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2.
BMC Infect Dis ; 19(1): 923, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666021

RESUMO

BACKGROUND: Pulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination for acid fast bacilli without performing culture. This may lead to erroneous treatment outcomes as viable bacteria may be missed due to the low sensitivity of direct smear method. The aim of this study was to investigate if sterilizing cure is achieved among the new pulmonary TB cases declared cured by sputum smear conversion and to evaluate the impact of addition of ethambutol in the continuation phase in achieving it. METHODS: New sputum smear-positive pulmonary TB patients registered at a tertiary care hospital in Pakistan from November 2013 to March 2014 were followed under standard Directly Observed Treatment Short Course strategy for 6 months. Half of these patients received ethambutol in addition to isoniazid and rifampicin in the continuation phase. Sputum specimens were examined on microscopy at 2 months and at the end of treatment. Sputa of patients with negative direct smear examination at the end of treatment were cultured. RESULTS: Among 5746 TB suspects, 1595 were new sputum smear positive pulmonary TB cases, and 533 were registered at our hospital. Among these, 504 converted sputum negative at 2 months and 348 converted at the end of 6 months of treatment and were declared cured. Sputa of 204/348 patients were cultured, and 12/204 (6%) were culture-positive. Culture positivity at 6 months was not associated with bacterial load, smoking, diabetes, presence of cavities, history of contact with TB patients, age, sex, socioeconomic status, or addition of ethambutol in the continuation phase. CONCLUSION: Viable cultivable bacilli were detected in 6% of cured patients, which would have significant impact on the control of TB. This highlights the need for an inexpensive and accurate surrogate marker for culture as it is not feasible to perform culture in routine for monitoring treatment response in the low-resource settings. The treatment outcome did not improve by addition of ethambutol emphasizing the need to find the optimal duration of treatment for individual or carefully selected groups of patients.


Assuntos
Antituberculosos/uso terapêutico , Etambutol/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Idoso , Carga Bacteriana , Testes Diagnósticos de Rotina , Quimioterapia Combinada , Feminino , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paquistão , Rifampina/uso terapêutico , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico por imagem , Adulto Jovem
3.
BMC Infect Dis ; 19(1): 851, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615439

RESUMO

BACKGROUND: In Lao People's Democratic Republic (PDR), tuberculosis (TB) prevalence was estimated at 540/100,000 in 2011. Nevertheless, little is known about the genetic characteristics and anti-TB drug resistance of the Mycobacterium tuberculosis population. The main objective of this work was to study the genetic characteristics and drug resistance of M. tuberculosis population collected during the first National TB Prevalence Survey (TBPS) of Lao PDR (2010-2011). METHODS: Two hundred and twenty two isolates collected during TBPS (2010-2011) were analyzed with the GenoType MTBDRplus test for M. tuberculosis identification and drug resistance detection. Then, 206 of the 222 isolates were characterized by spoligotyping and MIRU-VNTR typing. RESULTS: Among the 222 M. tuberculosis isolates, 11 were mono-resistant to isoniazid and 2 were resistant to isoniazid and rifampicin (MDR-TB), using the GenoType MTBDRplus test. Among the 202 genetically characterized isolates, the East African-Indian (EAI) family was predominant (76.7%) followed by the Beijing (14.4%) and T (5.5%) families. EAI isolates came from all the country provinces, whereas Beijing isolates were found mainly in the northern and central provinces. A higher proportion of Beijing isolates was observed in people younger than 35 years compared to EAI. Moreover, the percentage of drug resistance was higher among Beijing (17.2%) than EAI (5.2%) isolates, and the two MDR-TB isolates belonged to the Beijing family. Combined analysis of the MIRU-VNTR and spoligotyping results (n = 202 isolates) revealed an estimated clustering rate of 11% and the occurrence of mini-outbreaks of drug-resistant TB caused by Beijing genotypes. CONCLUSIONS: The EAI family, the ancient and endemic family in Asia, is predominant in Lao PDR whereas the prevalence of Beijing, the most harmful M. tuberculosis family for humans, is still low, differently from neighboring countries. However, its association with drug resistance, its presence in young patients and its potential association with recent transmission suggest that the Beijing family could change TB epidemiological pattern in Lao PDR. Therefore, efficient TB control and surveillance systems must be maintained and reinforced to prevent the emergence of highly transmissible and drug-resistant strains in Lao PDR, as observed in neighboring countries.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Adolescente , Adulto , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Análise por Conglomerados , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Genótipo , Humanos , Isoniazida/farmacologia , Isoniazida/uso terapêutico , Laos/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/isolamento & purificação , Filogenia , Prevalência , Rifampina/farmacologia , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 852, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615537

