factor alpha inhibitor, was well tolerated and possibly showed some clinical benefit in children with tuberculous meningitis during a pilot study. The purpose of the present study was to assess the effect of adjunctive thalidomide in addition to standard antituberculosis and corticosteroid therapy on the outcome of tuberculous meningitis. Thalidomide (24 mg/kg/day orally) or placebo was administered in a double-blind randomized fashion for 1 month to patients with stage 2 or 3 tuberculous meningitis. The study was terminated early because all adverse events and deaths occurred in one arm of the study (thalidomide group). Thirty of the 47 children enrolled received adjunctive thalidomide, of whom 6 (20%) developed a skin rash, 8 (26%) hepatitis, and 2 (6%) neutropenia or thrombocytopenia. Four deaths (13%) occurred in patients with very severe neurologic compromise at baseline; two deaths were associated with a rash. Motor outcome after 6 months of antituberculosis therapy was similar in the two groups, even though the thalidomide group showed greater neurologic compromise on admission. In addition, the mean IQ of the two treatment groups did not differ significantly (mean IQ thalidomide group 57.8 versus mean IQ control group 67.5; P = .16). These results do not support the use of adjunctive high-dose thalidomide therapy in the treatment of tuberculous meningitis.

Adrenal Cortex Hormones↗
PubMed1979

[The tuberculosis situation in the German Federal Republic (author's transl)].

Based on a statistical anlaysis of the records the present tuberculosis situation in Germany and how it has developed during the past years are reviewed. The main means of control are: BCG vaccination, mass radiography and public health measures. Suggestions made by the Central Committee for the Control of Tuberculosis concerning surveillance and protection against occupational exposure to tuberculous infections are discussed. Recommendations regarding the assessment of incapacity for work and degree of disablement are evaluated. The aims and plans of the Committee for the next years, also in the international field, are reviewed.

BCG Vaccine↗
PubMedDate not supplied

Effect of drug-induced hyperuricaemia on renal function in Nigerians with pulmonary tuberculosis.

Some anti-tuberculosis chemotherapeutic agents have been established as causing hyperuricaemia. Hyperuricaemia in turn causes renal damage. This study therefore aims at establishing the effect of anti-tuberculosis drugs-induced hyperuricaemia on renal function of the patients. Fifty patients with newly diagnosed pulmonary tuberculosis with mean age of 36.8 years (SD 13.69) consisting of 14 females and 17 males were longitudinally studied each for 6 months to determine the effect of drug-induced hyperuricaemia on their renal function. The Biochemical indices determined included serum urate level, serum creatinine level, and creatinine clearance of newly diagnosed patient with tuberculosis, before and during treatment with anti-tuberculosis therapy. Serum urate level revealed that 16 (51.6%) and 15 (48.4%) of the patients were hyperuricaemic at the end of the first and second months of anti-tuberculosis therapy. There was no significant difference in the mean serum creatinine level of the control group 96 micromol/L when compared with both the pre-treat value 89 micromol/L (P > 0.25) as well as the value at the end of the sixth month of treatment 91 micromol/L (P > 0.40). However, there was a statistically significant difference in the mean creatinine clearance of the control group 102 ml/min/1.73 m2 when compared with the patient's mean pre-treatment value (89 ml/min/1.73 m2) P < 0.05. Also the mean creatinine clearance increased to (103 ml/min/1.73 m2) by the end of the 6th month of treatment, a value that is statistically significant when compared with the pretreatment value of (89 ml/min/1.73 m2) P < 0.05. We submit as follows: that pulmonary tuberculosis as a disease with significant impairment of renal function; despite the associated drug-induced hyperuricaemia recorded during the treatment, renal function steadily improved with the treatment of pulmonary tuberculosis to the extent that comparable values with control was obtained at the end of treatment. We conclude therefore that drug-induced hyperuricaemia associated with treatment of pulmonary tuberculosis has no detectable negative effect on renal function of the patient.

Adult↗
PubMed2006

Directly observed therapy for treating tuberculosis.

