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PubMed2003

Risk factors for tuberculosis infection in sub-Saharan Africa: a contact study in The Gambia.

Few studies have investigated the risk factors for tuberculosis (TB) infection in highly endemic countries. We conducted a household study in The Gambia, in which a tuberculin skin test (TST) was performed in members of the households of 315 smear-positive pulmonary TB cases and 305 community control subjects. The risk of being TST positive (10 mm or more) was higher in contacts of cases than in contacts of control subjects. It increased with age, male sex, and duration of stay in the household but was not associated with the presence of a bacille de Calmette-Guérin scar. Within the households of the TB cases, the risk of TST positivity was higher in males and was increased with age, social proximity to the case, and the radiologic extent of the disease in the case's chest X-ray. Adjusting on these, the risk of TST positivity was higher in first-degree relatives compared with more distant relatives and nongenetically related household members, but the effect was not statistically significant. In highly endemic areas, the risk of TB infection in contacts of TB infectious cases is associated with age, sex, intensity of exposure to the case, and severity of disease in the case, but it is possible that genetic factors contribute to the susceptibility to Mycobacterium tuberculosis infection.

Adolescent↗

PubMed1996

Video-assisted thoracoscopic anatomic lung resections. The initial Hong Kong experience.

We report our combined experience on video-assisted thoracoscopic (VAT) anatomic lung resections from two major hospitals in Hong Kong over a 17-month period. From August 1993 to December 1994, 82 cases of major lung resections were attempted using the VATS approach, of which 60 were successfully completed (55 lobectomies, 2 bilobectomies, 2 pneumonectomies, and 1 segmentectomy). Of these 60 cases, there were 43 men and 17 women with a mean age of 66 years (range, 37 to 85 years). The final pathologies were 52 primary lung cancers (37 adenocarcinoma, 11 squamous cell carcinoma, 2 bronchoalveolar carcinoma, 1 adenosquamous carcinoma, and 1 undifferentiated carcinoma); 1 pulmonary metastasis (from nasopharyngeal carcinoma); and 7 benign lesions (3 tuberculosis, 1 bronchiectasis, 1 sclerosing hemangioma, 2 organizing pneumonia). There was one postoperative death (mortality rate, 1.8%). Complications include persistent air leak over 10 days (four), wound infection (two), supraventricular tachycardia (three), and recurrence of tumor over the utility thoracotomy scar (one). All the patients were followed up from 8 weeks to 19 months (mean, 10 months). The mean duration of chest drainage was 5.4 days (range, 2 to 25 days). The mean hospital stay was 7.2 days (range, 4 to 35 days). The average postoperative parenteral narcotic (meperidine hydrochloride [Pethidine]) requirement by patient-controlled analgesia was 275 mg (range, 75 to 800 mg). This compared favorably with an age- and sex-matched historic group of patients who underwent posterolateral thoracotomy and had a hospital stay of 10.4 days (statistically non-significant) and narcotic requirement of 950 mg (statistically significant by paired t test). We conclude that VAT anatomic lung resection is technically feasible. However, there are some specific complications associated with major lung resection through minimal access. Refinement of our present technique and attention to details are important to improve our results.

Adenocarcinoma↗

PubMed2006

On the trail of pulmonary tuberculosis based on rib lesions: results from the Human Identified Skeletal Collection from the Museu Bocage (Lisbon, Portugal).

In the last 20 years, studies on human identified skeletal collections have revealed a significant relationship between new bone formation on the visceral surface of ribs and pulmonary tuberculosis (TB). To improve methods of differential diagnosis of respiratory diseases in archaeological skeletons, an investigation was conducted on 197 individuals from the Human Identified Skeletal Collection of the Museu Bocage (Lisbon, Portugal). This sample included 109 males and 88 females who lived during the 19th-20th centuries, with ages at death ranging from 13-88 years. The skeletons were grouped according to cause of death: 1) pulmonary TB (N = 84); 2) pulmonary non-TB diseases (N = 49); and 3) a control group (N = 64) composed of individuals randomly selected among the extrapulmonary non-TB causes of death. The ribs, sterna, scapulae, and clavicles were macroscopically observed. New bone formation on the visceral surface of ribs was recorded in 90.5% (76/84) of individuals who died from pulmonary TB, in 36.7% (18/49) with a pulmonary non-TB disease as cause of death, and in 25.0% (16/64) of the control group. These differences were statistically significant (P < 0.001). Furthermore, in individuals with pulmonary TB, the bony lesions presented mainly as lamellar bone on the vertebral end of the upper and middle thoracic rib cage. Proliferative alterations also occurred on one sternum and in nine clavicles and eight scapulae. This work strongly supports the results of similar studies performed on other documented collections, suggesting that new bone formation on ribs, although not pathognomonic, is a useful criterion for the differential diagnosis of pulmonary TB.

