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1.
IDCases ; 27: e01379, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35036320

RESUMO

Mycobacterium szulgai is a slow growing non-tuberculous mycobacterium associated with rare but severe infections. It most commonly presents as pulmonary disease in people with underlying structural lung disease. We report a case of progressive cavitary lung disease over a three year period due to Mycobacterium szulgai and the subsequent outcome.

4.
Int J Mycobacteriol ; 5(3): 273-275, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27847009

RESUMO

Non-tuberculous mycobacteria are increasingly recognized as a cause of infection in both immunocompromised and immunocompetent hosts. Mycobacterium heraklionense is a recently described member of the Mycobacterium terrae complex. Herein we report a case of M. heraklionense chronic flexor tenosynovitis in the hand, managed with surgery and antibiotics.


Assuntos
Mãos/patologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/patologia , Micobactérias não Tuberculosas/isolamento & purificação , Tenossinovite/etiologia , Tenossinovite/patologia , Idoso , Antibacterianos/uso terapêutico , Mãos/cirurgia , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/terapia , Micobactérias não Tuberculosas/classificação , Procedimentos Cirúrgicos Operatórios , Tenossinovite/microbiologia , Tenossinovite/terapia , Resultado do Tratamento
5.
Emerg Infect Dis ; 17(3): 372-378, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21392426

RESUMO

In 2004, identification of patients infected with the same Mycobacterium tuberculosis strain in New York, New York, USA, resulted in an outbreak investigation. The investigation involved data collection and analysis, establishing links between patients, and forming transmission hypotheses. Fifty-four geographically clustered cases were identified during 2003-2009. Initially, the M. tuberculosis strain was drug susceptible. However, in 2006, isoniazid resistance emerged, resulting in isoniazid-resistant M. tuberculosis among 17 (31%) patients. Compared with patients with drug-susceptible M. tuberculosis, a greater proportion of patients with isoniazid-resistant M. tuberculosis were US born and had a history of illegal drug use. No patients named one another as contacts. We used patient photographs to identify links between patients. Three links were associated with drug use among patients infected with isoniazid-resistant M. tuberculosis. The photographic method would have been more successful if used earlier in the investigation. Name-based contact investigation might not identify all contacts, particularly when illegal drug use is involved.


Assuntos
Antituberculosos/farmacologia , Surtos de Doenças , Farmacorresistência Bacteriana , Isoniazida/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Idoso , Criança , Análise por Conglomerados , Usuários de Drogas , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Cidade de Nova Iorque/epidemiologia , Tuberculose Pulmonar/diagnóstico , Adulto Jovem
6.
J Public Health Manag Pract ; 16(5): E09-17, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20689383

RESUMO

Public health departments rely on the timely receipt of tuberculosis (TB) reports to promptly initiate patient management and contact investigations. In 2003, 43% of persons in New York City with confirmed or suspected TB were reported 4 or more days late. An intervention to increase the timeliness of TB reporting was initiated in 2004. A list of patients who were reported late and had a smear positive for acid-fast bacilli, a pathology finding consistent with TB, or who initiated 2 or more anti-TB medications was generated quarterly. Health care providers and laboratories were contacted to determine the reasons for reporting late and were educated on TB reporting requirements. To assess the effectiveness of the intervention, we evaluated the trend in delayed reports between 2003 and 2006, using the Jonckheere-Terpstra test for trend. The proportion of patients who were reported late decreased from 43% (942/2183) in 2003 to 20% (386/1930) in 2006 (Ptrend < .0001). There were improvements in reporting timeliness for all 3 reporting criteria included in the evaluation and all provider types (all Ptrend < .0001); however, private providers consistently had a higher proportion of delayed reporting (22% reported late in 2006). This relatively simple intervention was very effective in improving the timeliness of TB reporting and could be utilized for other reportable diseases where prompt reporting is critical.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico , Notificação de Doenças/legislação & jurisprudência , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Cidade de Nova Iorque , Fatores de Tempo
7.
Clin Infect Dis ; 50(11): 1524-31, 2010 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-20415570

