The treatment results of patients with multidrug resistant tuberculosis and factors affecting treatment outcome.

The treatment of multi-drug resistant tuberculosis (MDR-TB) is complicated and results are not always satisfactory. We aimed to investigate treatment results of our patients, relapse rates, factors affecting treatment outcome. We evaluated prospectively, 142 patients, who had been hospitalised with diagnosis of MDR-TB in our clinic between January 1995-December 2000 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital in Istanbul, Turkey. All patients were male and human immunodeficiency virus negative. The mean age was 39 + or - 11 (16-65) years. A mean number of 5.5 + or - 0.8 (4-8) second line drugs, including one parenteral drug, were administered. Of 142 patients, 102 (71.8%) were classified as cured, 16 (11.3%) patients were defaulters, failure was seen in 10 (7.0%) patients and 14 (9.9%) patients died during treatment. Surgical resection was applied in 35 patients and cure was achieved in 88.5% of them. Of 102 patients who were cured, 89 (87.2%) were available for follow up and mean duration of follow up was 19.2 + or - 10.3 (12-72) months. Relapse was not detected in any of them. Patients with unsuccessful outcomes had a higher incidence and higher mean number of second-line drugs usage in previous regimens, higher incidence of antecedent prothionamide and ofloxacin usage, higher incidence of extensive radiologic involvement and withdrawal of responsible drugs due to adverse effects. Limited radiologic involvement, non-usage of antecedent prothionamide and adjuvant surgery were found as significant independent factors effecting successful treatment outcome. MDR-TB is a complex but a treatable disease. To know much more about the factors effecting treatment results and to arrange the proper conditions, are expected to make increases in the success rates of MDR-TB treatment.

Diagnostic value of repeated sputum examinations in pulmonary tuberculosis: how many sputum specimens are adequate?

The aim of this study was to assess the value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis (PTB). We analyzed sputum smear and culture results of patients diagnosed with culture-proven PTB during 2002. In 1027 patients, the diagnosis was established by detection of Mycobacterium tuberculosis bacilli in sputum samples. The number of sputum specimens submitted to laboratory was one in 634 cases, two in 167 cases, three in 186 cases and more than three in 48 cases. 760 (74%) cases had positive smear examination result. The first sputum smear examination was positive in 82.3% of smear positive cases. Either the first or the second sputum was diagnostic in 94.9% of these cases. Smear examination of third sputum revealed 4.2% additional diagnostic yield. In 863 (84%) cases, culture examination of the first sputum was positive. The second and the third sputum culture examinations revealed additional diagnostic yield of 11% and 4.5%, respectively. Percent 95 of culture-proven cases were diagnosed with the first two sputum cultures. In conclusion the majority of PTB cases can be diagnosed with the examination of two sputum specimens. Three or more sputum specimens submitted obtain a small additional diagnostic yield.

[A case of endobronchial aspergilloma]. / Endobronsiyal aspergilloma olgusu.

Infections caused by Aspergillus spp. in immunocompromised or atopic patients may present as invasive aspergillosis, allergic bronchopulmonary aspergillosis and aspergilloma. In this report a 69 years old female patient admitted to the hospital with the complaints of intermittent cough and sputum and diagnosed as endonbronchial aspergilloma, has been presented. The patient was not immunocompromised, however she has bronchial asthma for 10 years and the disease is now under control. The chest radiography and computed tomography revealed lung infiltration with undefined borders, and bronchoscopy demonstrated the presence of a mass at left lower lobe. In the pathologic examination of biopsy specimen with the use of methenamine silver and PAS methods, hyphae formations concordant with Aspergillus were detected. The direct microscopic examinations of biopsy material and sputum obtained after bronchoscopy, have also revealed the presence of hyphae. A. fumigatus was isolated from the cultures of biopsy material and sputum specimen. The patient was diagnosed as endonbronchial aspergilloma, however the follow-up was failed since she has not accepted medical or surgical treatment. In conclusion, aspergilloma should be considered in the differential diagnosis of mass lesions in the endobronchial area.

Effect of pharmacist-led patient education on adherence to tuberculosis treatment.

PURPOSE: The purpose of this study was to assess the effect of a clinical pharmacist-directed patient education program on the therapy adherence of first-time tuberculosis (TB) patients and to identify the major pharmaceutical care needs and issues of first-time TB and multidrug-resistant (MDR)-TB patients. METHODS: In the first part of the study, first-time TB patients were randomized either to the No EDU group (n = 58) where patients received routine medical and nursing care or to the EDU group (n = 56) where patients were also provided with clinical pharmacist-directed patient education. The patient's adherence to treatment was evaluated by attendance at scheduled visits, medication counting, and urine analysis for the presence of isoniazid metabolites. In the second part of the study, the pharmaceutical care needs and issues were determined for first-time TB patients and for MDR-TB patients (n = 40). RESULTS: The adherence of patients who received pharmacist-directed patient education was greater than that of patients who did not. The attendance at scheduled visits and urine analysis for the presence of isoniazid metabolites yielded better results in respect to adherence for the EDU group (p < 0.05), while medication counting did not differ between the two groups. The major pharmaceutical care needs of first-time TB patients were for pain control, nutrient replacement, appropriate prescribing, respiratory control, and diabetic control. Similar findings were recorded for MDR-TB patients. CONCLUSION: Patients' adherence to TB treatment improved when a pharmacist provided patient education on medication use and addressed patients' pharmaceutical care issues.