Adolescent↗

PubMed2001

The epidemiology of the homeless population and its impact on an urban emergency department.

OBJECTIVES: To characterize the homeless adult population of an urban emergency department (ED) and study the medical, psychiatric, and social factors that contribute to homelessness. METHODS: A prospective, case-control survey of all homeless adult patients presenting to an urban, tertiary care ED and a random set of non-homeless controls over an eight-week period during summer 1999. Research assistants administered a 50-item questionnaire and were trained in assessing dentition and triceps skin-fold thickness. INCLUSION CRITERIA: all homeless adults who consented to participate. Homelessness was defined as being present for any person not residing at a private address, group home, or drug treatment program. Randomly selected controls were concurrently enrolled with a 3:1 homeless:control rate. EXCLUSION CRITERIA: critically ill, injured, or incapacitated patients, or patients <21 years of age. Univariate analysis with appropriate statistical tests was used. The Mantel-Haenszel test was used to adjust for population differences. RESULTS: Two hundred fifty-two homeless subjects and 88 controls were enrolled. Data are presented for homeless vs control patients, and all p-values were <0.01. Odds ratios (ORs) with 95% confidence intervals (95% CIs) are given where appropriate: mean age (+/-SD) = 42 +/- 10 vs 48 +/- 13; male gender 95% vs 54% (OR = 17; 95% CI = 8 to 37); history of (hx) tuberculosis 49% vs 15% (OR = 2.5; 95% CI = 1.2 to 3); hx HIV infection 35% vs 13% (OR = 3.8; 95% CI = 1.8 to 8); hx penetrating trauma 62% vs 16% (OR = 8.62; 95% CI = 4.4 to 17.1); hx depression 70% vs 15% (OR = 13.4; 95% CI = 6.7 to 27); hx schizophrenia 27% vs 7% (OR = 5.1; 95% CI = 2.0 to 14); hx alcoholism 81% vs 15% (OR = 24; 95% CI = 12 to 49); significant tooth loss (>3) 43% vs 18% (OR = 3.3; 95% CI = 1.8 to 6.4); percentage of body fat 16.5% vs 19.7%; hx social isolation (no weekly social contacts) 81% vs 11% (OR = 33.3; 95% CI = 14 to 100); mean number of ED visits/year 6.0 vs 1.6. CONCLUSIONS: In the study population homelessness was associated with a history of significantly higher rates of infectious disease, ethanol and substance use, psychiatric illness, social isolation, and rates of ED utilization.

Adult↗

PubMed2000

[The monitoring of the drug resistance of the causative agent of tuberculosis in Russia in 1979-1998].

The Russian 1979-1998 annual reports of the centralized microbiology laboratories of the tuberculosis controlling service were used to examine the pattern and trends of formation of drug-resistance in the tuberculosis pathogen. The data on over 1.2 million cases of drug resistance to 7 antituberculous drugs were pooled. The analysis indicated that drug resistance had increased in two steps in the past 2 decades. The maximum levels of the drug resistance of Mycobacterium tuberculosis to some drugs were limited (7.8 and 37.2%), which are not greater those as indicated by the international statistics.

Antitubercular Agents↗

PubMed1991

[Seroprevalence of HIV-1 virus in Zaire. Analysis of 1404 subjects].

