Chemotherapy For Pulmonary Tuberculosis Research Articles

Handgrip strength deficit and time lag between symptom onset and starting of chemotherapy in pulmonary tuberculosis: A cross-sectional study in North India

Objectives: Wasting is the predominant systemic clinical manifestation of chronic diseases like tuberculosis (TB). Delay in diagnosis and therapy initiation may affect handgrip strength, severity and outcome of the disease. Limited data are available on this in the Indian context, despite a high prevalence of TB. This study aimed to estimate and correlate deficits in handgrip strength amongst sputum-positive and sputum-negative pulmonary TB patients in relation to the time lag between symptom onset and starting of antitubercular therapy (ATT). Materials and Methods: We conducted a cross-sectional study amongst newly diagnosed sputum-positive and sputum-negative pulmonary TB patients and age- and sex-matched apparently healthy volunteers. Handgrip strength of 341 newly diagnosed patients of TB was monitored within 1 week of starting ATT and analysed. Demographic details and clinical history of the participants were noted in the pre-designed form. The handgrip strength of 100 healthy volunteers was also taken for comparison. Results: The study findings suggest that deficits in handgrip strength amongst sputum-negative patients were more than sputum-positive patients in comparison to age- and sex-matched healthy controls. It took an average of 63 ± 27 days between the onset of symptoms and starting of ATT in sputum-negative patients in comparison to an average of 47 ± 12 days in sputum-positive patients. Conclusion: Early consultation by patients, rapid diagnosis of TB and the start of ATT, thereby decreasing the time lag between the symptom onset and start of ATT, may lead to a decreased deficit in handgrip strength with the improved overall health of patients. Extensive Information, Education and Communication activities and newer diagnostic modalities for early identification of cases and the start of chemotherapy are required for optimal management of TB patients.

Влияние дополнительной нутритивной поддержки на нутритивный статус и переносимость химиотерапии у детей в реальной практике противотуберкулезного диспансера

Aim: in conditions of the real clinical practise, to evaluate the effect of nutritional support (NS) with a hypercaloric polymer formula with dietary fibers on the nutritional status of children with pulmonary tuberculosis (TB) who started chemotherapy, as well as the possible NS impact on the chemotherapy efficacy and tolerability. Patients and Methods: a retrospective and prospective, partial cross-sectional cohort study was conducted. The main group (prospective) included 23 children with an established diagnosis of pulmonary TB and I–III degree underweight. In the comparison group (retrospective), 20 children were selected who corresponded to the main characteristics of the main group patients. Main group, in addition to a balanced individually selected hospital diet, received NS with a hypercaloric polymer formula with dietary fibers in the amount of 100 ml 2 times a day on a daily basis (300 kcal/day). The patient's body weight, height, subscapular skinfold thickness, body mass index (BMI) Z-score, hemoglobin level, total protein, urine specific gravity, chemotherapy tolerance and NS product tolerance (in the main group) were assessed initially and after 3 months. Results: the study demonstrated that the NS use has a significant positive effect on the nutritional status (body weight, height, BMI) of children with malnutrition who received chemotherapy in pulmonary TB. NS use with a specialized product contributed to a significant improvement in blood parameters (an increase in hemoglobin and total protein count) and normalization of urine specific density versus the comparison group, which achieved no significant improvement in these indicators. The good tolerability of the specialized product helped to reduce the risk of adverse events during daily chemotherapy administration by 65.2%, which improved treatment adherence. Conclusion: the obtained results confirmed the NS administration efficacy for children with diagnosed pulmonary TB during chemotherapy indicated to normalize the nutritional status. KEYWORDS: tuberculosis, children, adverse events, nutritional support, adherence, efficacy. FOR CITATION: Barbolina S.F., Naumov A.G., Ovchinnikova O.A., Bikbaev R.R. Nutritional support effect on the nutritional status and tolerability of chemotherapy in children in the real clinical practice of the tuberculosis dispensary. Russian Journal of Woman and Child Health. 2023;6(4):405–410 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-13.

