Two Difficult Pandemics: Tuberculosis and COVID-19.

BACKGROUND: The coinfection of Mycobacterium tuberculosis and SARS-CoV-2 is called tuberculosis and COVID-19 coinfection (TB-COVID-19). We aimed to share the clinical, radiological, and laboratory findings and treatment processes of our patients with TB-COVID-19 coinfection in our tertiary reference hospital. METHODS: Patients aged 18 years and over and hospitalized in the tuberculosis service between March 2020 and September 2022 were included. All coinfected patients whose COVID-19 polymerase chain reaction results were positive while receiving tuberculosis treatment or who were diagnosed with tuberculosis while receiving treatment for COVID-19 were included. RESULTS: The number of patients was 39; 61.6% of males; the mean age was 52 ± 17.1 years; 20% were foreign nationals; 92.5% were Asian; 69.5% had a bacteriological diagnosis; 84.6% had pulmonary tuberculosis; 10% had received antituberculosis treatment before; and 87.5% were sensitive to the first-line antituberculosis drugs. The most common comorbidities were diabetes and hypertension. 87.5% of the patients were diagnosed with tuberculosis and were superinfected with COVID-19 while receiving tuberculosis treatment. 49.5% of patients had received at least one dose of COVID-19 vaccine. The most common presenting symptom was cough and sputum; the prominent laboratory parameter was C-reactive protein increase, and thorax computed tomography finding was consolidation, tree-in-bud, and cavitation. While 45.9% of the patients were still under treatment, 1 (2.5%) patient also resulted in mortality. CONCLUSION: In this study, attention was drawn to two infectious diseases seen with respiratory tract symptoms. The mortality rate was found to be low. Neither disease was found to be a factor aggravating the course of each other.

Comparison of Computed Tomography Findings in Lung Tuberculosis in Diabetic and Nondiabetic Patients.

BACKGROUND: Tuberculosis (TB) is one of the leading infectious causes of mortality globally. The purpose of this research is to examine the clinical and radiological characteristics of patients with TB and diabetes. METHODS: The research comprised 276 TB patients, 52 of whom were diabetic and 224 of whom were not. During the evaluation of the patients' clinical histories, age, gender, diagnostic indicator, and whether or not they had undergone prior treatment were questioned, as were the requirement of inpatient treatment and the existence of drug resistance. Radiographically, they were questioned in terms of bilateral-unilateral extent, percentage of parenchymal involvement, cavitation, tree-in-bud appearance, the presence of ground glass, consolidation, miliary involvement, sequela fibrotic changes, parenchymal calcification, mediastinal lymphadenopathy, pleural effusion, and pleural calcification. In addition, segmenting was used to assess involvement in the affected lobes. RESULTS: When we look at the results of 276 patients, 182 males and 94 females, the mean age is 46.01 ± 17.83. Diabetes and TB coexistence are more prevalent in male individuals (P = 0.029). Smear positivity and the need for inpatient treatment were found to be higher in the clinical features of diabetic patients (P = 0.05 and P = 0.01, respectively). Radiologically, diabetes individuals are more likely to have larger mediastinal lymph nodes (P = 0.032). CONCLUSION: In the coexistence of both TB and diabetes, there are variations in radiological findings, complexity in treatment response, and patient management.

Disseminated Tuberculosis: A 6-year Case Series Experience in a Tertiary Care Center.

BACKGROUND: Disseminated tuberculosis (dTB) disease is associated with a significant burden of morbidity and mortality and it requires improved awareness among clinicians. Case reports revealing the clinical and microbiological characteristics of dTB patients will help us to extend our knowledge of dTB. In our study, we have documented dTB cases followed for 6 years and revealed patients' clinical characteristics. METHODS: Patients followed between 2017 and 2023 who were diagnosed with dTB in a tertiary referral hospital in Istanbul have been evaluated. Data regarding patients' characteristics, methods used in establishing the definitive diagnosis, radiological patterns in chest X-rays, extrapulmonary sites involved, antituberculosis (TB) treatment regimens received, medication side effects, and drug resistance have been examined. Descriptive statistics were performed. RESULTS: Clinical characteristics of 55 patients with a median age of 41 (range 20-85, 52.7% male) were examined. The most common extrapulmonary involvements in our study were the skeletal system (n = 24), central nervous system (n = 7), and genitourinary tract (n = 7). Isoniazid (INH) resistance was detected in four patients. Mono resistance was reported for pyrazinamide in one patient. Multidrug resistance was detected in two patients and one of them was also resistant to ethambutol. Preextensively, drug resistance was reported in three patients. Another three patients were evaluated as resistant to both INH and streptomycin. CONCLUSION: Migrating from a high TB burden country and comorbidities such as diabetes mellitus, human immunodeficiency virus, and rheumatoid arthritis that are related to immunocompromisation are thought to be risk factors for dTB.