RESUMO

BACKGROUND: The dual challenge of low diagnostic sensitivity of microscopy test and technical challenge of performing a TB culture test poses a problem for case detection and initiation of Tuberculosis (TB) second-line treatment. There is thus need for a rapid, reliable and easily accessible assay. This comparative analysis was performed to assess diagnostic performance characteristics of GeneXpert MTB/RIF and Line Probe Assay (LPA). METHODS: Three hundred twenty nine sputum samples of patients across the 47 counties in Kenya suspected to have drug resistant TB were picked and subjected to GeneXpert, LPA and Culture MGIT at the National TB Reference Laboratory. Sensitivity, specificity and predictive values were then determined to assess the performance characteristics of the various assays. RESULTS: Against culture MGIT as the gold standard for TB diagnosis, GeneXpert had a sensitivity, specificity, positive predictive value, and negative predictive value of 78.5, 64.9, 59.4 and 82.2% respectively while LPA had 98.4, 66.0, 65.4 and 98.4%. For diagnosis of rifampicin mono-resistance GeneXpert had a moderate agreement (Kappa 0.59, P < 0.01) (sensitivity 62.50%, specificity 96.50%) while LPA that had almost perfect agreement (Kappa = 0.89, p < 0.01) with a (sensitivity 90.0% and specificity 99.1%). CONCLUSION: LPA has a better performance characteristic to GeneXpert and an alternative to culture with regards to detection of RIF's mono-resistance.


Assuntos
Farmacorresistência Bacteriana/genética , Mycobacterium tuberculosis/genética , Rifampina/uso terapêutico , Tuberculose/diagnóstico , Proteínas de Bactérias/genética , Feminino , Humanos , Quênia , Masculino , Reação em Cadeia da Polimerase Multiplex/métodos , Mycobacterium tuberculosis/isolamento & purificação , Hibridização de Ácido Nucleico/métodos , Oxirredutases/genética , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Escarro/microbiologia , Tuberculose/tratamento farmacológico
5.
Internist (Berl) ; 60(11): 1155-1175, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31641790

RESUMO

Tuberculosis is a bacterial infectious disease that is usually transmitted by inhalation of droplets containing the bacteria. The World Health Organization (WHO) estimates that approximately 10 million patients were newly diagnosed with tuberculosis in 2017. Rapid diagnosis relies on a combination of imaging and microbiological, molecular, and, rarely, immunological tests. Genotypic methods enable early diagnosis and allow highly accurate prediction of drug resistance. Phenotypic (culture-based) methods are the diagnostic gold standard. Standard management of patients with pan drug-susceptible pulmonary tuberculosis includes a combination of rifampicin, isoniazid, ethambutol and pyrazinamide for 2 months followed by rifampicin and isoniazid for additional 4 months, which leads to cure rates of >80%. With individualized treatment schemes, similar cure rates can be achieved for patients with multidrug-resistant tuberculosis.


Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Etambutol/uso terapêutico , Humanos , Isoniazida/uso terapêutico , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Tuberculose/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
6.
BMJ ; 367: l5894, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31649017

RESUMO

OBJECTIVE: To measure the association between phenotypic drug resistance and the risk of tuberculosis infection and disease among household contacts of patients with pulmonary tuberculosis. SETTING: 106 district health centers in Lima, Peru between September 2009 and September 2012. DESIGN: Prospective cohort study. PARTICIPANTS: 10 160 household contacts of 3339 index patients with tuberculosis were classified on the basis of the drug resistance profile of the patient: 6189 were exposed to drug susceptible strains of Mycobacterium tuberculosis, 1659 to strains resistant to isoniazid or rifampicin, and 1541 to strains that were multidrug resistant (resistant to isoniazid and rifampicin). MAIN OUTCOME MEASURES: Tuberculosis infection (positive tuberculin skin test) and the incidence of active disease (diagnosed by positive sputum smear or chest radiograph) after 12 months of follow-up. RESULTS: Household contacts exposed to patients with multidrug resistant tuberculosis had an 8% (95% confidence interval 4% to 13%) higher risk of infection by the end of follow-up compared with household contacts of patients with drug sensitive tuberculosis. The relative hazard of incident tuberculosis disease did not differ among household contacts exposed to multidrug resistant tuberculosis and those exposed to drug sensitive tuberculosis (adjusted hazard ratio 1.28, 95% confidence interval 0.9 to 1.83). CONCLUSION: Household contacts of patients with multidrug resistant tuberculosis were at higher risk of tuberculosis infection than contacts exposed to drug sensitive tuberculosis. The risk of developing tuberculosis disease did not differ among contacts in both groups. The evidence invites guideline producers to take action by targeting drug resistant and drug sensitive tuberculosis, such as early detection and effective treatment of infection and disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT00676754.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/transmissão , Tuberculose Pulmonar/transmissão , Adolescente , Adulto , Idoso , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Busca de Comunicante/métodos , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Isoniazida/farmacologia , Isoniazida/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Peru/epidemiologia , Estudos Prospectivos , Rifampina/farmacologia , Rifampina/uso terapêutico , Escarro/microbiologia , Teste Tuberculínico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adulto Jovem
7.
Eklem Hastalik Cerrahisi ; 30(3): 333-7, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650935

