Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 963
Filter
1.
Rev. inf. cient ; 100(4): e3470, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289656

ABSTRACT

RESUMEN Introducción: En los últimos 10 años en Cuba y, especialmente, en provincia Guantánamo se ha observado incremento del número de pacientes tuberculosos farmacorresistentes; esta es la provincia de mayor incidencia en el país. Objetivo: Identificar las características epidemiológicas y el patrón de resistencia de la tuberculosis farmacorresistente en provincia Guantánamo. Método: Se diseñó un estudio descriptivo y transversal que incluyó la totalidad de casos (n=6) con tuberculosis farmacorresistentes diagnosticados entre diciembre de 2010 y diciembre de 2019. Se estudiaron las variables: edad, sexo, régimen terapéutico, situación económica, categorías de casos, clasificación epidemiológica de la resistencia y resistencia de la cepa aislada según el grado y perfil. Resultados: Predominó el sexo masculino (66, 6 %) y el grupo de edades de menores de 45 años (83,3 %), la mayor cantidad de resistencia estuvo propiciada por violaciones en los tratamientos anteriores (66,6 %), categorizados mayormente como crónicos y reingresos por abandono. Predominó el nivel educacional de secundaria básica terminada (66,7 %), con situación económica regular (50,0 %) y alto nivel de alcoholismo (66,7 %). La multidrogorresistencia prevaleció en cepas de pacientes con tratamiento previo (66,6 %). Conclusiones: Existe coincidencia del patrón epidemiológico y el patrón de resistencia mostrado en la investigación actual con los resultados de estudios previos nacionales e internacionales, estos resultados sugieren fallas en la aplicación local del Programa Nacional de Control y Tratamiento de la tuberculosis. Se recomienda investigar y resolver estas fallas lo que produciría un impacto inmediato en la disminución de la incidencia de tuberculosis farmacorresistentes.


ABSTRACT Introduction: An increase in the number of drug-resistant tuberculosis patients has been observed in the last 10 years in Cuba and, especially, in Guantánamo province. This is the province with the highest incidence in the country. Objective: To identify the epidemiological characteristics and the resistance pattern of drug-resistant tuberculosis in Guantánamo province. Method: A descriptive, cross-sectional study was designed that included all cases (n=6) with drug-resistant tuberculosis, diagnosed between December 2010 and December 2019. The variables studied were: age, gender, therapeutic regimen, economic situation, categories of cases, epidemiological classification of resistance, and resistance of the isolated strain according to the grade and profile. Results: Males predominated (66.6%), and also the age group under 45 years (83.3%), the greatest resistance was caused by not abiding the previous treatments (66.6%), categorized mostly as chronic, and readmitted due to treatment abandonment. Highschool degree (66.7%) predominated, with a moderate economic situation (50.0%) and high levels of alcoholism (66.7%). Multi-drug resistance prevailed in the strains in patients with previous treatment (66.6%). Conclusions: There is a coincidence of the epidemiological pattern and the resistance pattern shown in the current research with the results of previous national and international studies; these results suggest flaws in the local application of the Programa Nacional de Control y Tratamiento de la tuberculosis. It is recommended to investigate and resolve these flaws, which would have an immediate impact on reducing the incidence of drug-resistant tuberculosis.


RESUMO Introdução: Nos últimos 10 anos, em Cuba e, principalmente, na província de Guantánamo, observou-se um aumento no número de pacientes com tuberculose resistente aos medicamentos; esta é a província com maior incidência no país. Objetivo: Identificar as características epidemiológicas e o padrão de resistência da tuberculose resistente a medicamentos na província de Guantánamo. Método: Foi elaborado um estudo descritivo e transversal que incluiu todos os casos (n=6) com tuberculose resistente a medicamentos diagnosticados entre dezembro de 2010 e dezembro de 2019. Foram estudadas as variáveis: idade, sexo, regime terapêutico, situação econômica, categorias de casos, classificação epidemiológica de resistência e resistência da cepa isolada de acordo com o grau e perfil. Resultados: Houve predomínio do sexo masculino (66,6%) e na faixa etária abaixo de 45 anos (83,3%), a maior quantidade de resistência foi causada por violações nos tratamentos anteriores (66,6%), categorizados principalmente como crônicos e reinternações por abandono. Predominou situação econômica regular (50,0%) e alto nível de alcoolismo (66,7%). A multirresistência prevaleceu em cepas de pacientes com tratamento anterior (66,6%). Conclusões: Há coincidência do padrão epidemiológico e do padrão de resistência mostrado na pesquisa atual com os resultados de estudos nacionais e internacionais anteriores, esses resultados sugerem falhas na aplicação local do Programa Nacional de Controle e Tratamento da Tuberculose. Recomenda-se investigar e resolver essas falhas, que teriam um impacto imediato na redução da incidência de tuberculose resistente aos medicamentos.


Subject(s)
Humans , Male , Middle Aged , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/epidemiology , Rifampin , Streptomycin , Epidemiology, Descriptive , Cross-Sectional Studies , Isoniazid
2.
Rev. cuba. salud pública ; 47(2): e2101, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1341492

