Tuberculous meningitis in South African urban adults.
(1/959)
We retrospectively reviewed 56 adults with culture-proven tuberculous meningitis (TBM), investigating clinical signs, cerebrospinal fluid (CSF) findings and outcome. There were 50 patients, aged 18-59 years, 39 with and 11 without human immunodeficiency virus (HIV) infection. Six were aged 60 years or older. Neurological signs of TBM in 18-59-year-olds were unaffected by HIV serostatus while, compared to those > or = 60 years of age, there were more patients with meningism (86.0% vs. 33.3%; p = 0.011) and fewer with seizures (12.0% vs. 50.0%; p = 0.046). The HIV-infected 18-59-year-olds had significantly more extrameningeal tuberculosis compared to the non-HIV-infected (76.9% vs. 9.1%; p = 0.0001) and 23.1% had 'breakthrough' TBM. CSF analysis revealed 12 patients (21.4%) with acellular fluid (more common in those > or = 60 years of age, p = 0.016), of whom three had completely normal CSF. A neutrophil predominance was found in 22 patients (39.3%). Only three patients (5.4%) had a positive CSF smear for acid-fast bacilli. In-hospital mortality occurred in 39 patients (69.1%), was similar in all study groups, and was not related to neurological stage. The diagnosis of TBM can be masked by lack of meningism in the elderly and by atypical CSF findings. (+info)
Epidemiology of drug-resistant tuberculosis in Texas.
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During 1987-1996, over 22,000 tuberculosis cases were reported in Texas, at an average annual incidence rate of 12.5 cases per 100,000 population. Counties with the highest rates were located along the Mexico-Texas border and in northwestern Texas. Nine percent of cases were resistant to at least one of the five first-line antituberculosis drugs used for treatment. Almost 5 percent (4.6%) were resistant to isoniazid, either alone or in combination with other antibiotics; 2.3% were resistant to rifampin; and only 1.3% were resistant to both isoniazid and rifampin. Being a recurrent case, being foreign-born, being 20-39 years of age, and residing in a Mexico-Texas border county were independent risk factors for isoniazid resistance and rifampin resistance. Tuberculosis patients with human immunodeficiency virus (HIV) infection were more likely to have rifampin resistance and less likely to have isoniazid resistance than patients without HIV infection. Factors associated with multi-drug-resistant tuberculosis included a history of previous tuberculosis (relative risk (RR) = 4.91, 95% confidence interval (CI) 3.5-6.8), non-US birth (RR = 2.69, 95% CI 2.1-3.5), age younger than 20 years (RR = 1.97, 95% CI 1.1-3.5), age 20-39 years (RR = 1.82, 95% CI 1.3-2.6), and residence in a Mexico-Texas border county (RR = 2.33, 95% CI 1.8-3.1). (+info)
Issues in the treatment of active tuberculosis in human immunodeficiency virus-infected patients.
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Most HIV-infected patients with tuberculosis can be treated satisfactorily with standard regimens with expectations of good results. Treatment of tuberculosis in these patients has been complicated by the introduction of HAART, which relies on drugs that interfere with the most potent class of antituberculous medications. Rifampin-free regimens or regimens that employ rifabutin may be acceptable strategies for patients who are receiving protease inhibitors, although these regimens have not been rigorously evaluated in patients with AIDS. At present, there is good reason to believe that a 6-month course of a rifabutin-containing regimen or a 9-12-month course of a regimen of streptomycin, isoniazid, and pyrazinamide should be adequate therapy for most patients with drug-susceptible disease. As the treatment of HIV infection with antiretroviral agents evolves, the treatment of tuberculosis in patients with AIDS is likely to evolve as well. This will require careful coordination of antituberculosis and antiretroviral therapies. (+info)
Susceptibility of multidrug-resistant strains of Mycobacterium tuberculosis to amoxycillin in combination with clavulanic acid and ethambutol.