Between January and December 1989, 1,404 subjects (mean age 26 years) admitted or seen at the out-patient clinic of the hospital of Goma, Northern Kivu, were investigated for anti-HIV 1 antibodies by the ELISA and Western blot techniques. Seventy-eight out of 808 men (10 percent) and 127 out of 596 women (21 percent) were seropositive. Anti-HIV1 antibodies were found in 14/631 blood donors (2 percent), 25/241 in-patients awaiting blood transfusion (10 percent), 3/42 women hospitalized for complications of pregnancy (7 percent), 130/388 subjects with signs and/or symptoms of HIV1 infection (33 percent) and 33/102 patients with tuberculosis (32 percent). The difference in seropositivity between men and women was statistically significant. A significantly high seroprevalence was found in men who were having regular sexual intercourse with prostitutes (42/167 = 25 percent, P less than 0.01) and in subjects with a history of sexually transmitted disease during the last 5 years (64/180 = 36 percent, P less than 0.01), compared with subjects who had none of these risk factors. The installation of a blood bank where blood products are controlled has contributed to the reduction of HIV1 transmission throughout the town. The foundation of an association of unpaid voluntary blood donors recruited among secondary school students has been another educative measure in the anti-AIDS national plan.

Acquired Immunodeficiency Syndrome↗

PubMed2006

The effect of fertility control on the transmission of bovine tuberculosis in wild brushtail possums.

AIM: To determine the effect of fertility control on the rate of transmission of bovine tuberculosis (Tb), caused by Mycobacterium bovis, in brushtail possums (Trichosurus vulpecula). METHODS: At two study sites with a history of Tb infection in the resident possum population, a sample of adult male and female possums (n=50), determined by palpation to be Tb-free, was surgically sterilised by gonadectomy. A sample of untreated Tb-free male and female possums (n=54) served as controls. Each study site was trapped every 2 months over a 3-year period, and the Tb status of the individuals in the trial assessed. At the conclusion of the trial, all remaining experimental individuals were killed, necropsied and examined for characteristic lesions typical of Tb. The rate of transmission of Tb infection was estimated using the incidence of tuberculous cases in the experimental animals and comparing it between sites, sex and sterilisation treatment. RESULTS: Sterilisation by gonadectomy resulted in a reduction in the rate of transmission of Tb in male possums by 53%, but a corresponding increase in sterilised females for reasons that are still unclear. However, this interaction was statistically weak (p=0.10). When the sexes were combined, there was no overall effect of sterilisation on the rate of transmission of Tb (p=0.43). Sterility treatment notwithstanding, there was a highly significant difference in the rate of transmission between the sexes (p=0.01), being almost one order of magnitude higher in untreated males compared with untreated females. CONCLUSIONS: Although lacking strong statistical support, these results suggest that fertility control that targets endocrine control of fertility may provide some additional benefits for disease control over that achieved by reductions in population density, by reducing the rate of transmission of M. bovis in male possums. However, additional studies are needed to confirm the validity of these results. The large difference in the rate of transmission of M. bovis in untreated males compared with untreated females suggests that transmission of Tb among males may be an important driver of the dynamics of Tb infection in possums.

Animals↗

PubMed2002

Depressed interleukin-12 production by peripheral blood mononuclear cells after in vitro stimulation with the 30-kDa antigen in recurrent pulmonary tuberculosis patients.

Some patients develop recurrent tuberculosis (R-TB), even after successfully completing initial anti-tubercular treatment. Although R-TB may be caused by relapse or exogenous reinfection, little is known about the underlying host responses associated with R-TB. This study investigated the profile of cytokines [interferon (IFN)-gamma, interleukin (IL)-12, tumor necrosis factor (TNF)-alpha, IL-6, and IL-10] present in peripheral blood mononuclear cells (PBMCs) of 17 R-TB patients after stimulation with the 30-kDa antigen (Ag) or purified protein derivative (PPD) Ag of Mycobacterium tuberculosis. These data were compared with data obtained from 15 patients with newly diagnosed pulmonary TB (N-TB), 22 patients with treatment failure (TF-TB), and 19 healthy tuberculin reactors (HTR). N-TB and R-TB patients were enrolled in this study within 1 month of beginning anti-tubercular chemotherapy. ELISA results showed that IFN-gamma production following stimulation with the 30-kDa Ag was significantly lower in each group of TB patients than in the HTR controls. In addition, patients with R-TB showed the most significant IL-12 depression among the subject groups after in vitro stimulation with either Ag. Furthermore, a significant decrease in TNF-alpha and IL-10 levels was observed in R-TB patients relative to N-TB patients. However, there was no statistical difference in TNF-alpha and IL-10 production between R-TB patients, TF-TB patients, and HTR controls. Our findings suggest that the underlying mechanisms of cytokine regulation might differ between N-TB and R-TB patients, and that decreased IL-12 production in response to the 30-kDa or PPD Ag might be involved in the immunopathogenesis of human R-TB.

