ABSTRACT
Abstract Introduction Spinal Tuberculosis (STB) represents between 1% and 2% of total tuberculosis cases. STB management remains challenging; the first-line approach consists of medical treatment, while surgery is reserved for patients with complications. No data regarding STB treatment with bedaquiline-containing regimens are available in the literature. Case description Herein, we report the case of a 21-year-old man from Côte d'Ivoire with a multidrug resistance STB with subcutaneous abscess. After approval of the hospital off-label drug committee, we started bedaquiline 400 mg daily for two weeks, followed by 200 mg three times per week, for 22 weeks, associated with linezolid 600 mg daily, rifabutin 450 mg daily, and amikacin 750 mg daily (interrupted after eight weeks). During treatment, we performed a weekly EKG. No QT prolongation was shown, but inverted T waves appeared, requiring several cardiological consultations and cardiac MRI, but no cardiac dysfunction was found. After 24 weeks, bedaquiline was replaced with moxifloxacin 400 mg daily. The patient continued treatment for another year. We performed another computer tomography at the end of treatment, confirming the cure. Discussion A salvage regimen containing bedaquiline proved effective in treating multidrug-resistance tuberculosis spinal infection without causing severe adverse effects. However, further studies are needed to evaluate better bedaquiline bone penetration and the correct duration of treatment with bedaquiline in MDR spinal tuberculosis.
ABSTRACT
ABSTRACT Objective: To investigate the diagnostic accuracy of a chest X-ray (CXR) score and of clinical and laboratory data in predicting the clinical course of patients with SARS coronavirus 2 (SARS-CoV-2) infection. Methods: This is a pilot multicenter retrospective study including patients with SARS-CoV-2 infection admitted to the ERs in three hospitals in Italy between February and March of 2020. Two radiologists independently evaluated the baseline CXR of the patients using a semi-quantitative score to determine the severity of lung involvement: a score of 0 represented no lung involvement, whereas scores of 1 to 4 represented the first (less severe) to the fourth (more severe) quartiles regarding the severity of lung involvement. Relevant clinical and laboratory data were collected. The outcome of patients was defined as severe if noninvasive ventilation (NIV) or intubation was necessary, or if the patient died. Results: Our sample comprised 140 patients. Most of the patients were symptomatic (132/138; 95.7%), and 133/140 patients (95.0%) presented with opacities on CXR at admission. Of the 140 patients, 7 (5.0%) showed no lung involvement, whereas 58 (41.4%), 31 (22.1%), 26 (18.6%), and 18 (12.9%), respectively, scored 1, 2, 3, and 4. In our sample, 66 patients underwent NIV or intubation, 37 of whom scored 1 or 2 on baseline CXR, and 28 patients died. Conclusions: The severity score based on CXR seems to be able to predict the clinical progression in cases that scored 0, 3, or 4. However, the score alone cannot predict the clinical progression in patients with mild-to-moderate parenchymal involvement (scores 1 and 2).
RESUMO Objetivo: Investigar a acurácia diagnóstica de um escore de radiografia de tórax (RxT) e também de dados clínicos e laboratoriais na previsão da evolução clínica de pacientes com infecção por SARS coronavirus 2 (SARS-CoV-2). Métodos: Estudo piloto multicêntrico retrospectivo incluindo pacientes com infecção por SARS-CoV-2 internados nos PSs de três hospitais na Itália entre fevereiro e março de 2020. Dois radiologistas avaliaram as RxT iniciais dos pacientes de forma independente utilizando um escore semiquantitativo para determinar a gravidade do comprometimento pulmonar: escore 0 representava ausência de comprometimento pulmonar, enquanto escores de 1 a 4 representavam o primeiro (menos grave) ao quarto (mais grave) quartil de gravidade do comprometimento pulmonar. Coletaram-se dados clínicos e laboratoriais relevantes. O desfecho dos pacientes foi definido como grave se foi necessária ventilação não invasiva (VNI) ou intubação ou se o paciente faleceu. Resultados: Nossa amostra foi composta por 140 pacientes. A maioria era sintomática (132/138; 95,7%), e 133/140 (95,0%) apresentavam opacidades na RxT da admissão. Dos 140 pacientes, 7 (5,0%) não apresentavam comprometimento pulmonar, enquanto 58 (41,4%), 31 (22,1%), 26 (18,6%) e 18 (12,9%), respectivamente, receberam escore 1, 2, 3 e 4. Em nossa amostra, 66 pacientes foram submetidos a VNI ou intubação, 37 dos quais receberam escore 1 ou 2 na RxT inicial, e 28 pacientes faleceram. Conclusões: O escore de gravidade baseado em RxT parece ser capaz de prever a evolução clínica em casos com escore 0, 3 ou 4. No entanto, o escore isoladamente não consegue prever a evolução clínica de pacientes com comprometimento leve a moderado do parênquima (escores 1 e 2).