SHOULD CHEMOTHERAPY FOR PULMONARY TUBERCULOSIS BE STARTED AFTER THE COMPLETION OF PRETREATMENT SPUTUM EXAMINATION

Investigation on the influence of early start of chemotherapy on the results of sputum smear and culture (Ogawa medium and BACTEC MGIT960). Retrospective study for tubercle bacilli positive pulmonary tuberculosis cases in our hospital. Starting chemotherapy before the completion of pretreatment sputum examination was found to have no adverse effect on smear positive rate and smear positive grade (246 cases), culture contamination rate on Ogawa medium and BACTEC MGIT960 (1128 sputums), culture positive rate and culture positive grade/time to confirm positive on Ogawa medium (245 cases), and culture positive rate on BACTEC MGIT960 (239 cases). Time to confirm positive on BACTEC MGIT960 was slightly, but significantly prolonged (1.16 days delay in cases with 1-3 days chemotherapy [228 cases], and 4.01 days delay in cases with 4-6 days chemotherapy [59 cases]). Unfluence of early start of chemotherapy on the results of sputum smear and culture is minor. In most of bacilli positive pulmonary tuberculosis cases chemotherapy can be started before the completion of pretreatment sputum examination.

Short course chemotherapy and relapse in pulmonary tuberculosis in Japan

As far as short course chemotherapy of pulmonary tuberculosis is concerned, Japan is considered to have been a little behind the trend of the world in the past. However, since 1978 the concept of the chemotherapy has begun to be adopted in some hospitals and research councils (Cooperative Study Unit of Chemotherapy of Tuberculosis of National Sanatoria, Tuberculosis Research Committees, Ryoken), and then seems to be prevailing in other hospitals as the results of their gradual understanding. This movement has likely been accelerated since Dr. W. Fox came to Japan in 1978 at the invitation of Japanese Society of Tuberculosis and gave us much information and suggestion through his special lecture on short course chemotherapy of tuberculosis. Fifteen years have past since short course chemotherapy started in Japan. At this opportunity, I would like to review the results of short course chemotherapy studies reported by Japanese investigators. Bacteriological relapse rates in cases followed-up for three years and for from five to nine years after the end of short course chemotherapy were 1.9% (20 out of 1067) and 3.3% (26 out of 783), respectively. According to the analysis of the time of relapse after completion chemotherapy, bacteriological relapses could be divided into two types. One was early relapse which occurred within one year after completing treatment, and the other was late relapse which occurred two or three years after completing treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculosis of the central nervous system experienced at the International Medical Center of Japan

In spite of recent advances in diagnosis and chemotherapy of tuberculosis, prognosis of tuberculosis of the central nervous system (CNS) is still poor. We evaluated clinical characteristics of 14 patients with the CNS tuberculosis (10 male and 4 female, 21 to 71 years of age) who were hospitalized at IMCJ from 1988 to 1997. Twelve patients had tuberculous meningitis (2 of them had also intracranial tuberculoma), 1 had intracranial tuberculoma and 1 had spinal cord tuberculosis. For the acid-fast bacilli, the smears of cerebrospinal fluids (CSF) were all negative but the cultures for M. tuberculosis were positive in 5. Using PCR method, M. tuberculosis was identified from CSF specimens in 2 out of 9 culture negative patients, thus suggesting the usefulness of the PCR for the rapid diagnosis of CNS tuberculosis. The adenosine deaminase (ADA) levels in CSF may provide another diagnostic clue because they were elevated in 8 out of 10 cases. It is to be noted that there were three patients who developed clinical manifestations of CNS tuberculosis after the initiation of chemotherapy for pulmonary tuberculosis. In the last five cases, four-drug regimen which included PZA, was used with a good result. The success could be related to the addition of PZA which penetrates blood-brain barrier just as good as INH. Two patients died and one remains unconscious with severe neurological sequelae. The present study indicates that positive CSF culture, hydrocephalus and consciousness disturbance are important factors in determining poor prognosis of the CNS tuberculosis.

Current approach to chemotherapy of pulmonary tuberculosis

Current approach to chemotherapy of pulmonary tuberculosis

Chemotherapy of pulmonary tuberculosis

.