(4/959)
Thirty clinical isolates of Mycobacterium tuberculosis, 20 of which were multidrug-resistant (MDR), were tested for susceptibility to different combinations of amoxycillin, clavulanic acid and subinhibitory concentrations of ethambutol. beta-Lactamase production was assessed semiquantitatively with the nitrocefin method and susceptibility testing was performed with the BACTEC method. All isolates were beta-lactamase positive and were resistant to 16 mg/L amoxycillin. The MIC of amoxycillin in combination with clavulanic acid was > or =2 mg/L for 27/30 (90%) isolates. Addition of subinhibitory concentrations of ethambutol significantly reduced the MIC of amoxycillin for all tested isolates. Twenty-nine (97%) isolates had an MIC of amoxycillin of < or =0.5 mg/L when subinhibitory concentrations of ethambutol were added; this is well below the concentrations achievable in serum and tissue. (+info)
Rapid film-based determination of antibiotic susceptibilities of Mycobacterium tuberculosis strains by using a luciferase reporter phage and the Bronx Box.
(5/959)
Detecting antibiotic resistance in Mycobacterium tuberculosis is becoming increasingly important with the global recognition of drug-resistant strains and their adverse impact on clinical outcomes. Current methods of susceptibility testing are either time-consuming or costly; rapid, reliable, simple, and inexpensive methods would be highly desirable, especially in the developing world where most tuberculosis is found. The luciferase reporter phage is a unique reagent well-suited for this purpose: upon infection with viable mycobacteria, it produces quantifiable light which is not observed in mycobacterial cells treated with active antimicrobials. In this report, we describe a modification of our original assay, which allows detection of the emitted light with a Polaroid film box designated the Bronx Box. The technique has been applied to 25 M. tuberculosis reference and clinical strains, and criteria are presented which allow rapid and simple discrimination among strains susceptible or resistant to isoniazid and rifampin, the major antituberculosis agents. (+info)
rpoB mutations in multidrug-resistant strains of Mycobacterium tuberculosis isolated in Italy.
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Mutations of rpoB associated with rifampin resistance were studied in 37 multidrug-resistant (MDR) clinical strains of Mycobacterium tuberculosis isolated in Italy. At least one mutated codon was found in each MDR strain. It was always a single-base substitution leading to an amino acid change. Nine different rpoB alleles, three of which had not been reported before, were found. The relative frequencies of specific mutations in this sample were different from those previously reported from different geographical areas, since 22 strains (59.5%) carried the mutated codon TTG in position 531 (Ser-->Leu) and 11 (29.7%) had GAC in position 526 (His-->Asp). (+info)
Multiple drug resistant tuberculosis: aetiology, diagnosis and outcome.
(7/959)
Tuberculosis is an increasing problem worldwide both in terms of disease burden and resistance to conventional antibiotic therapy. Studies of outbreaks involving resistant strains have highlighted the need for both improved infection control and the rapid provision of accurate susceptibility data. Each patient should undergo a risk assessment for possible resistance and those in whom risk factors exist should be investigated by means of rapid molecular techniques or other phenotypic methods, so that appropriate management can be instituted with minimal delay. The ultimate outcome will vary according to whether the patient is immunosuppressed, the time taken to make a diagnosis, the severity of disease as well as the degree of resistance. The prognosis can be improved when adequate antibiotic therapy is started as soon as resistance is suspected. Adjuncts to conventional treatment, such as surgery and perhaps immunotherapy may be considered when response to antimicrobial chemotherapy has been suboptimal. (+info)
Spread of strain W, a highly drug-resistant strain of Mycobacterium tuberculosis, across the United States.
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Strain W, a highly drug-resistant strain of Mycobacterium tuberculosis, was responsible for large nosocomial outbreaks in New York in the early 1990s. To describe the spread of strain W outside New York, we reviewed data from epidemiologic investigations, national tuberculosis surveillance, regional DNA fingerprint laboratories, and the Centers for Disease Control and Prevention Mycobacteriology Laboratory to identify potential cases of tuberculosis due to strain W. From January 1992 through February 1997, 23 cases were diagnosed in nine states and Puerto Rico; 8 were exposed to strain W in New York before their diagnosis; 4 of the 23 transmitted disease to 10 others. Eighty-six contacts of the 23 cases are presumed to be infected with strain W; 11 completed alternative preventive therapy. Strain W tuberculosis cases will occur throughout the United States as persons infected in New York move elsewhere. To help track and contain this strain, health departments should notify the Centers for Disease Control and Prevention of cases of tuberculosis resistant to isoniazid, rifampin, streptomycin, and kanamycin. (+info)