Initiation Of Antituberculosis Therapy Research Articles

Choroidal Granuloma as an Initial Manifestation of Systemic Tuberculosis: A Case Report

Purpose: To describe the presentation and management of presumed ocular tuberculosis, successfully treated with anti-tubercular therapy alone. Case Report: Presumed tuberculous choroidal granuloma associated with serous retinal detachment healed after initiation of antituberculosis therapy without concomitant corticosteroid therapy. Conclusion: Although corticosteroids are often used as add-on treatment for ocular tuberculosis, selected patients can be treated with anti-tuberculosis therapy alone with close follow-up.

Rifampcin-induced Thrombocytopaenia Purpura

We report the case of a 28-year-old resident doctor with no past history of having taken rifampicin, who presented with thrombocytoapaenic purpura occurring after the initiation of anti-tuberculosis therapy (isoniazid, rifampicin, pyrazinamide and ethambutol) for tubercular lymphadenopathy.

Yellow Subretinal Lesions following Initiation of Antituberculosis Therapy in A Tubercular Choroidal Granuloma: A Sign of Paradoxical Worsening?

ABSTRACT Purpose To describe the presentation and management of atypical subretinal lesions following initiation of antitubercular therapy for a tubercular choroidal granuloma. Case report An 18-year-old female was diagnosed with choroidal granuloma and shallow exudative retinal detachment in the left eye. Biopsy from a cervical lymph node was positive for tuberculosis. She was treated with antitubercular therapy (ATT) and oral steroids. After one week of therapy exudative detachment increased markedly and discrete yellowish-white subretinal lesions appeared first in the inferior periphery, then temporally and later involved the macula leading to a drop in visual acuity. A diagnosis of paradoxical worsening was considered and she was managed with a higher dose of oral corticosteroids, intravitreal methotrexate and intravitreal ranibizumab. The granuloma healed and the subretinal lesions as well as exudative detachment gradually resolved with improvement in visual acuity. Conclusion Subretinal yellow-white lesions may develop as a paradoxical response to ATT.

Identification and Treatment of Tuberculosis in Pediatric Recipients of Allogeneic Hematopoietic Stem Cell Transplantation: Case Series and Review of the Literature.

BackgroundTuberculosis is a rare but life-threatening complication in patients who received hematopoietic stem cell transplantation. Early identification and intervention are essential to prevent severe complications.Case PresentationWe report two pediatric patients who developed tuberculosis after receiving hematopoietic stem cell transplantation for thalassemia major among 330 recipients between January 2012 and August 2019. Patient A presented with pulmonary tuberculosis and patient B presented with lymph node tuberculosis mimicking post-transplantation lymphoproliferative disorder associated with Epstein–Barr virus reactivation. Patient B’s condition was deteriorated, and shortly after the initiation of anti-tuberculosis therapy, the patient was found to have disseminated pulmonary tuberculosis. Patient B was also found to have tuberculous granulomas, an uncommon manifestation of tuberculosis causing severe airway obstruction. Both patients developed critical respiratory failure and required mechanical ventilation; however, they recovered with almost full resolution of pulmonary lesions after multiple treatment adjustments.ConclusionTuberculosis must be carefully evaluated in all pediatric patients that receive hematopoietic stem cell transplantation, regardless of the identification of other pathogens. Prophylactic tuberculosis therapy should be considered for high-risk pediatric hematopoietic stem cell transplantation recipients from tuberculosis-endemic regions.

Multifocal Tuberculosis with Prolonged Paradoxical Reaction

This is a case report describing successful treatment of a challenging case of an 18-year old previously healthy high school male student with multifocal tuberculosis involving the spleen and mediastinal and abdominal lymph nodes confirmed by histopathology of splenectomy tissue. The patient initially responded well to antituberculosis therapy with complete resolution of fever and improvement in his general health and weight. However, two months after initiation of anti-tuberculosis therapy, the patient developed paradoxical reaction manifest as recurrence of fever that persisted for five months and was associated with enlargement of lymph nodes. The fever failed to abate with continuation of the same antituberculosis therapy. Despite reassurance that the fever was due to a prolonged paradoxical reaction, a decision was made by the family to seek advice in another hospital where lymphoma was excluded again by histopathological examination of an excisional lymph node biopsy that revealed caseating granulomatous lymphadenitis and negative tuberculosis stain, culture, and polymerase chain reaction. The patient was continued on anti-tuberculosis therapy and treated with corticosteroids that resulted in complete resolution of fever and subsequent full recovery from his tuberculosis.