Pattern of initial drug resistance and its impact on short course chemotherapy of pulmonary tuberculosis

Objectives : To find the pattern of initial drug resistance in fresh sputum culture positive cases of pulmonary tuberculosis and its impact on maintenance phase of short course chemotherapy (SCC) and treatment outcome. Methods : Case records of all patients of initial drug resistance treated by us be­tween Jan 2001 to May 2004 were analyzed retrospectively. Pattern of drug resis­tance leading to modification of maintenance phase of anti-tubercular treatment (ATT) and treatment out-come in these patients were analyzed. After treatment all cases were followed up for a minimum of six months duration, for relapse. Results : Out of 769 cases of culture positive pulmonary tuberculosis , drug resis­tance was seen in 138 patients. Out of total 203 individual drug resistance, resis­tance was present to isoniazid in 22, rifampicin in 27, ethambutol in 23, streptomy­cin in 16, pyrazinamide in 36 and ciprofloxacin in 79 cases. Among them 5 drugs resistance was seen in 4 patients, 4 drugs resistance in 3 patients, 3 drugs resistance in 9 patients, 2 drugs resistance in 22 patients and single drug resistance in 100 patients, Multi drug resistance (MDR) was observed in 12 patients. One patient died of hemoptysis after 4 months of ATT. Four patients continued to be sputum positive even after one year of second line ATT. They were subsequently lost to follow up. All the remaining patients achieved cure and had no relapse at the end of six months follow up. Conclusion: This study highlights the importance of initial drug resistance in modifying maintenance phase of short course chemotherapy, thereby improving success rates and helps in preventing multidrug resistance tuberculosis.

Effect of antitubercular drugs on dipalmitoylphosphatidylcholine monolayers: implications for drug loaded surfactants

The year long chemotherapy in pulmonary tuberculosis results in dose related side effects and may not reach atelectatic areas. On account of its spreading properties and the ability to re-expand atelectatic areas, exogenous surfactant may act as a pulmonary drug delivery agent. We investigated the interactions between antitubercular drugs and the main surfactant component, dipalmitoylphosphatidylcholine (DPPC) with the aim of developing more effective antitubercular drug loaded surfactants. The surface properties were evaluated using a Langmuir-Blodgett trough and Wilhelmy balance at 37 degrees C. Lung surfactant was modeled as DPPC monolayers. The isoniazid (INH)-DPPC combination in 1:1 ratio by weight significantly improved the adsorption of DPPC, reached a minimum surface tension of zero, formed a low compressibility film and required 32.7% area change to decrease surface tension from 30 to 10 mN/m. The triple drug (INH-rifampicin-ethambutol in 1:2:3 ratio by weight) DPPC combination when used in 1:1 or 1:2 ratios by weight also achieved surface properties superior to those of DPPC alone. A significant improvement in the adsorption was observed (surface tensions of 34.7 mN/m for 1:1 and 32.0 mN/m for 1:2 triple drug: DPPC combinations in the first second), and the films had low compressibility reaching a minimum surface tension of zero on compression. Thus, we observed statistically significant improvements in all the surface parameters and we feel encouraged to continue developing a tuberculosis therapy consisting of surfactant liposomes carrying antitubercular drugs.

Recent Advances in Chemotherapy of Pulmonary Tuberculosis

NA

Clinical Characteristics of Paradoxical Response to Chemotherapy in Pulmonary Tuberculosis

Background : The paradoxical response refers to an enlargement of old lesions or unexpected new ones during apparently adequate antituberculous therapy. This response has been reported in cases of intracranial tuberculoma, tuberculous lymphadenopathy, tuberculous pleurisy and pulmonary tuberculosis. However, there are few reports on its frequency and clinical characteristics. Materials and Methods : This study enrolled 205 patients who were treated with first line antituberculous agents for more than 6 months. We retrospectively studied 155 patients with pulmonary tuberculosis and 57 patients with pleural tuberculosis (7 patients had both) from July 1998 to March 2000. The patients were divided into the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical group were investigated. Statistical analysis was done with an independent sample T-test and Chi-squared test. Results : 29 of the 205 patients(14.1%) had paradoxical response. Among the 29 patients, there were 19 pulmonary tuberculosis, 8 tuberculous pleurisy(2 patients had both). Paradoxical response appeared 32 days (mean 35 days in pulmonary tuberculosis, mean 25 days in tuberculous pleurisy) after the beginning of chemotherapy. The duration to regress less than half of initial chest lesion was 114 days in pulmonary tuberculosis and 124 days in tuberculous pleurisy, respectively. Most common clinical manifestation of paradoxical response patients was coughing in both pulmonary tuberculosis and tuberculous pleurisy. Male sex, high blood WBC count and high level of pleural fluid LDH were related with paradoxical response. Conclusion : These findings suggest that presponse usually appears 1 month and disappears within 4 months after the beginning of anti-tuberculous chemotherapy. Paradoxical response was relatively correlated with male sex, high blood WBC count and high level of pleural fluid LDH.

