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2.
Arch. argent. pediatr ; 116(3): 463-467, jun. 2018. ilus
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-950028

ABSTRACT

La tuberculosis, considerada desde 2003 por la Organización Mundial de la Salud una emergencia global de salud, provoca una mortalidad anual de alrededor de 2 millones de personas, fundamentalmente, en países en vías de desarrollo. En la población pediátrica española, la incidencia es de 5 casos/100 000 niños de entre 5 y 14 años y 13 casos/100 000 niños de entre 0 y 4 años. La infección se transmite por vía respiratoria por enfermos bacilíferos. Los niños eliminan escasos bacilos en secreciones respiratorias y no suelen transmitir la infección. En España, el porcentaje de resistencias a isoniazida en la población general es de 5% y es superior en la población inmigrante, lo cual es importante tener en cuenta para el tratamiento de los casos. Se presenta un caso de tuberculosis por Mycobacterium africanum multirresistente al tratamiento, con evolución satisfactoria posterior a la terapia múltiple.


Tuberculosis, considered since 2003 by the World Health Organization a global health emergency, causes annual mortality of approximately 2 million people, mainly in developing countries. In the Spanish pediatric population, the incidence is 5 cases/100 000 children between 5 and 14 years and 13 cases/100 000 children between 0 and 4 years. The infection is transmitted through the respiratory tract by baciliferous patients. Children eliminate few bacilli in respiratory secretions and do not usually transmit the infection. In Spain, the resistance to isoniazid in the general population is 5%, being higher in the immigrant population, which is important to take into account for the treatment of cases. A case of tuberculosis due to Mycobacterium africanum multiresistant to treatment is presented, with satisfactory evolution after multiple therapy.


Subject(s)
Humans , Female , Child, Preschool , Tuberculosis, Multidrug-Resistant/diagnosis , Mycobacterium/isolation & purification , Antitubercular Agents/administration & dosage , Treatment Outcome , Mycobacterium/drug effects , Antitubercular Agents/pharmacology
4.
Ciênc. saúde coletiva ; 22(6): 1969-1977, jun. 2017. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-839997

ABSTRACT

Resumo O objetivo deste artigo é analisar fontes de registro da tuberculose (TB) antes e após a implantação do Sistema Informatizado para Registro da Assistência à TB em Ribeirão Preto (SP). Estudo epidemiológico descritivo-analítico, do tipo intervenção. Os dados foram coletados em fontes secundárias, a partir de um formulário estruturado, e analisados através de teste Qui-quadrado ou Exato de Fisher com nível de significância de 5%. Identificou-se associação entre o período anterior da implantação do sistema com o arquivamento da Ficha do Tratamento Diretamente Observado no prontuário e o registro de orientação de retorno às consultas pela equipe de enfermagem. O posterior esteve associado com o aumento do registro do contato telefônico e endereço do doente de TB, data de término do tratamento, situação de encerramento, resultado da baciloscopia de escarro para controle mensal, teste anti-HIV, consultas mensais e solicitação de exames realizados pelo médico, atendimento com assistente social, condições de vida do doente, controle de comunicantes, incentivos sociais e uso de álcool e drogas. A implantação do sistema possibilitou a melhora no registro de algumas variáveis, ainda que outras fontes de registro tenham permanecido que não fossem o próprio sistema.


Abstract Objective to analyze sources of data for tuberculosis (TB) before and after the implementation of the Computerized System to Record Care for TB in Ribeirão Preto - SP. Method Intervention, descriptive-analytical epidemiological study. Data was collected from secondary sources using a structured form, and analyzed using Chi-squared or Fisher’s Exact Test, with a significance level of 5%. Results We found an association between the period before implementation of the system and placing the Directly Observed Treatment Card in the file, and registration of instructions for the return visit by the nursing team. The latter was associated with an increase in registered data regarding TB patient telephone number, address, end of treatment date, status at closing, sputum smear results for monthly control, HIV test, monthly checkups, tests ordered by physician, social worker visits, patient living conditions, contact control, social incentives and the use of drugs and alcohol. Conclusion Implementing the system improved the registration of a number of variables, despite the fact that other sources of data other than the system continue to exist.