RESUMO

Brucellosis is a zoonosis seen all over the world and is still endemic in certain parts of the world. Brucellosis is a systemic infection which involves multiple organs and tissues. Although musculoskeletal system involvement is frequent in brucellosis, bursal involvement is seen rarely. In this article, we present a case of subacromial and subdeltoid brucellar bursitis with positive serology and aspiration culture. Patient achieved complete recovery with rifampicin and doxycycline treatment, without any evidence of relapse. A high clinical suspicion is required for the diagnosis of brucellar bursitis.


Assuntos
Brucelose/diagnóstico , Bursite/diagnóstico , Articulação do Ombro , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Brucelose/tratamento farmacológico , Brucelose/microbiologia , Bursite/tratamento farmacológico , Bursite/microbiologia , Diagnóstico Diferencial , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Rifampina/administração & dosagem , Rifampina/uso terapêutico
8.
West Afr J Med ; 36(3): 283-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622493

RESUMO

BACKGROUND: Latent Tuberculosis (LTBI) affects approximately a third of the world population. Paediatric health workers caring for adolescent Tuberculosis (TB) patients in high TB endemic regions are particularly susceptible as they are exposed to TB in the community and in the work place. However, there is a paucity of reports on LTBI in paediatric health workers. OBJECTIVES: To identify the factors that could have resulted in latent TB in a paediatric health worker Methods/Results: We present a case of a 38-year old female paediatrician who was diagnosed with LTBI by a positive QuantiFERON-TB gold test during the routine new entry immigrant screening for tuberculosis on arrival in the United Kingdom for postgraduate studies. She was treated with three months course of Rifampicin and Isoniazid (plus pyridoxine). CONCLUSION: Latent TB infection may have been acquired from her involvement in the management of adolescents with adult type TB without the use of personal protective equipment. In this case, routine systematic screening of an at risk individual helped to eliminate TB infection. RECOMMENDATION: Paediatric health workers should use personal protective equipment when managing childhood TB and should also be routinely screened for latent TB.


Assuntos
Antituberculosos/uso terapêutico , Pessoal de Saúde , Isoniazida/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Mycobacterium tuberculosis/isolamento & purificação , Piridoxina/uso terapêutico , Rifampina/uso terapêutico , Adolescente , Adulto , Técnicas de Laboratório Clínico , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Tuberculose Latente/diagnóstico , Exposição Ocupacional , Resultado do Tratamento
9.
BMC Infect Dis ; 19(1): 864, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638905

RESUMO

BACKGROUND: While Legionella is a common cause of pneumonia, extrapulmonary infections like arthritis are scarce. Here, we describe a case of monoarthritis due to Legionella bozemanii, with no history of pneumonia. We provide a literature review of the 9 previously published Legionella arthritis and highlight a dichotomous epidemiology suggesting different physiopathological pathways leading to joint infection. CASE PRESENTATION: A 56-year old woman under immunosuppressive treatment by oral and intra-articular corticosteroids, methotrexate, and tocilizumab for an anti-synthetase syndrome was hospitalized for worsening pain and swelling of the left wrist for 3 days. Clinical examination showed left wrist synovitis and no fever. The arthritis occurred a few days after an accidental fall on wet asphalt responsible for a cutaneous wound followed by a corticosteroid intra-articular injection. Due to both the negativity of conventional culture of articular fluid and suspicion of infection, 16S rRNA and specific PCRs were performed leading to the identification of L. bozemanii. Legionella-specific culture of the articular fluid was performed retrospectively and isolated L. bozemanii. The empiric antibiotic therapy was switched for oral levofloxacin and rifampin and the patient recovered after a 12-week treatment. CONCLUSION: We report a case of L. bozemanii monoarthritis in an immunosuppressed woman, following a fall on wet asphalt and intra-articular corticosteroid injection. The review of the literature found that the clinical presentation reveals the mode of infection and the bacterial species. Monoarthritis more likely occurred after inoculation in patients under immunosuppressive therapy and were associated with non-Legionella pneumophila serogroup 1 (Lp1) strains that predominate in the environment. Polyarthritis were more likely secondary legionellosis localizations after blood spread of Lp1, the most frequently found in pneumonia. In both settings, 16S rRNA and Legionella-specific PCR were key factors for the diagnosis.