ABSTRACT

Introducción: En el departamento del Atlántico los estudios de resistencia del Mycobacterium tuberculosis se han limitado a drogas de segunda línea. Objetivo: Determinar prevalencia de resistencia a amikacina, kanamicina, capreomicina y ofloxacina en casos de tuberculosis resistente a isoniacida, rifampicina o a ambas drogas, en el periodo 2013 a 2016 en el departamento del Atlántico. Métodos: Estudio transversal de 194 aislamientos resistentes a isoniacida, rifampicina o ambas, por metodología Genotype MTBDR plus versión 2, enviados al Instituto Nacional de Salud en el periodo 2013 al 2016 para ser confirmados y procesados para drogas de segunda línea. La proporción de resistencia, se hizo según variables sociodemográficas, clínica y de vigilancia en salud pública. Resultados: Las comorbilidades frecuentes encontradas fueron desnutrición con el 18,56 por ciento, seguido de infección concomitante VIH-tuberculosis con el 13,40 por ciento. La ofloxacina en casos no tratados obtuvo la mayor resistencia global con el 1,50 por ciento (IC 95 por ciento 0,18-5,33). En los que fueron previamente tratados la resistencia global a capreomicina fue del 8,10 por ciento (IC 95 por ciento 2,7-17,8). En los resistentes a rifampicina, un caso fue extensivamente resistente y dos casos resistentes en los multidrogorresistente. Conclusiones: Se encontró baja resistencia a fluoroquinolonas y fármacos inyectables en pacientes no tratados resistentes a isoniacida, rifampicina o ambas, que muestra que todavía no constituye un problema mayor en el departamento del Atlántico. Se debe complementar su seguimiento con buen manejo tanto físico como psicológico y un equipo de salud fortalecido que actúe prontamente y ayude a la adherencia del paciente a los tratamientos(AU)


Introduction: In Atlántico department, resistance studies of Mycobacterium tuberculosis have been limited to second-line drugs. Objective: Determine prevalence of resistance to amikacin, kanamycin, capreomycin and ofloxacin in cases of tuberculosis resistant to isoniazid, rifampicin or both, in the period 2013 to 2016 in Atlántico department. Methods: Cross-sectional study of 194 isolations resistant to isoniazid, rifampicin or both, by Genotype MTBDR plus version 2 methodology, that were sent to the National Institute of Health from 2013 to 2016 to be confirmed and processed for second-line drugs. The resistance ratio was made according to sociodemographic, clinical and public health surveillance variables. Results: The common comorbilities found were malnutrition with 18.56 percent, followed by concomitant HIV-tuberculosis infection with 13.40 percent. Ofloxacin in non-treated cases achieved the highest overall resistance with 1.50 percent (95 percent CI 0.18-5.33). In those previously treated, global resistance to capreomycin was 8.10 percent (95 percent CI 2.7-17.8). In the ones resistant to rifampicin, one case was extensively resistant and two cases were resistant in multi-drugs resistant. Conclusions: Low resistance to fluoroquinolones and injectable drugs was found in non-treated patients who were resistant to isoniazid, rifampicin or both, showing that it is not yet a major problem in Atlántico department. Its follow-up should be complemented with good physical and psychological management and a strengthened health team that acts promptly and helps the patient adherence to treatments(AU)


Subject(s)
Humans , Rifampin/therapeutic use , Tuberculosis, Multidrug-Resistant , Fluoroquinolones/antagonists & inhibitors , Isoniazid/therapeutic use , Cross-Sectional Studies
3.
Con-ciencia (La Paz) ; 9(1): 1-20, jun. 2021.
Article in Spanish | LILACS | ID: biblio-1284396

ABSTRACT

INTRODUCCIÓN: la tuberculosis es una enfermedad infecto-contagiosa, causada por diversas especies del Complejo Mycobacterium tuberculosis, actualmente se estima que un tercio de la población mundial se encuentra afectada por lo que representa una amenaza para la salud pública, principalmente por el surgimiento de cepas Multidrogorresistentes (TB-MDR). En Bolivia se reportaron 7.538 personas enfermas con Tuberculosis, los últimos datos sobre TB-MDR indican un aumento de 0,2% por año, en 2019 se registró un 3,1% de TB-MDR. Actualmente en nuestro país se emplean métodos moleculares para la identificación de este agente infeccioso; no obstante, existen muy pocos o ningún trabajo acerca de la aplicación de métodos moleculares para la detección precisa y efectiva de cepas TB-MDR que otorguen validez a los resultados emitidos. Este trabajo resuelve el cuestionamiento de, si la PCR en tiempo real (RT-qPCR) acoplada a curvas melting es una herramienta de diagnóstico alternativo aplicable, para la identificación de Tuberculosis Multidrogorresistente MATERIALES Y MÉTODOS: se trabajó con 74 cepas de Mycobaterium tuberculosis fenotípicamente identificadas por cultivo (método de las proporciones, Canetti Rist) como gold standar. El material genético para las pruebas moleculares se obtuvo por el método de columnas, se utilizaron dos controles primarios para la determinación de resistencia a los fármacos Isoniacida y Rifampicina, tanto los controles como las muestras se procesaron por RT-qPCR acoplada a curvas melting, mediante cambios de temperatura de disociación. RESULTADOS: los parámetros de test diagnóstico de la prueba demostraron sensibilidad: 67.4%, especificidad: 83.3%, Exactitud: 73.97%, VPP: 85.3%, VPN: 64.1% para Isoniacida. Mientras que para Rifampicina: Sensibilidad: 97%, especificidad: 20%, exactitud: 58.9%, VPP: 55.4% y VPN: 87.5%. CONCLUSIÓN: el método evaluado para la determinación de resistencia a Isoniacida presenta un equilibrio entre sensibilidad y especificidad, por lo que representa una alternativa diagnóstica confiable, mientras que para resistencia a Rifampicina presenta una alta sensibilidad que es muy útil para países endémicos como el nuestro.