Subject(s)
Humans , Delivery of Health Care/methods , Directly Observed Therapy/methods , Health Information Systems , Tuberculosis/therapy , Antitubercular Agents/administration & dosage , Brazil
5.
Rev. chil. enferm. respir ; 33(1): 54-61, mar. 2017. tab
Article in Spanish | LILACS (Americas) | ID: biblio-844396

ABSTRACT

During 2016, American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC and Infectious Disease Society of America: IDSA jointly sponsored the development of Guidelines for the treatment of drug-susceptible tuberculosis using the P-I-C-O (Patient-Intervention-Comparison-Outcome) system to answer nine questions. The preferred regimen for treating adults with drug-susceptible tuberculosis, consider a 2 month intensive phase with isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF For patients who have cavitation on the initial chest radiograph and have positive cultures at completion of 2 months therapy, it is recommended to extend the continuation phase to prevent relapse. EMB can be discontinued as soon as susceptibility to INH and RIF is demonstrated. The guidelines also makes recommendations for the management in different clinical situations as in patients co-infected with HIV and in extrapulmonary tuberculosis. In tuberculous pericarditis no longer is recommended the routinely use of corticosteroids together with the anti TB treatment. In the case of tuberculous meningitis it is recommended the addition of corticosteroids and to extend the continuation phase to 9-12 months.


Durante el año 2016, la American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC y la Infectious Disease Society of America: IDSA desarrollaron en conjunto una guía de recomendaciones para el tratamiento de la tuberculosis (TBC) sensible, empleando el sistema P-I-C-O (Patient-Intervention-Comparison-Outcome) para contestar 9 preguntas. El régimen de terapia farmacológica óptima para el paciente con TBC sensible considera una fase intensiva de 2 meses de duración con isoniacida (H), rifampicina (R), pirazinamida (Z) y etambutol (E) seguida de una fase de continuación por 4 meses de H y R. En los casos con cavitación en la radiografía de tórax inicial y en pacientes con cultivo de esputo positivo al segundo mes de tratamiento, se propone prolongar la fase de continuación con el propósito de reducir el riesgo de recaída. La guía también recomienda retirar el etambutol una vez que se haya demostrado la sensibilidad a H y R. Se hacen además recomendaciones de manejo en distintas situaciones clínicas como en pacientes co-infectados con VIH y en las TBC extrapulmonares. En la pericarditis TBC se sugiere no utilizar de forma rutinaria la terapia corticoesteroidal coadyuvante al tratamiento anti TBC. En el caso de la TBC meníngea se recomienda usar corticoesteroides y prolongar la quimioterapia durante la fase de continuación a 9 -12 meses.


Subject(s)
Humans , Antitubercular Agents/administration & dosage , Surveys and Questionnaires , Tuberculosis/drug therapy , Treatment Outcome
6.
Mem. Inst. Oswaldo Cruz ; 111(7): 454-459, tab, graf
Article in English | LILACS (Americas) | ID: lil-787556

ABSTRACT

In this study we evaluated the crystal violet decolorization assay (CVDA) for detection of minimum inhibitory concentration (MIC) of antituberculosis drugs. 53 isolates were tested in this study and 13 of them were multidrug resistant (MDR) isolates. The antibiotics concentrations were 2-0.06 mg/L for isoniazid (INH) and rifampicin (RIF) and were 16-0.25 mg/L for streptomycin (STM) and ethambutol (EMB). Crystal violet (CV-25 mg/L) was added into the microwells on the seventh day of incubation and incubation was continued until decolorization. Decolorization of CV was the predictor of bacterial growth. Overall agreements for four drugs were detected as 98.1%, and the average time was detected as 9.5 ± 0.89 day after inoculation. One isolate for INH and two isolates for STM were determined resistant in the reference method, but susceptible by the CVDA. One isolate was susceptible to EMB by the reference method, but resistant by the CVDA. All results were concordant for RIF. This study shows that CVDA is a rapid, reliable and suitable for determination of MIC values of Mycobacterium tuberculosis. And it can be used easily especially in countries with limited-sources.