RESUMO

BACKGROUND: Although highly active antiretroviral therapy (HAART) has decreased human immunodeficiency virus (HIV)-related morbidity, tuberculosis remains an important disease among HIV-infected individuals. METHODS: By use of surveillance data, sociodemographic and clinical changes among HIV-infected and HIV-uninfected tuberculosis patients in New York City were evaluated using the Cochran-Armitage trend test and multivariate logistic regression across 3 periods: 1992-1995 (pre-HAART), 1996-2000 (early HAART), and 2001-2005 (late HAART). RESULTS: Among tuberculosis patients with known HIV status, 4345 (60%) of 7224 were HIV-infected in pre-HAART, 1943 (33%) of 5933 in early HAART, and 851 (22%) of 3815 in late HAART (P < .001 for trend). During the study period, the age of HIV-infected tuberculosis patients increased, and greater proportions were female, non-Hispanic black, Asian, and foreign born; the proportion that was non-Hispanic white decreased. The proportion that was culture-negative for Mycobacterium tuberculosis increased (from 7% pre-HAART to 21% late HAART; P < .001 for trend; early HAART vs pre-HAART adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.38-2.04), and the proportion with extrapulmonary disease also increased (from 32% to 46%; P < .001 for trend). The proportion with multidrug-resistant tuberculosis decreased (from 16% to 4%; P < .001 for trend), especially from pre-HAART to early HAART (aOR, 0.31; 95% CI, 0.25-0.40). The proportion who died before tuberculosis treatment decreased (from 12% to 7%), and the proportion who died during tuberculosis treatment also decreased (from 29% to 11%) (both, P < .001 for trend). Over time, HIV-infected tuberculosis patients had AIDS longer before the diagnosis of tuberculosis (P < .001 for trend). Similar trends for culture, site of disease, and drug resistance were seen for HIV-uninfected tuberculosis patients. CONCLUSIONS: The sociodemographic and clinical characteristics changed substantially among HIV-infected tuberculosis patients in New York City. Awareness of these changes may speed diagnosis of tuberculosis. Future studies should evaluate HAART's effect on tuberculosis presentation among HIV-infected patients.


Assuntos
Infecções por HIV/complicações , Tuberculose/epidemiologia , Tuberculose/patologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Demografia , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Cidade de Nova Iorque/epidemiologia , Tuberculose/microbiologia , Tuberculose/mortalidade , Adulto Jovem
9.
J Antimicrob Chemother ; 65(4): 775-83, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20150181

RESUMO

UNLABELLED: Rationale Linezolid may be effective for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB); however, serious adverse events are common and there is little information on the management of these toxicities. METHODS: We retrospectively reviewed public health and medical records of 16 MDR TB patients, including 10 patients with XDR TB, who were treated with linezolid in New York City between January 2000 and December 2006, to determine treatment outcomes and describe the incidence, management and predictors of adverse events. RESULTS: Linezolid was added to MDR TB regimens for a median duration of 16 months (range: 1-29). Eleven patients (69%) completed treatment, four (25%) died and one (6%) discontinued treatment without relapse. Myelosuppression occurred in 13 (81%) patients a median of 5 weeks (range: 1-11) after starting linezolid, gastrointestinal adverse events occurred in 13 (81%) patients after a median of 8 weeks (range: 1-57) and neurotoxicity occurred in seven (44%) patients after a median of 16 weeks (range: 10-111). Adverse events were managed by combinations of temporary suspension of linezolid, linezolid dose reduction and symptom management. Five (31%) patients required eventual discontinuation of linezolid. Myelosuppression was more responsive to clinical management strategies than was neurotoxicity. Leucopenia and neuropathy occurred more often in males and older age was associated with thrombocytopenia (P < 0.05). CONCLUSIONS: The majority of MDR TB patients on linezolid had favourable treatment outcomes, although treatment was complicated by adverse events that required extensive clinical management.


