Some Manifestations of Tuberculosis in Otorhinolaryngology - Case Series and a Short Review of Related Data from South-Eastern Europe.

Tuberculosis is a disease of global outreach that may affect the entire human body but is most commonly located in the lungs. Otorhinolaryngological manifestations of tuberculosis are rare, mostly occurring secondary to pulmonary disease but nevertheless represent significant diagnostic challenges. Nasopharyngeal tuberculosis is rare, representing around 1% of all upper air-way localizations and the most common presentation is in the form of adenoids. Tuberculous glossitis (oral tuberculosis) is even scarcer and may present in various clinical forms, usually mimicking a malignant neoplasm, or, less often, trauma or other infectious lesions. Oropharynx tuberculosis is usually misdiagnosed as hypertrophic chronic tonsillitis. We present four rare cases of ENT tuberculosis, primary adenoiditis and tonsillitis in a 13-year-old girl, a curious case of tuberculous glossitis in a 65-year-old woman, clinically diagnosed as a lingual neoplasm and two cases of tuberculous lymphadenopathy uncommonly located in the submandibular and supraclavicular regions. A comprehensive review of literature follows the case presentations. Tuberculous manifestation in the ear, nose and throat area remains a difficult diagnosis to establish, particularly because of its rarity and non-specific clinical appearance, and should be included in the differential diagnosis of pharynx lesions. An early diagnosis is essential to avoid occurrence of complications.

New isoniazid derivatives with improved pharmaco-toxicological profile: Obtaining, characterization and biological evaluation.

Tuberculostatic drugs are the most common drug groups with global hepatotoxicity. Awareness of potentially severe hepatotoxic reactions is vital, as hepatic impairment can be a devastating and often fatal condition. The treatment problems that may arise, within this class of medicines, are mainly of two types: adverse reactions (collateral, toxic or hypersensitive reactions) and the initial or acquired resistance of Mycobacterium tuberculosis to one or more antituberculosis drugs. Prevention of adverse reactions, increase treatment adherence and success rates, providing better control of tuberculosis (TB). In this regard, obtaining new drugs with low toxicity and high tuberculostatic potential is essential. Thus, in this work, we have designed or synthesized new derivatives of isoniazid (INH), such as new Isonicotinoylhydrazone (INH-a, INH-b and INH-c). These derivatives demonstrated good biocompatibility, antimicrobial property similar to that of parent isoniazid and last but not least, a significantly improved Pharmacotoxicological profile compared to that of isoniazid.

[Monitoring of Mycobacterium tuberculosis infections in Iasi County in 2009]. / Monitorizarea infectiei cu Mycobacterium tuberculosis în judetul Iasi, în anul 2009.

UNLABELLED: Tuberculosis is a major public health problem worldwide. Our study aimed to investigate epidemiological and demographic characteristics of tuberculosis infection and resistance to antituberculous drugs in Iasi County in 2009. MATERIAL AND METHOD: We have analysed the epidemiological parameters for 687 patients with pulmonary tuberculosis, new cases confirmed by microscopy and cultivation on Lowenstein Jensen. First and second-line antituberculous susceptibility testing was done for 130 strains, using agar proportion method and absolute-concentration method. RESULTS: The number of new cases of tuberculosis was higher in rural areas and in males 41-50 years old (sex ratio=2.22). The proportion of positive cases in microscopy was 81.51%. Drug resistance was as follows: 16 isolates (12.3%) to isoniazid, 5 (3.84%) to rifampin, 2 (1.53%) to ethambutol, 2 (1.53%) to streptomycin and 4 (3.07%) were multidrug-resistant. CONCLUSIONS: In this study we found high resistance rates to isoniazid, streptomycin and ethambutol. This requires increasing efficiency of tuberculosis diagnosis and susceptibility testing.

Romanian anti-TB drugs resistance surveillance 2003-2004.

UNLABELLED: Romania decided and initiated a DRS for anti-TB drugs at national level using the standardized methodology proposed by WHO and IUATLD. The DRS protocol was designed with technical assistance from WHO; the surveillance started in June 2003 and ended in June 2004. It was tested the susceptibility to the 4 first line anti-TB drugs: Isoniazide (H), Rifampicin (R), Streptomycin (S), Ethambutol (E). Drug susceptibility testing used: indirect absolute concentration method. There were included in the survey 1251 TB patients from the 60 clusters: 869 new cases and 382 previously treated. From the penitentiary system were included 85 TB patients, 47 new cases and 38 previously treated. RESULTS: [table: see text]. Estimations of the trend of anti-TB drug resistance in Romania for the next period was proposed.

Synthesis and antituberculosis action of some new pyruvic acid derivatives.