Antigens, Bacterial↗

PubMed2003

Tuberculosis epidemics driven by HIV: is prevention better than cure?

OBJECTIVE: To compare the benefits of tuberculosis (TB) treatment with TB and HIV prevention for the control of TB in regions with high HIV prevalence. DESIGN AND METHODS: A compartmental difference equation model of TB and HIV has been developed and fitted to time series and other published data using Bayesian methods. The model is used to compare the effectiveness of TB chemotherapy with three strategies for prevention: highly active antiretroviral therapy (HAART), the treatment of latent TB infection (TLTI) and the reduction of HIV transmission. RESULTS: Even where the prevalence of HIV infection is high, finding and curing active TB is the most effective way to minimize the number of TB cases and deaths over the next 10 years. HAART can be as effective, but only with very high levels of coverage and compliance. TLTI is comparatively ineffective over all time scales. Reducing HIV incidence is relatively ineffective in preventing TB and TB deaths over 10 years but is much more effective over 20 years. CONCLUSIONS: In countries where the spread of HIV has led to a substantial increase in the incidence of TB, TB control programmes should maintain a strong emphasis on the treatment of active TB. To ensure effective control of TB in the longer term, methods of TB prevention should be carried out in addition to, but not as a substitute for, treating active cases.

AIDS-Related Opportunistic Infections↗

PubMed2004

[A study on the Th1/Th2 cytokines in the pathogenesis of human tuberculous pleuritis].

OBJECTIVE: To evaluate the distribution characteristics of Th1-type cytokines (IFN-gamma and IL-2) and Th2-type cytokines (IL-4 and IL-10) in the serum and the pleural effusion in patients with pleural tuberculosis, therefore to gain insight into the possible role of the local and the systemic Th1/Th2 cell-mediated immune response in the pathogenesis of human pleural tuberculosis. METHODS: The concentrations of IFN-gamma, IL-2, IL-4, and IL-10 in the serum and the pleural effusion of patients with pleural tuberculosis (Group pleuritis) were measured with enzyme linked immuno-sorbent assay (ELISA). The serum levels of the four cytokines were compared with those of patients with pulmonary tuberculosis (Group tuberculosis) and of healthy controls with positive reaction to PPD skin test (Group healthy). RESULTS: (1) The median concentrations of IFN-gamma, IL-2, IL-4, and IL-10 in serum were 118.60 ng/L, 0.00 ng/L, 1.49 ng/L, and 0.00 ng/L respectively in Group pleuritis, 265.75 ng/L, 18.03 ng/L, 16.00 ng/L, and 0.00 ng/L respectively in Group tuberculosis; and 221.70 ng/L, 18.52 ng/L, 16.00 ng/L, and 0.00 ng/L respectively in Group healthy. (2) For IFN-gamma and IL-2, there existed no statistical differences among the three groups (K-W chi(2) value was 1.15 and 4.68, P > 0.05); For IL-4 and IL-10, there existed no statistical differences between Group tuberculosis and Group healthy (Mann-Whitney Z value was -0.27 and -1.93, P > 0.05), but the level of IL-4 in Group pleuritis was lower than that in Group tuberculosis (Mann-Whitney Z value was -2.84, P < 0.01). (3) The ratio of the median of IFN-gamma to IL-4 in serum was 27.93 in Group pleuritis, 21.72 in Group tuberculosis, and 10.82 in Group healthy respectively. There existed no statistical difference among the three groups (K-W chi(2) value was 4.18, P > 0.05). (4) The median concentrations of IFN-gamma, IL-2, IL-4, and IL-10 in pleural effusion of Group pleuritis were 823.37 ng/L, 43.76 ng/L, 26 ng/L and 38.69 ng/L respectively, each being statistically higher than that in the serum (Wilcoxon Signed Rank test Z value was -4.34, -2.82, -3.29 and -5.15, P < 0.05). CONCLUSIONS: Immunocompetent persons including patients with pleural tuberculosis, with pulmonary tuberculosis or the healthy with positive results to PPD test, showed similar systemic Th1 response to Mycobacterium bacilli. Due to the relatively lower level of systemic Th2 response, patients with pleural tuberculosis had higher systemic Th1/Th2 level and the enhancement of local Th1 and Th2 responses in the pleural cavity was a pathophysiologic characteristic of human pleural tuberculosis. Both Th1 and Th2 responses might play an important role in the pathogenesis of human pleural tuberculosis.

