Hepatotoxicity from isoniazid and rifampin in inner-city AIDS patients.

OBJECTIVE: To determine the incidence of hepatotoxicity due to isoniazid and rifampin in inner-city patients with active tuberculosis. DESIGN: A hospital-based review of 70 consecutive in-patients in a 770-bed, inner-city hospital. The patient population is primarily African-American and Hispanic. METHODS: Fifty-eight men and 12 women were followed from 2-12 wk (median 4 wk). Patients had to be treated for at least 2 wk to be eligible for the study. Patients were excluded if they had been on any anti-tuberculous or any other hepatotoxic drug during the 2-month period before their hospitalization. Aminotransferases, alkaline phosphatase, bilirubin, and albumin were obtained at least every 2 wk. RESULTS: Hepatocellular toxicity, defined as AST and/or ALT greater than 200 IU/L, occurred in eight out of 70 (11.4%) patients. The mean age of these patients was 38.9 yr (22-58 yr). Patients with AIDS were significantly more likely to develop hepatotoxicity than those with any other risk factor (p < 0.01). CONCLUSIONS: Baseline aminotransferases followed by monitoring may be necessary in AIDS patients.

Tuberculosis: pathogenesis and laboratory diagnosis.

Emerging molecular biologic technologies hold the promise of more rapid diagnosis of tuberculosis and more definitive epidemiologic linkages of cases of TB. In addition to reviewing the pathogenesis of tuberculosis, this chapter covers a variety of methods for the rapid detection of the disease, including the acid-fast smear, conventional culture, the BACTEC system, immunodiagnostic methods, and DNA-based techniques.

Peripheral nerve involvement in sarcoidosis: an electrodiagnostic study.

The frequency of peripheral nerve involvement in sarcoidosis is uncertain. To determine how often peripheral nerves are affected in the absence of symptoms, electromyography was performed on 29 sarcoid patients and 29 age-matched controls. Nineteen sarcoid patients, compared to two controls, had abnormally low sensory amplitudes in one or more nerves, and the mean sensory amplitudes for median, ulnar, and sural nerves were lower in the patient than in the controls. Subclinical mononeuropathy multiplex appears to be common in sarcoidosis.

Diffuse intrapulmonary hemorrhage, renal failure and a systemic vasculitis. A case report and review of the literature.

A 63 year old women was hospitalized with massive hemoptysis, anemia and renal failure. Despite intensive supportive care, she died soon after admission. Autopsy revealed diffuse necrotizing alveolitis, rapidly progressive glomerulonephritis and a systemic vasculitis. Massive intrapulmonary hemorrhage with hemoptysis is an unusual complication of a systemic vasculitis. The case is discussed and the literature reviewed.

Drug dependence, a possible new risk factor for tuberculosis disease.

A study was performed to assess the risk of drug-dependent persons for developing tuberculosis. Tuberculosis prevalence was 3,740/100,000 drug-dependent inpatients compared with 584/100,000 non-drug-dependent discharges. In another program, prevalence was 3,750/100,000; in the New York Methadone Program, prevalence was 2,652/100,000 patients in Harlem and 1,372/100,000 city-wide. The city-wide prevalence rate in the entire population was 86.7/100,000 in 1971 and 64.7/100,000 in 1973. Similar elevations in incidence also were found in drug-dependent vs non-drug-dependent populations. Our data show that disease rate is elevated in drug-dependent populations, suggesting that drug dependency reflects a high-risk situation for tuberculous infected individuals developing tuberculosis disease. We suggest that infected drug-dependent persons (tuberculin positive) be considered for preventive therapy with isoniazid, which can be piggybacked onto a drug treatment program.

Miliary tuberculosis presenting as acute respiratory failure: treatment by membrane oxygenator and ventricle pump.

A 58-year-old woman with high fever, dyspnea, rapidly progressive hypoxemia and opacification of the lung fields presented the clinical picture of catastrophic respiratory failure. Extracorporeal support of oxygenation using a membrane oxygenator and a new ventricle pump was initially successful. At autopsy, miliary tuberculosis was found to be the cause of this "shock lung like" syndrome.