Chemotherapy of Pulmonary Tuberculosis

Chemotherapy of Pulmonary Tuberculosis

A CASE OF TUBERCULOSIS OF THE SMALL INTESTINE CAUSING INTESTINAL PERFORATION DUE TO MYCOBACTERIUM TUBERCULOSIS ON CHEMOTHERAPY

With a decrease in tuberculosis, tuberculosis of the small intestine has become a rare disease recently. We report a case of small bowel tuberculosis causing intestinal perforation during chemotherapy for pulmonary tuberculosis. A 51-year-old man received examination for lower abdominal pain and was found to have active ulcer due to Mycobacterium Tuberculosis just under the Bauhim valve in the ileocecal region. Pulmonary tuberculosis was also noted. Tuberculostatic chemotherapy was started, when the lower abdominal pain was intensified. With a diagnosis of generalized peritonitis, an emergency operation was perfomed. Upon laparotomy, a perforation in the small intestine about 60cm from the terminal ileum was present and generalized peritonitis with transudation of intestinal juice was confirmed. In addition small miliary-sized tubercles were sporadically present on the visceral peritonium. A part of the ileum by 80cm and the ileocecal region were resected. Postoperative course was unevenful. The patient was transferred to another hospital for treatment of tuberculosis. These complications occur uncommonly, but we should be so careful for treatment of Mycobacterium tuberculosis by entertaining these complications.

Tolerance of pyrazinamide in short course chemotherapy for pulmonary tuberculosis in children.

This prospective study was performed to evaluate the tolerance of pyrazinamide in short course chemotherapy in children. A total of 114 children ages 6 months to 15 years (4.5 +/- 3.4 years) with diagnosed pulmonary tuberculosis from 1985 to 1995 entered the trial. A 2-month regimen of isoniazid, rifampin and pyrazinamide, followed by rifampin and isoniazid for the remaining 4 months, was administered orally to all children. Clinical adverse effects specifically investigated were gastrointestinal disturbances, rash, signs of hepatotoxicity and arthralgias. Laboratory toxicity data (number of leukocytes, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase and serum uric acid) were collected before treatment and 1, 3 and 5 months after the beginning of chemotherapy. Clinical adverse effects were mild in all cases. Three children (2.6%) had fever and 5 (4.4%) had gastrointestinal disturbances. Aspartate aminotransferase and alanine aminotransferase mean values showed no differences along time and no patients had clinical signs of hepatotoxicity. Only 11 children (19.6%) showed a slight increase in alanine aminotransferase (< 194 units/l). Serum uric acid increased in 92.2% of the children compared with pretreatment values. This increase remained within the normal range in all but 9.8% of patients. There was a significant increase in uric acid mean concentrations after 1 month of therapy (from 3.7 +/- 0.7 mg/dl to 5.7 +/- 1.6 mg/dl, P < 0.05), which fell again (4.0 +/- 1.1) 1 month after pyrazinamide was stopped. There were no signs of gout or arthralgias. In no case was the treatment interrupted. The addition of pyrazinamide in chemotherapy for pulmonary tuberculosis in children was found to be safe. The slight increase in uric acid concentration during its administration had no recognized adverse consequences.

Follow-Up Study of 6-Month Short Course Chemotherapyfor Pulmonary Tuberculosis with 2SKHRZ/4HRZ

Follow-Up Study of 6-Month Short Course Chemotherapyfor Pulmonary Tuberculosis with 2SKHRZ/4HRZ

Thoracoplasty: By no means an obsolete procedure

After the advent of chemotherapy for pulmonary tuberculosis, the operation of thoracoplasty became rare in the western world. However, this phenomenon was not seen in countries like India. Between July 1992 and June 1993, we performed thoracoplasty in 39 patients. Indications of surgey were tubercular empyema (25 patients), pyogenic empyema (9 patients), postoperative empyema with bronchopleural fistula (3 patients), drug resistant pulmonary tuberculosis (1 patient) and recurrent haemoptysis (1 patient). Successful outcome in the form of control of sepsis, closure of bronchopleural fistula, sputum conversion and control of haemoptysis could be achieved in all the cases. There was no mortality in the entire series. We conclude that with the persisting problem of pulmonary tuberculosis in developing countries, thoracoplasty is still an operation of continued relevance.