Assuntos
Acetamidas/efeitos adversos , Acetamidas/uso terapêutico , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Oxazolidinonas/efeitos adversos , Oxazolidinonas/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Idoso , Doenças da Medula Óssea/induzido quimicamente , Criança , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Incidência , Linezolida , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/induzido quimicamente , Cidade de Nova Iorque , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Int J Infect Dis ; 14(4): e292-7, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19656705

RESUMO

BACKGROUND: Low adherence to treatment of latent tuberculosis infection (TLTBI) diminishes TB prevention efforts. This study examined the treatment completion rate among those who started TLTBI and factors associated with adherence to TLTBI. METHODS: Patients who started TLTBI in New York City (NYC) Health Department chest clinics during January 2002-August 2004 were studied. TLTBI completion rate were described and compared according to patient demographic and clinical characteristics by regimen using univariate analysis and log-binomial regression. RESULTS: A total of 15 035 patients started and 6788 (45.2%) completed TLTBI. Treatment completers were more likely than non-completers to be >or=35 years old (52.5%, adjusted relative risk (aRR)=1.2, 95% confidence interval (CI)=1.1, 1.2), contacts to pulmonary TB patients (57.4%, aRR=1.5, 95% CI=1.4, 1.7), treated by directly observed preventive therapy (DOPT) (71.4%, aRR=1.3, 95% CI=1.2, 1.3), and to have received the rifamycin-based regimen (60.0%, aRR=1.2, 95% CI=1.1, 1.3). The completion rate with an isoniazid regimen did not differ between HIV-infected and HIV-uninfected persons. Among those who failed to complete, 3748 (47.8%) failed to return for isoniazid and 59 (14.7%) for rifamycin after the first month of medication dispensing. CONCLUSIONS: Shorter regimen and DOPT increased completion rates for LTBI. Though efforts to improve TLTBI completion need to address all groups, greater focus is needed for persons who are contacts and HIV-infected, as they have higher risk of developing TB.


Assuntos
Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Adesão à Medicação , Mycobacterium tuberculosis/crescimento & desenvolvimento , Rifampina/uso terapêutico , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Tuberculose Latente/epidemiologia , Tuberculose Latente/microbiologia , Masculino , Cidade de Nova Iorque/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Adulto Jovem
11.
J Immigr Minor Health ; 12(6): 816-22, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18985452

RESUMO

The prevalence of latent tuberculosis infection (LTBI) in the various populations of New York City (NYC), a city with a high density of non-US-born persons, is unknown. We examined the prevalence of TST positivity in patients who received a tuberculin skin test (TST) between 1/2002 and 8/2004 at any of 10 NYC health department chest centers. A positive TST was defined as an induration reaction to tuberculin of ≥10 mm. In the study population of 41,022 individuals, prevalence of TST positivity was 24.4% (95%CI = 24.0, 24.8); four times higher among non-US-born persons than US-born (39.5% vs. 8.8%, Prevalence ratio (PR) = 4.5; 95%CI = 4.4, 4.6). Prevalence of TST positivity increased with age in both US and non-US-born persons. Persons from countries with a TB case rate >100/100,000 population had higher prevalence of TST positivity (47% vs. ≤39%), even after controlling for BCG (PR = 1.3, 95%CI = 1.2, 1.4). These findings provide insight into current prevalence of TST positivity in many immigrant populations and will help both clinicians and health departments to target patients for LTBI treatment.


Assuntos
Pele/imunologia , Teste Tuberculínico/estatística & dados numéricos , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Bases de Dados Factuais , Emigrantes e Imigrantes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Tuberculina/isolamento & purificação , Tuberculose/epidemiologia , Tuberculose/etnologia , Adulto Jovem
12.
Clin Infect Dis ; 49(1): 46-54, 2009 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-19476429