Subject(s)
Humans , Antitubercular Agents/pharmacology , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/administration & dosage , Biological Assay , Drug Resistance, Multiple, Bacterial/drug effects , Ethambutol/administration & dosage , Ethambutol/pharmacology , Gentian Violet/chemistry , Indicators and Reagents/chemistry , Isoniazid/administration & dosage , Isoniazid/pharmacology , Microbial Sensitivity Tests/methods , Mycobacterium tuberculosis/growth & development , Rifampin/administration & dosage , Rifampin/pharmacology , Streptomycin/administration & dosage , Streptomycin/pharmacology , Tuberculosis, Multidrug-Resistant/microbiology
7.
Lima; s.n; ene. 2016.
Non-conventional in Spanish | LILACS (Americas), BRISA | ID: biblio-847801

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente informe expone la evaluación del medicamento linezolid, respecto a su uso en pacientes con tuberculosis extremadamente resistente (TB- XDR). Aspectos Generales: La tuberculosis continúa siendo un problema de salud pública mundial importante. A pesar que la incidencia de TB está disminuyendo globalmente aproximadamente 2% cada año y la mortalidad relacionada con la TB disminuyo un 45% entre los años 1995 y 2012, el número de casos de TB en el mundo es aún ingente, con 8.6 millones de personas con la enfermedad y 1.3 muertes en el 2012. Además, los casos de tuberculosis multidrogo resistente (TB-MDR) y tuberculosis extremadamente resistente (TB-XDR) presentan nuevos y enormes retos para el manejo y control de esta enfermedad. Tecnologia Sanitaria de Interés: Linezolid: El Linezolid pertenece a la clase de antibióticos denominada oxazolidinonas. Este medicamento se une a la subunidad ribosomal 50S inhibiendo la formación del complejo de iniciación y previniendo la traducción y síntesis de proteínas. Este mecanismo de acción tiene la ventaja de limitar la reacción cruzada con otros inhibidores de la síntesis de proteínas, haciéndolo atractivo para las infecciones resistentes. METODOLOGÍA: Estrategia de Búsqueda: La búsqueda de la literatura respecto a la eficacia y seguridad de linezolid para el \r\ntratamiento de pacientes con TB-XDR incluyo la búsqueda de guías de práctica clínica, evaluaciones de tecnologías sanitarias, revisiones sistemáticas y estudios primarios. La búsqueda de GPC se realizó en las páginas de internet de la Organización Mundial de la Salud, de los Centros para el Control y Prevención de las Enfermedades (CDC), la National Institute for Health and Care Excellence (NICE), la Scottish Intercollegiate Guidelines Network (SIGN) y el repositorio creado por la agencia para la investigación \r\nen salud y calidad (Agency for Healthcare Research and Quality (AHRQ)). Se utilizaron las bases creadas por NICE, SIGN y Cochrane para la búsqueda de evaluaciones de tecnología sanitaria. La búsqueda de las revisiones sistemáticas y los estudios primarios fueron realizados en las bases de datos de OVID MEDLINE y TRIPDATABASE. RESULTADOS: Se realizó la búsqueda bibliográfica y de evidencia científica para el sustento del uso del linezolid en los esquemas de tratamiento antituberculoso para pacientes adultos y niños \r\ncon TB-XDR. Guías Clínicas: la búsqueda identificó tres guías desarrolladas por la OMS para el manejo de la tuberculosis multidrogo resistente: la guía de la OMS para el manejo programático de la tuberculosis resistente 2008, la guía de la OMS para el manejo programático de la tuberculosis resistente 2011, y la guía de la OMS para los programas nacionales de tuberculosis para el manejo de la tuberculosis en los niños 2014. Evaluaciones de tecnología sanitaria: no se identificó alguna evaluación del medicamento de linezolid como tratamiento antituberculoso. Revisiones sistemáticas: se identificaron tres revisiones sistemáticas que examinaron los efectos de beneficio y de daño del uso de linezolid en pacientes con TB-DR. Ensayos clínicos: se incluyó un ensayo controlado aleatorizado que evaluó la eficacia y seguridad del uso de linezolid en pacientes adultos con TB-XDR. Otros estudios: se incluyeron una revisión narrativa que describió los resultados de reportes de casos del uso de linezolid en pacientes pediátricos con TB-DR. Ensayos Clínicos registrados en www.clinicaltrials.gov: no se identificaron estudios registrados que tengan como objetivo evaluar los efectos del linezolid en pacientes con TB-XDR. CONCLUSIONES: En la presente evaluación de tecnología sanitaria se identificó evidencia de baja calidad respecto a los efectos de beneficio y de daño de los regímenes que contienen linezolid comparado con los regímenes sin linezolid. El Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, aprueba temporalmente el uso del linezolid para el tratamiento de pacientes con TB-XDR. Dado que la evidencia que respalda este uso de linezolid dentro de los esquemas \r\nantituberculosos para casos de TB-XDR es aún limitada, se establece que el efecto de la aprobación del linezolid para su uso en el tratamiento de TB-XDR se evaluará con los datos de los pacientes que hayan recibido el esquema por el lapso de dos años para determinar el impacto de su uso en varios desenlaces \r\nclínicos. Esta información será tomada en cuenta en la re-evaluación de este medicamento para efectos de un nuevo dictamen al terminar la vigencia del presente Dictamen Preliminar.