Clinical Evaluation of Surgical Resection of Pulmonary Tuberculosis

Background: In spite of initial intensive and long-term chemotherapy for pulmonary tuberculosis, many problems remain in the treatment of the residual lesion. The role of surgical intervention for pulmonary tuberculosis is getting rid of such residual lesion of pulmonary tuberculosis to support the healing process and to induce bacteriologically negative conversion in the end. Method: We experienced 30 cases of pulmonary resection for pulmonary tuberculosis from Aug. 1994 through Apr. 1995 in National Masan Tuberculosis Hospital. We conducted retrospective study to analyze several variables for the cases. Results: 1) The ratio between male and female was 4:1(male 24, female 6) and the age of peak incidence was in 3rd and 4th decades. 2) Indications for pulmonary resection in the radiographic findings were cavitary lesions of 19 cases(63.3%), destroyed one side of 8 cases(26.7%) and destroyed one lobe of 3 cases(10%). 3) 16 of 20 cases with unilateral lesions and all of 10 cases with bilateral lesions on chest X-ray films showed AFB positive on preoperative sputum smears. 14 cases(87.5%) of unilateral lesions and 9 cases(90%) of bilateral ones were converted into AFB negative postoperatively. Negative conversion rates of pneumonectomy and lobectomy cases were 100% and 85.7%, respectively. 4) Preoperative combined disease was 3 cases(10%) of DM and postoperative complications were 2 cases(6.7%) of dead space and no death. Conclusion: Chemotherapy only has some limitation in treatment of all tuberculosis. So, surgical intervention for pulmonary tuberculosis is an effective method as partner of chemotherapy.

Resolution of Fever in Patients on Chemotherapy for Pulmonary Tuberculosis

Thirty-nine febrile and 37 afebrile patients with pulmonary tuberculosis were compared. Fever was defined as oral temperature of more than 37.2_C. Afebrile status on chemotherapy was presumed to have been achieved if patients remained without fever for at least seven consecutive days. Both groups were given short-course supervised chemotherapy in hospital consisting of isoniazid (INH), rifampin, ethambutol and pyrazinamide for the first two months and INH and rifampicin for the next four months. The two groups did not differ demographically or by the presence of cavitary disease. However, more patients with fever had anemia and elevated erythrocyte sedimentation rate (ESR) than afebrile patients. Resolution of fever occurred in 92% by four weeks. However, two female patients had fever lasting more than 60 days even though almost 1/4th of patients were afebrile one day after the start of chemotherapy and 1/3rd after three days.

Controlled Trial of Ciprofloxacin in Short-term Chemotherapy for Pulmonary Tuberculosis

The study was undertaken in patients with newly diagnosed bacteriologically positive pulmonary tuberculosis. The patients were randomly allocated to receive one of two regimens. In one of the regimens, patients received 2 months of daily treatment with streptomycin, isoniazid, rifampin, and pyrazinamide (SHRZ) followed by isoniazid plus rifampin for 4 months (4 HR). In the other regimen, patients received 2 months of daily streptomycin, isoniazid, pyrazinamide, and ciprofloxacin (SHZ Cipro) followed by isoniazid plus ciprofloxacin for 4 months. All patients in the SHRZ/HR regimens and all but one in the SHZ Cipro/H Cipro regimens had a favorable bacteriologic response during chemotherapy. In the patients in the SHZ Cipro/H Cipro regimen, ciprofloxacin was well tolerated during the period of treatment. After chemotherapy, one (5.9 percent) of 17 patients in the SHRZ/HR group and three (16.6 percent) of 18 patients in the SHZ Cipro/H Cipro group relapsed bacteriologically.

Tuberculous Subcutaneous Abscesses Developing during Chemotherapy for Pulmonary Tuberculosis

A 32-year-old woman with systemic lupus erythematosus developed military tuberculosis. Several subcutaneous abscesses infected with a strain of Mycobacterium tuberculosis susceptible to all antituberculosis drugs occurred successively during initial 1-4 months of regular antituberculosis therapy. The lung and skin lesions disappeared after continuous treatment. We emphasize that emergence of tuberculous skin lesions may occur during treatment but this does not necessarily indicate treatment failure.