Drug hypersensitivity in drug-resistant tuberculosis.

Objective: To evaluate drug resistant tuberculosis patients who developed drug hypersensitivity to antituberculosis drug. Methods: This was a retrospective study. The primary aim of the study is to determine the demographic and clinical characteristics of patients who develop drug hypersensitivity in drug resistant tuberculosis patients. The secondary aim of the study is to examine the treatment results. Demographic features, tuberculosis diagnostic indicator, clinical signs of developing hypersensitivity reaction, reaction time, and treatment were evaluated. Results: A total of 25 patients were included in the study. The prevalence of hypersensitivity in drug resistance patients was 11.9%. Twelve (48%) of the cases were women. Mean age (mean ± SD) was 37.24 ± 14.44 years; early type hypersensitivity reaction in 13 (52%). Three patients were isoniazid resistant; 19 patients were multidrug-resistant (MDR); 2 patients were pre-extensive drug resistant (Pre-XDR), 1 patient was extensive drug resistance (XDR) tuberculosis. The most common skin findings were maculopapular eruption and urticaria. But also we had seen isole angiodema, urticaria and angioedema, erythema multiforme, lichenoid drug eruption and drug rash with eosinophilia and systemic symptoms. In patients who developed a hypersensitivity reaction, the responsible agent was identified in 14 cases in total. Among the drugs, pyrazinamide, ethambutol, moxifloxacin, amikacin, para amino salicylic, prothionamide, and cycloserine are the responsible agents. When evaluated in terms of treatment results, 15 (60%) patients successfully completed the treatment. Conclusion: Our study is the first study in the literature that evaluated the drug hypersensitivity in drug resistance tuberculosis patients. Drug hypersensitivity that develops with tuberculosis treatment may lead to discontinuation or change in treatment. It can cause treatment failure, drug resistance, relapse, and even death. In resistant tuberculosis, the already existing resistance pattern may become more difficult to treat. Success can be achieved with the right management in these patients who have few treatment options, more drug side effects, and high treatment failure rates. The established regimen should be curative and prevent recurrence.

Nontuberculous mycobacteria isolation from sputum specimens: A retrospective analysis of 1061 cases.

Background: In recent years, with the development of laboratory methods, the frequency of nontuberculosis mycobacteria (NTM) infections has increased. The primary aim of this study was to evaluate the clinical significance of therapeutic drug monitoring (TDM) growths in respiratory samples, and the secondary aim was to evaluate the treatment regimens and treatment outcomes of treatment for TDM disease. Methods: This study was a retrospective cohort study. Persons with NTM growth in respiratory samples admitted to the reference hospital between 2009 and 2020 were included in this study. Samples detected as NTM by the immunochromatographic rapid diagnostic test, those requested by the clinicians, species were determined by the hsp65PCRREA method. The subjects were classified into 3 groups: patients with NTM infection who received treatment (135, 12.7%), those followed up without treatment (690, 65.1%), and a last group of patients with Mycobacterium tuberculosis (TB) complex strains were isolated and received TB treatment (236, 22.2%). Initiating NTM treatment was decided in accordance with the American Thoracic Society recommendations. Results: The mean ± standard deviation age of patients was 53.8 ± 16.5 years, and 749 (70.6%) were male. In total, 278 (26.2%) out of 1061 cases had identified, and the most frequent species were MAC (81; Mycobacterium avium: 39, Mycobacterium intracellulare: 39, and MAC: 3), Mycobacterium abscessus (67), Mycobacterium kansasii (48), Mycobacterium fortuitum (23), Mycobacterium chelonae (12), Mycobacterium gordonae (11), and Mycobacterium szulgai (11). In the NTM treatment group, 116 (85.9%) of 135 patients had multiple culture positivity. Previous TB treatment history had 51 (37.8%) of 135 patients, respiratory comorbidities were evident in 37 (27.4%) of 135 patients. Thorax computed tomography imaging in 84 patients revealed nodule 38 (45.2%), consolidation 46 (54.8%), cavity 52 (61.9%), and bronchiectasis 27 (32.1%). Treatment results in the NTM treatment group were as follows: ongoing treatment 14 (10.4%), cure 64 (47.4%), default 33 (24.4%), exitus 19 (14.1%), recurrence 3 (2.2%), and refractory disease 2 (1.5%). Conclusion: This is a large case series evaluating the clinical significance of NTM growths and NTM treatment in Turkey. The clinical significance of NTM growth in respiratory samples is low. Treatment success rates of NTM patients who are treated are low. Treatment defaults and mortality rates are high. New drugs and new regimens are needed.