Assuntos
Artrite Infecciosa/imunologia , Artrite Infecciosa/microbiologia , Legionellaceae/isolamento & purificação , Legionelose/microbiologia , Acidentes por Quedas , Administração Oral , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Feminino , Humanos , Hidrocarbonetos , Hospedeiro Imunocomprometido , Injeções Intra-Articulares , Legionellaceae/genética , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Rifampina/uso terapêutico , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(41): e17523, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593125

RESUMO

Therapeutic drug monitoring has been employed in anti-tuberculosis (TB) drugs to assess optimal dose for maximum therapeutic effects and minimal toxicity. But the determinants of serum concentration need further evidences.In a retrospective case-control study, clinical and laboratory data were collected from 717 in-patients with TB at Xi'an Chest Hospital, China. Two hours serum concentrations of isoniazid, rifampicin, pyrazinamide as well as ethambutol were obtained and analyzed by liquid chromatography-tandem mass spectrometry.The month 2 culture conversion group had lower concentration of isoniazid, pyrazinamide, and ethambutol than month 1 group. Statistical analysis showed that serum concentrations of isoniazid, rifampicin, pyrazinamide, and ethambutol revealed a positive relationship with dose (mg/kg) (P < .001, P < .001, P < .001, and P = .003, respectively). Furthermore, isoniazid concentration was related to smoking (P = .009) and prior TB (P = .011), while rifampicin and pyrazinamide concentrations were correlated to sex (P = .004 and 0.025, respectively). Ethambutol concentration was associated with creatinine clearance (Ccr, P = .002).It is necessary to optimize drug doses using therapeutic drug monitoring while considering the following determinants: weight, smoking status, prior TB, sex, and Ccr. Furthermore, low 2 hours serum concentrations can be associated with longer culture conversion.


Assuntos
Etambutol/sangue , Isoniazida/sangue , Pirazinamida/sangue , Rifampina/sangue , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/sangue , Antituberculosos/metabolismo , Antituberculosos/uso terapêutico , Estudos de Casos e Controles , China/epidemiologia , Cromatografia Líquida/instrumentação , Creatinina/metabolismo , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Etambutol/metabolismo , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/metabolismo , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pirazinamida/metabolismo , Pirazinamida/uso terapêutico , Estudos Retrospectivos , Rifampina/metabolismo , Rifampina/uso terapêutico , Fatores Sexuais , Fumar/efeitos adversos , Tuberculose/sangue , Adulto Jovem
11.
PLoS Negl Trop Dis ; 13(9): e0007646, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31539374

RESUMO

BACKGROUND: The country of Kiribati is a small Pacific island nation which had a new case detection rate of 191 per 100,000 in 2016, and is one of the few countries yet to reach the WHO leprosy elimination goal. Chemoprophylaxis of household contacts of new cases, or to the whole population in a highly endemic areas have been found to be effective in reducing new case rates. This study investigated the potential impact of different chemoprophylaxis strategies on future cases in South Tarawa, the main population centre of Kiribati. METHODOLOGY: The microsimulation model SIMCOLEP was calibrated to simulate the South Tarawa population and past leprosy control activities, and replicate annual new cases from 1989 to 2016. The impact of six different strategies for delivering one round of single dose rifampicin (SDR) chemoprophylaxis to household contacts of new cases and/or one or three rounds of SDR to the whole population was modelled from 2017 to 2030. PRINCIPAL FINDINGS: Our model predicted that continuing the existing control program of high levels of public awareness, passive case detection, and treatment with multidrug treatment would lead to a substantial reduction in cases but this was less effective than all modelled intervention scenarios. Mass chemoprophylaxis led to a faster initial decline in cases than household contact chemoprophylaxis alone, however the decline under the latter was sustained for longer. The greatest cumulative impact was for household contact chemoprophylaxis with three rounds of mass chemoprophylaxis at one-year intervals. CONCLUSIONS: The results suggest that control of leprosy would be achieved most rapidly with a combination of intensive population-based and household chemoprophylaxis. These findings may be generalisable to other countries where crowding places social contacts as well as household contacts of cases at risk of developing leprosy.


