Latent tuberculosis infection treatment completion in Biscay: differences between regimens and monitoring approaches.

Introduction: Contact tracing and treatment of latent tuberculosis infection (LTBI) is a key element of tuberculosis (TB) control in low TB incidence countries. A TB control and prevention program has been active in the Basque Country since 2003, including the development of the nurse case manager role and a unified electronic record. Three World Health Organization-approved LTBI regimens have been used: isoniazid for 6 months (6H), rifampicin for 4 months (4R), and isoniazid and rifampicin for 3 months (3HR). Centralized follow-up by a TB nurse case manager started in January 2016, with regular telephone follow-up, telemonitoring of blood test results, and monitoring of adherence by electronic review of drugs dispensed in pharmacies. Objective: To estimate LTBI treatment completion and toxicity of different preventive treatment regimens in a real-world setting. Secondary objective: to investigate the adherence to different approaches to preventive treatment monitoring. Methods: A multicentre retrospective cohort study was conducted using data collected prospectively on contacts of patients with TB in five hospitals in Biscay from 2003 to 2022. Results: A total of 3,066 contacts with LTBI were included. The overall completion rate was 66.8%; 86.5% of patients on 3HR (n = 699) completed treatment vs. 68.3% (n = 1,260) of those on 6H (p < 0.0001). The rate of toxicity was 3.8%, without significant differences between the regimens. A total of 394 contacts were monitored by a TB nurse case manager. In these patients, the completion rate was 85% vs. 67% in those under standard care (p < 0.001). A multivariate logistic regression model identified three independent factors associated with treatment completion: being female, the 3HR regimen, and nurse telemonitoring. Conclusion: 3HR was well tolerated and associated with a higher rate of treatment completion. Patients with nurse telemonitoring follow-up had better completion rates.

Absceso de psoas tras bacteriemia por Staphylococcus aureus meticilín-resistente asociada a catéter / Psoas abscess after catheter-related meticillin-resistant Staphylococcus aureus bacteremia

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[Pulmonary disease caused by Mycobacterium kansasii. Analysis of 39 cases]. / Enfermedad pulmonar por Mycobacterium kansasii. Análisis de 39 casos.

OBJECTIVE: To study the epidemiological, clinical, radiological, and microbiological characteristics as well as clinical course and response to treatment of patients with lung disease due to Mycobacterium kansasii. METHODS: All cases of lung disease caused by M. kansasii diagnosed between 1993 and 1998 in Santa Marina Hospital in Bilbao (Spain) were reviewed. RESULTS: The nurse identified 39 cases of lung disease caused by M. kansasii. The incidence in our practice is growing. Most patients were men (97.4%). Mean patient age was 55.9 years. Relevant features of patients' case histories were lung tuberculosis (38.4%), chronic airflow limitation (28.2%) and smoking (87%). Most patients lived in urban settings (94.8%). The most frequent symptoms were cough (87%) and general malaise (72%). Hemoptysis occurred in 31%. Chest images showed mainly a localized alveolar pattern (69%). Cavitation was present in 76.9%. Bacilli were observed in 76.9%. Antibiograms (for 30 cases) showed resistance to the following drugs: rifampicin 3.3%, isoniazid (1 microgram/ml 10%, isoniazid (0.2 microgram/ml 100%, ethambutol 6.6%, streptomycin 90%, pyrazinamide 90%. Eight patients (22% of 36) died; all had severe associated disease. In 33% of the 21 patients with cavitation, closure was not achieved according to follow-up images. Follow-up microbiological tests revealed one case (2.7% of 36 patients) of treatment failure and four cases (15.3% of 26 patients) of relapse. CONCLUSIONS: The number of patients with lung disease due to M. kansasii has increased significantly in recent years in our hospital. The mortality rate in these patients was high, but we believe it is explained by the severity of associated disease. The 15.3% rate of relapse calls for long-term follow-up of such patients.