INTRODUCTION: tuberculosis is an infectious-contagious disease, caused by various species of the Mycobacterium tuberculosis Complex, it is estimated that one third of the world population is affected by what represents a threat to public health, mainly by the emergence of multidrugresistant strains (MDR-TB). In Bolivia, 7,538 people are reported sick with Tuberculosis, the latest data on MDR-TB indicate an increase of 0.2% per year, in 2018 there was 3.1% of MDR-TB. Currently in our country molecular methods are used to identify this infectious agent; however, there is very little or no work on the application of molecular methods for the precise and effective detection of MDR-TB strains that give validity to the results issued. This work resolves the question of whether real-time PCR (RT-qPCR) coupled to melting curves is an applicable alternative diagnostic tool for the identification of multidrug-resistant tuberculosis MATERIALS AND METHODS: we worked with 74 strains of Mycobaterium tuberculosis phenotypically identified by culture (method of proportions, Canetti Rist) as a gold standar. The genetic material for molecular methods was obtained by the column assay, two primary controls were used for the determination of resistance to the drugs Isoniazid and Rifampicin, both the controls and the samples were processed by RT-qPCR coupled to melting curves, by means of temperature changes of dissociation. RESULTS: the diagnostic test parameters of the test demonstrated sensitivity: 67.4%, specificity: 83.3%, Accuracy: 73.97%, PPV: 85.3%, NPV: 64.1% for Isoniazid. While for Rifampicin: Sensitivity: 97%, Specificity: 20%, Accuracy: 58.9%, PPV: 55.4% and NPV: 87.5% CONCLUSION: the method evaluated for the determination of resistance to Isoniazid presents a balance between sensitivity and specificity, therefore it represents a reliable diagnostic alternative, while for resistance to Rifampicin it presents a high sensitivity that is very useful for endemic countries such as ours.


Subject(s)
Polymerase Chain Reaction , Mycobacterium tuberculosis , Rifampin , Tuberculosis , Public Health , Isoniazid
4.
Rev. patol. trop ; 50(3)2021. ilus
Article in English | LILACS | ID: biblio-1292484

ABSTRACT

Tuberculosis is the leading cause of death amongst adults with human immunodeficiency virus (HIV) infection. The lifetime risk of tuberculosis disease for a person with latent infection is estimated at 5-10% with most cases occurring within five years of initial infection. The World Health Organization recommends isoniazid preventive therapy (IPT) for latent tuberculosis treatment, amongst other strategies. The aim was to assess tuberculosis incidence, survival (free of tuberculosis) and associated factors in HIV-positive patients. IPT was offered to participants with a positive (≥5mm) tuberculin skin test. Participants were followed from February 2003-December 2016. Kaplan-Meier was used for survival analysis. Variables with p-value ≤ 0.2 in the univariate analysis entered into the multivariate Cox-Model, keeping those with p-value ≤ 0.05. The 95% confidence interval of incidence of tuberculosis was estimated using Poisson distribution. One hundred nineteen patients completed the IPT and were followed for a median duration of 110.7 months (IQR 93.1-121.0). The probability of developing tuberculosis (10 years post-IPT) was 5.4%. Tuberculosis incidence was 0.58/100 patient/years (CI 95% 0.213-1.264). IPT over 6 months provided long-term protection against tuberculosis. AIDS-defining illness was the only statistically significant variable (HR=5.67) in the multivariate model.


Subject(s)
Humans , Survival Analysis , HIV , Latent Tuberculosis , Isoniazid
5.
Braz. j. med. biol. res ; 54(8): e10660, 2021. graf
Article in English | LILACS | ID: biblio-1249330

ABSTRACT

It is known that the combined use of antibiotics, such as isoniazid and rifampicin, in the treatment of tuberculosis causes oxidative kidney damage. The aim of this study was to biochemically and histopathologically investigate the effect of lycopene on oxidative kidney damage due to the administration of isoniazid and rifampicin in albino Wistar male rats. Lycopene at a dose of 5 mg/kg was orally administered to lycopene+isoniazid+rifampicin (LIR) rats, and normal sunflower oil (0.5 mL) was orally administered to isoniazid+rifampicin (IR) and healthy control (HG) rats as vehicle by gavage. One hour after the administration of lycopene and vehicle, 50 mg/kg isoniazid and rifampicin were given orally to the LIR and IR groups. This procedure was performed once a day for 28 days. Rats were sacrificed by a high dose of anesthesia at the end of this period, and oxidant-antioxidant parameters were measured in the removed kidney tissues. Creatinine and blood urea nitrogen (BUN) levels were measured in blood samples, and kidney tissues were also evaluated histopathologically. The combined administration of isoniazid and rifampicin changed the oxidant-antioxidant balance in favor of oxidants, and it increased blood urea nitrogen and creatinine levels, which are indicators of kidney function. Co-administration of isoniazid and rifampicin also caused oxidative kidney damage. Lycopene biochemically and histopathologically decreased oxidative kidney damage induced by isoniazid and rifampicin administration. These results suggested that lycopene may be beneficial in the treatment of nephrotoxicity due to isoniazid and rifampicin administration.


Subject(s)
Animals , Male , Rats , Rifampin/toxicity , Isoniazid/toxicity , Carotenoids/metabolism , Oxidative Stress , Lycopene/metabolism , Kidney/metabolism , Antioxidants/metabolism
6.
Article in English | WPRIM | ID: wpr-887737

ABSTRACT

Objective@#To evaluate multidrug resistant loop-mediated isothermal amplification (MDR-LAMP) assay for the early diagnosis of multidrug-resistant tuberculosis and to compare the mutation patterns associated with the @*Methods@#MDR-LAMP assay was evaluated using 100 @*Results@#The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDR-LAMP were 85.5%, 93.6%, 96.7%, and 74.4% for the detection of resistance to isoniazid and rifampicin, respectively, and 80.5%, 92.3%, 98.6%, and 41.4% for the detection of @*Conclusion@#MDR-LAMP is a rapid and accessible assay for the laboratory identification of rifampicin and isoniazid resistance of


