The importance of audiometric monitoring in patients with multidrug-resistant tuberculosis

Abstract INTRODUCTION: A total of 771 cases of multidrug-resistant tuberculosis (MDR-TB) were reported in Brazil in 2014. Treatment of MDR-TB with aminoglycosides can produce serious side effects such as permanent and irreversible hearing loss, which occurs in 5-64% of cases, and severely compromise patient quality of life. The goal of this research was to evaluate auditory and vestibular side effects in patients treated for MDR-TB and to identify associations between these complaints and the type of aminoglycoside used. METHODS: We performed a retrospective review of 599 medical records from patients with MDR-TB who were treated at the Hélio Fraga/Fiocruz Reference Center between 2006 and 2010. Cases without auditory or vestibular complaints and patients who were not treated with aminoglycoside drugs were excluded from the study. RESULTS: Of 164 eligible cases, 55 (33.5%) reported an auditory or vestibular complaint and medication was subsequently suspended, although hearing damage was not confirmed in all cases. Audiometric testing confirmed hearing loss in 11 (21.7%) of 12 cases submitted for evaluation. Hearing loss related to ototoxicity was confirmed in 15 (62.5%) cases. Tinnitus was significantly associated with the use of amikacin and streptomycin. CONCLUSIONS: Evaluations of ototoxicity symptoms were not usually reported in the routine care of patients with MDR-TB. Complaints of tinnitus were associated with amikacin and streptomycin use. These results require confirmation in future studies.

Tratamiento directamente observado de la tuberculosis en un hospital de la Ciudad de Buenos Aires / Directly observed treatment for tuberculosis in a Buenos Aires City hospital

Se describe la experiencia en la aplicación del tratamiento directamente observado de tuberculosis (TDO) en el período 1/1/1979-31/12/2009 y la comparación de los resultados obtenidos en el periodo 1979-1999 versus los de 2000- 2009. En un hospital de la Ciudad de Buenos Aires, 582 pacientes HIV negativos recibieron inicialmente rifampicina, isoniazida, pirazinamida y etambutol o estreptomicina. En la segunda fase 424 de estos pacientes tratados entre 01/01/1979 y 31/12/1999 (G1), recibieron esquemas bisemanales con rifampicina/isoniazida o isoniazida/estreptomicina y otros 158 pacientes, tratados entre 01/01/2000 y 31/12/2009 (G2) recibieron un esquema bisemanal o trisemanal con rifampicina/isoniazida. Se siguieron las recomendaciones de los programas de control de la Nación y la Ciudad. Los pacientes bajo TDO tuvieron tasas de tratamiento completo más elevadas (82.8% versus 48.7%), (p < 0.0001) con respecto a otros 483, que siguieron tratamiento autoadministrado (AUTO); la edad promedio fue de 36.3 ± 15.3 años, 63.1% eran varones y 69.4% tenían nacionalidad argentina. Presentaron tratamiento previo el 8.9%, comorbilidades el 6.1% y el 70.6% de las formas pulmonares fueron confirmadas bacteriológicamente. El 9.5% presentó efectos adversos a drogas y el sexo masculino presentó mayor frecuencia de abandonos (p = 0.004). Con respecto al G1, en el G2 hubo menor proporción de pacientes argentinos (48.7% vs. 77.1%), (p ≤ 0.0001), mayor frecuencia de comorbilidades (10.7% vs. 4.4%), (p = 0.005), de formas clínicas pulmonares con confirmación bacteriológica (95% vs. 87%), (p = 0.02) y de efectos adversos a drogas (17% vs. 6.6%), (p ≤ 0.0001). Hallamos tasas de cumplimiento total elevadas en TDO (82.8%), similares a las otras publicaciones.

The outcomes of directly observed therapy of tuberculosis (DOT) between 1/1/1979 and 12/31/2009 were analyzed. Results obtained in the 1979-1999 period were compared with those achieved in the 2000-2009 period. In a Buenos Aires City hospital, 582 HIV negative TB patients received rifampin, isoniazid, pyrazinamide and ethambutol or streptomycin in the initial stage, followed by a second stage where patients were included in two groups: G1 composed by 424 patients (period 1/1/1979-12/31/1999) who received either rifampin and isoniazid or rifampin and streptomicin twice a week, and G2, with 158 patients (period 1/1/2000-12/31/2009) who received either rifampin and isoniazid twice or three times a week. National and Buenos Aires City TB Control Programs recommendations were followed. Patients who underwent DOT had higher completeness rates than those included in self-administered therapy (82.8% vs. 48.7%), (p <0.0001). Mean age: 36.3±15.3 years, males: 63.1% and 69.4% were Argentine citizens. A 8.9% had been previously treated, 6.1% had co-morbidities. A 70.6% of pulmonary cases was bacteriologically confirmed, 82.8% of them completed the treatment, while 11.5% defaulted. Adverse effects to antituberculosis drugs were observed in 9.5% of cases; male patients showed higher rates of non adherence. G2 had a lower proportion of native people (48.7% vs. 77.1%), (p ≤ 0.0001), higher frequency of co-morbidities (10.7% vs. 4.4%), (p = 0.005), of bacteriologically confirmed pulmonary cases (95% vs. 87%), (p = 0.02) and more adverse effects than G1 (17% vs. 6.6%), (p ≤ 0.0001). In coincidence with other experiences, this work shows high treatment success rates in patients treated under DOT strategy.

Preditores dos desfechos do tratamento da tuberculose / Predictors of tuberculosis treatment outcomes

OBJETIVO: Analisar os desfechos do tratamento da tuberculose e seus preditores. MÉTODOS: Estudo longitudinal de coorte de pacientes com tuberculose tratados entre 2004 e 2006 no Instituto de Pesquisa Evandro Chagas, na cidade do Rio de Janeiro. As razões de risco ajustadas (RRa) dos preditores foram estimadas. RESULTADOS: Foram incluídos 311 pacientes. As taxas de cura, de abandono, de mortalidade e de falha terapêutica foram, respectivamente, 72 por cento, 19 por cento, 6 por cento e 2 por cento. A troca de regime terapêutico por eventos adversos foi necessária em 8 por cento. O alcoolismo (RRa, 0,30), uso do regime estreptomicina+etambutol+ofloxacina (SEO; RRa, 0,32), infecção por HIV sem tratamento antirretroviral (TARV; RRa, 0,36) e o uso do regime rifampicina+isoniazida+pirazinamida+etambutol (RRa, 0,58) reduziram a probabilidade de cura. A faixa etária mais jovem (RRa, 3,84) e o alcoolismo (RRa, 1,76) aumentaram a probabilidade do abandono. Não foi possível determinar as RRa para os demais desfechos devido a suas baixas prevalências. Entretanto, medidas do risco relativo (RR) identificaram os seguintes potenciais preditores do óbito: uso de esquema SEO (RR, 11,43), infecção pelo HIV sem TARV (RR, 9,64), forma clínica disseminada (RR, 9,09), ausência de confirmação bacteriológica (RR, 4,00), diabetes mellitus (RR, 3,94) e comportamento homo/bissexual (RR, 2,97). A baixa renda (RR, 11,70) foi potencial preditor para falha terapêutica, ao passo que infecção pelo HIV com uso de TARV (RR, 2,46) e forma clínica disseminada (RR, 3,57) foram potenciais preditores para troca do esquema por evento adverso. CONCLUSÕES: O esquema SEO deve ser utilizado transitoriamente quando possível. Os dados confirmam a importância de TARV e sugerem a necessidade de seu início precoce.

OBJECTIVE: To analyze tuberculosis treatment outcomes and their predictors. METHODS: This was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2004 and 2006 at the Instituto de Pesquisa Evandro Chagas, in the city of Rio de Janeiro. We estimated adjusted risk ratios (ARRs) for the predictors of treatment outcomes. RESULTS: Among 311 patients evaluated, the rates of cure, treatment abandonment, treatment failure, and mortality were 72 percent, 19 percent, 2 percent, and 6 percent, respectively. Changes in the treatment regimen due to adverse events occurred in 8 percent. The factors found to reduce the probability of cure were alcoholism (ARR, 0.30), use of the streptomycin+ethambutol+ofloxacin (SEO) regimen (ARR, 0.32), HIV infection without the use of antiretroviral therapy (ART; ARR, 0.36), and use of the rifampin+isoniazid+pyrazinamide+ethambutol regimen (ARR, 0.58). Being younger and being alcoholic both increased the probability of abandonment (ARR, 3.84 and 1.76, respectively). It was impossible to determine the ARR for the remaining outcomes due to their low prevalence. However, using the relative risk (RR), we identified the following potential predictors of mortality: use of the SEO regimen (RR, 11.43); HIV infection without ART (RR, 9.64); disseminated tuberculosis (RR, 9.09); lack of bacteriological confirmation (RR, 4.00); diabetes mellitus (RR, 3.94); and homosexual/bisexual behavior (RR, 2.97). Low income was a potential predictor of treatment failure (RR, 11.70), whereas disseminated tuberculosis and HIV infection with ART were potential predictors of changes in the regimen due to adverse events (RR, 3.57 and 2.46, respectively). CONCLUSIONS: The SEO regimen should not be used for extended periods. The data confirm the importance of ART and suggest the need to use it early.

mtDNA mutations, hearing loss and aminoglycoside treatment in Mexicans / Mutações em DNA mitocondrial, hipoacusia e tratamento de mexicanos com aminoglicosídeos

Streptomycin and aminoglycoside derivatives are commonly used to treat tuberculosis and other stubborn infections; these drugs may alter auditory and/or vestibular function. Mutations in mitochondrial DNA have been associated with hypersensitivity to aminoglycosides; no studies have been conducted in Mexicans, which are very prone to such alterations because aminoglycosides have been prescribed carelessly for many years, irrespective of the ailment to be treated. AIM: We investigated "hot spot" mutations described previously as causing inner ear alterations. METHODS: Hot spot mutations at the 12S rRNA gene and the tRNA Serine (UCN) gene were screened by PCR-RFLP and sequencing in 65 subjects undergoing audiological and vestibular testing. STUDY DESIGN: Experimental. RESULTS: 32 individuals had healthy auditory and vestibular function, whereas 33 subjects had auditory affections. We found none of the previously reported mutations related to aminoglycoside hypersensitivity, or non-syndromic hearing loss. Two hearing-impaired patients that had been treated with streptomycin had the T1189C variant of the mitochondrial 12S rRNA region. CONCLUSION: Mutations related to hearing loss in other ethnic backgrounds were not found in Mexicans. However, the T1189C variant is possibly a putative mutation related to aminoglycoside hypersensitivity and was present in 2 patients.

Derivados de aminoglicosídeos e estreptomicina são comumente utilizados para tratar tuberculose e outras infecções mais resistentes; esses medicamentos podem alterar a função vestibular e/ou auditiva. Mutações no DNA mitocondrial têm sido associadas à hipersensibilidade a aminoglicosídeos; não há estudos conduzidos com mexicanos, que são muito predispostos a tais alterações, uma vez que aminoglicosídeos têm sido exageradamente prescritos há anos, sem associações à doença sendo tratada. OBJETIVO: investigamos mutações "hot spot" previamente descritas como causas de alterações no ouvido interno. MÉTODOS: Mutações hot spot no gene 12S rRNA e gene SerinatRNA (UCN) foram triados pela PCR-RFLP e sequenciados em 65 indivíduos sujeitos a exames audiométricos e vestibulares. Desenho do estudo: Experimental. RESULTADOS: 32 indivíduos com funções auditiva e vestibular normais, e 33 indivíduos com doenças auditivas. Não encontramos nenhuma das mutações previamente relatadas como associadas à hipersensibilidade aos aminoglicosídeos, ou perda auditiva não-sindrômica. Dois pacientes com hipoacusia que haviam sido tratados com estreptomicina tinham a variante T1189C na região 12S rRNA. CONCLUSÃO: Mutações associadas à hipoacusia em outras etnias não foram encontradas em mexicanos. Entretanto, a variante T1189C é possivelmente uma mutação associada à hipersensibilidade a aminoglicosídeos, e esteve presente em dois pacientes.

Desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 em Porto Alegre, Brasil / Retreatment of tuberculosis patients in the city of Porto Alegre, Brazil: outcomes

OBJETIVO: Descrever os desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 (estreptomicina, etambutol, etionamida e pirazinamida por 3 meses + etambutol e etionamida por 9 meses) devido à falência do tratamento com o esquema básico (rifampicina, isoniazida e pirazinamida por 2 meses + rifampicina e isoniazida por 4 meses). MÉTODOS: Estudo descritivo de coorte histórica, não controlada, com adultos que foram tratados com o esquema 3. Foram avaliados os desfechos desse tratamento, as reações adversas aos fármacos, as recidivas e os fatores associados. RESULTADOS: Foram incluídos no estudo 229 pacientes. A taxa de cura geral foi de 62 por cento. Entre os pacientes que usaram a medicação regularmente e aqueles que a usaram irregularmente, a taxa de cura foi de 88 por cento e 31 por cento, respectivamente. Observaram-se reações adversas em 95 pacientes (41,5 por cento), principalmente digestivas. Ocorreram 17 recidivas (12,0 por cento) nos cinco anos de seguimento. CONCLUSIONS: Os desfechos com o uso do esquema 3, em geral, não foram satisfatórios, pois esse esquema foi aplicado em uma população selecionada com alto risco de não adesão ao tratamento e apresenta altas taxas de reações adversas, especialmente as de tipo digestivo, possivelmente causadas pela etionamida. No entanto, para aqueles que conseguiram tomar a medicação regularmente, a taxa de cura foi satisfatória. A taxa de recidiva foi superior àquela preconizada por consensos internacionais, possivelmente devido ao tempo de tratamento curto (apenas 12 meses). Acreditamos que o esquema 3 estendido para 18 meses poderia ser uma alternativa para pacientes com comprovada adesão ao tratamento.

OBJECTIVE: To describe the outcomes of retreatment in tuberculosis patients receiving the regimen known, in Brazil, as regimen 3 (streptomycin, ethambutol, ethionamide, and pyrazinamide for 3 months + ethambutol and ethionamide for 9 months) after treatment failure with the basic regimen (rifampin, isoniazid, and pyrazinamide for 2 months + rifampin and isoniazid for 4 months). METHODS: A descriptive, uncontrolled, historical cohort study involving adult tuberculosis patients treated with regimen 3. We evaluated adverse drug effects, recurrence, treatment outcomes, and associated factors. RESULTS: The study included 229 patients. The overall cure rate was 62 percent. For the patients who used the medications regularly and those who did not, the cure rate was 88 percent and 31 percent, respectively. Adverse events occurred in 95 patients (41.5 percent), and most of those events were related to the gastrointestinal tract. In the five-year follow-up period, relapse occurred in 17 cases (12.0 percent). CONCLUSIONS: Overall, the outcomes of treatment with regimen 3 were unsatisfactory, in part because this regimen was administered to a selected population of patients at high risk for noncompliance with treatment, as well as because it presents high rates of adverse effects, especially those related to the gastrointestinal tract, which might be caused by ethionamide. However, for those who took the medications regularly, the cure rate was satisfactory. The recurrence rate was higher than that recommended in international consensus guidelines, which might be attributable to the short (12-month) treatment period. We believe that regimen 3, extended to 18 months, represents an option for patients with proven treatment compliance.

Evaluation of aminoglycosides [gentamicin, neomycin, streptomycin] and fluoroquinolones [ofloxacin] antibiotics on spermatogenesis in rat

Gentamicin, Neomycin, Streptomycin and ofloxacin are synthetic antibacterial agent belonging to the family of aminoglycoside and fluoroquinolones antibiotics with a very broad spectrum against microbial pathogens, especially Gram-negative and urinary tract infectious diseases which nowadays have good effect in diseases treatment in more countries world-wide. The aim of this study was to see the effects of this drugs inducement, in Spermatogenesis cycle in rat. The fifty male wistar rat were selected and randomly divided into five groups; control [n=10] and test [n=40]. The test groups was received 5mg/kg [IP] Gentamicin, 50mg/kg [IP] Neomycin, 40mg/kg [IP] Streptomycin, and 72mg/kg [PO] ofloxacin daily for fourteenth day; however the control group just received vehicle [IP]. In fourteenth day the testis tissue of Rat in whole groups were removed and sperm was collected from epididymis then prepared for analysis. Light microsopic Obervation Showed that sperm cell count and viability as compared with compared with control group decreased significantly [p<0.001]. When compared with control group, percentage of sperm motility decreased significantly in all experimental except ofloxacin group [p>0.05]. Since in our study ofioxacin had only effect on sperm population and viability and hadn't any effect on sperm motility percentage, so it seems that using this antibiotic is safest more than others on sperm health parmeters

Hearing impairment in patients with tuberculosis from Northeast Brazil

Este trabalho teve por objetivo descrever o perfil auditivo de pessoas que realizaram tratamento para tuberculose com estreptomicina em Recife nos anos de 2000 e 2001. Para tal foi utilizado o banco de dados do Sistema de Informação de Agravos de Notificação, fornecido pela Secretária de Saúde deste município, sendo selecionadas 78 pessoas que usaram a droga no período em estudo. Do total de pacientes selecionados sete eram menores de 18 anos ou maiores de 58 anos, 19 haviam falecido, 13 não foram localizados, dois eram presidiários, um negou-se a participar, restando, pois 36 indivíduos que puderam ser submetidos a uma entrevista, a meatoscopia e a audiometria. No grupo estudado predominou o sexo masculino (79,4%) e a média das idades era de 38,8 anos. Dos 36 pacientes, 27 (75,0%) apresentaram alteração auditiva, sendo a mais freqüente a sensório-neural bilateral (63,9%), com predomínio de freqüências agudas, a partir de 4000 Hz. Os achados com elevados percentuais de alteração auditiva entre os usuários de estreptomicina, apontam para a necessidade de aprofundamento deste tema em outros estudos, e também sugerem a necessidade de estruturação de um sistema de monitoramento auditivo para a população de pacientes submetidos a esse quimioterápico no tratamento para tuberculose.

Anti-tuberculosis drug inducd hepatitis - a Sri Lankan experience.

OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal). RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.

possible protective effect[s] of linseed oil against nephrotoxicity of some drugs

Linseed oil is a popular dietary element in Egypt It was found to decrease hepatic toxicity and acute lethality of acetaminophen and to decrease renal toxicity induced by gentamycin or acetaminophen [Metwally et al, 2001]. The present work aims for studying the possible protective effect[s] of linseed oil against nephrotoxicity induced by cisplatin [anticancer], cyclosporine [immunosuppressant], as well as streptomycin [amino glycoside antibiotic]. Adult male Sprague Dawely rats were fed daily by either control diet [control rats], or diet containing 5% linseed oil for 15 days. Twenty four hours later, animals of each group were subdivided into 4 subgroups and treated as follows: control [drug free], cisplatin [4mg/kg i.p. X 1 day], cyclosporine [50mg/kg orally X 6 days] or streptomycin [800mg/kg i.p. X 6 days]. Seven days after administering the first dose of the nephrotoxic agents the following parameters were assessed: serum creatinine and urea, glomerular filtration rate, urea clearance, serum and urine sodium and potassium as well as specific gravity and urine volume. Kidney histopathology and relative weights were evaluated. The results showed that linseed oil causes pronounced protective effect against streptomycin nephrotoxicity, slight protection against cyclosporine and very slight protective effect against cisplatin treated animals. The obtained results will be discussed in view of the possible impacts on eicosanoids and throinboxane synthesis

Alfa-Glucosidasa con Posible Acción Hidrolítica Sobre Aminoglicósidos en la Sangre y el Vestíbulo de Ratas / Alpha-glucosidase with possible hydrolytic action over aminoglycosides in the blood and vestibule of rats

Antecedentes e hipótesis. La estreptomicina (STP)es un antibiótico aminoglicósido que se usa en el tratamiento de la tuberculosis, con efectos tóxicos importantes sobre la función vestibular. Los antecedentes farmacocinéticos muestran que la STP se acumula en un principio en la parte perilinfática y por mecanismos aún no descritos pasa a la endolinfa donde su principal blanco de acción son los cilios sensorios de las células pilosas vestibulares. Consideramos importante averiguar que parte de la molécula de STP es la responsable de su toxicidad vestibular, y tenemos evidencias que señalan la parte estreptidina (STD)como la porción activa, por lo que se propone que la STP actúa fragmentada por acción de una alfa-glucosidasa que hidroliza el enlace -1,4 con la liberación de la STD y que esté presente ya sea en el vestíbulo, en el torrente sanguíneo o en ambos. Método. Se determinó la actividad de alfa-glucosidasa en el suero y en homogeneizado vestibular de la rata usando p-nitrofenil--d-glucósido como sustrato; siguiendo el p-nitrofenilo (pNP)liberado espectrofotométricamente a 400 nm. Resultados. Se encontró alfa-glucosidasa tanto en el suero como en el vestíbulo de la rata con actividades específicas de 0.035 y 1.3 nmol de pNP/mg proteína/min respectivamente. Conclusión. La actividad encontrada en vestíbulo es semejante a la de la alfa-glucosidasa lisosomal del hígado de la rata (1.5 nmol de pNP/mg proteína/min)por lo que es posible que la alfa-glucosidasa presente en el suero y en el vestíbulo pueda romper a la STP, liberando la parte STD que actuaría sobre el oído

Estreptomicina: propiedades fisicoquímicas y toxicidad vestibular / Streptomycin, physical and chemical characteristics and vestibular toxicity

Propósito: Los antibióticos aminoglucósidos estreptomicina (STP) y kanamicina (KAN) son tóxicos para las células sensoriales del vestíbulo y de la cóclea, respectivamente. Químicamente están constituidos por estreptidina (STD) un derivado del inositol y dos azúcares, la esteptosa (Stosa) y la N-metilglucosamida (nm-GLUN); sin embargo, en la STP, la STD tiene dos sustituyentes guanidino, los que están ausentes en la KAN. Por lo tanto, se propone estudiar si la vestíbulo-toxicidad específica de la STP se debe a los grupos guanidino. Material y Métodos: Se incubaron en vitro, membranas celulares aisladas de los órganos vestibulares, con 3H-espermidina (3H-Spdina), un análogo estructural de la STP. Se midió la capacidad de los siguientes compuestos: STP, STD, KAN, guanidina (GUA) y n-acetilglucosamina (na-GLUN) para desplazarlos específicamente. Resultados: Se encontró que el orden de desplazamiento de la 3HSPdina para esas sustancia era STP=STD KanGUAn-a-GLUN. Conclusiones: Los resultados sugieren fuertemente que la STP debe su especificidad vestibulotóxica, a la presencia de los grupos guanidino en la porción de STD de su molécula, los que interactuarían por sus cargas positivas con estructuras membranales vestibulares relacionadas con la transducción, muy probablemente los cilios sensorios de las células ciliadas vestibulares

Genotipificación de mycobacterium tuberculosis y susceptibilidad a drogas / Genetic characterization of mycobacterium tuberculosis and susceptibility to drugs

Conocer la epidemiología de la tuberculosis y transmisión de cepas resistentes en la población estudiada. Estudio prospectivo de cohortes, 150 pacientes sintomáticos respiratorios que acudieron a la consulta de Neumotisiología del Distrito Sanitario Nº3 (n=115) y a la emergencia de Medicina Interna del Hospital Miguel Pérez Carreño (n=35), desde junio de 1995 hasta agosto de 1996. Se tomaron 2 muestras sucesivas de esputo para baciloscopia, cultivo, susceptibilidad a drogas y genotificación por análisis de polimorfismos de longitud de fragmentos de restricción. Se obtuvieron 14 baciloscopias positivas (9,3 por ciento) y 16 cultivos positivos para Mycobacterium tuberculosis, de los cuales 10 fueron baciloscopias positivas y 6 baciloscopias negativas. Se encontró resistencia en 3 cepas: isoniacida (1), estreptomicina (1) y thiocetazona (1), lo que representa una resistencia global del 20 por ciento. El análisis de polimorfismos de longitud de fragmantos de restricción realizado en 14 cepas demostró patrones diferentes. No hay relación epidemiológica entre las cepas aisladas; la resistencia global fue del 20 por ciento y no se encontró multirresistencia

Deafness in children--an analysis.

This study was conducted at the Government Deaf and Dumb School, Thanjavur to ascertain the possible etiological factors. The social outlook of the parents of these children was analysed. Boys were more often affected (60.2%). Consanguinity was observed in 65.4% parents; 23.1% had one or more affected sibling and 14.1% had affected relatives. Parents detected the hearing disability in their children between 3-6 months of age in about 79% cases. Syphilis and chickenpox were the common antenatal associated infections. Streptomycin, chloroquine and abortificients were used during early pregnancy. Eight were preterm and 9 were asphyxiated at birth. A total of 11.5% had purulent ear discharge, and 2 had ear injury. Parents were committed to help the children to be self dependent.

Atrofia óptica pós-neurite induzida pelo etambutol, isoniazida e drogas correlatas / Optic atrophy induced by Ethambutol isoniazid and others drugs

O autor apresenta um caso de uso de drogas anti-microbianas usadas na quimioterapia da tuberculose que levou a uma atrofia óptica pós-neurite em ambos os olhos em uma paciente de 58 anos, do sexo feminino, branca, natural de Alegrete, RS

Atrofia óptica pós-neurite induzida pelo etambutol, isoniazida e drogas correlatas / Optic atrophy induced for ethambutol, isoniazid and others drugs

O autor apresenta um caso de uso de drogas anti-microbianas usada na quimioterapia da tuberculose que levou a uma trofia óptica pós-neurite em ambos os olhos em uma paciente de 58 anos, do sexo feminino, branca, natural de Alegrete, RS