RESUMO

BACKGROUND: A diagnosis of tuberculosis (TB) relies on acid-fast bacilli (AFB) smear and culture results. Two rapid tests that use nucleic acid amplification (NAA) have been approved by the US Food and Drug Administration for the diagnosis of TB based on detection of Mycobacterium tuberculosis from specimens obtained from the respiratory tract. We evaluated the performance of NAA testing under field conditions in a large urban setting with moderate TB prevalence. METHODS: The medical records of patients with suspected TB during 2000-2004 were reviewed. Analysis was restricted to the performance of NAA on specimens collected within 7 days after the initiation of treatment for TB. The assay's sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. RESULTS: The proportion of patients with confirmed or suspected TB whose respiratory tract specimens were tested by use of NAA increased from 429 (12.9%) of 3334 patients in 2000 to 527 (15.6%) of 3386 patients in 2004; NAA testing among patients whose respiratory tract specimens tested positive for AFB increased from 415 (43.6%) of 952 patients in 2000 to 487 (55.5%) of 877 patients in 2004 (P < .001 for both trends). Of the 16,511 patients being evaluated for pulmonary TB, 4642 (28.1%) had specimens that tested positive for AFB on smear. Of those 4642 patients, 2241 (48.3%) had NAA performed on their specimens. Of those 2241 patients, 1279 (57.1%) had positive test results. Of those 1279 patients, 1262 (98.7%) were confirmed to have TB. For 1861 (40.1%) of the 4642 patients whose specimens tested positive for AFB on smear, the NAA test had a sensitivity of 96.0%, a specificity of 95.3%, a PPV of 98.0%, and an NPV of 90.9%. For 158 patients whose specimens tested negative for AFB on smear, the NAA test had a sensitivity of 79.3%, a specificity of 80.3%, a PPV of 83.1%, and an NPV of 76.0%, respectively. For the 215 specimens that tested positive for AFB by smear, we found a sensitivity, specificity, PPV, and NPV of 97.5%, 93.6%, 95.1%, and 96.8%, respectively. A high-grade smear was associated with a better test performance. CONCLUSION: NAA testing was helpful for determining whether patients whose specimens tested positive for AFB on smear had TB or not. This conclusion supports the use of this test for early diagnosis of pulmonary and extrapulmonary TB.


Assuntos
Técnicas de Diagnóstico Molecular/métodos , Mycobacterium tuberculosis/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , Tuberculose/diagnóstico , DNA Bacteriano/genética , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/genética , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Escarro/microbiologia , Estados Unidos , População Urbana
13.
J Public Health Manag Pract ; 13(3): 252-62, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17435492

RESUMO

BACKGROUND: We aimed to increase human immunodeficiency virus (HIV) counseling, testing, referral (CTR), and knowledge of HIV serostatus of close contacts of tuberculosis patients and improve tuberculosis screening and treatment of HIV-infected contacts. METHODS: Of close contacts to infectious tuberculosis patients reported from December 2002 to November 2003, investigators (1) offered HIV CTR, (2) identified factors associated with HIV testing, and (3) assessed study costs. RESULTS: Of 614 contacts, 569 (93%) were provided HIV information and offered HIV CTR. Of the 569, 58 (10%) were previously HIV tested; 165 (29%) were newly HIV tested; and 346 (61%) were not tested. None of the 165 newly HIV tested contacts were HIV infected. Contacts more likely to be newly HIV tested (vs not tested) included those aged 18-24, Hispanic, or non-Hispanic Black. Of 24 HIV-infected contacts, 71 percent received chest-radiograph screening for tuberculosis disease; 56 percent of 18 eligible for latent-tuberculosis-infection treatment started and half completed. It cost $1 per patient to provide HIV information and $5-$8 to offer HIV CTR. CONCLUSION: The project increased HIV CTR of close contacts of infectious tuberculosis patients. The important factor for success in knowing contacts' HIV serostatus was simply for TB program staff to ask about it and offer the test to those who did not know their status.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Busca de Comunicante/métodos , Aconselhamento/estatística & dados numéricos , Infecções por HIV/diagnóstico , Administração em Saúde Pública/métodos , Tuberculose Pulmonar/prevenção & controle , Sorodiagnóstico da AIDS/economia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Busca de Comunicante/economia , Análise Custo-Benefício , Aconselhamento/economia , Notificação de Doenças/economia , Estudos de Viabilidade , Feminino , Infecções por HIV/complicações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Administração em Saúde Pública/economia , Radiografia Torácica/estatística & dados numéricos , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Socioeconômicos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia
15.
Virtual Mentor ; 9(12): 799-805, 2007 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-23228640
16.
Clin Infect Dis ; 43(11): 1468-75, 2006 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-17083024

