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PubMed2005

A registry of tuberculous meningitis in Hong Kong.

BACKGROUND: A prospective observational study of the presentation, diagnosis, treatment and outcome of tuberculous meningitis (TBM). METHODS: Demographic characteristics, clinical information, treatment and progress of TBM patients were followed. Their outcomes were ascertained every 6 months for 3 years after diagnosis. Prognostic factors associated with death or full recovery were examined using multivariate Cox's and logistic regression models, respectively. RESULTS: Between 1993 and 2000, 166 TBM patients were recruited. Their mean age was 42.9, 153 were Chinese and 81 were males; 92% received HRZS (H = isoniazid; R = rifampicin; Z = pyrazinamide; S = streptomycin), HRZE (E = ethambutol) or HRZES. Steroids were given to 105 patients, with no significant effect on outcome. After 3 years of follow-up, 110 patients had completely recovered, 20 survived with disability and 26 died. Death was significantly associated with older age, lower cerebrospinal fluid (CSF) lymphocyte and poorer consciousness levels at the time of presentation, while full recovery was associated with younger age, being female and absence of complications. CONCLUSIONS: Relatively good outcomes of TBM cases were documented in this Hong Kong study with a case-fatality ratio of 15.7% (26/166) up to 3 years. Early recognition, diagnosis and administration of effective treatment regimens were probably the most important factors in reducing mortality and morbidity.

Adolescent↗

PubMed2006

A community-based TB drug susceptibility study in Mimika District, Papua Province, Indonesia.

SETTING: A district level tuberculosis (TB) control programme in Papua Province, Indonesia. OBJECTIVE: To determine the nature and extent of drug-resistant TB in newly diagnosed sputum smear-positive patients. METHODS: Sputum was collected from previously untreated smear-positive pulmonary TB patients diagnosed in the district over a 10-month period. Sputum specimens were processed and inoculated into a BACTEC MGIT960 tube. Isolates were identified by Ziehl-Neelsen staining, hybridisation with nucleic acid probes and biochemical investigations. Susceptibility testing was performed using the radiometric proportion method. Pyrazinamide testing was performed using the Wayne indirect method. RESULTS: One hundred and seven patients had sputum sent to a reference laboratory; 101 (94.4%) were culture-positive for Mycobacterium tuberculosis, with 87 (86.1%) fully sensitive to first-line anti-tuberculosis drugs. Two per cent were multidrug-resistant (MDR-TB) and 12 (11.9%) had other drug resistance. Each of the MDR-TB isolates was susceptible to amikacin, capreomycin, ciprofloxacin and para-aminosalicylic acid (PAS), but were resistant to rifabutin. One isolate was also resistant to ethionamide. CONCLUSIONS: MDR-TB is present in Indonesia but is not a major problem for TB control in this district. Generalisability to other districts in Indonesia, particularly large urban areas, needs to be confirmed by future studies.

Adolescent↗

PubMed2006

Tuberculosis in county jail prisoners in the western sector of the city of São Paulo, brazil.

SETTING: Tuberculosis (TB) status among county jail prisoners in the western sector of the city of São Paulo, Brazil. OBJECTIVE: To estimate the prevalence of TB disease and the rate of TB infection in prisoners. DESIGN: An observational study was conducted in 2000-2001 among 1052 prisoners in nine São Paulo county jails. After the application of an interview and tuberculin skin testing (TST), the following laboratory investigations were carried out: sputum smear examination and culture, identification and drug sensitivity testing. RESULTS: Of 1052 prisoners, 932 underwent TST (PPD RT23 - 2TU/0.1 ml) and 64.5% were reactors. The prevalence rate of prisoners with active TB per 100,000 prisoners was 2065, around 70 times higher than among the Brazilian population and 79 times higher than in the population of the city of São Paulo. Among the 21 Mycobacterium tuberculosis strains identified, 85.7% were sensitive and 9.5% were resistant to isoniazid (INH) and rifampicin (RMP); 4.8% of the total were resistant to INH, RMP and pyrazinamide. CONCLUSION: TB prevalence and infection rates were much higher in prisoners than among the general population.

Adolescent↗

PubMed1991

[Intra-macrophagic activity of antibiotics combinations against Mycobacterium marinum].

Fourteen strains of Mycobacterium marinum were isolated from patients with granulomatous skin lesion. All the strains were resistant to isoniazid and pyrazinamid and five resistant to rifampicin. The following antibiotics are used alone or in combination: ethambutol, rifabutin, ciprofloxacin, temafloxacin, erythromycin, clarithromycin, minocyclin. Minimal inhibitory concentrations are evaluated using agar dilution method. After what, activity of antibiotics against Mycobacterium marinum strains within human macrophages in investigated. After treating the monolayers at 24 and 96 h, a bactericidal effect is observed with rifabutin, ciprofloxacin, temafloxacin, clarithromycin and minocyclin. Combinations of ciprofloxacin, temafloxacin or clarithromycin with ethambutol and rifabutin produced synergistic effect.