Subject(s)
Humans , Antitubercular Agents/administration & dosage , Extensively Drug-Resistant Tuberculosis/drug therapy , Linezolid/administration & dosage , Peru , Technology Assessment, Biomedical , Treatment Outcome
9.
Rev. Soc. Bras. Med. Trop ; 48(5): 507-513, Sept.-Oct. 2015. tab, graf
Article in English | LILACS (Americas) | ID: lil-763334

ABSTRACT

AbstractLatent tuberculosis infection (LTBI) and human immunodeficiency virus (HIV)-coinfection are challenges in the control of tuberculosis transmission. We aimed to assess and summarize evidence available in the literature regarding the treatment of LTBI in both the general and HIV-positive population, in order to support decision making by the Brazilian Tuberculosis Control Program for LTBI chemoprophylaxis. We searched MEDLINE, Cochrane Library, Centre for Reviews and Dissemination, Embase, LILACS, SciELO, Trip database, National Guideline Clearinghouse, and the Brazilian Theses Repository to identify systematic reviews, randomized clinical trials, clinical guidelines, evidence-based synopses, reports of health technology assessment agencies, and theses that investigated rifapentine and isoniazid combination compared to isoniazid monotherapy. We assessed the quality of evidence from randomized clinical trials using the Jadad Scale and recommendations from other evidence sources using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The available evidence suggests that there are no differences between rifapentine + isoniazid short-course treatment and the standard 6-month isoniazid therapy in reducing active tuberculosis incidence or death. Adherence was better with directly observed rifapentine therapy compared to self-administered isoniazid. The quality of evidence obtained was moderate, and on the basis of this evidence, rifapentine is recommended by one guideline. Available evidence assessment considering the perspective of higher adherence rates, lower costs, and local peculiarity context might support rifapentine use for LTBI in the general or HIV-positive populations. Since novel trials are ongoing, further studies should include patients on antiretroviral therapy.


Subject(s)
Humans , AIDS-Related Opportunistic Infections/drug therapy , Antitubercular Agents/administration & dosage , Isoniazid/administration & dosage , Latent Tuberculosis/drug therapy , Rifampin/administration & dosage , Rifampin/analogs & derivatives , Drug Therapy, Combination , Evidence-Based Medicine , Randomized Controlled Trials as Topic
10.
Clinics ; 70(6): 429-434, 06/2015. tab, graf
Article in English | LILACS (Americas) | ID: lil-749788

ABSTRACT

OBJECTIVES: Fixed-dose combination formulations, which simplify the administration of drugs and prevent the development of drug resistance, have been recommended as a standard anti-tuberculosis treatment regimen. However, the composition and dosage recommendations for fixed-dose combination formulations differ from those for separate formulations. Thus, questions about the effectiveness and side effects of combination formulations remain. The aim of this study was to compare the safety and efficacy of these two types of anti-tuberculosis regimens for pulmonary tuberculosis treatment. METHOD: A prospective, randomized controlled study was conducted using the directly observed treatment short-course strategy. Patients were randomly allocated to one of two short-course regimens. One year after completing the treatment, these patients’ outcomes were analyzed. ClinicalTrials.gov: NCT00979290. RESULTS: A total of 161 patients were enrolled, 142 of whom were evaluable for safety assessment. The two regimens had a similar incidence of adverse effects. In the per-protocol population, serum bilirubin concentrations at the peak level, at week 4, and at week 8 were significantly higher for the fixed-dose combination formulation than for the separate formulations. All patients had negative sputum cultures at the end of the treatment, and no relapse occurred after one year of follow-up. CONCLUSIONS: In this randomized study, transient higher serum bilirubin levels were noted for the fixed-dose combination regimen compared with the separate formulations during treatment. However, no significant difference in safety or efficacy was found between the groups when the directly observed treatment short-course strategy was used. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antitubercular Agents/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Antitubercular Agents/adverse effects , Bilirubin/blood , Drug Administration Schedule , Drug Combinations , Directly Observed Therapy/methods , Drug Therapy, Combination/adverse effects , Drug Therapy, Combination/methods , Follow-Up Studies , Hyperuricemia/chemically induced , Prospective Studies , Skin Diseases/chemically induced , Sputum/microbiology , Treatment Outcome , Tuberculosis, Pulmonary , Vision Disorders/chemically induced
11.
Mem. Inst. Oswaldo Cruz ; 110(4): 543-550, 09/06/2015. tab, graf
Article in English | LILACS (Americas) | ID: lil-748862