RESUMO

Rifapentine is a recently approved antituberculosis drug that has not yet been widely used in clinical settings. Clinical data support intermittent use of rifapentine with isoniazid during the continuation phase of tuberculosis treatment. Patients with culture-positive, noncavitary, pulmonary tuberculosis whose sputum smear is negative for acid-fast bacilli at the end of the 2-month intensive treatment phase are eligible for rifapentine therapy. Rifapentine should not be used in human immunodeficiency virus-infected patients, given their increased risk of developing rifampin resistance with currently recommended dosages. Rifapentine is not currently recommended for children aged <12 years, pregnant or lactating women, or individuals with culture-negative or extrapulmonary tuberculosis. Rifapentine (600 mg) is administered once weekly with isoniazid (900 mg) during the continuation phase of treatment. This combination should only be given under direct observation. As with rifampin, drug-drug interactions are common, and regular patient monitoring is required. Ease of administration makes this regimen attractive both for tuberculosis-control programs and for patients.


Assuntos
Antituberculosos/uso terapêutico , Rifampina/análogos & derivados , Tuberculose Pulmonar/tratamento farmacológico , Humanos , Rifampina/administração & dosagem , Rifampina/química , Rifampina/uso terapêutico
17.
J Clin Microbiol ; 44(8): 2890-6, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16891508

RESUMO

We studied two large Mycobacterium tuberculosis genotype clusters associated with recent outbreaks in homeless persons to determine factors associated with these tuberculosis (TB) strains. Isolates from all culture-positive TB cases diagnosed from 1 January 2001 to 31 December 2004 were genotyped. Patients whose isolates had identical restriction fragment length polymorphism patterns and spoligotypes were considered clustered. Health department records were reviewed and reinterviews attempted for clustered cases. Patients with the Cs30 and BEs75 strains were compared to other genotypically clustered cases and to each other. The two largest genotype clusters among homeless persons were the Cs30 strain (n = 105) and the BEs75 strain (n = 47). Fifty-one (49%) patients with the Cs30 strain and 28 (60%) with the BEs75 strain were homeless. Compared to patients with the BEs75 strain, patients with the Cs30 strain were less likely to be respiratory acid-fast bacillus smear positive (51% versus 72%). Furthermore, patients with the BEs75 strain were more likely to be HIV infected (74% versus 42%), which suggests that most patients with this strain advanced to disease after recent infection. Cases in clusters of strains that have been circulating in the community over a long time period, such as the Cs30 strain, require additional investigation to determine whether clustering is a result of recent transmission or reactivation of remote infection.


Assuntos
Pessoas em Situação de Rua , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise por Conglomerados , Impressões Digitais de DNA , DNA Bacteriano/genética , Surtos de Doenças , Feminino , Genótipo , Infecções por HIV/complicações , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Mycobacterium tuberculosis/isolamento & purificação , Cidade de Nova Iorque/epidemiologia , Polimorfismo de Fragmento de Restrição , Escarro/microbiologia
18.
Emerg Infect Dis ; 12(5): 719-24, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16704826

RESUMO

In 2001, New York City implemented genotyping to its tuberculosis (TB) control activities by using IS6110 restriction fragment length polymorphism (RFLP) and spoligotyping to type isolates from culture-positive TB patients. Results are used to identify previously unknown links among genotypically clustered patients, unidentified sites of transmission, and potential false-positive cultures. From 2001 to 2003, spoligotype and IS6110-based RFLP results were obtained for 90.7% of eligible and 93.7% of submitted isolates. Fifty-nine (2.4%) of 2,437 patient isolates had false-positive culture results, and 205 genotype clusters were identified, with 2-81 cases per cluster. Cluster investigations yielded 57 additional links and 17 additional sites of transmission. Four additional TB cases were identified as a result of case finding initiated through cluster investigations. Length of unnecessary treatment decreased among patients with false-positive cultures.