Adolescent↗

PubMed2005

Selected RD1 peptides for active tuberculosis diagnosis: comparison of a gamma interferon whole-blood enzyme-linked immunosorbent assay and an enzyme-linked immunospot assay.

We recently set up a gamma interferon (IFN-gamma) enzyme-linked immunospot assay (ELISPOT), using selected early secreted antigenic target 6 (ESAT-6) peptides, that appears specific for active tuberculosis (A-TB). However, ELISPOT is difficult to automate. Thus, the objective of this study was to determine if the same selected peptides may be used in a technique more suitable for routine work in clinical laboratories, such as whole-blood enzyme-linked immunosorbent assay (WBE). For this purpose, 27 patients with A-TB and 41 control patients were enrolled. Our WBE, using the already described selected peptides from ESAT-6 plus three new ones from culture filtrate protein 10, was performed, and data were compared with those obtained by ELISPOT. Using our selected peptides, IFN-gamma production, evaluated by both WBE and ELISPOT, was significantly higher in patients with A-TB than in controls (P < 0.0001). Statistical analysis showed a good correlation between the results obtained by WBE and ELISPOT (r = 0.80, P < 0.001). To substantiate our data, we compared our WBE results with those obtained by QuantiFERON-TB Gold, a whole-blood assay based on region of difference 1 (RD1) overlapping peptides approved for TB infection diagnosis. We observed a slightly higher sensitivity with QuantiFERON-TB Gold than with our WBE (89% versus 81%); however, our test provided a better specificity result (90% versus 68%). In conclusion, results obtained by WBE based on selected RD1 peptides significantly correlate with those generated by ELISPOT. Moreover, our assay appears more specific for A-TB diagnosis than QuantiFERON-TB Gold, and thus it may represent a complementary tool for A-TB diagnosis for routine use in clinical laboratories.

Antigens, Bacterial↗

PubMed2005

Cattle movements and bovine tuberculosis in Great Britain.

For 20 years, bovine tuberculosis (BTB) has been spreading in Great Britain (England, Wales and Scotland) and is now endemic in the southwest and parts of central England and in southwest Wales, and occurs sporadically elsewhere. Although its transmission pathways remain poorly understood, the disease's distribution was previously modelled statistically by using environmental variables and measures of their seasonality. Movements of infected animals have long been considered a critical factor in the spread of livestock diseases, as reflected in strict import/export regulations, the extensive movement restrictions imposed during the 2001 foot-and-mouth disease outbreak, the tracing procedures after a new case of BTB has been confirmed and the Government's recently published strategic framework for the sustainable control on BTB. Since January 2001 it has been mandatory for stock-keepers in Great Britain to notify the British Cattle Movement Service of all cattle births, movements and deaths. Here we show that movements as recorded in the Cattle Tracing System data archive, and particularly those from areas where BTB is reported, consistently outperform environmental, topographic and other anthropogenic variables as the main predictor of disease occurrence. Simulation distribution models for 2002 and 2003, incorporating all predictor categories, are presented and used to project distributions for 2004 and 2005.

Agriculture↗

PubMed2003

Comparative analysis of HLA class I antigens in pulmonary sarcoidosis and tuberculosis in the same ethnic group.