BACKGROUND: People with tuberculosis require treatment for at least six months. As many patients do not complete their treatment, policies have been introduced to encourage adherence to treatment regimens. One such policy is directly observed therapy, which involves people directly observing patients taking their antituberculous drugs. OBJECTIVES: To compare directly observed therapy (DOT) with self administration of treatment in people requiring treatment for clinically active tuberculosis or prevention of active disease. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (November 2005), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to November 2005), EMBASE (1974 to November 2005), LILACS (1982 to November 2005), and reference lists of articles. We also contacted researchers and organizations working in the field. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing a health worker, family member, or community volunteer routinely observing people taking antituberculous drugs compared with routine self administration of treatment at home. We include patients requiring treatment for clinically active tuberculosis or medication for preventing active disease. DATA COLLECTION AND ANALYSIS: Both authors independently assessed trial methodological quality and extracted data. Data were analysed using relative risks (RR) with 95% confidence intervals (CI) and the fixed-effect model when there was no statistically significant heterogeneity (chi square P > 0.1). Trials of drug users were analysed separately. MAIN RESULTS: Ten trials with 3985 participants met the inclusion criteria. There was no statistically significant difference between DOT and self administration of treatment for the number of people cured (RR 1.02, 95% CI 0.86 to 1.21, random-effects model; 1603 participants, 4 trials) or who were cured or completed treatment (RR 1.06, 95% CI 1.00 to 1.13; 1603 participants, 4 trials). Stratifying the location of the DOT by home or at a clinic suggests a possible small effect with home-based DOT (RR 1.10, 95% CI 1.02 to 1.18; 1365 participants, 3 trials). Two small trials of tuberculosis prophylaxis in intravenous drugs users found no statistically significant difference between DOT and self administration (199 participants, 1 trial), or a choice of location for DOT for completion of treatment (108 participants, 1 trial). AUTHORS' CONCLUSIONS: The results of randomized controlled trials conducted in low-, middle-, and high-income countries provide no assurance that directly observed therapy compared with self-administered treatment has any quantitatively important effect on cure or treatment completion in people receiving treatment for tuberculosis.

Antitubercular Agents↗
PubMed1981

[A computerized information system of bacillary tuberculosis in the Czech Socialist Republic (author's transl)].

The automated information system for bacillary tuberculosis is based on the registration of all positive mycobacterial examinations in the 43 tuberculosis laboratories in CSR. Data on the patient, the health service reporting, the kind of the material examined, and the actual microbiological examination including the identification of species and sensibility to antituberculotics are surrendered to the computer by means of a punched card or tape. On the base of the entrance information all sources are collected in the computer the data input being checked in regard to accuracy of the parts and logical relationship to the various variables. All sources of information of the data bank, made actual concerning the mycobacterial examinations are available to the programme. Another programme is supplementing the information on tests for identification and antituberculotic sensibility of the mycobacteria. With the aid of other programmes regular monthly summaries are done by the data bank for the cooperating laboratories and the specialists in the districts and countries. Finally another programme answers the evaluation of the annual reports of the mycobacterial investigations and reports on the epidemiological data of the diseased persons. In 1977 13,909 notifications of tuberculosis findings were analysed, coming from 3,782 persons. This analysis made evident the following conclusions reflecting the recent situation of mycobacteriologic diagnostics and the significance of the tuberculosis problem in communities with a low tuberculosis prevalence: a) The prevalence of bacillary tuberculosis in CSR (37/100,000) is ranging in the various districts between 27 and 44/100,000. The prevalence of persons with proof of mycobacteria already by smear amounts to 10/100,000 inhabitants. b) The highest portion of bacillary tuberculosis comes from persons with symptoms (45%), it amounts to 17% in persons with active tuberculosis already in dispensary care, to 15% in persons with fibrotic lesions and 14% in recidives. After a five year experience with the computerized information system of bacillary tuberculosis the authors recommended to centralize and to combine it with the central state tuberculosis register in order to utilize the data and evaluated in the level of the districts and countries as well for the management of the tuberculosis control programme in the level of the whole state.

Czechoslovakia↗
PubMed2001

The value of Ca 125 in the evaluation of tuberculosis activity.