Subject(s)
Antitubercular Agents , Bacterial Proteins/genetics , Catalase/genetics , DNA, Bacterial/analysis , DNA-Directed RNA Polymerases/genetics , Drug Resistance, Multiple, Bacterial/genetics , Isoniazid , Molecular Diagnostic Techniques/methods , Mutation , Mycobacterium tuberculosis/isolation & purification , Nucleic Acid Amplification Techniques/methods , Oxidoreductases/genetics , Phenotype , Rifampin , Whole Genome Sequencing
7.
Infectio ; 24(3): 173-181, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1114862

ABSTRACT

Resumen Objetivo: Describir las características clínicas y desenlaces al tratamiento de los pacientes con tuberculosis resistente a isoniazida (Hr-TB) en una institución del suroccidente colombiano. Materiales y métodos: Se realizó un estudio observacional retrospectivo. Se incluyeron pacientes con confirmación diagnóstica, aislamiento microbiológico, pruebas de susceptibilidad a fármacos y evidencia de Hr-TB. Resultados: Se incluyeron 32 pacientes con Hr-TB entre 2006-2018 que corresponden al 6% (32/528) de resistencia del total de casos. El 78% (n=25) fueron casos nuevos, resistencia primaria, y el 22% (n=7) previamente tratados, resistencia adquirida. La comorbilidad más frecuente fue infección por VIH (n=9). El patrón de Hr-TB mostró en 23 (72%) casos con alto nivel, 4 (12%) de bajo nivel y 5 (16%) con bajo y alto nivel. El análisis de resultados al tratamiento se realizó a 22 pacientes, presentando el 50% cura, el 41% tratamiento completo y 9% muerte relacionada con la tuberculosis. Conclusiones: La Hr-TB predomina en los casos nuevos, lo que supone un obstáculo al tratamiento donde no se realizan las pruebas de susceptibilidad de forma rutinaria.


Abstract Objective: To describe the clinical characteristics and outcomes to the treatment of patients with isoniazid-resistant tuberculosis (Hr-TB) in an institution in southwest Colombia. Materials and methods: A retrospective observational study was conducted. Patients with diagnostic confirmation, microbiological isolation, drug susceptibility tests, and evidence of Hr-TB were included. Results: Thirty-two patients with Hr-TB were included between 2006-2018, corresponding to 6% (32/528) of resistance in total cases. 78% were new cases, primary resistance, and 22% previously treated, acquired resistance. The most frequent comorbidity was HIV infection (n = 9). The pattern of Hr-TB showed in 23 (72%) cases with high level, 4 (12%) of low level and 5 (16%) with low and high level. The analysis of treatment results was performed on 22 patients, presenting 50% cure, 41% completed treatment, and 9% death related to tuberculosis. Conclusions: Hr-TB predominates in new cases, which is an obstacle to treatment where susceptibility tests are not performed routinely.


Subject(s)
Humans , Male , Adult , Tuberculosis , Isoniazid , Mycobacterium tuberculosis , Therapeutics , Drug Resistance, Microbial , Pharmaceutical Preparations , HIV Infections , Colombia , Infections
8.
Rev. chil. enferm. respir ; 36(3): 215-222, set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138555

ABSTRACT

INTRODUCCIÓN: La prevención de la tuberculosis activa en los grupos de riesgo es clave para el control y eliminación de la tuberculosis. El tratamiento de la infección tuberculosa latente (TITL) con rifapentina e isoniazida en dosis semanales por 12 semanas es más corto que con otros esquemas, tiene menor hepatotoxicidad, mejor adherencia y es costo-efectivo. El OBJETIVO del estudio es evaluar la factibilidad de implementar este esquema a nivel programático en Chile. MÉTODOS: Se hizo una intervención piloto en territorios seleccionados entre mayo de 2018 y marzo de 2019. En esos territorios se reemplazó el esquema normado de TITL con isoniazida 6 meses por el esquema rifapentina-isoniazida 12 semanas. Además, se amplió la población objetivo, incluyendo a contactos mayores de 14 años. El tratamiento consistió en la administración conjunta de isoniazida y rifapentina por vía oral con frecuencia semanal, por 12 semanas, de forma supervisada por personal de salud. RESULTADOS: Ingresaron 238 pacientes al piloto, de los cuales 53% fueron mujeres y 54,2% fueron mayores de 14 años. Del total de pacientes, 203 (85,3%) completaron el tratamiento, 22 (9,2%) lo abandonaron, 8 (3,4%) presentaron reacciones adversas y 5 tuvieron otros motivos de egreso. CONCLUSIÓN: Tanto el TITL con rifapentinaisoniazida por 3 meses en dosis semanales supervisadas, como la incorporación de contactos adultos a TITL, son factibles de implementar a nivel programático en Chile.


INTRODUCTION: Prevention of active tuberculosis in risk groups is crucial in tuberculosis control and elimination. Treatment of latent tuberculosis (TITL) with rifapentine and isoniazid in weekly doses for 12 weeks is shorter than other pharmacological treatments, with less liver toxicity, better patient compliance and it is cost-effective. The OBJECTIVE of this study is to evaluate the feasibility to implement this treatment at a programmatic level in Chile. METHODS: A pilot intervention was conducted in selected territories between May 2018 and March 2019. Within these territories, the regulated treatment with isoniazid 6 months was replaced by the 12 weeks treatment with weekly rifapentine-isoniazide. Additionally, the target population was expanded to include contacts over 14 years old, currently not included in the national guidelines. Treatment consisted in oral administration of rifapentine and isoniazide together once a week for 12 weeks, under supervision of trained health workers. RESULTS: From 238 patients entered to the protocol, 53% of them were women and 54.2% were older than 14 years-old. Out of the total number of patients, 203 (85.3%) completed treatment, 22 (9.2%) abandoned, 8 (3.4%) had adverse drug reactions, and 5 ended treatment for different causes. CONCLUSION: Both TITL with rifapentine-isoniazide in 12 supervised weekly doses, and the inclusion of adult contacts in TITL, are feasible to implement at a programmatic level in Chile.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Rifampin/analogs & derivatives , Latent Tuberculosis/drug therapy , Isoniazid/therapeutic use , Antitubercular Agents/therapeutic use , Rifampin/therapeutic use , Time Factors , Drug Administration Schedule , Chile , Pilot Projects , Administration, Oral , Patient Compliance , Directly Observed Therapy , Drug Therapy, Combination , Treatment Adherence and Compliance , National Health Programs
9.
An. bras. dermatol ; 95(3): 343-346, May-June 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130895

ABSTRACT

Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.