OBJECTIVE: To compare occurrences of respective HLA class I antigens in patients with sarcoidosis (SA), patients with tuberculosis (TB), and healthy controls in the same ethnic group in Poland. PATIENTS AND METHODS: HLA-A, -B, and -C antigens were determined from 1994 to 1997 by using the National Institutes of Health method in 100 patients with SA, 100 patients with TB, and 100 healthy controls. Frequencies of specific antigens were compared among the 3 groups. RESULTS: Our study showed that among SA patients, the HLA-B51(5) and HLA-B8 antigens tended to be more common and the HLA-B13, -B35, and -Cw4 antigens tended to be less common than in the controls. However, after Bonferroni correction, only the HLA-B35 antigen was found to be significantly different in SA patients and controls. In TB patients, the expression of HLA-B62(15) and HLA-Cw5 antigens tended to be more common compared with controls and HLA-A2 less common compared with controls, but only the differences in B62(15) and Cw5 were significant after Bonferroni correction. HLA-B51(5) and HLA-B8 antigens were statistically more frequent and B13, B62(15), and Cw4 less frequent in SA than in TB patients and remained significant after Bonferroni correction. The occurrence of other antigens studied in both populations was comparable. CONCLUSION: We identified associations of HLA class I antigens in patients with SA or TB, with an expression pattern specific and different for each group.

Adult↗

PubMed1995

Proportionate mortality from pulmonary tuberculosis associated with occupations--28 states, 1979-1990.

The risk for occupational exposure to tuberculosis (TB) is increased among healthcare and other workers exposed to persons with active TB, workers exposed to silica or other agents that increase the risk of progression from latent infection to active TB, and workers in occupations associated with low socioeconomic status (SES). Accurate estimates of and surveillance for occupationally associated TB are limited because reports of incident TB cases lack comprehensive occupational data (1). Although occupation is routinely recorded on death certificates, this information is not routinely coded and entered into vital statistics data files. To identify occupations associated with increased risk for TB mortality, CDC's National Institute for Occupational Safety and Health (NIOSH) used data from the National Occupational Mortality Surveillance (NOMS) database to conduct a proportionate mortality study of persons with pulmonary TB by occupation for 1979-1990 (the most recent year for which data were available). This report presents the findings of the study.

Female↗

PubMed2006

Immunity status in children with Bacille Calmette-Guerin adenitis. A prospective study in Tehran, Iran.

OBJECTIVE: To determine the immunity status of children with Bacille Calmette-Guerin (BCG) lymphadenitis (patient group) and unaffected children (control group) in Iran. METHODS: We performed this longitudinal case-control study on 75 children between 2 months to 14 years old in Rasool Akram and Markaz Tebbi Hospital, Tehran, Iran during the period of 2 years (2000-2002). RESULTS: Ninety percent of patients had normal immunoglobulin, 10% had low level, 96.1% had normal nitro blue tetrazolium test and 3.9% had lower activity. There was a significant difference in the total lymphocyte CD3, CD8, CD19, CD16/CD56 and natural killers (NK) cell but no significant difference in the CD4/CD8 ratio and CD4 between case (n=75) and control (n=100) groups. Thirty-eight cases with mild lymphopenia, isolated CD4, CD3, CD19, NK cells (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients were observed. Thirty-eight cases were diagnosed as mild immune deficient without any previous recurrent infections (mild lymphopenia; Isolated CD4; CD3 or CD19 deficiency. Natural killers (CD16/CD56) deficiency in 3 (22%); idiopathic disseminated BCG infection (unknown immunodeficiency type) in 3 (22%) patients. The natural killers (CD16/CD56) deficient cases responded well to 3 antimycobacterial drugs without immunomodulator. Natural killers cell deficiency not yet reported as a risk factor for progression and complication of BCG infection. All cases of idiopathic disseminated BCG infection (unknown immunodeficiency type) with nonlethal and indulgent BCG infections responded well to needle aspiration and antimycobacterial drugs with immunomodulator (gamma interferon). CONCLUSION: In cases with multiple and recurrent BCG lymphadenitis without any previous recurrent infection complete immunological studies should be carried out. Most cases with mild immune deficiency usually response well to needle aspiration alone or combine with antimycobacterial drugs. The combination of IFN-gamma and chemotherapy in cases of idiopathic disseminated infections caused by BCG and without previous recurrent other infection except mycobacterium species, can limit the disease.