The aim of the present study was to investigate the value of Ca 125, a tumour marker, in evaluation of pulmonary tuberculosis activity. This study included 96 subjects who were divided into three groups. Group 1 consisted of 40 patients with active pulmonary tuberculosis. Group 2 included 20 patients with inactive pulmonary tuberculosis. There were 36 healthy subjects in group 3. While measurement of serum Ca 125 level was performed only once in groups 2 and 3, Ca 125 levels were measured five times in group 1. The measurements were performed before the treatment, at the second, fourth and sixth months and the third year following the end of the treatment. Mean +/- SD serum Ca 125 concentrations were 109.7 +/- 86.9 U ml(-1) in group 1, 14.5 +/- 7.8 U ml(-1) in group 2 and 10.5 +/- 7.3 U ml(-1) in group 3. Serum Ca 125 levels were significantly higher in group 1 than in the other groups (P < 0.0001), but there was no significant statistical difference between the values of groups 2 and 3 (P > 0.05). Ca 125 levels in group 1 showed a significant decrease after treatment (P < 0.0001). For estimation of the activity of tuberculosis, the sensitivity and specificity of Ca 125 were found 97.5% and 100%, respectively at a 31 U ml(-1) cut-off point. Our results suggest that Ca 125 is beneficial in the determinaton of tuberculosis activity and in differentiation between active and inactive pulmonary tuberculosis.

Acute Disease↗
PubMed1990

Complement activation in pulmonary tuberculosis.

The alterations in serum/plasma levels of total haemolytic complement activity (CH50), complement components C3 and C3d, and circulating immune complexes (CICs) in patients with pulmonary tuberculosis were analysed in relation to the severity of disease and treatment status. The mean levels of CH50, C3, C3d and CICs were significantly higher in untreated than treated patients and in normal controls. In the untreated group, the level of each of these four parameters except C3d was significantly higher in patients with far advanced disease than in those with moderately advanced disease, whereas the difference between treated patients and normal controls was not statistically significant for any of the four parameters tested. There were statistically significant correlations between levels of CICs and both C3 and C3d in the untreated tuberculosis patients. However, the correlations for the same parameters were not significant when treated patients were considered. The CH50 levels in tuberculosis patients suggest a functional classical complement pathway, which is essential for immune complex solubilisation. High C3d level in untreated patients is indicative of increased complement activation, which in turn shows significant correlation with levels of CICs. It appears that the intact and elevated complement proteins and their proper activation by CICs prevents tuberculosis from becoming a typical immune complex disease.

Adult↗
PubMed1991

Adenosine deaminase levels in cerebrospinal fluid in tuberculosis and bacterial meningitis.

Adenosine deaminase activity was measured in cerebrospinal fluid of patients with confirmed tuberculous and bacterial meningitis. The values were compared with those of control subjects without meningitis. A statistically significant increase in the level of this enzyme was noted in the two types of meningitis, but no definite demarcation in the levels was observed between the two types. Therefore increases in adenosine deaminase activity may not be of such diagnostic significance as reported elsewhere.

Adenosine Deaminase↗
PubMed1985

HLA-antigens and tuberculosis in the Egyptian population.

Peripheral blood lymphocytes from 42 unrelated Egyptian patients with tuberculosis and 156 healthy persons were HLA phenotyped for the A,B and DR loci using the NIH lymphocytotoxicity tests. Statistical analysis of the results showed that A2 and B5 had significantly increased frequencies among patients with tuberculosis compared with the controls. Patients with A2 had more severe disease than did patients without A2 and the number with B5 antigen was less than those without the antigen. This observation suggests that A2 and B5 may influence susceptibility to tuberculosis, but not the course of the disease. Furthermore, a linkage disequilibrium was found between A2 and B5 antigen among tuberculous patients, but their association bore no relation to the severity of the disease.

Adolescent↗
PubMed1969

Epidemiological significance of the local reaction to direct BCG vaccination as assessed from a study in Mongolia.

Direct BCG vaccination has considerable operational advantages over the classical method of vaccinating only persons who do not react to tuberculin. In the present study it is shown that the direct method as applied in Mongolia does not cause any untoward reactions in persons who react to tuberculin and therefore can be considered a rational public health procedure.By reason of the repeated follow-up examinations, it was possible to obtain a clear picture of the development of the local BCG reactions and to test the hypothesis that these reactions may give information on pre-existing tuberculin sensitivity. It appeared impossible to deduce with any accuracy from either the local induration or the tissue destruction at the site of vaccination whether a person had tuberculin sensitivity before vaccination or not, and the results obtained with 2 different vaccines were inconsistent. It is therefore concluded that the local BCG reaction has no epidemiological significance in this respect.

Adolescent↗
PubMed2003

Correlation of serum tumor necrosis factor-alpha, interleukin-4 and soluble interleukin-2 receptor levels with radiologic and clinical manifestations in active pulmonary tuberculosis.

