RESUMO
We report 2 cases of pulmonary tuberculosis, which did not respond to adequate therapy. Both these patients were later found to have coeliac disease, which led to malabsorption of the TB medications. On treating the coeliac disease with a gluten free diet, the patients responded to TB treatment.
Assuntos
Doença Celíaca/complicações , Tuberculose Pulmonar/complicações , Adulto , Antituberculosos/uso terapêutico , Doença Celíaca/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
OBJECTIVES: To determine the sensitivity of referral guidelines for induced sputum in pulmonary tuberculosis (PTB) case detection and determine the diagnostic yield of the test. METHODS: A retrospective analysis of case notes of adult patients referred for induced sputum was carried out at the North Trent Regional Department of Infection and Tropical Medicine, the Royal Hallamshire Hospital, Sheffield, UK. Clinical characteristics were noted on patients referred during a 12-month period in 2001-2002, and of all patients with positive induced sputum results from April 1998 to March 2002. RESULTS: Over a 12-month period 114 patients were referred in our unit for induced sputum sampling. Twelve of the 114 patients had positive sputum cultures giving a positive yield for the test of 10.5%. With strict adherence to our referral guidelines, 10 of the 12 positive cases (83.3%) would have been detected. With modification to the referral guidelines, all 12 microbiologically positive cases would have been detected making the guidelines 100% sensitive in detecting microbiologically positive cases among patients referred with a clinical suspicion of PTB who are unable to self-expectorate. The positive yield for the test would have been increased to 13.2%. In the past 4 years 29 patients had positive induced sputum results. Of these, 11 patients (37.9%) had concurrent microbiological proven extra-pulmonary TB (EPTB) and 10 (34.5%) had past histories of TB infection. Seven patients had chest X-rays reported as normal. CONCLUSIONS: Induced sputum offers a relatively non-invasive investigation for patients with suspected PTB who are unable to bring up sputum. Induced sputum also offers a means of establishing a microbiological diagnosis in some cases of EPTB. An investigative algorithm is suggested.Summary. In an era of increasing drug resistant disease, establishing a microbiological diagnosis of TB is paramount. Sputum induction can be used as an alternative investigation to bronchoscopy in suspected PTB patients who are able to self-expectorate. Induced sputum is a sensitive investigation for suspected PTB patients but with a low diagnostic yield. Referral guidelines are suggested.
Assuntos
Técnicas de Diagnóstico do Sistema Respiratório , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Management of human herpesviruses remains a considerable clinical challenge, in part due to their ability to cause both lytic and latent disease. Infection with the Herpesviridae results in lifelong infection, which can reactivate at any time. Control of herpesviruses is by the innate and adaptive immune systems. Herpesviruses must evade the host innate immune system to establish infection. Once infected, the adaptive immune response, primarily CD8(+) T-cells, is crucial in establishing and maintaining latency. Latent herpesviruses are characterised by the presence of viral DNA in infected cells and limited or no viral replication. These characteristics provide a challenge to clinicians and those developing antiviral agents. The scope of this review is two-fold. First, to provide an overview of all antivirals used against herpesviruses, including their mechanism of action, pharmacokinetics, side effects, resistance and clinical uses. And second, to address the management of each of the eight herpesviruses both in the immunocompetent and immunocompromised host, providing evidence for clinical management and therapeutic options, which is important to the clinician engaged in the management of these infections.
Assuntos
Antivirais/uso terapêutico , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/tratamento farmacológico , Antivirais/farmacocinética , Antivirais/farmacologia , Portador Sadio/diagnóstico , Portador Sadio/tratamento farmacológico , Infecções por Herpesviridae/prevenção & controle , Humanos , Latência ViralRESUMO
Herpes zoster (HZ; shingles)--a reactivation of the latent varicella zoster virus (VZV)--can cause significant morbidity. Its major complication is pain, particularly post-herpetic neuralgia (PHN). We will review the current management strategies available for the treatment of both acute HZ and PHN, including antiviral drugs, analgesic agents, anticonvulsants, tricyclic antidepressants and topical therapies. New molecules in development that show improved activity against VZV are also covered, and new drug targets are outlined. The role of translational neuroscience in moving towards a goal of finding disease-modifying treatments will be examined.
Assuntos
Herpes Zoster/tratamento farmacológico , Neuralgia Pós-Herpética/tratamento farmacológico , Analgésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antivirais/uso terapêutico , Ensaios Clínicos como Assunto , Herpes Zoster/complicações , Herpes Zoster/terapia , Herpesvirus Humano 3/efeitos dos fármacos , Humanos , Neuralgia Pós-Herpética/etiologia , Resultado do TratamentoRESUMO
UNLABELLED: To characterise predisposition to post herpetic neuralgia following herpes zoster. DESIGN: Late follow up of patients originally admitted with acute zoster to a double blind randomised placebo controlled study of oral acyclovir over 60 years of age. SETTING: Two UK cities of 1.5 million population. RESULTS: 158 of the 298 patients from the original study were available for evaluation at a mean follow up of 9 years. Thirty four (21%) described experiencing pain from the zoster within the previous 12 months. Pain at follow up was associated with characteristics at the time of acute zoster of: moderate or severe acute pain (p = 0.006), prodromal pain >72 h before rash (p = 0.006), severity of rash (p = 0.033) and female gender (p = 0.046). There was no association between pain at 9 year follow up and use of placebo or aciclovir nor with the presence or absence of pain at the point of discharge from the original study. Further analysis of 17 of the 34 patients with long term pain who have full data available, the median pain score was 4 out of 10 and more than 50% described persistent pain and interference with sleep. CONCLUSION: Long term pain in the elderly following zoster is associated with identifiable characteristics during the acute illness.
Assuntos
Herpes Zoster/complicações , Neuralgia Pós-Herpética/epidemiologia , Aciclovir/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Causalidade , Feminino , Seguimentos , Herpes Zoster/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reino Unido/epidemiologiaRESUMO
PURPOSE OF REVIEW: Since Kapakian first identified a virus in the stool of a patient with diarrhoea in 1972, many viruses have been described that cause diarrhoea directly or indirectly. It is now appreciated that viruses are the most common cause of diarrhoeal illness worldwide. Although bacteria and other pathogens cause significant numbers of gastroenteritis, it is the viruses that are dealt with in this review. The viruses responsible will be discussed individually. RECENT FINDINGS: Rotavirus remains the leading cause of diarrhoeal disease overall, with the newly designated calicivirus family causing the most outbreaks in the industrialized nations. As diagnostic techniques improve, however, the importance of astrovirus and other previously under-reported pathogens is becoming more apparent and the number of viruses associated with gastroenteritis continues to increase. The emergence of severe acute respiratory syndrome coronavirus, arguably the most important emerging infection of recent years and a cause of significant gastrointestinal disease, is also discussed. SUMMARY: No effective treatments have been developed for viral gastroenteritis. Current efforts are targeted at the development of suitable vaccines and the implementation of infection control measures.