Subject(s)
Humans , Male , Young Adult , Tuberculosis, Cutaneous/immunology , Tuberculosis, Cutaneous/pathology , Immunocompromised Host , Arthritis, Reactive/immunology , Immunocompetence , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Skin Ulcer/immunology , Skin Ulcer/pathology , Skin Ulcer/drug therapy , Tuberculosis, Cutaneous/drug therapy , Treatment Outcome , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
10.
J. bras. pneumol ; 46(6): e20190345, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1134909

ABSTRACT

RESUMO Objetivo Avaliar características clínicas, tomográficas e microbiológicas dos pacientes com doença pulmonar causada pela M. kansasii (DPMK) atendidos em unidade ambulatorial no período 2006-2016. Métodos Estudo descritivo, em que foram analisados 38 pacientes. Foram analisadas as características demográficas, clínico-radiológicas, laboratoriais e terapêuticas. Resultados A média de idade foi 64 anos (DP=10,6; IIQ=57-72; mediana=65,0) e 22 (57,9%) eram pacientes do sexo masculino. Comorbidade pulmonar estava presente em 89,5%. A comorbidade mais frequente foi a bronquiectasia (78,9%). Tratamento anterior para tuberculose pulmonar (TBP) foi relatado em 65,9%. O esquema terapêutico mais utilizado foi rifampicina, isoniazida e etambutol (44,7%). A tomografia de tórax (TCT) mostrou bronquiectasia (94,1%), distorção arquitetural (76,5%), espessamento de septo (67,6%) e cavidades (64,7%). A doença foi bilateral em 85,2%. Houve 10,7% de resistência à rifampicina, 67,9% resistentes ao etambutol e sensibilidade à claritromicina. Conclusão Em pacientes com doença pulmonar estrutural, é importante a busca de DPMNT, principal diagnóstico diferencial com TBP. TC de tórax demonstra diferentes padrões que se sobrepõem ao de doença estrutural causada por TBP ou outras enfermidades pulmonares. Destaca-se a resistência ao etambutol, fármaco componente do esquema preconizado.


ABSTRACT Objective To evaluate clinical, tomographic, and microbiological characteristics of pulmonary disease caused by M. kansasii (MKPD) in patients treated at an outpatient unit from 2006-2016. Methods We studied thirty eight patients, and analyzed socio-demographic, clinical-radiological, laboratory, and therapeutic characteristics. Results The mean age was 64 years (SD = 10.6; IIQ = 57-72; median = 65.0), and 22 (57.9%) male patients. Pulmonary comorbidity was present in 89.5% of the patients. The most frequent comorbidity was bronchiectasis (78.9%). Previous treatment for pulmonary tuberculosis (PTB) was found in 65.9%. The most used therapeutic regimen was rifampicin, isoniazid and ethambutol (44.7%). Chest tomography (CT) showed bronchiectasis (94.1%), architectural distortion (76.5%), septum thickening (67.6%), and cavities (64.7%). Disease was bilateral in 85.2%. We observed 10.7% resistance to rifampicin, 67.9% resistance to ethambutol, and sensitivity to clarithromycin. Conclusion In patients with structural lung disease, it is important to search for NTM, the main differential diagnosis with PTB. Chest CT showed different patterns that overlapped with structural disease caused by PTB or other lung diseases. We observed resistance to ethambutol, a drug component of the recommended regimen.


Subject(s)
Humans , Male , Female , Middle Aged , Mycobacterium kansasii/isolation & purification , Lung/diagnostic imaging , Lung Diseases/drug therapy , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/epidemiology , Antitubercular Agents/therapeutic use , Rifampin/therapeutic use , Brazil/epidemiology , Drug Resistance, Microbial , Tomography, X-Ray Computed , Treatment Outcome , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Lung Diseases/microbiology , Mycobacterium Infections, Nontuberculous/diagnosis
11.
Mem. Inst. Oswaldo Cruz ; 115: e190407, 2020. tab
Article in English | LILACS | ID: biblio-1101275

ABSTRACT

BACKGROUND Early diagnosis of tuberculosis (TB) and identification of strains of Mycobacterium tuberculosis resistant to anti-TB drugs are considered the main factors for disease control. OBJECTIVES To standardise a real-time polymerase chain reaction (qPCR) assay technique and apply it to identify mutations involved in M. tuberculosis resistance to Isoniazid (INH) directly in Ziehl-Neelsen (ZN) stained slides. METHODS Were analysed 55 independent DNA samples extracted from clinical isolates of M. tuberculosis by sequencing. For application in TB diagnosis resistance, 59 ZN-stained slides were used. The sensitivity, specificity and Kappa index, with a 95% confidence interval (CI95%), were determined. FINDINGS The agreement between the tests was, for the katG target, the Kappa index of 0.89 (CI95%: 0.7-1.0). The sensitivity and specificity were 97.6% (CI95%: 87.7-99.9) and 91.7% (CI95%: 61.5-99.5), respectively. For inhA, the Kappa index was 0.92 (CI95%: 0.8-1.0), the sensitivity and specificity were 94.4% (CI95%: 72.7-99.8) and 97.3% (CI95%: 85.8-99.9), respectively. The use of ZN-stained slides for drug-resistant TB detection showed significant results when compared to other standard tests for drug resistance. MAIN CONCLUSIONS qPCR genotyping proved to be an efficient method to detect genes that confer M. tuberculosis resistance to INH. Thus, qPCR genotyping may be an alternative instead of sequencing.