Outcomes of latent tuberculosis infection treatment in Istanbul.

Aim: Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in Istanbul between 2016 and 2018. Methods: The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. Results: 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). Conclusion: In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.

Tuberculosis treatment-related lichenoid drug eruptions.

Tuberculosis is one of the leading causes of death from infectious diseases in adults worldwide. Drug hypersensitivity in tuberculosis is an important problem affecting the treatment process. Although treatment is started with isoniazid, rifampicin, ethambutol, and pyrazinamide in drug-sensitive tuberculosis patients, it may not always be continued in this way. When hypersensitivity develops under antituberculosis treatment, type 4 hypersensitivity is the most common, and maculopapular drug eruption develops as a subgroup. Lichenoid drug eruption is very rare. We present our case who was diagnosed with pulmonary tuberculosis, who developed lichenoid drug eruption while receiving treatment, and whose treatment was completed by giving the new regimen with successful desensitization.

Management of type 1 immediate hypersensitivity reactions to antituberculosis drug: succesful desensitization.

OBJECTIVE: In this study, it was aimed to investigate the prevalence of type 1 hypersensitivity reaction under tuberculosis treatment and the management of hypersensitivity. METHODS: The study is a case series. All of the patients who were hospitalized between 01.02.2015-01.05.2021 were examined. All patients who developed a drug-induced type 1 immediate hypersensitivity reaction were included. Antituberculosis drugs were given with the protocol made by Buhari et al. However, unlike what is stated in the protocol, pyrazinamide was given last during the administration of the drugs. RESULTS: 2677 patients received inpatient tuberculosis treatment; type 1 immediate hypersensitivity reactions were seen in 94 (3.5%) patients. Due to missing data in the file, 81 patients were included in the study. 44 (54.3%) of the cases were women; mean age (mean ± SD) 50.7 ± 17.69 years; 76 (93.8%) of them are citizens of the Republic of Turkey; 58 (71.6%) of them were diagnosed bacteriologically; 65 (80.2%) of them were pulmonary tuberculosis. The most common skin finding was urticaria in 49 (60.5%). The drug responsible for the most common reaction was pyrazinamide. In 49 (60.5%) cases, drugs were given by desensitization and it was successful. The duration of treatment was 7.91 ± 2.5 months (6-18 months). When evaluated in terms of treatment results, 68 (84%) patients successfully completed the treatment. CONCLUSION: Our study is the largest series of patients who developed type 1 immediate hypersensitivity reaction while receiving antituberculosis treatment. A practical, easy desensitization scheme has been shared.

Treatment and management of hypersensitivity reactions developed against anti-tuberculosis drug.