ABSTRACT

The recommended treatment for latent tuberculosis (TB) infection in adults is a daily dose of isoniazid (INH) 300 mg for six months. In Brazil, INH was formulated as 100 mg tablets. The treatment duration and the high pill burden compromised patient adherence to the treatment. The Brazilian National Programme for Tuberculosis requested a new 300 mg INH formulation. The aim of our study was to compare the bioavailability of the new INH 300 mg formulation and three 100 mg tablets of the reference formulation. We conducted a randomised, single dose, open label, two-phase crossover bioequivalence study in 28 healthy human volunteers. The 90% confidence interval for the INH maximum concentration of drug observed in plasma and area under the plasma concentration vs. time curve from time zero to the last measurable concentration “time t” was 89.61-115.92 and 94.82-119.44, respectively. The main limitation of our study was that neither adherence nor the safety profile of multiple doses was evaluated. To determine the level of INH in human plasma, we developed and validated a sensitive, simple and rapid high-performance liquid chromatography-tandem mass spectrometry method. Our results showed that the new formulation was bioequivalent to the 100 mg reference product. This finding supports the use of a single 300 mg tablet daily strategy to treat latent TB. This new formulation may increase patients’ adherence to the treatment and quality of life.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Antitubercular Agents/pharmacokinetics , Isoniazid/pharmacokinetics , Latent Tuberculosis/drug therapy , Area Under Curve , Antitubercular Agents/administration & dosage , Biological Availability , Chromatography, High Pressure Liquid , Cross-Over Studies , Isoniazid/administration & dosage , Latent Tuberculosis/metabolism , Tablets , Tandem Mass Spectrometry , Therapeutic Equivalency
12.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-157577

ABSTRACT

Zinc being a stronger electron acceptor than iron might replace iron from the critical thiol groups. So, Zinc supplementation in Tubercular Subjects might help the decompartmentalised state of iron in the body to revert back to normal compartmentalized state of iron. Again, Zinc inhibits the formation of superoxide radicals. Thus, Zinc supplementation might decrease the excess superoxide with simultaneous decrease in the formation of soluble oxygen made by dismutation reaction by the iron cofactored superoxide dismutase secreted extracellularly by the pathogenic M. tuberculosis. The study shows early and effective recovery with Zinc supplementation (50mgm. of elemental zinc orally / day for one month) along with anti - Tubercular drug therapy. This gets support by the significant changes in the serum level of three enzymes – Glutamine Synthetase, Superoxide Dismutase and Cholienesterase. Again, the dose of zinc supplementation instituted with a great benefit and without any toxic symptoms and signs, is below the Lowest Observed Adverse Effect Level (LOAEL) based on the superoxide dismutase activity in erythrocytes with zinc intake.


Subject(s)
Antitubercular Agents/administration & dosage , Dietary Supplements , Drug Tolerance , Cholinesterases/blood , Female , Glutamate-Ammonia Ligase/blood , Humans , Male , No-Observed-Adverse-Effect Level , Superoxide Dismutase/blood , Tuberculosis/drug therapy , Zinc/administration & dosage , Zinc/therapeutic use
13.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-154382

ABSTRACT

A 3-year-old girl presented with a history of intermittent fever of six months duration associated with respiratory symptoms consisting of recurrent cough, fever, wheeze and a suspected history of contact with tuberculosis (TB). Chest radiograph revealed pulmonary infiltrates mimicking miliary TB. She was started on anti-tuberculous treatment, but in view of clinical deterioration, a further work-up including a lung biopsy revealed non-Hodgkin’s lymphoma (NHL). This case documents the extremely rare occurrence of pulmonary involvement and miliary infiltrates on the chest radiograph in NHL.