The precise clinical manifestations of tuberculosis are likely to result from a complex interaction between the host and the pathogen. We took serum samples from a group of patients with a variety of clinical and radiological stages of pulmonary tuberculosis in order to characterize tumor necrosis factor-alpha (TNF-alpha), interleukin-4 (IL-4) and soluble interleukin-2 receptor (sIL-2R) response. We further evaluated whether the levels of TNF-alpha, IL-4 and soluble IL-2R are related with each other, and also evaluated the levels of TNF-alpha, IL-4 and sIL-2R after anti-tuberculosis therapy and relation with radiologic scores. Forty-three inpatients with active pulmonary tuberculosis and 19 healthy controls participated in the study. Patients were divided into four categories radiologically on chest X-ray (minimal, moderate-advanced, far-advanced and with miliary infiltration). Concentrations of TNF-alpha (20.9+/-10/15.4+/-8 pg/ml) and sIL-2R (2569+/-842/1444+/-514 pg/ml) were statistically different between patients and controls (p=0.02 and p=0.0001, respectively). Before chemotherapy there was a positive correlation between TNF-alpha and sIL-2R (r=0.34), but there was no correlation between IL-4 and TNF-alpha, and between IL-4 and sIL-2R (r=-0.23 and r=-0.22). The TNF-alpha level was not statistically different in four groups before and after chemotherapy. Results of this study provided some evidence confirming the previously reported role of TNF-alpha, IL-4 and sIL 2R in the control of tuberculosis, but these cytokines were not found related with disease severity.

Adolescent↗
PubMed1976

Quantitative levels of immunoglobulin E in advanced tuberculosis.

Quantitative levels of immunoglobulin E (IgE) were determined in samples of sera obtained from 29 patients with proven moderate to far-advanced tuberculosis. The sensitive radioimmunoassay test for IgE was used. Statistical analysis of the results revealed no difference in IgE values as compared to a control group of normal sera. In contrast to other chronic pulmonary infections, such as bronchopulmonary aspergillosis, the IgE level in pulmonary tuberculous infection is of no diagnostic significance. Simultaneous determination of levels of immunoglobulins G, A, M, and D (IgG, IgA, IgM, IgD) in these same sera by radial immunodiffusion showed elevated IgG and lowered IgM levels in the tuberculous patients, confirming previous studies. The significance of these alterations in immunoglobulin levels is unclear and may represent a secondary phenomenon rather than a primary host response.

Adult↗
PubMed1998

Epidemiology of AIDS and tuberculosis among United States Veterans.

SETTING: US veterans. OBJECTIVE: To evaluate the frequency of the acquired immune-deficiency syndrome (AIDS) and tuberculosis (TB) among US veterans. DESIGN: Analysis of statistics for 1984-1993 from the Department of Veterans Affairs and the Centers for Disease Control and Prevention (CDC). RESULTS: For the first time in the available literature the incidence of AIDS and TB per 100000 were calculated for US veterans receiving health care from Veterans Administration Medical Centers (VAMC). Among these veterans, the incidence of AIDS in 1993 was 2.5-fold (P < 0.001) and the incidence of TB at least 1.3-fold (P < 0.001) higher than among the corresponding general population. The higher the incidences of AIDS and TB among general population of a state, the higher are the incidences of the diseases among veterans of this state (P < 0.001). A high correlation (r = 0.6, P < 0.001) between AIDS and TB among veterans was found. CONCLUSION: The study shows that US veterans receiving health care at VAMC are a high risk group for both AIDS and TB, and increased preventive measures are recommended. The spread of AIDS and TB among veterans of a state is probably determined by the spread of these diseases among the general population of that state.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Elaboration of economic methods of the management of tuberculosis control and their introduction into practice].

To increase the efficiency of antituberculosis measures, some efforts have been taken to improve on the basis of economic methods of management the structure of district tuberculosis control service financing and activities. The network of antituberculosis institutions is centralized into big tuberculous associations and ++inter-district dispensaries. ++Clinico-statistical groups, including the quality standards and the models of end results, i. e. the lists of indicators and their standard values, were developed to support mutual financial operations and quality evaluation efforts of the current activities. The amount of material incentive of the medical personnel directly depends on the quality of its work. In this way a material incentive of every medical worker, structural unit, institution and service as a whole is ensured in bringing up the effectiveness of the antituberculosis activities. Initial positive results have already been obtained.

Adult↗