Background: The World Health Organization Global Tuberculosis Report 2021 defines tuberculosis as the second infectious disease that causes sickness and death after COVID 19 and ranks it as the 13th among the global causes of death. However, the prevalence of the patients developing a hypersensitivity reaction against antituberculosis treatment is yet unknown. This study aimed to investigate the prevalence of drug allergy against antituberculosis treatment and the management of such a problem. Methods: This is a case--control study. All patients hospitalized in the tuberculosis inpatient service between February 01, 2015 and May 01, 2021 due to hypersensitivity reaction or who developed hypersensitivity during hospitalization were included in the case group. Patients who received inpatient treatment between the same dates and did not develop any drug allergy were included in the control group. The demographic characteristics of the patients, the tuberculosis diagnostic indicator, the type of hypersensitivity reaction that developed, the duration of the manifestation of the reaction and its treatment were evaluated for the purpose of the study. Results: A total of 2677 patients were hospitalized in the tuberculosis inpatient service between the specified dates. Two hundred and ten patients were consulted for drug hypersensitivity reactions in the Allergy Clinic. The prevalence of drug allergy in inpatients was calculated as 7.8%. One hundred and forty-eight patients examined by the authors were included in the study. Seventy-nine of the 148 patients (53.4%) who developed a hypersensitivity reaction were male, the mean age of these patients was 47.20 ± 18.95 years, 89.2% (n = 132) were citizens of the Republic of Turkey, 7.4% (n = 11) of the patients had received tuberculosis treatment before, 16.9% (25) had developed antituberculosis drug resistance and the bacteriological diagnosis was present in 79.7% (118) of the patients. Chi-square test results applied in the allergy group revealed that the risk of developing a hypersensitivity reaction is statistically significantly higher in female patients (P < 0.001), Turkish citizen patients (P = 0.004), in new cases (P = 0.017), in the group not diagnosed bacteriologically (histopathologically, clinically, and radiologically) (P = 0.006). The results of the logistic regression analysis performed also revealed that the risk of developing a hypersensitivity reaction is statistically significantly higher in female patients (P = 0.006), Turkish citizen patients (P = 0.023), in new cases (P = 0.017) and in the group not diagnosed bacteriologically (histopathologically, clinically, and radiologically) (P = 0.006). The success of the treatment was higher in the group that developed a hypersensitivity reaction compared to the control group. About 63.5% (94) of the patients examined developed Type I hypersensitivity reactions, whereas 36.7% (53) of the patients examined developed Type IV hypersensitivity reactions. Type I and Type IV reactions were observed simultaneously in a single patient. Considering the prevalence of developing a hypersensitivity reaction, pyrazinamide was determined as the drug inducing the hypersensitivity reaction in 25 (48.1%) patients. This figure was 15 patients (28.2%) for rifampicin, nine patients (17.3%) for isoniazid, and five patients (9.6%) for ethambutol. As a result, even patients who developed Type I or Type IV reactions were able to complete their antituberculous drug regimens with successful desensitization. Conclusion: The risk of developing an allergic reaction in patients who are administered on antituberculosis treatment is common, particularly in the first 2 months of treatment. However, we believe that the compliance of the patients to the antituberculosis treatment has been improved at the end of appropriate management of hypersensitivity reactions and the treatment results in success.

Disseminated Tuberculosis: A 3-Year Case-Series Experience in a Tertiary Care Center.

OBJECTIVE: Disseminated tuberculosis (dTB) is an important health issue resulting from the hematogenous spread of Mycobacterium tuberculosis, and is associated with a globally significant burden of morbidity and mortality. Despite several studies from various countries, there are no data from Turkey specifically evaluating this special population. Our study aimed to evaluate the characteristics and treatment outcomes of dTB patients followed in our institution. MATERIAL AND METHODS: In the current case series, patients with dTB followed between 2017 and 2020 in our institution were retrospectively examined. Data regarding patient characteristics, diagnostic methods, organ involvement, radiological patterns, treatment regimen, and outcomes were recorded. Descriptive statistics were performed. RESULTS: In the present study, 23 dTB patients (median age 36, 56.5% male) were evaluated. The most common extrapulmonary manifestations were observed in the skeletal (n = 13) and genitourinary systems (n = 5). Multidrug-resistant TB was detected in 3 patients. The most common risk factors for dTB were living in a country with a high TB burden, and HIV infection. CONCLUSION: Foreign-born patients were at high risk for disseminated TB in our study. HIV infection was also defined as the most important risk factor. Our data contribute to the current knowledge on the characteristics and outcomes of dTB patients in Turkey.

Evaluating the effectiveness of anti-tuberculosis treatment by detecting Mycobacterium tuberculosis 85B messenger RNA expression in sputum.

