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.

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.

The outcome of tuberculosis cases with persistent smear positivity at the end of extended initial phase.

INTRODUCTION: To present the treatment outcome in tuberculosis patients with sputum smear positivity in the third month of category 1 treatment regimes. PATIENTS AND METHODS: A total of 1024 patients with tuberculosis treated in Ministry of Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital from January 2004 to December 2005 were included in this retrospective cohort study. Categorization and appropriate treatment of tuberculosis was performed according the World Health Organization guidelines. RESULTS: Of overall 1024 patients, 655 (64%) were determined to receive category 1 treatment while sputum smear positivity was identified in 11 of them [2%; mean (SD) age: 46 (17.9) years] in the third month. Continuation phase treatment was initiated in these 11 patients. Sputum conversion was evident in six of 10 cases in the 4th month, in three cases in the 5th month and in one case in the 6th month. None had culture positivity after the 3rd month. Of 11 cases, 10 completed therapy with major drugs in six months and treatment outcome was cure. No relapse was identified after five years later. CONCLUSION: Based on our data we recommend that the continuing phase should be started in cases with positive sputum smear at the end of the extended initial phase.

Tracheobronchopathia osteochondroplastica: an unusual presentation.

A 24-year-old woman presented with chronic cough and noisy breathing. Chest x-ray revealed diffuse irregularity and narrowing of the tracheal lumen. Thorax computed tomography showed irregularity, stenosis, and areas of ossification throughout the trachea and both main bronchia. Flexible bronchoscopy revealed multiple nodules protruding into the tracheal lumen. Histopathology of the nodules confirmed the diagnosis of "tracheobronchopathia osteochondroplastica." Tracheobronchopathia osteochondroplastica is a rare, benign disease that is characterized by multiple cartilaginous and osseous submucosal nodules protruding through tracheal lumen and large bronchia. The etiology is still unexplained.