Concomitant bedaquiline and delamanid therapy in patients with drug-resistant extra-pulmonary tuberculosis in Mumbai, India.

Background: World Health Organization suggests concurrent bedaquiline-delamanid (BDQ-DLM) as part of individualised regimens for eligible patients with pulmonary drug-resistant tuberculosis (DR-TB); however, data for patients with drug-resistant extrapulmonary tuberculosis (EPTB) is extremely limited. This study documents the treatment outcomes and adverse events associated with concurrent BDQ-DLM-based regimens in patients with drug-resistant EPTB at a Médecins Sans Frontières clinic in Mumbai, India. Methods: Retrospective cohort study based on routinely collected programmatic data. Individualised regimens were based on drug-susceptibility testing and previous drug exposure. Drug-resistant EPTB patients initiated on regimens containing concurrent BDQ and DLM from April 2016 to October 2019 were included. Patients who completed treatment were followed up at 12 months. Results: Of 17 patients, median age was 23 years (IQR = 21-30 years) and 12/17 (71 %) were female. Pre-extensively drug-resistant tuberculosis and extensively drug-resistant TB was reported in 13/17 (76.4 %) and 2/17 (11.7 %) patients respectively. Microbiological reports were unavailable for two patients with central nervous system TB. Lymph node TB was the commonest form of EPTB in 9/17 (53 %) of patients. Median duration of treatment was 18.9 months. At least one grade three or four severe adverse event (SAE) was reported by 13/17 (76.4 %) patients. Thirteen (76.4 %) patients had favourable outcomes. None of the patients relapsed or died in the one-year period of post-treatment follow-up. Conclusion: Concurrent BDQ-DLM-based regimens in drug-resistant EPTB were effective and associated with manageable adverse events.

Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India.

BACKGROUND: HIV programs are increasingly confronted with failing antiretroviral therapy (ART), including second-line regimens. WHO has provided guidelines on switching to third-line ART. In a Médecins Sans Frontières clinic in Mumbai, India, receiving referred presumptive second-line ART failure cases, an evidence-based protocol consisting of viral load (VL) testing, enhanced adherence counselling (EAC) and genotype for switching was implemented. OBJECTIVE: To document the outcome and genotype of presumptive second-line ART failure cases switched to third-line or maintained on second-line ART. DESIGN: Retrospective cohort study of patients referred between January 2011 and September 2017. RESULTS: The cases (n = 120) were complex with median 9.2 years of ART exposure, poor adherence at baseline, and exposure to multiple ART regimens other than recommended by WHO. Out of 90 evaluated cases, 39(43%) were maintained on second-line ART. Forty-nine (54%) were ever switched to third-line ART. Twelve months virological suppression was 72% in the second-line and 93% in the third-line ART cohort, while retention in care was 80% and 94% respectively. Genotyping showed 62% resistance for PIs, and 52% triple class resistance to NRTIs, NNRTIs and PIs. Resistance was noted for the new class of integrase inhibitors, and for different drugs without any documented previous exposure to the same drug. CONCLUSION: Adopting WHO guidelines on switching ART regimens and provision of EAC can prevent unnecessary switching/exposure to third-line ART regimens. Genotyping is urgently required in national HIV programs, which currently use only the exposure history of patients for switching to third-line ART regimens.

Treatment Outcomes of Patients Switching From an Injectable Drug to Bedaquiline During Short Standardized Treatment for Multidrug-resistant Tuberculosis in Mozambique.

Bedaquiline was recommended by the World Health Organization as the preferred option in treatment of multidrug-resistant tuberculosis (MDR-TB) with long regimens. However, no recommendation was given for the short MDR-TB regimen. Data from our small cohort of patients who switched from injectable drug to bedaquiline suggest that a bedaquiline-based short regimen is effective and safe.

Síndrome febril prolongado sin focalidad / Prolonged febrile syndrome with no focal source

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Aspectos epidemiológicos de la leishmaniasis visceral en el Estado Bolívar 1989-1999 / Epidemic aspects of the visceral leishmaniasis in the Bolívar State 1989-1999

Estudio retrospectivo de Leishmaniasis visceral diagnosticado en el Estado Bolívar en los últimos diez años (1989-1999) y un estudio prospectivo de la fauna flebotómica en el ambiente de una casa localizada en el perímetro del Estado Bolívar, donde habita un niño diagnosticado con Leishmaniasis vísceral nativa. Las historias clínicas de los casos de Leishmaniasis visceral en seis centros hospitalarios del Estado Bolívar fueron revisados, encontrándose nueve casos; de estos nueve casos; cuatro de ellos fueron diagnosticados en el curso de la presente investigación. La investigación determinó que el origen de los pacientes eran del área rural. El Municipio Heres fue el que tubo mayor número de casos el 33,3 por ciento. Sexo masculino el 88,88 por ciento y menores de cuatro años el 44 por ciento. La clínica y los resultados encontrados por exámenes paraclínicos son similares a aquellos reportados en otras investigaciones en diversas regiones de Venezuela. La evolución de los pacientes fue satisfactoria después de la terapia con Glucantime, con dosis para niños, adultos y en ciclos de un esquema ya conocidos. En relación al estudio de la Flebofauna capturada alrededor de la casa en la cual uno de los casos fue periurbano, durante 18 meses fueron encontrados las siguientes especies de Flebotóminos: Lu. Antunesi, Lu. Evansi, Lu. Ovallesi y Lu. Gomezi, siendo uno de los menos abundantes. Estos hallazgos representan una contribución en el estudio epidemiológico de la Leishmaniasis visceral en el Estado Bolívar