BACKGROUND: The antigen 85 complex (85B) is secreted in large quantities from growing mycobacteria and the presence of bacterial mRNA is an indicator of cell viability. The quantitative detection of 85B mRNA expression levels can be used to assess the success of anti-tuberculosis treatment outcomes to detect viable mycobacteria cells. Therefore, we evaluated the levels of 85B mRNA of Mycobacterium tuberculosis strains in patients with pulmonary tuberculosis. METHODS: Thirty patients with primary tuberculosis were included in this study. The sputum specimens of patients were collected on days 0, 15, and 30 days and were cultured and evaluated by 85B mRNA-based RT-qPCR. RESULTS: Overall, 23 of the studied tuberculosis strains were susceptible to the primary anti-tuberculosis antibiotics used in this study, 7 were resistant. By the 30th day of treatment, 85B mRNA was detected in only one of the susceptible strains, but in all 7 of the resistant strains, though the relative gene expression varied between the strains. This difference between the susceptible and resistant strains at day 30 was statistically significant (p < 0.05). CONCLUSION: 85B mRNA expression levels could be used to follow up on primary tuberculosis cases. 85B mRNA seems to be a good diagnostic marker for monitoring anti-tuberculosis treatment outcomes.

Tuberculosis screening and efficacy of prophylaxis in contacts of patients with pulmonary tuberculosis.

INTRODUCTION: To evaluate tuberculosis screening and efficacy of prophylaxis in contacts of patients with pulmonary tuberculosis. PATIENTS AND METHODS: A total of 7453 contacts of 1909 patients with pulmonary tuberculosis treated at four tuberculosis dispensaries located in Istanbul, between 2005 and 2009 were included in this retrospective screening-based study. Data on demographics, smear positivity, PPD positivity, rate and onset of secondary tuberculosis and prophylaxis were recorded in contacts. RESULT: Overall 184 (2.5%) secondary cases of tuberculosis were identified within a mean 2.9 (1-5) years of follow-up. The rate for secondary tuberculosis was 3.1% (163/5335) in smear positive and 1.0% (20/2118) in smear negative contacts. With and without prophylaxis rates for secondary tuberculosis after 6 months of index case was identified in 0.7% (6/912) and 2.0% (9/455) of contacts aged 0-15 years, in 0.9% (3/339) and 2.8% (51/1826) of contacts aged 16-35 years and in 0% (0/215) and 0.9% (14/1507) of contacts aged ≥ 36 years, respectively. CONCLUSION: In conclusion, our findings indicate high risk of being infected and diseased in smear positive contacts along with efficacy of prophylactic therapy among contacts not only in the childhood but also in adults, particularly in contacts aged 16-35 years.

Plasma concentrations of isoniazid and rifampin are decreased in adult pulmonary tuberculosis patients with diabetes mellitus.

Plasma isoniazid and rifampin concentrations, but not pyrazinamide and ethambutol concentrations, were decreased by about 50% (P < 0.05) in diabetic pulmonary tuberculosis patients. The prevalences of subnormal plasma isoniazid, rifampin, pyrazinamide, and ethambutol concentrations were 49% or 100% (P < 0.01), 66% or 100% (P < 0.05), 30% or 50% (P = 0.198), and 32% or 21% (P = 0.742) in nondiabetic or diabetic tuberculosis patients, respectively. These data show that plasma concentrations of isoniazid and rifampin were greatly reduced in diabetic tuberculosis patients.

Biomass smoke exposure as a serious health hazard for women.

INTRODUCTION: Lung diseases caused by biomass exposure cause a significant health hazard particularly amongst women. The present study was designed to investigate biomass exposure in women suffering from lung disease. MATERIALS AND METHODS: A total of 100 women [mean (SD) age: 55.13 (17.65) years] hospitalized for chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, tuberculosis or interstitial lung disease were included in this study conducted between September 2008-March 2009 in three chest disease clinics at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital. Data collection on biomass exposure was based on application of hospital-based survey questionnaire including items on occupation, level of education, place of birth (location, region), exposure to biomass fuel fumes for heating and cooking purposes (animal dung, wood, charcoal, dried plant) and years of exposure with animal dung, wood, charcoal, dried plant. RESULTS: COPD in 22% patients, lung carcinoma in 12%, bronchitis in 8%, tuberculosis in 26%, and interstitial lung disease in 17% were the diagnosis for hospitalization. The most identified occupation was housewifery 86%. Active, former and non-smokers composed 6%, 22% and 72% of the population. Birth place was village in 67% patients while districts in 9%. According to regional distribution, the most common place of birth was Central Anatolia region in (29%). Exposure to biomass fuels was identified in all of patients including wood (92%), animal dung (30%), charcoal (23%), and dry plant (23%). Mean (SD) years of exposure was identified to be 52.6 (17.9) years for wood, 40.8 (17.9) years for animal dung, 48.1 (20.8) years for dry plant and 38.5 (21.4) years for charcoal. The most common type of biomass exposure was wood in village (97%), city (79%) and county (89%). CONCLUSION: Findings indicating impact of biomass exposure in women seem to emphasize the need for analytic epidemiologic studies assessment measuring biomass exposure levels-particularly for women and young children.