UNLABELLED: The present paper studies the synthesis and activity of 12 new azoic derivatives against Mycobacterium tuberculosis. MATERIAL AND METHOD: In order to obtain new antituberculosis substances, we studied 6 thiadiazolic derivatives and 6 triazolic derivatives of pyruvic acid and we observed the influence of the different radical groups inserted in the molecule on their antituberculosis activity. For this study we developed a simple method to obtain the new derivatives. The first stage of the experiment was the synthesis of the thyosemicarbazide derivatives. In order to obtain the thiadiazolic derivatives we treated the thyosemicarbazides with concentrated sulfuric acid. The triazolic derivatives were obtained after treating the thiosemicarbazide derivatives with a diluted NaOH solution at boiling. RESULTS: The structure of the substances was furthermore confirmed by IR and quantitative elemental analysis. The newly obtained substances were tested on the Mycobacterium tuberculosis complex, 6 concentrations for each substance. Early tests on Mycobacterium tuberculosis indicate that 2 of the tested substances have clear antituberculosis activity in vitro for the tested concentrations. For the other tested substances further research is needed since the CMI hasn't been reached in their cas. CONCLUSIONS: We synthesised 12 new thiadiazolic and triazolic derivatives in order to obtain new possible antituberculosis agents. Early tests on Mycobacterium tuberculosis indicate that 2 of the tested substances have clear antituberculosis activity in vitro for the tested concentrations.

[Comparative evaluation between MB/BacT system and Löwenstein-Jensen solid culture media for mycobacterial isolation]. / Evaluare comparativa a sistemului MB/BacT cu mediul Löwenstein-Jensen pentru izolarea micobacteriilor.

Tuberculosis is a public health issue in both developed and developing countries. Success of the treatment depend on the identification of patients with positive sputum smears, rapid confirmation of diagnosis in patients with negative microscopy and identification of mycobacterial strains with altered drug susceptibility. Data from the literature show that liquid culture media have a higher sensitivity for isolation mycobacteria than solid culture media as Löwenstein-Jensen. In our series inoculation on liquid media resulted in retrieval of a significant higher number of mycobacterial strains than on solid media (435 vs 250). The time needed to obtain a positive culture was also lower for liquid media (15.89 +/- 9 days, mean +/- standard deviation) than for solid media (27.77 +/- 10.13 days), p < 0.001. These differences were seen in both smear negative and smear positive cases. Culture in liquid media isolated more strains with altered drug susceptibility but this difference was not statistically significant.

Researches concerning the synthesis and antituberculosis action of some new sulphacetamide derivatives.

In the present study we emphasized the antituberculosis action of new sulphacetamide derivatives. In order o extend the research for obtaining antituberculosis substances, we decided to study the influence of the introducing of the thiourea and sulphamide groups in the molecule on the antituberculosis activity of the Isoniazid. We have developed a simple and precise method for obtaining the thiourea derivatives of sulphamides' isonicotinoilhydrazone. The structure of the newly synthesized compounds was confirmed by the quantitative elemental analysis as well as IR spectral measurements. We tested the antituberculosis action of new eight obtained sulphacetamide derivatives. Testing new substances on the Mycobacterium tuberculosis complex implies the insemination of inoculums on tubes containing the new substances, in chosen concentrations. Early tests on Mycobacterium tuberculosis strains show susceptibility to these new compounds (for the tested concentrations). The new compounds represent a premise for obtaining new antimycobacterial agents.

[Direct detection by ligase chain reaction of Mycobacterium tuberculosis complex in pleural fluid]. / Depistarea directa prin reactia de legare în lant a complexului Mycobacterium tuberculosis în probe de lichid pleural.

Our purpose was to investigate the utility of the DNA amplification by ligase chain reaction (LCR) for the direct detection of Mycobacterium tuberculosis complex (MTC) in pleural fluid specimens from patients suspected for tuberculous pleural effusion. We have used the LCx M. tuberculosis kit (Abbott) which uses the amplification of the gene that encodes for antigen b. We have examined 81 pleural fluid specimens by isolation (on Löwenstein-Jensen medium and MB/BacT system) and by LCR. Out of 10 positive specimens in culture, 4 were also positive by LCR; out of 71 negative specimens in culture, 8 were positive by LCR. We have re-evaluated the LCR results according to the clinical diagnosis, sustained by the successful therapy, and to the pathological diagnosis on the pleural biopsy. The sensitivity and specificity of LCR in the diagnosis of tuberculous pleural effusion were 31.5% and 100%. This commercial LCR kit is a rapid, specific, but less sensitive test for the routine diagnosis of the tuberculous pleural effusion.