Detection of Mycobacterium tuberculosis in sputum in patients coinfected with HIV / tuberculosis by various methods (literature review)

The review presents the special aspects of bacillary excretion in tuberculosis patients co-infected with HIV and the yield of acid-fast smear depending on the CD4-cell count. Predictors of positive growth of Mycobacterium tuberculosis from sputum under negative microscopy in this category of patients are considered. The experience of different countries of the world on the effectiveness of various diagnostic algorithms for detecting tuberculosis in HIV/TB co-infection and the role of molecular-genetic methods in the diagnosis of tuberculosis are discussed. According to the data presented in the review, the yield of acid-fast sputum smear microscopy varies significantly, and depends on a variety of factors, including the immune status of the patient with HIV infection, the level of the laboratory service. The different yield of the smear microscopy in combination with the subclinical course of tuberculosis and atypical radiologic presentation in patients with HIV infection leads to a delay in diagnosis and to late initiation of antituberculosis therapy. The culture and the molecular-genetic methods of sputum examination increase the frequency of detection of the pathogen, however, the diagnosis of tuberculosis by culture can not be considered rapid in patients with immunodeficiency. Therefore, in the context of the continuing increase in the number of patients with co-infection, rapid, molecular-genetic methods for the detection of MTB DNA should be included in the algorithm for screening for tuberculosis of HIV- infected patients during their first encounter with the healthcare system.

Detection of transrenal DNA for the diagnosis of pulmonary tuberculosis and treatment monitoring.

Molecular diagnostics of patients with MTB tuberculosis from urine samples. We developed a new molecular assay based on the detection of M. tuberculosis-specific transrenal DNA (trDNA) and tested it for the diagnosis of active tuberculosis at the initiation of anti-tuberculosis therapy and during treatment follow-up. The overall sensitivity of trDNA was 96 and 100% when smear-microscopy and trDNA was combined. In a subset of TB treatment naïve patients (n=11) sensitivity and specificity of trDNA was 64 and 100%, respectively. For this subset of patients the sensitivity was 91% when smear-microscopy and trDNA diagnosis were combined. After treatment initiation, trDNA showed a significant reduction in concentration over time reaching undetectable trDNA values at week 12 in 9 of 11 accessible patients (82%). Kinetics in treatment-naïve patients showed low base-line trDNA levels, which increased to maximal trDNA levels within one week indicating bactericidal activity of anti-tuberculosis drugs after the initiation of effective therapy. Maximal trDNA levels correlated positively with a radiological score, suggesting that the process of DNA excretion may reflect the extent of pulmonary disease. Matched samples showed an inverse correlation between the time to positivity of solid culture with maximum trDNA levels as well as the expected positive correlation between smear grade and maximum trDNA values. The detection of M. tuberculosis trDNA from urine specimen is a promising method for the diagnosis tuberculosis. The assay may be a candidate diagnostic tool for patients with paucibacillary and extrapulmonary disease, as method to assess treatment responses and could be helpful to diagnose tuberculosis in children.

Mortality in HIV-infected patients with tuberculosis treated with streptomycin and a two-week intensified regimen: data from an HIV cohort study using inverse probability of treatment weighting.

Background. Despite the dramatic scale-up of antiretroviral therapy in low- and middle-income countries, tuberculosis (TB) is still the main cause of death among HIV-infected patients in resource-limited settings. Previous studies in patients with TB meningitis suggest that the use of higher doses of common anti-TB drugs could reduce mortality.Methods. Using clinical data from an HIV cohort study in India, we compared the mortality among HIV-infected patients diagnosed with TB according to the regimen received during the first two weeks of treatment: standard anti-tuberculosis therapy (ATT) (N = 847), intensified ATT (N = 322), and intensified ATT with streptomycin (N = 446). The intensified ATT comprised double dose of rifampicin and substitution of ethambutol with levofloxacin. Multivariate analysis was performed using Cox proportional hazard models and inverse probability of treatment weighting (IPTW) based on propensity scores. Patients with TB meningitis were excluded.Results. The use of intensified ATT alone did not improve survival. However, when streptomycin was added, the use intensified ATT was associated with reduced mortality in Cox models (adjusted hazard ratio 0.72, 95% CI [0.57–0.91]) and after IPTW (hazard ratio 0.77, 95% CI [0.67–0.96]). Other factors associated with improved survival were high serum albumin concentration, high CD4 lymphocyte cell-counts, and high glomerular filtration rates. Factors associated with increased mortality were high urea concentrations, being on antiretroviral therapy at the time of ATT initiation and high BUN/creatinine ratio. In an effect modification analysis, the survival benefits of the intensified ATT with streptomycin disappeared in patients with severe hypoalbuminemia.Conclusion. The results of this study are in accordance with a previous study from our cohort involving patients with TB meningitis, and suggest that an intensified 2-week ATT with streptomycin could reduce mortality in HIV infected patients with TB. As this is an observational study, we should be cautious about our conclusions, but given the high mortality of HIV-related TB, our findings deserve further research.

