Primary Rifampicin Mono-Resistant Tuberculosis of the Cervical, Mediastinal, and Axillary Lymphadenopathy in an Indian Male: A First-of-Its-Type Case.

Tuberculosis is common in endemic countries. However, extrapulmonary tuberculosis is relatively rare, and primary extrapulmonary rifampicin mono-resistant tuberculosis of the cervical, mediastinal, and axillary lymph nodes simultaneously without pulmonary focus in an immunocompetent male has never been reported. Herein is a case of a 27-year-old Indian male with no previous history of tuberculosis who was diagnosed after an extensive clinical assessment with a radiometric and cartridge-based nucleic acid amplification assay of the swollen lymph nodes. He was put on antituberculous treatment per the all-oral longer regimen of the national program.

Primary Rifampicin Mono-Resistant Extrapulmonary Tuberculosis of the Knee Without Pulmonary Involvement: One of the First Cases of Its Type in an Immunocompetent Male.

Tuberculosis presentation at sites other than the lungs is relatively infrequent, and isolated knee involvement without a pulmonary focus is exceptionally rare. Furthermore, there have been no reported cases of primary rifampicin mono-resistant extrapulmonary tuberculosis of the knee in males. In this case, a 24-year-old male patient presented with pain and swelling in his left knee after a fall five years ago. Given the absence of a history of tuberculosis, arriving at a diagnosis posed a significant challenge. However, the diagnosis was ultimately established through cartridge-based nucleic acid amplification tests and clinical link-up with radiometric techniques. Management was based on the latest national guidelines for anti-tuberculous treatment, which were tailored to his weight. To date, he has completed nine months of treatment with a significant improvement in his symptoms. This rare presentation emphasizes the need for a high degree of suspicion even in extrapulmonary tuberculosis cases.

Isoniazid Mono-Resistant Tuberculosis Presenting as Empyema Thoracis With Citrobacter koseri and Morganella morganii Infections: The World's First Reported Case of Its Type.

Drug resistance is very common in developing countries. Isolated cases of concomitant infection with Mycobacterium tuberculosis, Citrobacter koseri, and Morganella morganii are rare. Furthermore, there is no report available in the literature of concurrent infection of Citrobacter koseri and Morganella morganii in an isoniazid mono-resistant tuberculosis patient. In this case, we present a concomitant infection with drug-resistant strains of Mycobacterium tuberculosis, Citrobacter koseri, and Morganella morganii in a 40-year-old Indian male who presented with fever, dry cough, and chest pain. He was initiated on an isoniazid mono regimen and a broad-spectrum antibiotic, following the national guidelines.

A Retrospective Analysis of Clinico-Demographic and Genetic Characteristics and Treatment Outcomes in Isoniazid Mono-Resistant Tuberculosis Patients: A Single-Center Study.

INTRODUCTION: Treatment failure and relapse rates are more likely to occur when there is isoniazid (INH) resistance. So, we can no longer ignore the problem of isoniazid mono-resistance. It is pertinent to control the spread of primary INH resistance and prevent secondary resistance. AIM: This study aims to evaluate subjects' clinical, demographic, and genetic characteristics and explore their treatment outcomes. METHODS: All data of isoniazid mono-resistant tuberculosis (TB) patients, which were maintained in the electronic database of mandatory notifications (NIKSHAY Portal) between 2017 and 2022, were reviewed. A total of 54 patients were included after excluding five patients with ongoing treatment. RESULTS: Of 54 patients, 41 (75.9%) were cured, which was classified under favorable outcome, and the rest were classified under unfavorable outcome. Phenotypic, high-level mutation (katG) was found in 48 (88.9%) patients. Kaplan-Meier curves show that survival probabilities increase in weeks with regular intake of drugs. CONCLUSION: Our study found that those with younger ages and males were more affected. We found favorable outcomes in the majority of patients.

Tratamiento de la tuberculosis drogorresistente en adultos y niños. Revisión narrativa / Treatment of drug-resistant tuberculosis in adults and children. A narrative review

Resumen Desde 2018 han surgido a la luz de la evidencia importantes cambios en el tratamiento de la tuberculosis drogorresistente. El descubrimiento de nuevas drogas antituberculosis, como la bedaquilina y los derivados de nitroimidazopiranos, así como la utilización de drogas repropuestas, llevó a la recomendación de organismos internacionales de nuevos esquemas de tratamiento de la tuberculosis monorresistente y multidro gorresistente que son totalmente orales y así dejan de lado el uso prolongado de inyectables, con su inherente toxicidad e incomodidad. Algunas de las definiciones de tuberculosis drogorresistente han cambiado. También está en revisión el tiempo de su tratamiento y con algunos nuevos esquemas en estudio, como el BpaL (bedaquilina, pretomanid y linezolid), se ha logrado una duración similar a la del tratamiento de la tuberculosis pansensible. En esta revisión bibliográfica narrativa describimos las nuevas definiciones, algunos aspectos diagnósticos básicos, los aspectos farmacológicos y la nueva clasificación de las drogas a utilizar en el tratamiento de la tuberculosis drogorresistente, así como los esquemas actualmente propuestos para tratarla, contextualizados con la realidad nacional. Finalizamos con una breve reseña de los estudios clínicos en curso de nuevos esquemas acortados de tratamiento.