Adolescent↗

PubMed2004

Treatment and follow-up of HIV-negative multidrug-resistant tuberculosis patients in an infectious diseases reference hospital, Buenos Aires, Argentina.

SETTING: An Argentinean reference hospital specialising in infectious diseases. OBJECTIVE: To assess the outcomes of all human immunodeficiency virus (HIV) negative multidrug-resistant tuberculosis (MDR-TB) patients referred to or diagnosed at Hospital Muñiz. DESIGN: Clinical study for the period 1996-1999, with follow-up until June 2002. RESULTS: One hundred and forty-one adult patients (52.5% female) with resistance to two to seven drugs were studied. Fifty patients (35.5%) had not been treated previously. The most frequently used second-line drugs were 5-F-quinolones, cycloserine and ethionamide in susceptibility based individually tailored three- to five-drug regimens. Hospital admission was associated with treatment success. Forty-five episodes of severe toxicity occurred. Treatment was successful in 51.8% of cases, but follow-up of 73 patients yielded 11.9% relapse. The mortality rate was 19.1% and default was 19.9%. Logistic regression analysis was statistically significant for treatment success in relation to patient admission, residence and resistance pattern. CONCLUSION: The burden of MDR-TB in this setting--prolonged infection, treatment cost and difficulties, low rates of cure and treatment adherence and high rates of fatality and relapse--can be improved by strengthening TB control programme activities and fighting against poverty and HIV/AIDS.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

[Study investigating infection in contacts of tuberculosis patients in a semi-urban area].

INTRODUCTION: The most important factors for establishing priorities in studies of contacts are the bacteriological status of the patient and the degree of exposure of contact persons to the index case. The aim of the present study was to analyze the results of tuberculosis contact tracing and the relationship between these results and the bacteriological situation of the index case and the proximity of exposure. METHODS: We studied the contacts of tuberculosis cases examined in the Center for Tuberculosis Control and Prevention of Lleida (a city in the autonomous region of Catalonia, Spain) over the period 1991-1997. The Mantoux test with 2 TU of PPD-RT23 was used to identify infected persons. Diagnosis of tuberculosis disease was made on evidence from the clinical situation, chest radiography and bacteriological status. Associations between infection or disease in the contact, and the bacteriological status of the index case and proximity of exposure, were analyzed. The chi-square test was used for statistical analyses; significance was set at a p value of, 0.05. The odds ratio was calculated as a measure of association. RESULTS: The prevalence of tuberculosis infection among the contacts was 44% (763/1733). Tuberculin conversion was observed in 7.8% of contacts, and 31 new cases of tuberculosis were detected (1.8%). The percentages of tuberculosis infection, tuberculin conversion and case detection were higher among persons exposed to sputum smear-positive patients and among those in close contact with the index case. Contact infection was more highly associated with the bacteriological status of the index case and degree of proximity of exposure when the analysis was restricted to contacts less than 15 years old. Case detection was 4% among close contacts living with a sputum smear-positive patient. CONCLUSIONS: Investigation into tuberculosis contacts offered a high yield of detection of infected contact persons and new tuberculosis cases, even among contacts of culture-negative pulmonary tuberculosis patients and contacts of extrapulmonary tuberculosis patients.

Adolescent↗

PubMed2004

Disposition of uric acid upon administration of ofloxacin alone and in combination with other anti-tuberculosis drugs.

Disposition of uric acid upon administration of ofloxacin (O) alone and in combination with other anti-tuberculosis drugs, rifampicin (R), isoniazid (H) and pyrazinamide (Z) was studied. Twelve male healthy volunteers were investigated on four different occasions with the four drugs alone or in combinations. A partially balanced incomplete block design was adopted and the subjects were randomly allocated to each group. Uric acid concentration in urine samples excreted over 0-8 hr, were determined after coding the samples. There was significant decrease in the group receiving Z when compared to other groups. Though there was a decrease in uric acid excretion in the group receiving O, it was not statistically significant. Rifampicin and H seem to increase the uric acid excretion. The incidence of arthralgia was mainly due to Z and not due to either O or other drugs in the treatment of pulmonary tuberculosis.

Adult↗