Subject(s)
Humans , Genetic Markers/genetics , Drug Resistance, Bacterial/genetics , Isoniazid/pharmacology , Mutation/genetics , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , DNA, Bacterial/genetics , Microbial Sensitivity Tests , Sensitivity and Specificity , Real-Time Polymerase Chain Reaction , Genotype , Mycobacterium tuberculosis/drug effects
12.
Article in English | WPRIM | ID: wpr-762473

ABSTRACT

BACKGROUND: Although the incidence of tuberculosis (TB) is decreasing, cases of multidrug-resistant (MDR) TB and extensively drug-resistant (XDR) TB continue to increase. As conventional phenotype drug susceptibility testing (pDST) takes six to eight weeks, molecular assays are widely used to determine drug resistance. we developed QuantaMatrix Multiplexed Assay Platform (QMAP) MDR/XDR assay (QuantaMatrix Inc., Seoul, Korea) that can simultaneously detect mutations related to both first- and second-line drug resistance (rifampin, isoniazid, ethambutol, fluoroquinolones, second-line injectable drugs, and streptomycin). METHODS: We used 190 clinical Mycobacterium tuberculosis (MTB) strains isolated from Myanmar, compared QMAP and pDST results, and determined concordance rates. Additionally, we performed sequence analyses for discordant results. RESULTS: QMAP results were 87.9% (167/190) concordant with pDST results. In the 23 isolates with discordant results, the QMAP and DNA sequencing results completely matched. CONCLUSIONS: The QMAP MDR/XDR assay can detect all known DNA mutations associated with drug resistance for both MDR- and XDR-MTB strains. It can be used for molecular diagnosis of MDR- and XDR-TB to rapidly initiate appropriate anti-TB drug therapy.


Subject(s)
Diagnosis , DNA , Drug Resistance , Drug Therapy , Ethambutol , Extensively Drug-Resistant Tuberculosis , Fluoroquinolones , Incidence , Isoniazid , Myanmar , Mycobacterium tuberculosis , Phenotype , Seoul , Sequence Analysis , Sequence Analysis, DNA , Tuberculosis , Tuberculosis, Multidrug-Resistant
15.
Arch. argent. pediatr ; 117(5): 497-501, oct. 2019. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1054970

ABSTRACT

La vacuna con el bacilo de Calmette-Guérin es una vacuna atenuada utilizada para prevenir formas graves de tuberculosis. Se aplica a los recién nacidos en países con alta prevalencia de tuberculosis. Pueden presentarse, después de su aplicación, complicaciones a nivel local, como supuración o adenopatías regionales. La enfermedad por diseminación del bacilo es infrecuente y ocurre, por lo general, en pacientes con alteraciones inmunitarias subyacentes. Se presenta el caso de un niño de 5 meses que ingresó por un cuadro de 2 meses de evolución con detención del aumento de peso y nódulos subcutáneos. Se sospechó enfermedad por diseminación del bacilo y se diagnosticó por la biopsia de las lesiones. Se realizó el tratamiento con tres drogas antituberculosas, y se recuperó clínicamente. Si bien se realizaron estudios inmunológicos, no logró demostrarse ninguna inmunodeficiencia como afección predisponente.


The bacillus Calmette-Guérin vaccine is an attenuated vaccine historically used to prevent severe forms of tuberculosis. It is applied to all newborns in countries with high prevalence of tuberculosis. Local complications, such as suppuration or regional adenopathies, may occur after application. Disease due to the spread of the bacillus is infrequent, usually occurring in a patient with an underlying immune alteration. We present the case of a 5-month-old child who was admitted due to a 2-month evolution with weight loss and subcutaneous nodules. Disease was suspected to be due to bacillus Calmette-Guérin dissemination, being diagnosed by biopsy of the lesions. Treatment was carried out with three antituberculous drugs, evolving towards clinical recovery. Although immunological studies were carried out, no immunodeficiency could be demonstrated as a predisposing condition.


Subject(s)
Humans , Male , Infant , BCG Vaccine/adverse effects , Rifampin/therapeutic use , Biopsy , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Antibiotics, Antitubercular/therapeutic use , Mycobacterium bovis
17.
Electron. j. biotechnol ; 41: 81-87, sept. 2019. tab, graf, ilus
Article in English | LILACS | ID: biblio-1087242

ABSTRACT

Background: The search for innovative anti-tubercular agents has received increasing attention in tuberculosis chemotherapy because Mycobacterium tuberculosis infection has steadily increased over the years. This underlines the necessity for new methods of preparation for polymer-drug adducts to treat this important infectious disease. The use of poly(ethylene glycol)(PEG) is an alternative producing anti-tubercular derivatives. However, it is not yet known whether PEGylated isonicotinylhydrazide conjugates obtained by direct links with PEG are useful for therapeutic applications. Results: Here, we synthesized a PEGylated isoniazid (PEG-g-INH or PEG­INH) by gamma radiation-induced polymerization, for the first time. The new prodrugs were characterized using Raman and UV/Vis spectrometry. The mechanism of PEGylated INH synthesis was proposed. The in vitro evaluation of a PEGylated isonicotinylhydrazide macromolecular prodrug was also carried out. The results indicated that PEG­INH inhibited the bacterial growth above 95% as compared with INH, which showed a lower value (80%) at a concentration of 0.25 µM. Similar trends are observed for 0.1, 1, and 5 µM. Conclusions: In summary, the research suggests that it is possible to covalently attach the PEG onto INH by the proposed method and to obtain a slow-acting isoniazid derivative with little toxicity in vitro and higher antimycobacterial potency than the neat drug.