Assuntos
Hanseníase/prevenção & controle , Adolescente , Adulto , Quimioprevenção , Criança , Busca de Comunicante , Características da Família , Feminino , Humanos , Hansenostáticos/administração & dosagem , Hanseníase/epidemiologia , Masculino , Micronésia/epidemiologia , Modelos Teóricos , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Adulto Jovem
12.
BMC Infect Dis ; 19(1): 823, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533647

RESUMO

BACKGROUND: The purpose of this study was to gather temporal trends on bacteria epidemiology and resistance of intraoperative bone culture from chronic ostemyelitis at an affiliated hospital in South China. METHOD: Records of patients with chronic osteomyelitis from 2003 to 2014 were retrospectively reviewed. The medical data were extracted using a unified protocol. Antimicrobial susceptibility testing was carried out by means of a unified protocol using the Kirby-Bauer method, results were analyzed according to Clinical and Laboratory Standards Institute definitions. RESULT: Four hundred eighteen cases met our inclusion criteria. For pathogen distribution, the top five strains were Staphylococcus aureus (27.9%); Pseudomonas aeruginosa (12.1%); Enterobacter cloacae (9.5%); Acinetobacter baumanii (9.0%) and Escherichia coli (7.8%). Bacterial culture positive rate was decreased significantly among different year-groups. Mutiple bacterial infection rate was 28.1%. One strain of Staphylococcus aureus was resistant to linezolid and vancomycin. Resistance of Pseudomonas aeruginosa stains to Cefazolin, Cefuroxime, Cefotaxime, and Cefoxitin were 100% nearly. Resistance of Acinetobacter baumanii stains against Cefazolin, Cefuroxime were 100%. Ciprofloxacin resistance among Escherichia coli isolates increased from 25 to 44.4%. On the contrary, resistance of Enterobacter cloacae stains to Cefotaxime and Ceftazidime were decreased from 83.3 to 36.4%. CONCLUSIONS: From 2003 to 2014, positive rate of intraoperative bone culture of chronic osteomyelitis was decreased; the proportion of Staphylococcus aureus was decreased gradually, and our results indicate the importance of bacterial surveilance studies about chronic osteomyelitis.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Osteomielite/diagnóstico , Adolescente , Adulto , Antibacterianos/uso terapêutico , Cefotaxima/farmacologia , Cefotaxima/uso terapêutico , China , Doença Crônica , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Hospitais , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Rifampina/farmacologia , Rifampina/uso terapêutico , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Adulto Jovem
13.
Expert Rev Clin Pharmacol ; 12(10): 981-989, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31498683

RESUMO

Introduction: Psoriasis is affected by many environmental factors, including infections and antibiotics. However, the relationship between antibiotics and psoriasis is inadequately studied. Some antibiotics were listed as triggering factors; others showed benefit for psoriasis control. The aim of this article is to review current evidence that may help identify appropriate antibiotics for patients with psoriasis. Areas covered: The PubMed, Embase, Clinicalkey databases, and google scholar were searched for relevant articles published up to May 2019. Literature regarding antibiotics and psoriasis were included. Six randomized controlled trials and four controlled or cohort studies were identified in 13 kinds of antibiotics. Expert opinion: Macrolides and rifampin showed decrease of psoriasis area and severity index score in plaque-type psoriasis, while penicillin revealed no statistically significant improvement in guttate psoriasis. Previously tetracyclines were considered as triggering factors, but data were found only in cases or retrospective studies. Mechanisms were thought to be related to immunomodulation rather than bacteria inhibition. Research gap in the influence of genetic susceptibility, the impact on microbiota, and the mode of actions remain to be investigated.