A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey.

The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26-4.36), age > 65 years (OR, 2.79; 95% CI, 2.21-3.53), and male gender (OR, 1.91; 95% CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.

A retrospective case-control study, factors affecting treatment outcomes for pulmonary tuberculosis in istanbul, Turkey.

BACKGROUND: Tuberculosis is a public health problem and its transmission is a threat to the community. AIMS: The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey. STUDY DESIGN: Case-Control Study. METHODS: A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up. RESULTS: The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99-5.76)) ; male gender (OR:2.11 (1.49-2.99)); born outside Turkey (OR: 5.48 (2.13-14.04)); co-morbidity (OR: 1.85 (1.29-2.65)); bilateral radiologic lesions (OR: 2.07 (1.41-3.00); previous treatment history (OR: 3.99 (2.78-5.74)); 3(rd) month positive microscopy (OR: 4.96 (3.04-8.09)) and any H&R +/- others multidrug resistant (MDR) resistance (OR: 22.64 (6.92-74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors. CONCLUSION: Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. However, patients with certain characteristics should be carefully monitored and aggressively treated.

Multidrug resistant tuberculosis with multiple organ involvement.

Multidrug resistant tuberculosis has been a challenging situation in the clinical practice with respect to appropriate clinical treatment and management of the disease. The likelihood of resistance development is known to be lower in lesions with lesser percentages of the bacterial population. The present paper was designed to present a rare case of pulmonary multidrug resistant tuberculosis with extrapulmonary involvement to emphasize the consideration of genital tuberculosis with possible infertility in patients admitting with a scrotal mass.

Management of and risk factors related to hepatotoxicity during tuberculosis treatment.

INTRODUCTION: Hepatotoxicity is one of the most frequent adverse events occurring during tuberculosis treatment that may negatively affect treatment compliance, clinical outcome. This study was designed to evaluate management, risk factors related to hepatotoxicity during tuberculosis treatment. PATIENTS AND METHODS: Hospitalized patients for tuberculosis treatment at Sureyyapasa Chest Diseases, and Chest Surgery Training and Research Hospital were included, between January 2004 and December 2007. Prevalence of hepatotoxicity, risk factors were evaluated among tuberculosis patients under anti-tuberculosis treatment according to World Health Organization (WHO) guideline. Hepatotoxicity was defined any elevated liver function tests with accompanying symptoms. Age, gender, past history of anti-tuberculosis treatment, extensity of radiological findings, co-morbid disorders and drug resistance were the risk factors evaluated in terms of development and recurrence of hepatotoxicity. RESULTS: Of 1443 patients (38.37 ± 16.74 years; 64.5% were males), 106 (7.3%) was identified to develop hepatotoxicity on an average of 20 days after beginning treatment and lasting an average of 14 days. Hepatotoxicity for once in 78.3% (n= 83) of patients and more than once in 21.7% (n= 23) patients. All anti-tuberculosis drugs was continued at full dosage after the normalization of liver enzyme in 76.4% (n= 81). In recurrence a step-by-step treatment was re-started by exclusion of responsible drug/s. Treatment was administered without modification of WHO regimes in 79.2%. Pyrazinamide was omitted in 15 cases while rifampicin only in one patient. Triple drug regimen with isoniazid, ethambutol and streptomycin was used in six cases. Quinolon was added to treatment only in one patient. Presence of a co-morbidity was determined to be significant predictor of hepatotoxicity development OR= 3.093 (CI= 1.95-4.89; p= 0.000) past history of anti-tuberculosis treatment was significantly associated with recurrence (p= 0.027). There was no hepatotoxicity dependent mortality. CONCLUSION: Hepatotoxicity can be successfully management of hepatotoxicity without second line tuberculosis drugs in ongoing treatment regime.