Subject(s)
Polyethylene Glycols/chemistry , Isoniazid/chemistry , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/chemistry , Polyethylene Glycols/pharmacology , Polymers , Spectrum Analysis, Raman , In Vitro Techniques , Prodrugs , Polymerization , Gamma Rays , Isoniazid/pharmacology , Antitubercular Agents/pharmacology
18.
Rev. bras. oftalmol ; 78(3): 195-198, May-June 2019. graf
Article in English | LILACS | ID: biblio-1013672

ABSTRACT

ABSTRACT Tuberculosis (TB) is an infectious disease of great magnitude in the world. Of patients with extrapulmonary disease, ocular manifestations are rare but among reported cases the most common ocular manifestation is uveitis. The diagnosis of ocular TB should be made as early as possible so that treatment is initiated and the risks of ocular complications are minimized. The objective of this study is to report an ocular TB case that presented as anterior uveitis. A 52-year-old female patient, a nursing technician at a large hospital, presented a history of low visual acuity associated with myiodesopsia for 4 days. Her ophthalmologic history included an iridotomy due to narrow angle in both eyes. On examination, the best corrected visual acuity was 20/100, right eye, and 20/80, left eye. Among the most significant ocular alterations were granulomatous keratic precipitates, anterior chamber reaction, flare and light vitreitis, corresponding to anterior uveitis. Based on clinical history and ophthalmologic examination, tests were ordered that corroborated the diagnosis of ocular TB. Thereafter, antituberculous therapy was instituted with a good response in 15 days, including improvement in visual acuity. The patient was followed-up by ophthalmology and infectology. Intraocular TB should be considered in the differential diagnosis of any type of intraocular inflammation. The diagnosis of presumed ocular TB is a clinical challenge with the diagnosis modalities currently available. The faster the onset of treatment, the better the visual prognosis of the affected patient.


RESUMO A tuberculose (TB) é uma doença infecciosa de grande magnitude no mundo. Dos pacientes com doença extrapulmonar, as manifestações oculares são raras, mas entre os casos relatados, a manifestação ocular mais comum é a uveíte. O diagnóstico de TB ocular deve ser feito o mais precoce possível para que o tratamento seja iniciado e os riscos de complicações oculares sejam minimizados. O objetivo deste estudo é relatar um caso de TB ocular que se apresentou como uveíte anterior. Uma paciente do sexo feminino, 52 anos, técnica de enfermagem de um hospital de grande porte, apresentou história de baixa acuidade visual associada à miodesopsia por 4 dias. Sua história oftalmológica incluía uma iridotomia devido ao ângulo estreito em ambos os olhos. No exame, a melhor acuidade visual corrigida foi 20/100, olho direito, e 20/80, olho esquerdo. Dentre as alterações oculares mais significativas, destacam-se precipitados ceráticos granulomatosos, reação de câmara anterior, flare e vitreíte leve, correspondendo à uveíte anterior. Com base na história clínica e no exame oftalmológico, foram solicitados exames que corroboram o diagnóstico de TB ocular. Posteriormente, a terapia antituberculosa foi instituída com uma boa resposta em 15 dias, incluindo melhora na acuidade visual. A paciente foi acompanhada pelas especialidades: oftalmologia e infectologia. A TB intraocular deve ser considerada no diagnóstico diferencial de qualquer tipo de inflamação intraocular. O diagnóstico presumível de tuberculose ocular é um desafio clínico com as modalidades de diagnóstico atualmente disponíveis. Quanto mais rápido o início do tratamento, melhor o prognóstico visual do paciente afetado.


Subject(s)
Humans , Female , Middle Aged , Tuberculosis, Ocular/complications , Uveitis, Anterior/etiology , Rifampin/therapeutic use , Visual Acuity , Tuberculosis, Ocular/diagnosis , Tuberculosis, Ocular/drug therapy , Uveitis, Anterior/diagnosis , Uveitis, Anterior/drug therapy , Ethambutol/therapeutic use , Isoniazid/therapeutic use
19.
J. bras. pneumol ; 45(2): e20180128, 2019. tab, graf
Article in English | LILACS | ID: biblio-1002440

ABSTRACT

ABSTRACT Objective: To evaluate the rapid diagnosis of multidrug-resistant tuberculosis, by using a commercial line probe assay for rifampicin and isoniazid detection (LPA-plus), in the routine workflow of a tuberculosis reference laboratory. Methods: The LPA-plus was prospectively evaluated on 341 isolates concurrently submitted to the automated liquid drug susceptibility testing system. Results: Among 303 phenotypically valid results, none was genotypically rifampicin false-susceptible (13/13; 100% sensitivity). Two rifampicin-susceptible isolates harboured rpoB mutations (288/290; 99.3% specificity) which, however, were non-resistance-conferring mutations. LPA-plus missed three isoniazid-resistant isolates (23/26; 88.5% sensitivity) and detected all isoniazid-susceptible isolates (277/277; 100% specificity). Among the 38 (11%) invalid phenotypic results, LPA-plus identified 31 rifampicin- and isoniazid-susceptible isolates, one isoniazid-resistant and six as non-Mycobacterium tuberculosis complex. Conclusions: LPA-plus showed excellent agreement (≥91%) and accuracy (≥99%). Implementing LPA-plus in our setting can speed up the diagnosis of multidrug-resistant tuberculosis, yield a significantly higher number of valid results than phenotypic drug susceptibility testing and provide further information on the drug-resistance level.