Enfermedad pulmonar por Mycobacterium kansasii. Análisis de 39 casos / Lung disease due to Mycobacterium kansasii: analysis of 39 cases. Lung disease due to Mycobacterium kansasii: analysis of 39 cases

Objetivo: Determinar las características epidemiológicas, clínicas, radiológicas, evolutivas y de respuesta al tratamiento en pacientes con enfermedad pulmonar por Mycobacterium kansasii. Métodos: Se incluyeron en el estudio todos los pacientes diagnosticados de enfermedad pulmonar por M. kansasii entre los años 1993 y 1998 en el Hospital de Santa Marina de Bilbao. Resultados: Encontramos a 39 pacientes con enfermedad pulmonar por M. kansasii que cumplían para su diagnóstico los criterios de la ATS. La incidencia de la enfermedad en nuestro medio es creciente. El predominio de afección del sexo masculino fue muy notable (97,4 por ciento). La media de edad de los pacientes fue de 55,9 años. Entre los antecedentes personales destacan la tuberculosis pulmonar (38,4 por ciento), la OCFA (28,2 por ciento) y el tabaquismo (87 por ciento). La mayoría de los pacientes procedían del medio urbano (94,8 por ciento). Entre los síntomas destacaron por su frecuencia la tos (87 por ciento) y el síndrome general (72 por ciento). La hemoptisis se dio en el 31 por ciento de los pacientes. En la radiografía del tórax predominó el patrón alveolar localizado (69 por ciento). La presencia de cavitación se dio en el 76,9 por ciento de los casos. La baciloscopia directa fue positiva en el 76,9 por ciento de los pacientes. Los antibiogramas (sobre 30 casos) indicaron las siguientes resistencias: rifampicina, 3,3 por ciento; isoniacida (1 µg/ml), 10 por ciento; isoniacida (0,2 µg/ml), 100 por ciento; etambutol, 6,6 por ciento; estreptomicina, 90 por ciento; pirazinamida, 90 por ciento. Fallecieron 8 pacientes (22 por ciento, sobre 36 pacientes), todos con graves enfermedades asociadas. En la evolución radiológica destacamos que en el 33 por ciento de las formas cavitarias no se consiguió el cierre de las mismas (sobre 21 pacientes). En la evolución microbiológica destaca un caso de fracaso bacteriológico (2,7 por ciento, sobre 36 pacientes) y 4 casos de recaída (15,3 por ciento, sobre 26 pacientes). Conclusiones: El número de pacientes con enfermedad pulmonar por Mycobacterium kansasii ha aumentado en los últimos años de forma significativa en nuestro hospital. La mortalidad en los pacientes con esta enfermedad fue alta, pero parece explicarse por la gravedad de las enfermedades asociadas que padecían. La tasa de recaídas, del 15,3 por ciento, obliga al seguimiento posterior a largo plazo de estos pacientes. (AU)

[Pulmonary aspergillomas. Analysis of 31 patients]. / Aspergilomas pulmonares. Análisis de 31 pacientes.

Thirty-one patients with pulmonary aspergilloma were studied retrospectively, leading to the following main findings: 1) Men are most often affected (90% of cases). 2) Diagnosis occurs significantly more often when the patient is between 50 to 60 years of age. 3) Aspergilloma originates most often in residual pulmonary tuberculosis (74% of cases). 4) The incidence of hemoptysis was high (87% of patients). Traditional tomography afforded images that were diagnostically useful in 77.4% of the cases, whereas simple X-rays were useful in only 38.7%. 6) In 94% aspergilloma occurred in the upper lobes. 7) Aspergillus was found in respiratory secretions in 55%. 8) Serum samples were positive for Aspergillus precipitins in 94.4%. 9) Forty-eight percent did not meet criteria for surgical intervention. 10) Noteworthy features of the course of the disease were that spontaneous lysis occurred in 13.6% and that hemoptysis led to death in 9%.