Non-tuberculous mycobacteria infection: 75 cases.

INTRODUCTION: Non-tuberculosis mycobacterium is especially seen in AIDS and non-immunosuppressant patients. This study was designed to evaluate data relating to non-tuberculosis mycobacterium content in patients' sputum for the clinical importance. PATIENTS AND METHODS: During 2009-2010 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital clinics, 75 patients [30 women (40%) and 45 men (69%); mean age (SD): 48.7 (15.9) years] with non-tuberculosis mycobacterium were determined by the rapid test and NAP test in Mycobacteria Growth Indicator Tube (MGIT), which had atypical growth in 51.864 Lowenstein-Jensen. Identification was done with Hsp65PCRREA methods in 32 (43%) cases. Treatment management, radiology, bacteriology, co-morbidity, treatment outcomes were evaluated from medical records, calling patients and from tuberculosis dispensaries. RESULTS: In 9 (28%) patients Mycobacterium abscessus, in 8 (25%) patients Mycobacterium avium complex (MAC), in 5 (16%) patients Mycobacterium kansasii was found with identification Hsp65PCRREA methods. In 18 (24%) of 75 cases with American Thoracic Society definition and treatment criteria, treatment was administered using major and minor drugs. Standard tuberculosis treatment was administered in 25 (33%) of the 75 cases. In 8 of 25 (32%) cases identification of non-tuberculosis mycobacterium was evident. In 32 of 75 cases follow up was performed with no treatment. One positive atypical growth culture was identified in 23 (72%) of 32 patients. Treatment was administered in 43 cases while 25 (58%) of 43 were cured, 3 (7%) of 43 were default and 3 (7%) died. Drug resistance was the outcome in 36 cases. While 31 (86%) had any drug resistance, 27 (75%) had HR drug resistance. Past history of tuberculosis treatment was evident in 20 (40%) cases. Respiratory and non-respiratory diseases were identified equally in 18 (38%) cases. Radiological consolidation in 28 (65%), and cavity in 16 (37%) cases were determined. CONCLUSION: In order to carry out the right treatment and epidemiologic evaluation, it is important to identify non-tuberculosis mycobacterium by culture methods.

Occupation and tuberculosis: a descriptive study in Turkish patients with tuberculosis.

INTRODUCTION: The present study was designed to determine the distribution of tuberculosis patients according to their occupations in Turkey. PATIENTS AND METHODS: A total of 757 patients with bacteriologically and histopathologically confirmed diagnosis of tuberculosis and under the tuberculosis treatment were included in this retrospective descriptive study. Medical records of patients admitted to the Ministry of Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital between the years of 2004 and 2007 were evaluated in terms of patient demographics and the occupations. Occupations were classified into 10 groups according to the International Standardization Classification Occupation (ISCO-88). RESULTS: Males composed 67% of the overall population [mean age (SD) was 41.3 (16.4) years]. Recurrent and newly diagnosed tuberculosis patients composed 81 and 19% of the patients, respectively. The most frequently identified major occupational groups were; craft and related workers (32%), plant and machine operators and assembler (10%), followed by the subgroups of textile, garment and related trades workers (12.9%), motor vehicle drivers (5.8%). The youngest subgroup among the most popular subgroups with a mean age (SD) of 29.5 (11.1) years, was textile, garment and related trades workers while the subgroup of mining and construction laborers was the oldest with a mean age (SD) of 63.9 (7.9) years. In all occupational subgroups, the frequency of males was higher than females. In female patients, the most frequently identified subgroup was, textile, garment and related trades workers while, mining and construction laborers, motor vehicle drives, building frame and related trades workers were composed solely of males. The frequency of newly diagnosed patients was significantly higher than former tuberculosis patients in the occupational subgroups. CONCLUSION: It seems crucial to improve conditions of workplaces with arrangements enabling healthier environment such as adequate ventilation, appropriate living space as well as routine health controls of employees especially for the textile industry.