Anti-Infective Agents↗

PubMed2005

[Accuracy of treatment regimens performed in patients with culture positive pulmonary tuberculosis].

The key element in any tuberculosis control is the early diagnosis and prompt initiation of effective therapy. This is especially important in the smear-positive patients, who are the main source of infection in the community. A six month regimen comprising rifampin, isoniazid, pyrazinamide and ethambutol/streptomycin for the initial 2 months followed by rifampin and isoniazid for a next 4 months is the recommended standard treatment for pulmonary tuberculosis. The retrospective study was designed to investigate accuracy of treatment regimens performed in patients with culture positive pulmonary tuberculosis (CPPT). Medical records of patients with CPPT treated in Warsaw, Gdansk and Siedlce in 1995 and 2000 were reviewed. Median delay in the treatment of active tuberculosis was 16 days in 1995 and 11 days in 2000. In both study groups the most patients were given the standard treatment but in only 31.8% of cases in 1994 and 34.1% in 2000 duration of chemotherapy was in accord with current guidelines. In 60.3% of cases in 1995 and in 54.1% in 2000 the treatment was prolonged without obvious reason. This is demonstrating not satisfactory acceptance of short-course therapy by physicians. Treatment given too long increas the cost of therapy, lead to more side-effects and to poor patients compliance.

Antitubercular Agents↗

PubMed2006

[A case of severe intestinal tuberculosis, treated with ciprofloxacin, kanamycin and prednisolone].

A 31-year-old man was admitted to our hospital because of frequent diarrhea. Colonoscopy showed ring ulcers on the rectum and ascending colon and chest X-ray showed abnormal shadows which were diagnosed as tuberculosis by sputum PCR. He started treatment with isoniazid (INH), rifampicin (RFP), pyrazinamide (PZA) and streptomycin (SM), however, eruption and ileus were seen. Then, he was retreated with ciprofloxacin (CPFX), kanamycin sulfate (KM) and prednisolone (PSL). Subsequently, we added RFP and further added calcium para-aminosalicylate (PAS). All these treatment was effective, and he was discharged from the hospital.

Adult↗

PubMed2006

[A case of pulmonary tuberculosis complicated with an orthotopic liver transplantation].

The infectious disease is one of the most important complications related to the organ transplantation. Patients using immunosuppressive agents often present atypical tuberculosis and the treatment of such case is far more difficult in some cases due to the liver damage and/or the drug interaction. We report a case of pulmonary tuberculosis in a patient of 60-year-old man using tacrolimus after an orthotopic liver transplantation. He had liver transplanted orthotopically for the long-term history of chronic hepatitis B and subsequent liver failure on January 28, 2004. An abnormal shadow was first detected on his chest X-ray film on October, 2004. He was admitted to our hospital after the smear of the gastric juice showed some acid-fast bacilli and tubercle bacilli were confirmed by polymerase chain reaction (PCR). Tuberculin skin test was positive (erythema 10 x 10) and the computed tomography (CT) scan of his chest revealed a nodular opacity with some smaller nodules scattered around in the right upper lobe. We started four anti-tuberculous drugs other than pyrazinamide (PZA) and rifampicin (RFP), which included isoniazid (INH), ethambutol (EB), streptomycin (SM), levofloxacin (LVFX). The liver enzyme was transiently elevated (AST 123 IU/I, ALT 103 IU/I) but improved after desensitization against INH. The blood concentration of tacrolimus preserved between 5 and 7 ng/ml and there was no need to change the dosage.

Humans↗

PubMed2006

Improvements in treatment success rates with directly observed therapy in Rio de Janeiro City.

SETTING: Rio de Janeiro City, Brazil. OBJECTIVE: To evaluate the effect of directly observed therapy (DOT) on treatment success, by comparing the treatment success rates between patients treated under DOT with those who received self-administered therapy (SAT). DESIGN: A longitudinal study in a cohort of tuberculosis (TB) patients. Of 9929 new pulmonary TB cases, 1190 (12%) were treated under DOT and 8739 (88%) under SAT. All patients received a three-drug regimen consisting of rifampicin (RMP), isoniazid (INH) and pyrazinamide for 2 months followed by 4 months of RMP and INH. RESULTS: Patients under DOT were more likely to convert to sputum-negative at the end of the second month than those treated under SAT (86.3% vs. 61.9%, P < 0.001). DOT alone was significantly associated with successful treatment (OR 1.6, 95%CI 1.37-1.86, P < 0.001), even when controlled by sex, age and positive smear or culture at enrollment (OR 1.56, 95%CI 1.33-1.82, P < 0.001). CONCLUSION: This pilot DOTS implementation phase showed that DOT is highly effective and feasible in a large urban centre of a developing country.