Abstract Since 2018, important changes in the treatment of drug-resistant tuberculosis have been produced in the light of new evidence. The discovery of new anti-tuberculosis drugs, such as bedaquiline and nitroimidazopirane derivatives, as well as the use of repurposed drugs, led to international organizations to recommend new, totally oral, treatment regimens for mono-resistant and multidrug-resistant tuberculosis, leaving aside the prolonged use of injectables, with their inherent toxicity and discomfort. Some definitions of drug-resistant tuberculosis have changed. The duration of treatment is also under review, leading some new regimens under study, such as BPaL (bedaquiline, pretomanid and linezolid), to a duration similar to that for treating susceptible tuberculosis. In this narrative review, we describe the new definitions, some basic diagnostic aspects, the pharmacological aspects, and the new classification of drugs to be used in the treatment of drug-resistant tuberculosis as well as the cur rently proposed schemes to treat it available within the Argentinean context. Finally, we include a brief review of ongoing clinical trials on new shortened treatments.

[Treatment of drug-resistant tuberculosis in adults and children. A narrative review]. / Tratamiento de la tuberculosis drogorresistente en adultos y niños. Revisión narrativa.

Since 2018, important changes in the treatment of drug-resistant tuberculosis have been produced in the light of new evidence. The discovery of new anti-tuberculosis drugs, such as bedaquiline and nitroimidazopirane derivatives, as well as the use of repurposed drugs, led to international organizations to recommend new, totally oral, treatment regimens for mono-resistant and multidrug-resistant tuberculosis, leaving aside the prolonged use of injectables, with their inherent toxicity and discomfort. Some definitions of drug-resistant tuberculosis have changed. The duration of treatment is also under review, leading some new regimens under study, such as BPaL (bedaquiline, pretomanid and linezolid), to a duration similar to that for treating susceptible tuberculosis. In this narrative review, we describe the new definitions, some basic diagnostic aspects, the pharmacological aspects, and the new classification of drugs to be used in the treatment of drug-resistant tuberculosis as well as the currently proposed schemes to treat it available within the Argentinean context. Finally, we include a brief review of ongoing clinical trials on new shortened treatments.

Desde 2018 han surgido a la luz de la evidencia importantes cambios en el tratamiento de la tuberculosis drogorresistente. El descubrimiento de nuevas drogas antituberculosis, como la bedaquilina y los derivados de nitroimidazopiranos, así como la utilización de drogas repropuestas, llevó a la recomendación de organismos internacionales de nuevos esquemas de tratamiento de la tuberculosis monorresistente y multidrogorresistente que son totalmente orales y así dejan de lado el uso prolongado de inyectables, con su inherente toxicidad e incomodidad. Algunas de las definiciones de tuberculosis drogorresistente han cambiado. También está en revisión el tiempo de su tratamiento y con algunos nuevos esquemas en estudio, como el BpaL (bedaquilina, pretomanid y linezolid), se ha logrado una duración similar a la del tratamiento de la tuberculosis pansensible. En esta revisión bibliográfica narrativa describimos las nuevas definiciones, algunos aspectos diagnósticos básicos, los aspectos farmacológicos y la nueva clasificación de las drogas a utilizar en el tratamiento de la tuberculosis drogorresistente, así como los esquemas actualmente propuestos para tratarla, contextualizados con la realidad nacional. Finalizamos con una breve reseña de los estudios clínicos en curso de nuevos esquemas acortados de tratamiento.

Rifampicin Mono-Resistant Tuberculosis-A Review of an Uncommon But Growing Challenge for Global Tuberculosis Control.

Tuberculosis (TB) remains the leading cause of death by an infectious pathogen worldwide, and drug-resistant TB is a critical and rising obstacle to global control efforts. Most scientific studies and global TB efforts have focused on multidrug-resistant TB (MDR-TB), meaning isolates resistant to both isoniazid (INH) and rifampicin (RIF). Newer diagnostic tests are resulting in an increasing awareness of RIF-resistant TB in addition to MDR disease. To date, RIF resistance has been assumed to be synonymous with MDR-TB, but this approach may expose TB patients with RIF mono-resistance disease to unnecessarily long and toxic treatment regimens. We review what is currently known about RIF mono-resistant TB, its history and epidemiology, mechanisms of RIF resistance, available diagnostic techniques, treatment outcomes reported globally, and future directions for combatting this disease.

Sputum culture and drug sensitivity testing outcome among X-pert Mycobacterium tuberculosis/rifampicin-positive, rifampicin-resistant sputum: A retrospective study - Not all rifampicin resistance is multi-drug resistant.

OBJECTIVE: Rifampicin-resistant (RR) tuberculosis (TB) on X-pert Mycobacterium tuberculosis/rifampicin (MTB/Rif) is assumed to be a surrogate for multi-drug resistant (MDR) TB. Following an RR result, a second specimen was taken for confirmatory culture and drug-susceptibility testing (DST). This study compared the initial diagnostic X-pert MTB/RIF result with the confirmatory DST in a high human immunodeficiency virus (HIV) seroprevalence setting. DESIGN: Records analysing demographics, HIV serostatus, prior TB treatments, and DST results were retrospectively reviewed. RESULTS: Of 604 patients with X-pert MTB/RIF RR, 374 (61.9%) had DST and were included. The mean age was 36.9 years and 82% were HIV infected. Following DST, MDR was confirmed in 49% and Rif mono-resistant (RMR) TB in 36%. Amongst RMR TB, 84% were HIV-infected, and amongst those with CD4 < 50 versus those 50-350 cells/mm3 RMR TB was noted in 51% versus 33%, respectively (P = 0.012). Primary DR was diagnosed in 43% (61% MDR and 33% RMR). CONCLUSION: Rifampicin resistance detected on a diagnostic X-pert MTB/Rif assay did not always predict MDR. Rifampicin mono-resistance is emerging amongst those with HIV co-infection and low CD4 counts (<50 cells/mm3). Research is needed to reduce the number of drugs and treatment durations for RMR TB.