Assuntos
Antibacterianos/uso terapêutico , Fatores Imunológicos/uso terapêutico , Psoríase/tratamento farmacológico , Animais , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Humanos , Fatores Imunológicos/farmacologia , Macrolídeos/efeitos adversos , Macrolídeos/farmacologia , Macrolídeos/uso terapêutico , Psoríase/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rifampina/efeitos adversos , Rifampina/farmacologia , Rifampina/uso terapêutico , Índice de Gravidade de Doença
14.
BMC Infect Dis ; 19(1): 794, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500572

RESUMO

BACKGROUND: Regimens that could treat both rifampin-resistant (RR) and rifampin-susceptible tuberculosis (TB) while shortening the treatment duration have reached late-stage clinical trials. Decisions about whether and how to implement such regimens will require an understanding of their likely clinical impact and how this impact depends on local epidemiology and implementation strategy. METHODS: A Markov state-transition model of 100,000 representative South African adults with TB was used to simulate implementation of the regimen BPaMZ (bedaquiline, pretomanid, moxifloxacin, and pyrazinamide), either for RR-TB only or universally for all patients. Patient outcomes, including cure rates, time with active TB, and time on treatment, were compared to outcomes under current care. Sensitivity analyses varied the drug-resistance epidemiology, rifampin susceptibility testing practices, and regimen efficacy. RESULTS: Using BPaMZ exclusively for RR-TB increased the proportion of all RR-TB that was cured by initial treatment from 60 ± 1% to 67 ± 1%. Expanding use of BPaMZ to all patients increased cure of RR-TB to 89 ± 1% and cure of all TB from 87.3 ± 0.1% to 89.5 ± 0.1%, while shortening treatment by 1.9 months/person. In sensitivity analyses, reducing the coverage of rifampin susceptibility testing resulted in lower projected proportions of patients cured under all regimen scenarios (current care, RR-only BPaMZ, and universal BPaMZ), compared to the proportions projected using South Africa's high coverage; however, this reduced coverage resulted in greater expected incremental benefits of universal BPaMZ implementation, both when compared to RR-only BPaMZ implementation and when compared to to current care under the same low rifampin susceptibility testing coverage. In settings with higher RR-TB prevalence, the benefits of BPaMZ were magnified both for RR-specific and universal BPaMZ implementation. CONCLUSIONS: Novel regimens such as BPaMZ could improve RR-TB outcomes and shorten treatment for all patients, particularly with universal use. Decision-makers weighing early options for implementing such regimens at scale will want to consider the expected impact on patient outcomes and on the burden of treatment in their local context.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose/tratamento farmacológico , Adulto , Diarilquinolinas/uso terapêutico , Humanos , Cadeias de Markov , Nitroimidazóis/uso terapêutico , Prevalência , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , África do Sul/epidemiologia , Resultado do Tratamento , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
15.
BMC Infect Dis ; 19(1): 779, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492099

RESUMO

BACKGROUND: To investigate the prevalence and factors associated with the prevalence of multidrug/rifampicin-resistant tuberculosis among suspected drug resistant tuberculosis patients in Botswana. METHODS: A retrospective review of medical records of suspected drug resistant tuberculosis patients receiving care at public health facilities in Botswana was conducted from January, 2013 and December, 2014. Patient characteristics and drug susceptibility data were abstracted from 2568 medical records on to a pre-tested checklist form. The prevalence of multidrug/rifampicin resistance was computed. Bivariate and multivariate logistic regression was carried out to determine the factors associated with the prevalence of multidrug/rifampicin in the study population. RESULTS: Overall, multidrug/ rifampicin - resistance among suspected drug resistant tuberculosis patients in Botswana were found in 139 (5.4%) cases with 1.3% among new cases and 7.7% among previously treated tuberculosis patients. Being a previously treated tuberculosis patient and having a positive smear were found to be factors associated with the prevalence of multidrug/rifampicin-resistant tuberculosis (p < 0.05). However, age, sex, living in urban area and HIV status were not associated with this disease (p > 0.05). CONCLUSION: This study highlights a low burden of multidrug/rifampicin resistant tuberculosis among suspected drug resistant tuberculosis patients receiving care at public health facilities in Botswana. Strategies in controlling MDR/RR-TB should emphasize on effective implementation of Directly Observation Treatment - short course strategy, continuous surveillance of drug resistance cases, prevention of the development of new cases of MDR/RR-TB and to treat existing patients. Further interventions should focus on strengthening TB infection control activities.


