Multidrug-resistant tuberculosis: response to treatment.

OBJECTIVE: We investigated clinical response and mortality rates in 18 HIV- negative patients with multidrug-resistant tuberculosis. METHOD: We obtained detailed data from our hospital on patients with multidrug - resistant tuberculosis defined as tuberculosis resistant at least to isoniazid and rifampicin. Therapeutic responses were evaluated by both microbiologic and clinical data. RESULTS: From January 1985 to December 1990, 18 HIV-negative patients were identified and treated. One patient committed suicide 1 week after receiving antituberculous drugs. Of the 17 patients, 10 (58.8%) had clinical response as well as microbiologic response, 6 (35.3%) were persisters during 24 months of follow-up, and 1 (5.8%) died after 30 months of treatment. The median follow-up for the patients was 87 weeks (range, 24 to 212). For those who responded well, there was no relapse.

Nosocomial pneumonias in Thailand.

In order to compare the etiology, clinical manifestations, and prognosis of patients acquiring nosocomial pneumonia, we studied and compared sixty normal hosts who acquired nosocomial pneumonia during Jan 1, 1989-Dec 31, 1991 (group I) with seventy-two immunocompromised patients with nosocomial pneumonia who were admitted during 1984-1992 (group II). Both groups were similar in some patterns, eg gram-negative bacilli were common (80%, 50%), the chest roentgenogram showed initial localized lesions (74%, 72%), and there was a high mortality rate (46.7%, 54.2%). The differing findings were that the first group acquired pneumonia more often during the first 7 days after admission, transbronchial aspiration was believed to be the route of entry and most of the patients had productive coughs. Blood cultures rarely yielded the organisms (7%). The second group had pneumonia at a mean of 32 days after admission, hematogenous spread to the lungs was common and blood cultures more often yielded the etiologic organisms (41.7%).

Nosocomial pneumonias-a comparison among normal and compromised hosts in Thailand.

In order to compare the etiology, clinical manifestation, and prognosis of patients acquiring nosocomial pneumonia, we studied and compared twenty normal hosts who acquired nosocomial pneumonia from Jan 1, 1989 to Dec 31, 1989 (group 1) with fifty-four immunocompromised patients with nosocomial pneumonia who were admitted between 1984 and 1990 (group 2). Both groups were similar in some patterns such as: gram-negative bacilli were common (75%, 60%), the chest roentgenogram showed initial localized lesions (75%, 73%), there was a history of prolonged hospitalization (27, 33 days) and a high mortality rate (60%, 50%). The differing findings were that the first group acquired pneumonia more often during the first 7 days after admission; transbronchial aspiration was believed to be the route of entry and most of the patients had productive cough. Blood cultures rarely yielded the organisms (5%). The second group had pneumonia at a mean of 33 days after admission, hematogenous spread to the lungs was common and blood cultures yielded the etiologic organisms more often (40.7%).

Final diagnosis of "suspicious for malignancy" from bronchial washing cytology.

Our study showed that patients whose first bronchial washing cytology was reported "suspicious for malignancy" had 82 per cent positive predictive value for malignancy. Repeat bronchoscopy should be offered to those with a visible endobronchial mass, and transthoracic needle aspiration should be performed in patients with peripheral lesions.