Assuntos
Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Polimorfismo de Fragmento de Restrição , Tuberculose/microbiologia , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , Infecção Hospitalar/prevenção & controle , Reações Falso-Positivas , Genótipo , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Cidade de Nova Iorque/epidemiologia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Tuberculose/transmissão , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/prevenção & controle
19.
Clin Infect Dis ; 42(12): 1702-10, 2006 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-16705575

RESUMO

BACKGROUND: Two drug-resistance surveys showed a very high prevalence of drug resistance among isolates obtained from patients with tuberculosis in 1991 and 1994 in New York, New York. METHODS: A cross-sectional survey in April 1997 and a survey of incident cases in April-June 2003 were conducted. The trend in the proportion of drug resistance in the 4 surveys was examined separately for prevalent and incident cases. Risk factors for drug resistance in incident cases were also assessed. RESULTS: The number of patients was 251 in the 1997 survey and 217 in the 2003 survey. Among prevalent cases, the percentage of cases with resistance to any antituberculosis drug decreased from 33.5% in 1991 to 23.8% in 1994 and to 21.5% in 1997 (P < .001, by test for trend); cases of multidrug-resistant tuberculosis also decreased significantly, from 19% in 1991 to 6.8% in 1997 (P < .001, by test for trend). Among incident cases in the 4 surveys, the decrease in resistance to any antituberculosis drugs was not statistically significant; however, the decrease in multidrug-resistant tuberculosis (from 9% in 1991 to 2.8% in 2003) was statistically significant (P = .002, by test for trend). However, in 2003, a worrisome increase in incident cases of multidrug-resistant tuberculosis (an increase of 23%) was seen among previously treated patients with pulmonary tuberculosis not born in the United States. Human immunodeficiency virus infection, a strong predictor for drug resistance in 1991 and 1994, was not associated with drug resistance in subsequent surveys. CONCLUSIONS: Intensive case management, including directly observed therapy, adherence monitoring, and periodic medical review to ensure appropriate treatment for each patient, should be sustained to prevent acquired drug resistance.


Assuntos
Antituberculosos/farmacologia , Farmacorresistência Bacteriana Múltipla , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cidade de Nova Iorque/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tuberculose Pulmonar/tratamento farmacológico
20.
Am J Respir Crit Care Med ; 174(3): 331-8, 2006 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-16675781

RESUMO

RATIONALE: Moxifloxacin has promising preclinical activity against Mycobacterium tuberculosis, but has not been evaluated in multidrug treatment of tuberculosis in humans. OBJECTIVE: To compare the impact of moxifloxacin versus ethambutol, both in combination with isoniazid, rifampin, and pyrazinamide, on sputum culture conversion at 2 mo as a measure of the potential sterilizing activity of alternate induction regimens. METHODS: Adults with smear-positive pulmonary tuberculosis were randomized in a factorial design to receive moxifloxacin (400 mg) versus ethambutol given 5 d/wk versus 3 d/wk (after 2 wk of daily therapy). All doses were directly observed. MEASUREMENTS: The primary endpoint was sputum culture status at 2 mo of treatment. RESULTS: Of 336 patients enrolled, 277 (82%) were eligible for the efficacy analysis, 186 (67%) were male, 175 (63%) were enrolled at African sites, 206 (74%) had cavitation on chest radiograph, and 60 (22%) had HIV infection. Two-month cultures were negative in 71% of patients (99 of 139) treated with moxifloxacin versus 71% (98 of 138) treated with ethambutol (p = 0.97). Patients receiving moxifloxacin, however, more often had negative cultures after 4 wk of treatment. Patients treated with moxifloxacin more often reported nausea (22 vs. 9%, p = 0.002), but similar proportions completed study treatment (88 vs. 89%). Dosing frequency had little effect on 2-mo culture status or tolerability of therapy. CONCLUSIONS: The addition of moxifloxacin to isoniazid, rifampin, and pyrazinamide did not affect 2-mo sputum culture status but did show increased activity at earlier time points.


Assuntos
Antituberculosos/uso terapêutico , Compostos Aza/uso terapêutico , Etambutol/uso terapêutico , Quinolinas/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , África , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Compostos Aza/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Etambutol/efeitos adversos , Feminino , Fluoroquinolonas , Humanos , Masculino , Moxifloxacina , Mycobacterium tuberculosis/isolamento & purificação , Quinolinas/efeitos adversos , Escarro/microbiologia , Estados Unidos
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