Assuntos
Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Botsuana/epidemiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
17.
Brasília; CONITEC; set. 2019. tab.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1024747

RESUMO

CONTEXTO: A TB pode ser causada por qualquer uma das sete espécies que integram o complexo Mycobacterium tuberculosis, a espécie mais importante é a M. tuberculosis, conhecida também como bacilo de Koch. Estima-se que em 2015 cerca de 10,4 milhões de pessoas desenvolveram tuberculose (TB) dos quais 10% correspondem a tuberculose em crianças. TECNOLOGIA: Rifampicina 75 mg + isoniazida 50 mg + pirazinamida 150 mg e Rifampicina 75 mg + isoniazida 50 mg comprimidos dispersíveis. PERGUNTA: O uso do esquema terapêutico dose fixa combinada de rifampicina 75mg + isoniazida 50mg + pirazinamida 150mg seguida de rifampicina 75mg + isoniazida 50mg é eficaz, seguro e custo-efetivo em pacientes com tuberculose menores de 10 anos de idade quando comparado às formulações individualizadas de rifampicina 20 mg/ml (2%), rifampicina + isoniazida 150 mg + 75 mg, Isoniazida 100 mg, Pirazinamida 30 mg/ml (3%) ? EVIDÊNCIAS CIENTÍFICAS: Não foram encontrados estudos em pacientes pediátricos comparando a dose fixa combinada, em sua forma dispersível, com a dose padrão individualizada. Uma revisão sistemática não detectou diferença significativa entre as estratégias farmacológicas em relação à falha de tratamento (RR 1,28, IC95% 0,82 a 2,00), morte (RR 0,96, IC 95% 0,56 a 1,66), eventos adversos (RR 1,45 IC 95% 0,90 a 2,33) e eventos que levassem a descontinuação do tratamento (RR 0,56 IC 95% 0,56 a 1,66). AVALIAÇÃO ECONÔMICA: Assumindo-se que as duas estratégias de tratamento são similares, uma analise de custo-minimização foi realizada. A dose fixa combinada dispersível apresentou um custo de R$ 18,06 reais a menos por tratamento em relação a dose individualizada. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: O impacto em cinco anos da substituição do tratamento individualizado pela dose fixa combinada poderá resultar em uma economia de R$ 118.239,62. Cenários alternativos com a variação da taxa de câmbio em 10% podem variar em uma economia de recursos na ordem de R$ 68.420,88 a 166.936,09 em cinco anos. EXPERIÊNCIA INTERNACIONAL: Há um consenso nas diretrizes internacionais sobre o tratamento da tuberculose infantil. Não há recomendações específicas relacionadas à forma farmacêutica dispersível exceto pela OMS que recomenda formulações em dose fixa como parte das estratégias de combate a tuberculose. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: As pesquisas apontaram não haver medicamentos em fase de desenvolvimento clínico para o tratamento da tuberculose pediátrica. RECOMENDAÇÃO PRELIMINAR: A CONITEC, em sua 78ª reunião ordinária, realizada no dia 05 de junho de 2019, recomendou a incorporação da dose fixa combinada de Rifampicina 75 mg + isoniazida 50 mg + pirazinamida 150 mg e Rifampicina 75 mg + isoniazida 50 mg comprimidos dispersíveis. Considerou que o medicamento já vem sendo utilizado no tratamento da tuberculose pediátrica com sucesso e a nova forma farmacêutica em dose fixa combinada na forma dispersível, por sua melhor aceitabilidade, permitiria a melhor adesão ao tratamento e consequentemente aumento das taxas de curas da doença na população pediátrica. CONSULTA PUBLICA: Foram recebidas 31 contribuições técnico-científicas e 48 contribuições de experiência ou opinião, a maioria em concordância com as recomendações da Conitec. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na 80ª reunião ordinária, no dia 08 de agosto de 2019, deliberaram, por unanimidade, por recomendar a incorporação no SUS da dose fixas pediátricas RHZ (Rifampicina 75 mg + Isoniazida 50 mg + Pirazinamida 150 mg) e RH (Rifampicina 75 mg + Isoniazida 50 mg) comprimidos dispersíveis para tratamento da tuberculose em crianças menores de 10 anos. Foi assinado o Registro de Deliberação nº 463/2019. DECISÃO: Incorporar as doses fixas pediátricas RHZ (rifampicina 75mg + isoniazida 50mg + pirazinamida 150mg) e RH ( rifampicina 75mg + isoniazida 50mg) comprimido dispersíveis para tratamento de turbeculose em crianças menores de 10 anos, no âmbito do Sistema Único de Saúde - SUS. Dada pela Portaria nº 43, publicada no Diário Oficial da União nº 174, seção 1, página 190, em 09 de setembro de 2019.