Subject(s)
Antineoplastic Agents/administration & dosage , Antitubercular Agents/administration & dosage , Antitubercular Agents/adverse effects , Biopsy , Child, Preschool , Cyclophosphamide/administration & dosage , Diagnosis, Differential , Female , Humans , Lung/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, Large B-Cell, Diffuse/physiopathology , Prednisolone/administration & dosage , Symptom Assessment/methods , Treatment Outcome , Tuberculosis, Miliary/diagnosis , Tuberculosis, Miliary/drug therapy , Vincristine/administration & dosage
14.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-154378

ABSTRACT

Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/administration & dosage , Adult , Antitubercular Agents/administration & dosage , Biopsy, Fine-Needle/methods , Humans , Lymph Nodes/pathology , Male , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/isolation & purification , Sarcoidosis/complications , Sarcoidosis/diagnosis , Sarcoidosis/physiopathology , Sarcoidosis/therapy , Treatment Outcome , Tuberculosis, Lymph Node/drug therapy , Tuberculosis, Lymph Node/etiology , Tuberculosis, Lymph Node/pathology , Tuberculosis, Lymph Node/physiopathology
15.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-159966

ABSTRACT

Summary: Tuberculosis of the gastrointestinal tract (GIT) occurs as a primary lesion or secondary to a focus of tuberculosis elsewhere in the body, most commonly in the lungs. Tuberculosis can affect any part of the GIT from the oesophagus to the anal canal. Two main types are – the tuberculous ulcer and the rarer hypertrophic type which is generally found at the ileocecal junction, less commonly in the colon or rectum. Tuberculosis of bowel distal to ileocecal junction is rare and is seldom considered as a differential diagnosis of rectal stricture (2%).1,6 We report a case of rectal tuberculosis presenting with rectal prolapse and masquerading as malignancy, clinically, radiologically as well as on colonoscopy. The diagnosis was confirmed by repeated histopathological examination. The patient underwent definitive surgery along with anti-tuberculous therapy.


Subject(s)
Antitubercular Agents/administration & dosage , Colectomy/methods , Colonoscopy , Diagnosis, Differential , Dissection , Humans , Middle Aged , Rectal Neoplasms/diagnosis , Rectal Prolapse/etiology , Rectal Prolapse/surgery , Rectum/pathology , Treatment Outcome , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Gastrointestinal/therapy
16.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-159965

ABSTRACT

Summary: Opportunistic infections are common complications of advanced immuno-deficiency in individuals with Human Immunodeficiency Virus (HIV) infection. Following involvement of the lung, the central nervous system (CNS) is the second most commonly affected organ. We report two cases of concurrent cryptococcal meningitis and tuberculosis (TB) in HIV infected persons. A high suspicion of multiple opportunistic infections should be kept in mind in HIV seropositive individuals.


Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/microbiology , AIDS-Related Opportunistic Infections/physiopathology , Adult , Anti-Retroviral Agents/administration & dosage , Antifungal Agents/administration & dosage , Antitubercular Agents/administration & dosage , Coinfection , Cryptococcus neoformans/isolation & purification , HIV Infections/complications , HIV Infections/drug therapy , Humans , Male , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/physiopathology , Treatment Outcome , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/diagnostic imaging
17.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-159964

ABSTRACT

Summary: Mycobacterium abscessus is ubiquitously found rapidly growing mycobacteria. Although it is an uncommon pathogen, it has been known to cause cutaneous infection following inoculation, minor trauma or surgery. This communication reports an immuno-competent patient developing multiple sinuses due to Mycobacterium abscessus in the post- operative period.