Adult↗

PubMed2006

[Tuberculous abscess in the chest wall; report of a case].

A 72-year-old woman was admitted to our hospital with left chest pain. Chest computed tomography (CT) revealed an abscess in the left lateral chest wall. Bacterial examination of needle aspiration biopsy specimen from the chest wall abscess disclosed positive acid-fast bacilli. The size of chest wall abscess increased after initiation of antituberculous therapy with isoniazid, rifampicin, ethambutol hydrochloride and pyrazinamide, and therefore abscess drainage was subsequently performed. The lesion was resected after the abscess had diminished in size.

Abscess↗

PubMed1991

Successful treatment of tuberculous peritonitis while maintaining patient on CAPD.

Although conventional wisdom advises removal of the Tenckhoff catheter as part of the therapy for tuberculous peritonitis, there are a few recent reports of cases successfully treated while maintaining the patients on CAPD. We wish to report three cases treated without interrupting CAPD. In two of the patients, cultures were positive for Mycobacterium tuberculosis and in the third case, although the cultures were negative, the patient improved on anti-Tb medications. Smear for AFB was positive in one patient; and two had a positive PPD. All had predominance of lymphocytes and monocytes in effluent. The total WBC count was 160-300 and two patients had fever. All had abdominal pain. One patient was treated with INH and ethambutol; one with INH and rifampin and one (who was suspected of being HIV+) also received pyrazinamide (PZA) until culture was available. Cultures grew in 4-6 weeks. All were started on therapy prior to having the culture results, and all showed clinical improvement within two weeks. One patient had his catheter replaced two months later because of pseudomonas peritonitis, continued on CAPD for an additional five months, then changed to HD because of recurrent bacterial peritonitis. One patient died of complications of diabetic vascular disease three months later with no evidence of peritonitis. One patient has remained on anti-Tb treatment for seven months and is doing well on CAPD.

Adult↗

PubMedDate not supplied

Worsening of steroid dependent asthma : A possible role of rifampicin.

A 40-year-old male patient with chronic steroid dependent asthma developed pulmonary tuberculosis. After administration of antituberculosis therapy with rifampicin, isoniazid and pyrazinamide his asthma worsened. Omission of rifampicin from the drug regimen successfully controlled bronchospasm.

Adult↗

PubMedDate not supplied

Drug provocation test in patient with antituberculosis drug allergy.

Hypersensitivity reaction is an unexpected drug adverse effect which sometimes can lead to fatal condition. Confirmation of the suspected drugs that cause hypersensitivity reaction is sometimes difficult. Drug provocation test is still a gold standard to establish the diagnosis of hypersensitivity to certain drugs or agents. Drug provocation test is a controlled drug treatment which aims at making diagnosis of hypersensitivity reaction to drugs. We reported a demonstration case of a 47 year-old female patient with hypersensitivity to anti tuberculosis drugs (isoniazid, rifampicin, pyrazinamid and ethambutol). Drug provocation test is important in this case to confirm which drug had caused hypersensitivity reaction because anti tuberculosis drugs were the treatment of choice for her illness.

Antitubercular Agents↗

PubMed2006

[Transient worsening of chest radiograph and development of lymphadenopathy during chemotherapy for miliary tuberculosis].

A-37-year old woman was referred to our hospital because of bilateral pulmonary micronodular shadows on chest X-ray. Prednisolone was reported to be administered for her coughs and dyspnea more than a month, but was discontinued recently. Under the diagnosis as miliary tuberculosis, we started to treat her with the combined use of pyrazinamide, isoniazid, rifampicin, and ethambutol. Then her symptoms subsided gradually. Two months later, however, high fever developed, followed by exacerbation of the radiographic shadows, and marked cervical and mediastinal lymphadenopathy. We considered them so-called paradoxical worsening, and continued the antituberculosis therapy unchanged. Those clinical manifestations began to subside about 4 months after the initiation of the treatment. Paradoxical worsening has been described as a relatively rare manifestation, and seem to be attributable to prompt recovery of the immunity to mycobacterial antigens after the use of antituberculous therapy. We considered that, in this case, disseminated tuberculosis and firstly administered steroid that might suppress immune function, and discontinuation of steroid therapy followed by the bactericidal antituberculous chemotherapy were associated with the development of the paradoxical reactions, by analogy with immune reconstitution syndrome frequently reported in HIV-related tuberculosis patients.

Adult↗

PubMed2006

[A case of pulmonary Mycobacterium shimoidei infection].