Assuntos
Humanos , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Isoniazida/uso terapêutico , Avaliação da Tecnologia Biomédica , Sistema Único de Saúde , Brasil , Análise Custo-Benefício/economia
18.
Tuberk Toraks ; 67(2): 92-101, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414639

RESUMO

Introduction: Tuberculosis (TB) is continuing to be a important public health problem in the undeveloped countries. Drug sensitivity rate should be monitored for the effective treatment and control in the TB. The aim of this study was to determine the rate of resistance to first line TB drugs in the Mycobacterium tuberculosis complex isolates. Materials and Methods: During one-year period, M. tuberculosis complex was isolated in the 1193 samples from 974 patients in the Mycobacterial Laboratory of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital, Istanbul, Turkey. The majority of samples isolated in the M. tuberculosis complex were sputum (n= 897, 92.1%). Anti-TB drug susceptibility testing was performed with Mycobacterium Growth Indicator Tube 960 system. Result: Two hundred and sixty isolat (26.7%) were resistant to at least one of the four first-line anti-TB drugs tested. One hundred ninety seven isolates were resistances to isoniazid (20.2%); 82 to rifampin (8.4%), 63 to ethambutol (6.5%) and 140 to streptomycin (14.4%). Of the 197 isoniazid-resistant isolates, 89 (45.2%) isolates was only isoniazid-resistance, only rifampin-resistance were found 15.9% (n= 13), ethambutol 7.9% (n= 5) and streptomycin 30.7% (n= 43). There were 48 (4.9%) isolates with two drugresistance, 22 (2.3%) isolates with three drug-resistance, and 42 (4.3%) isolates with four drug-resistance. The multidrug resistance rate was 7% (68 of 974). There was no relationship with between the frequency of TB drug resistance and gender or age. The isoniazid--resistance and streptomycin-resistance were seen to tend to increase if together considered the results of this study with outcomes of previously reported studies from Turkey in the 1998-2003, 2004-2007 and 2008-2010 years. Conclusions: Monitoring of drug susceptibility test results can contribute to the management of TB treatment and increase treatment success. Isoniazid-resistance and streptomycin-resistance tend to increase in Turkey. Further clinical studies are needed to investigate regional and global factors affecting the development of resistance to first-line TB drugs.


Assuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapêutico , Etambutol/farmacologia , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/farmacologia , Isoniazida/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Saúde Pública , Rifampina/farmacologia , Rifampina/uso terapêutico , Escarro/microbiologia , Estreptomicina/farmacologia , Estreptomicina/uso terapêutico , Centros de Atenção Terciária , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Turquia , Adulto Jovem
19.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373467

RESUMO

Infections to the peritoneal catheter are common in Peritoneal Dialysis (PD). We report the clinical case of a 49-year-old male patient in PD, who showed an atypical manifestation of tunnel infection caused by Staphylococcus aureus. The infection was characterized by a little abscess, on the left pararectal abdominal line, 6 cm far from exit-site of the peritoneal catheter. The diagnosis was made using ultrasonography (US), which showed a fistulous communication from subcutaneous cuff to the skin. We treated the infection conservatively by performing cuff-shaving and drainage of the abscess, associated to antibiotic therapy (teicoplanin). Due to the persistence of the infection, we added oral and topical rifampicin, and advanced medication with freez-dried collagen plant impregnated with extended-release gentamicin. The complete resolution of the infection allowed us to avoid removing the catheter.


Assuntos
Parede Abdominal , Abscesso/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Diálise Peritoneal/instrumentação , Rim Policístico Autossômico Dominante/complicações , Infecções Estafilocócicas/microbiologia , Abscesso/diagnóstico por imagem , Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/diagnóstico por imagem , Infecções Relacionadas a Cateter/terapia , Terapia Combinada/métodos , Drenagem , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua , Rim Policístico Autossômico Dominante/terapia , Rifampina/uso terapêutico , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Teicoplanina/uso terapêutico , Ultrassonografia
20.
Zhonghua Nei Ke Za Zhi ; 58(8): 596-598, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365982

RESUMO

To explore how to diagnose and treat brucellosis accurately and timely in patients with fever of unkown origin in non-pastoral areas. The epidemiological history, clinical symptoms, complete blood counts, procalcitonin and treatment efficacy of 7 patients with brucellosis were analyzed retrospectively. Some characteristic manifestations should be differentiated from tuberculosis. The clinical symptoms were relieved after combination of doxycycline, rifampicin, levofloxacin and amikacin for 6 weeks, only one patient with bone destruction needed orthopedic surgery. The overall response rate was 6/7. No relapse occurred during half year follow-up.


Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Levofloxacino/uso terapêutico , Rifampina/uso terapêutico , Doença Aguda , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Humanos , Levofloxacino/administração & dosagem , Pró-Calcitonina , Estudos Retrospectivos , Rifampina/administração & dosagem , Resultado do Tratamento
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