RESUMO
OBJECTIVE: To investigate whether or not there is an increased risk of pulmonary tuberculosis (PTB) after non-tuberculous mycobacterial (NTM) disease. DESIGN: A retrospective cohort study of 212 NTM patients and 4240 control cases. RESULTS: Patients with previous NTM disease had a significantly higher incidence of PTB than controls (incidence rate ratio [IRR] 14.74, 95%CI 8.71-24.94, P < 0.0001). Cox's proportional hazards analysis yielded an adjusted hazards ratio (aHR) of 10.15 (95%CI 5.67-18.17, P < 0.05) for NTM-associated PTB. The majority of the PTB cases (17/23, 73.9%) were diagnosed within 6 months after the diagnosis of NTM disease. Older age (≥65 years, aHR 4.45, 95%CI 1.94-10.22, P < 0.05), male sex (aHR 1.75, 95%CI 1.01-3.13, P < 0.05), human immunodeficiency virus (HIV) infection (aHR 12.49, 95%CI 3.20-48.79, P < 0.05) and chronic obstructive pulmonary disease (aHR 4.46, 95%CI 2.19-9.10, P < 0.05) were independent risk factors for developing PTB after NTM disease. The cumulative incidence of PTB in patients with previous NTM disease was significantly higher than in controls (P < 0.0001, Kaplan-Meier analysis). However, there was no significant difference in the survival rates in the two cohorts. CONCLUSION: Increased PTB prevalence after NTM disease was demonstrated. HIV infection was the greatest independent risk factor for subsequent development of PTB.
Assuntos
Infecções por HIV/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Infecções por HIV/complicações , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/complicações , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida , Fatores de Tempo , Tuberculose Pulmonar/etiologia , Adulto JovemRESUMO
Two bacteraemic isolates of Aeromonas hydrophila and Klebsiella pneumoniae, Ah-2743 and Kp-129, respectively, were studied for their relative pathogenicity in comparison with Escherichia coli ATCC 25922. Ah-2743 caused significantly higher serum levels of tumour necrosis factor-alpha, interleukin (IL)-1beta or IL-6 in human whole blood, and higher serum IL-1beta and IL-6 levels in infected mice, than did Kp-129 and E. coli ATCC 25922. In addition, in BALB/c mice infected by intraperitoneal inoculation, Ah-2743 caused a higher fatality rate (80%) than did Kp-129 (0%). With intramuscular inoculation, Ah-2743 caused more rapid and intense local accumulation of inflammatory cells than did Kp-129, and myonecrosis was present only in Ah-2743-infected mice. These data indicate that Ah-2743 is more pathogenic than Kp-129 or E. coli ATCC 25922 for BALB/c mice. The cellular components or extracellular factors associated with increased cytokine induction and pathogenicity of A. hydrophila in mice merit further investigation.
Assuntos
Aeromonas hydrophila/patogenicidade , Bacteriemia/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/patogenicidade , Adulto , Aeromonas hydrophila/isolamento & purificação , Animais , Modelos Animais de Doenças , Escherichia coli/patogenicidade , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Feminino , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Interleucina-1/sangue , Interleucina-6/sangue , Infecções por Klebsiella/imunologia , Infecções por Klebsiella/patologia , Klebsiella pneumoniae/isolamento & purificação , Camundongos , Camundongos Endogâmicos BALB C , Peritonite/imunologia , Peritonite/microbiologia , Peritonite/patologia , Pele/patologia , Infecções dos Tecidos Moles/imunologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/patologia , Análise de Sobrevida , Taiwan , Fator de Necrose Tumoral alfa/análise , VirulênciaRESUMO
Many reports have shown that rifampicin could induce a variety of adverse effects. However, anaphylactic shock occurring after readministration of rifampicin, to our knowledge, has not been reported thoughtfully. Herein we present a case with anaphylactic shock after readministration of rifampicin. The possible mechanism may be the interaction between IgE antibody and mast cell or basophils. Compared with continuous regimen, intermittent rifampicin regimen has longer interval to accumulate more rifampicin-induced antibodies, and more immunogenic side effects are the sequelae when re-encountered with rifampicin.