A 68 year-old male who was ex-smoker presented with fever and cough. Chest radiograph showed infiltrative shadows in both upper lung fields. A sputum smear for acid-fast bacilli was positive. But the isolate was not identified by polymerase chain reaction method. Acid-fast bacilli were cultured from sputum, but the identification was not done by DNA-DNA hybridization method. Mycobacterium shimoidei was identified by 16S ribosomal RNA sequencing with 98.42% matching. Rifampicin, ethambutol, clarithromycin, pyrazinamide, and ciprofloxacin were administered, and the symptom and abnormal shadows on chest radiography improved. And three months later from the initiation of treatment, sputum smear for acid-fast bacilli became negative. Chest CT scan four months after treatments showed decrease of infiltrative shadows. We had treated him for six months, and after that no recurrence occurred.

Aged↗

PubMed1990

[The pyrazinamidase activity of bacteria of the genus Yersinia].

A modified nutrient medium, made of reagents and standard media manufactured in this country, tried in practice, is suggested for Yersinia pyrazinamidase test. Tisamid (Finland), a pyrazinamide antituberculosis agent was used as substrate. A positive test is characteristic of nonpathogenic and a negative one for pathogenic Yersinia. The test and the medium may be effectively used in laboratory diagnostic studies for identification of Yersinia.

Amidohydrolases↗

PubMed2006

[A case of Mycobacterium abscessus pulmonary infection; effectiveness of clarithromycin, amikacin and imipenem/cilastatin].

A 42-year-old woman presented with persistent cough, bloody sputum and fever. Her chest X-ray film showed an infiltrative shadow with cavitation in the upper lobe of the left lung. Acid-fast-bacilli were shown by sputum smear staining. The anti-tuberculosis drugs isoniazid, refampicin, ethambutol and pyrazinamide were prescribed, but her symptoms and chest X-ray findings did not improve. Findings of MTD and MAC-PCR were negative but Mycobacterium abscessus was confirmed by sputum culture with the DNA hybridization method. Combination therapy with clarithromycin, amikacin and imipenem/cilastatin for one month improved her symptoms and chest X-ray shadow, and clarithromycin monotherapy was carried out for another ten months. Drug susceptibility tests revealed this mycobacterium was sensitive to clarithromycin and amikacin. To determine the environmental factors related to this infection, several samples were examined. Acid-fast-bacilli were present in a smear from the bath room drain. However, to confirm the infectious routes, longer observation is needed. Moreover, serum amyloid protein A and ESR were useful markers to estimate the clinical course.

Adult↗

PubMed2006

[A case of giant tumorous shadow by pulmonary tuberculosis].

A 63-year-old woman who had been treated for myelodysplastic syndrome had a high fever. Chest radiography and computed tomography revealed a giant tumorous shadow from the right mediastinum to the hilum. She was treated with antibiotics but with little effect. The culture of bronchial washing fluid and sputum revealed Mycobacterium tuberculosis infection. There were no malignant cells in the sputum or bronchial washing fluid. Tumor markers were within normal limits. She was treated with isoniazid, rifampicin, streptomycin and pyrazinamide. On the sixth day of treatment, high fever disappeared, and sputum culture for tuberculosis became negative after two months. The size of the mass decreased with clinical improvement. The final diagnosis was pulmonary tuberculosis with mediastinal lymphadenopathy. Since the patient was a compromised host, the giant mass was considered to be induced by atypical response to mycobacterial infection.

Antitubercular Agents↗

PubMed2006

[Case of tuberculous psoas abscess successfully treated with surgery during antituberculosis therapy for miliary tuberculosis].

A case of tuberculous psoas abscess complicated during antituberculosis therapy for miliary tuberculosis and successfully treated with surgery was reported. A 20-year-old man visited our hospital because of fever lasting for 3 months. Chest radiography showed miliary nodules in both lungs and transbronchial lung biopsy revealed granuloma. Magnetic resonance imaging of the head showed small lesions in the brain. Computed tomography of the abdomen showed an enlarged paraaortic lymph node and a nodule in the spleen. Needle biopsy of the lymph node revealed necrotic tissue. Mycobacterium tuberculosis was not isolated; however, miliary tuberculosis was highly suspected based on clinical and radiographic findings. Once antituberculosis therapy was initiated with isoniazid, rifampicin, streptomycin, and pyrazinamide, the fever subsided. In spite of improvement of general radiographic findings, a new abscess was found in the right psoas major muscle after 8 months of therapy by computed tomography. A sample of the abscess showed a positive smear, negative culture, and positive PCR test for M. tuberculosis. Although antituberculosis therapy continued for another 6 months, the abscess enlarged to 7 cm and new retroperitoneal lymph nodes also appeared. Surgical drainage and curettage of the abscess was performed. Intra- and post-operative specimens were negative for bacteria, fungi, and M. tuberculosis. The patient was treated with isoniazid, rifampicin, and ethambutol for one year postoperatively. The disease disappeared without any evidence of relapse for 2.5 years after surgery.

Adult↗