Drug resistance pattern and outcome of treatment in recurrent episodes of tuberculosis

Patterns of drug resistance in recurrent cases of tuberculosis may be different than in those without a history of treatment. In this retrospective study, the drug resistance pattern and outcome of treatment with DOTS category I [CAT I] regimen was compared in 63 recurrent cases and 872 new cases of pulmonary tuberculosis from April 2003 to January 2008 at the National Research Institute of Tuberculosis and Lung Disease in Tehran, Islamic Republic of Iran. Resistance to isoniazid and ethambutol was significantly more common in recurrent cases, but there were no differences in rates of resistance to rifampin, pyrazinamide, streptomycin or the rate of multi-drug resistant strains. Resistance to streptomycin was the most common. No significant differences in treatment outcome and deaths were found between the 2 groups. Due to the low frequency of multi-drug resistance in the recurrent cases, a CAT I regimen may be suitable for empirical therapy before drug sensitivity results become available

Comparison of the effectiveness of 2 treatment regimens in patients with isoniazid-resistant tuberculosis

We compared the effectiveness of 2 treatment regimens for isoniazid-resistant tuberculosis [TB] in 42 patients attending a TB referral centre in the Islamic Republic of Iran. The patients were divided into 2 treatment groups: 26 received the 6-month standard HRZE treatment and 16 received a modified treatment of RZE for 6 months. There were no significant differences in age or sex of the groups. With the standard method of treatment, 21 [80.8%] patients were cured, 4 [15.4%] resulted in treatment failure, and 1 [3.8%] died. In the modified treatment group, 16 [100%] patients were cured. These differences were not statistically significantly different [P = 0.194]

Clinical and laboratory profile of patients with tuberculosis/HIV coinfection at a national referral centre: a case series

This case series describes the clinical and laboratory profile of 15 patients with tuberculosis [TB] HIV coinfection admitted to a referral centre in the Islamic Republic of Iran. Most of the patients [13] were male; the mean age was 36.9 years. Intravenous drug use was the route of transmission for all males and heterosexual intercourse for the 2 females; 12 patients had a history of imprisonment. All patients had pulmonary TB; 13 were smear-positive and all except 1 had atypical radiological presentation. Drug-induced hepatitis occurred in 3 patients and 12 had hepatitis C coinfection. Five patients died. The mean CD4 count was 229.2 [SD 199.5] cells/mm[3] and 78.6% had CD4 count < 350. TB may be an AIDS-defining illness in this country

Tuberculosis of the breast: report of 4 clinical cases and literature review

Nearly 18% of tuberculosis [TB] cases have only extrapulmonary manifestations. Breast tuberculosis is a rare type of extrapulmonary TB. This paper reports 4 cases of breast TB confirmed either pathologically or mycobacteriologically or both. These reports showed that TB should always be considered first in the differential diagnosis of granulomatous mastitis in TB-endemic areas. Therapy included at least 6 months of anti-TB medication and surgery when indicated

Reduction of clinical tuberculosis in HIV-infected males with isoniazid prophylaxis

Isoniazid [INH] chemoprophylaxis has a positive impact on the development of clinical tuberculosis. Due to the increased prevalence of tuberculosis among HIV-infected individuals, we evaluated the effect of INH on the prevention of clinical tuberculosis in HIV-infected patients. We administered 300 mg of INH daily to 246 HIV-infected, tuberculin skin test-positive patients for 12 months. During 3 years of follow-up, 41 participants died and 94 were lost to follow up. Of the 111 patients followed for the 3 years, 12 developed tuberculosis which is lower than might be expected in an untreated group. INH prophylaxis appears to be an effective method to prevent clinical tuberculosis among HIV-infected, tuberculin skin test-positive patients