RESUMO Objetivo: Avaliar o diagnóstico rápido de tuberculose multirresistente, utilizando um teste comercial de sondas em linha (LPA-plus), na rotina de um laboratório de referência de tuberculose. Métodos: O teste LPA-plus foi avaliado prospectivamente em 341 isolados simultaneamente submetidos ao teste de suscetibilidade aos antimicrobianos em meio líquido, pelo sistema automatizado. Resultados: Entre os 303 resultados fenotipicamente válidos, nenhum foi genotipicamente falso suscetível à rifampicina (13/13; 100% de sensibilidade). Dois isolados sensíveis à rifampicina apresentavam mutações no gene rpoB (288/290; especificidade de 99,3%), as quais, no entanto, não são associadas à resistência a rifampicina. O LPA-plus não identificou resistência à isoniazida em três isolados fenotipicamente resistentes (23/26; 88,5% de sensibilidade) e detectou todos os isolados sensíveis à isoniazida (277/277; especificidade de 100%). Entre os 38 (11%) resultados fenotípicos inválidos, o LPA-plus identificou 31 isolados sensíveis à rifampicina e à isoniazida, um resistente à isoniazida e seis como micobactérias não tuberculosas. Conclusões: O LPA-plus mostrou excelente concordância (≥91%) e acurácia (≥99%). Sua implementação pode acelerar o diagnóstico da tuberculose multirresistente, produzir número significativamente maior de resultados válidos do que o teste fenotípico de suscetibilidade aos antimicrobianos e fornecer informações adicionais sobre o nível de resistência aos fármacos.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Tuberculosis, Multidrug-Resistant/diagnosis , Molecular Diagnostic Techniques/methods , Phenotype , Rifampin/pharmacology , Time Factors , DNA, Bacterial , Microbial Sensitivity Tests , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Tuberculosis, Multidrug-Resistant/microbiology , Nucleic Acid Amplification Techniques/methods , Early Diagnosis , Isoniazid/pharmacology , Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/pharmacology
20.
J. bras. pneumol ; 45(6): e20180225, 2019. tab, graf
Article in English | LILACS | ID: biblio-1040292

ABSTRACT

ABSTRACT Objective: To describe the incidence of active tuberculosis and the occurrence of adverse events after isoniazid treatment in patients with latent tuberculosis infection (LTBI) who also had chronic inflammatory diseases and were treated with immunobiologic agents in an endemic area in Brazil. Methods: The diagnosis of LTBI was based on anamnesis, clinical examination, chest X-ray, and a tuberculin skin test (TST). Patients received prophylactic treatment (isoniazid for six months) in accordance with the Brazilian guidelines. Results: A total of 101 patients were evaluated between July of 2011 and July of 2015. Of those, 55 (54.46%) were women (mean age, 53.16 ± 1.76 years) and 46 (45.54%) were men (mean age, 45.39 ± 2.13 years). A total of 79 patients (78.22%) were being treated with immunobiologic agents and 22 (21.78%) were being treated with immunomodulatory or immunosuppressive agents. In the screening for LTBI, 53 patients (52.48%) had a TST induration ≥ 10 mm. Chest X-ray findings consistent with LTBI were observed in 36 patients (35.64%). Isoniazid preventive therapy was effective in 96 (95.05%) of the 101 patients evaluated. It is of note that 84 (83.17%) of the patients experienced no adverse effects from the use of isoniazid and that 83 (98.81%) of those patients completed the prophylactic treatment (p = 0.002). Active tuberculosis was diagnosed in 5 (6.33%) of the 79 patients treated with immunobiologic agents and in 1 (4.55%) of the 22 patients treated with other immunomodulators/immunosuppressants. Conclusions: A six-month course of isoniazid proved to be safe and effective in the treatment of LTBI, which is essential to reducing the risk of developing active tuberculosis.


RESUMO Objetivo: Descrever a incidência de tuberculose ativa e a ocorrência de eventos adversos do tratamento com isoniazida em pacientes diagnosticados com tuberculose latente (TBL), portadores de doenças inflamatórias crônicas e tratados com agentes imunobiológicos em uma área endêmica no Brasil. Métodos: O diagnóstico de TBL foi feito com base em anamnese, exame clínico, radiografia de tórax e teste tuberculínico (TT). O tratamento profilático foi realizado segundo diretrizes brasileiras com isoniazida por seis meses. Resultados: Foram estudados 101 pacientes entre julho de 2011 e julho de 2015. Desses, 55 (54,46%) eram mulheres (média de idade = 53,16 ± 1,76 anos) e 46 (45,54%) eram homens (média de idade = 45,39 ± 2,13 anos), sendo que 79 (78,22%) foram tratados com agentes imunobiológicos e 22 (21,78%) com outros agentes imunomoduladores ou imunossupressores. Na triagem para TBL, 53 pacientes (52,48%) apresentaram TT ≥ 10 mm. A radiografia de tórax alterada por imagens compatíveis com TBL foi observada em 36 pacientes (35,64%). O tratamento profilático com isoniazida mostrou uma eficácia de 95,05% (96/101). É relevante mencionar que 84 (83,17%) dos pacientes não apresentaram nenhum efeito adverso à isoniazida e, desses, 83 (98,81%) completaram o tratamento profilático (p = 0,002). Tuberculose ativa foi diagnosticada em 5 (6,33%) dos 79 pacientes tratados com agentes imunobiológicos e em 1 (4,55%) dos 22 pacientes tratados com outros imunomoduladores/imunossupressores. Conclusões: O uso de isoniazida por seis meses mostrou-se seguro e eficaz no tratamento da TBL nesses pacientes, o que é essencial para reduzir o risco de desenvolvimento de tuberculose ativa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Latent Tuberculosis/diagnosis , Latent Tuberculosis/drug therapy , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Isoniazid/therapeutic use , Antitubercular Agents/therapeutic use , Time Factors , Brazil/epidemiology , Tuberculin Test/methods , Radiography, Thoracic , Multivariate Analysis , Prospective Studies , Risk Factors , Treatment Outcome , Antibiotic Prophylaxis/methods , Endemic Diseases , Latent Tuberculosis/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL