Subject(s)
Down Syndrome/complications , Fever of Unknown Origin/complications , Fever of Unknown Origin/etiology , Tuberculosis, Lymph Node/complications , Anti-Bacterial Agents/therapeutic use , Fatal Outcome , Fever of Unknown Origin/microbiology , Foramen Ovale, Patent/complications , Humans , Infant , Male , Pericardial Effusion , Tuberculosis, Lymph Node/drug therapyABSTRACT
Tuberculosis is one of the most important infectious diseases in the world. Only 68 percent of the estimated new tuberculosis (TB) cases in Brazil are diagnosed. Our aim was to determine the risk of infection among household contacts. Study design. Cohort of tuberculin-negative household contacts followed for 12 Months. Methods. Household contacts of randomly selected index acid-fast bacilli (AFB)-positive TB cases were evaluated through clinical examination, thorax X-ray, tuberculin, AFB smear and culture. Contacts with a negative response to the tuberculin test (less than 10 mm diameter) were retested after 90 days. Tuberculin reversal (used as a parameter of infection risk) was defined as an increase of at least 10 mm from the last measurement. Results. 269 household contacts were followed. The prevalence of disease in this population was 3.7 percent. The prevalence of infection after the 12-month follow-up period was 63.9 percent. The risk of infection was 31.1 percent within 120 ± 48 days. Conclusion. Household contacts of AFB positive tuberculosis patients have a very high prevalence and risk of tuberculosis infection. TB preventive or therapeutic measures directed towards this group should be implemented in Brazil.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Contact Tracing/statistics & numerical data , Disease Transmission, Infectious , Tuberculosis, Pulmonary/transmission , Brazil/epidemiology , Cohort Studies , Family Characteristics , Follow-Up Studies , Incidence , Prevalence , Risk Factors , Tuberculin Test , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiologyABSTRACT
Forty-nine AIDS patients, most of who were antiretroviral therapy (ARV) naive, with active tuberculosis, were treated with Rifampin 600 mg, Isoniazid 400 mg and Pirazinamide 2 g daily. They also received ARV, consisting of Efavirenz (600 mg/day) plus 2 NRTIs. All patients were prospectively followed for at least 24 months. Baselines were: male/female ratio 2:1, mean age 34.7 +/- 9.4 yrs; weight 51 +/- 9.0 kg, viral load 5.6 +/- 0.6 logs, CD4 cell count 101 +/- 128 cells/ mm3. Follow up mean values of data logs of VL and CD4+ cell /mm3 counts were: VL 1.7 and CD4+ 265; VL 1.3 and CD4+ 251; VL 1.4 and CD4+ 326 at 6, 12 and 24 months, respectively. Weight gain changes were: 5 +/- 9.9 +/- 12 and 21 +/- 16 kg respectively at 6, 12 and 24 months. A non-concomitant ARV regimen was introduced at least three weeks after TB treatment initiation. Severe adverse reactions included rash (two), toxic hepatitis (six), Immune Reconstitution Syndrome (seven), and four deaths. We conclude that Efavirenz at a daily dose of 600 mg is sufficient and safe to treat HIV/TB patients using a Rifampin containing regimen.
Subject(s)
Anti-HIV Agents/administration & dosage , Antibiotics, Antitubercular/administration & dosage , HIV Infections/drug therapy , Oxazines/administration & dosage , Rifampin/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Adult , Alkynes , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active , Benzoxazines , CD4 Lymphocyte Count , Cohort Studies , Cyclopropanes , Drug Interactions , Female , HIV Infections/complications , Humans , Isoniazid/administration & dosage , Male , Middle Aged , Oxazines/adverse effects , Pyrazinamide/administration & dosage , Tuberculosis, Pulmonary/complicationsABSTRACT
Forty-nine AIDS patients, most of who were antiretroviral therapy (ARV) naïve, with active tuberculosis, were treated with Rifampin 600mg, Isoniazid 400mg and Pirazinamide 2g daily. They also received ARV, consisting of Efavirenz (600mg/day) plus 2 NRTIs. All patients were prospectively followed for at least 24 months. Baselines were: male/female ratio 2:1, mean age 34.7 ± 9.4 yrs; weight 51 ± 9.0 kg, viral load 5.6 ± 0.6 logs, CD4 cell count 101 ± 128 cells/ mm . Follow up mean values of data logs of VL and CD4+ cell /mm counts were: VL 1.7 and CD4+ 265; VL 1.3 and CD4+ 251; VL 1.4 and CD4+ 326 at 6, 12 and 24 months, respectively. Weight gain changes were: 5 ± 9.9 ± 12 and 21 ± 16 kg respectively at 6, 12 and 24 months. A non-concomitant ARV regimen was introduced at least three weeks after TB treatment initiation. Severe adverse reactions included rash (two), toxic hepatitis (six), Immune Reconstitution Syndrome (seven), and four deaths. We conclude that Efavirenz at a daily dose of 600 mg is sufficient and safe to treat HIV/TB patients using a Rifampin containing regimen.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anti-HIV Agents , Antibiotics, Antitubercular , HIV Infections , Rifampin , Tuberculosis, Pulmonary , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Cohort Studies , Drug Administration Schedule , Drug Interactions , Follow-Up Studies , Isoniazid , Prospective Studies , Pyrazinamide , Viral LoadABSTRACT
UNLABELLED: Tuberculosis is one of the most important infectious diseases in the world. Only 68% of the estimated new tuberculosis (TB) cases in Brazil are diagnosed. Our aim was to determine the risk of infection among household contacts. STUDY DESIGN: Cohort of tuberculin-negative household contacts followed for 12 months. METHODS: Household contacts of randomly selected index acid-fast bacilli (AFB)-positive TB cases were evaluated through clinical examination, thorax X-ray, tuberculin, AFB smear and culture. Contacts with a negative response to the tuberculin test (less than 10 mm diameter) were retested after 90 days. Tuberculin reversal (used as a parameter of infection risk) was defined as an increase of at least 10 mm from the last measurement. RESULTS: 269 household contacts were followed. The prevalence of disease in this population was 3.7%. The prevalence of infection after the 12-month follow-up period was 63.9%. The risk of infection was 31.1% within 120 +/- 48 days. CONCLUSION: Household contacts of AFB positive tuberculosis patients have a very high prevalence and risk of tuberculosis infection. TB preventive or therapeutic measures directed towards this group should be implemented in Brazil.