Subject(s)
Adult , Amikacin/administration & dosage , Antitubercular Agents/administration & dosage , Cholecystectomy, Laparoscopic/adverse effects , Cholecystitis, Acute/surgery , Clarithromycin/administration & dosage , Female , Humans , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/physiopathology , Nontuberculous Mycobacteria/isolation & purification , Surgical Wound Infection/drug therapy , Surgical Wound Infection/microbiology , Surgical Wound Infection/physiopathology , Treatment Outcome
18.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-159958

ABSTRACT

Background: Drug resistant tuberculosis (DRTB) is an emerging problem that adversely affects treatment outcomes and public health in the developing world. Objective: To determine the initial drug resistance pattern among pulmonary tuberculosis patients registered under the Revised National Tuberculosis Control Programme. Study Design: A cross-sectional study design. Setting: Two urban Directly Observed Treatment Supervised (DOTS) centres in Lucknow District of Uttar Pradesh. Methods: The present study consisted of newly diagnosed sputum smear-positive for acid-fast bacilli (AFB) cases at the time of registration under the tuberculosis control programme. All sputum smear positive cases were subjected to culture and drug-susceptibility testing by 1% proportion method on Lowenstein-Jensen (LJ) medium. Results: A total of 185 newly diagnosed sputum smear positive for AFB in pulmonary tuberculosis patients were subjected to culture and drug sensitivity test. Among 185 isolates, 170 (91.4%) isolates were culture positive. Of these 170 isolates, 169 (99.4%) were M. tuberculosis and one (0.5%) was Mycobacterium other than tuberculosis (MOTT). Out of 99.4% M. tuberculosis positive isolates, 21.3% were resistant to at least one drug. Resistance pattern of 21.3% strains of M. tuberculosis showing resistance to single, double, triple, and quadruple drugs were 5.9%, 10.7%, 2.4% and 2.4% respectively. Multi-drug resistance (MDR) was observed in 4.7% isolates. Conclusion: The present study highlights the high rate of drug resistance pattern among the new sputum smear positive pulmonary tuberculosis patients and also high MDR tuberculosis. Routine surveillance of drug resistance profile of patients provides useful information for adopting new strategies of effective treatment within National Tuberculosis Control Programmes in order to combat the threat of MDR-TB in the general population.


Subject(s)
Adolescent , Adult , Antitubercular Agents/administration & dosage , Cross-Sectional Studies , Drug Resistance, Bacterial , Female , Humans , Incidence , India/epidemiology , Male , Microbial Sensitivity Tests , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/isolation & purification , Sputum/microbiology , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiology
19.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-157517

ABSTRACT

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.


Subject(s)
Adult , Antitubercular Agents/administration & dosage , Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/methods , Female , Hernia, Umbilical/surgery , Humans , Laparoscopy/adverse effects , Laparoscopy/complications , Laparoscopy/methods , Middle Aged , Morbidity , Surgical Wound Infection/drug therapy , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiology , Tuberculosis/diagnosis , Tuberculosis/drug therapy
20.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-159943

ABSTRACT

Summary: Neurotuberculosis is one of the grave complications of primary tuberculous infection. Extensive BCG vaccination of children and inadequate antituberculous drug therapy have led to the emergence of newer complex clinical pictures and diagnostic dilemma. Here we report a case of right-sided hemiparesis with features of raised intracranial tension in a sixyear- old boy. Neuroimaging revealed presence of a high grade astrocytoma. On clinical examination, right-sided cervical lymphadenopathy with discharging sinus and tenderness over right hip joint were present. On further investigation, these were proved to be of tubercular origin. All preliminary findings were in favour of disseminated tuberculosis, but the nature of CNS lesion was creating diagnostic dilemma. Etiological diagnosis of the CNS lesion was necessary, as, if it was not of tubercular origin, the management protocol would be different and with any delay we could have lost the patient. Though on routine CSF study, no AFB were present, but we confirmed the presence of mycobacterial DNA by polymerase chain reaction. Patient showed considerable improvement after being put on Anti-tubercular Treatment (ATT) and steroids. Tuberculous brain abscess is rare. Very few cases have been reported even in adults. Most reported cases are in immunocompromised patients. This case highlights the fact that tuberculous brain abscess can have atypical presentation even in immunocompetent children mimicking CNS malignancy. Careful examination and thorough investigation are required to establish the diagnosis. Timely initiation of appropriate therapy can reduce mortality and neurological sequelae.


Subject(s)
Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , Astrocytoma/epidemiology , Brain Neoplasms/epidemiology , Child , Humans , Male , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/drug therapy , Tuberculosis, Meningeal/epidemiology , Tuberculosis, Meningeal/genetics , Tuberculosis, Meningeal/diagnostic imaging
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