Diabetes Is Associated with Worse Clinical Presentation in Tuberculosis Patients from Brazil: A Retrospective Cohort Study.

BackgroundThe rising prevalence of diabetes mellitus (DM) worldwide, especially in developing countries, and the persistence of tuberculosis (TB) as a major public health issue in these same regions, emphasize the importance of investigating this association. Here, we compared the clinical profile and disease outcomes of TB patients with or without coincident DM in a TB reference center in Brazil.MethodsWe performed a retrospective analysis of a TB patient cohort (treatment naïve) of 408 individuals recruited at a TB primary care center in Brazil between 2004 and 2010. Data on diagnosis of TB and DM were used to define the groups. The study groups were compared with regard to TB disease presentation at diagnosis as well as to clinical outcomes such as cure and mortality rates upon anti-tuberculosis therapy (ATT) initiation. A composite score utilizing clinical, radiological and microbiological parameters was used to compare TB severity between the groups.ResultsDM patients were older than non-diabetic TB patients. In addition, diabetic individuals more frequently presented with cough, night sweats, hemoptysis and malaise than those without DM. The overall pattern of lung lesions assessed by chest radiographic examination was similar between the groups. Compared to non-diabetic patients, those with TB-diabetes exhibited positive acid-fast bacilli in sputum samples more frequently at diagnosis and at 30 days after ATT initiation. Notably, higher values of the TB severity score were significantly associated with TB-diabetes comorbidity after adjustment for confounding factors. Moreover, during ATT, diabetic patients required more frequent transfers to TB reference hospitals for complex clinical management. Nevertheless, overall mortality and cure rates were indistinguishable between the study groups.ConclusionsThese findings reinforce the idea that diabetes negatively impacts pulmonary TB severity. Our study argues for the systematic screening for DM in TB reference centers in endemic areas.

A case of pseudomembranous colitis associated with antituberculosis therapy in a patient with tuberculous meningitis

Pseudomembranous colitis (PMC) is known to be associated with the long-term administration of antibiotics, which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. However, antituberculosis agents are rarely reported as a cause of this disease. Besides, most cases of antituberculosis agent-induced PMC have been observed in patients with pulmonary tuberculosis but not with tuberculous meningitis. This report presents a case of PMC associated with antituberculosis therapy in a patient with tuberculous meningitis. A 29-year-old female patient was admitted due to headaches and diplopia that had lasted for 2 weeks. She had not recently received antimicrobial therapy. She was diagnosed with tuberculous meningitis by cerebrospinal fluid findings and neurologic examination, including brain imaging study. She was treated with standard antituberculosis agents (HERZ regimen: isoniazid, ethambutol, rifampicin, and pyrazinamide). After 11 days of HERZ, she developed a fever, sudden widespread skin eruption, and elevation of liver enzymes. Considering adverse drug reactions, antituberculosis agents were stopped. One week later, her symptoms were relieved. Thus, antituberculosis agents were reintroduced one at a time after liver function returned to normal. However, she presented with frequent mucoid, jelly-like diarrhea, and lower abdominal pain. Sigmoidscopy revealed multiple yellowish plaques with edematous mucosa, which were compatible with PMC. She was treated with oral vancomycin considering drug interactions. Symptoms were relieved and did not recur when all antituberculosis agents except pyrazinamide were started again. Therefore, when a patient complains of abdominal pain or diarrhea after initiation of antituberculosis therapy, the physician should consider the possibility of antituberculosis agent-associated PMC.

Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis

BackgroundAntiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART initiation on mortality, is unclear.MethodsWe conducted a retrospective observational multi-center cohort study among HIV-infected persons concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study population included persons for whom 6 months of anti-tuberculosis therapy is recommended.ResultsOf 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64 cells/mm3, 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+ lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1 RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007).ConclusionsThe increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration guidelines should be re-evaluated.

Multiple ring-enhancing cerebral lesions in systemic lupus erythematosis: a case report

IntroductionInfectious disease in an immunosuppressed patient is a diagnostic challenge. The clinical presentation and the body’s immune response may be quite different from those seen in an immunocompetent patient with the same infection. It is also a race against time to diagnose, as many of these infections can be fatal without timely intervention.Case presentationWe present the case of a 39-year-old Sri Lankan woman who was on immunosuppressive treatment for systemic lupus erythematosis and who presented with multiple ring-enhancing lesions of the brain. The most likely diagnosis, given the clinical picture, available investigation results, and characteristics of magnetic resonance imaging, was central nervous system tuberculosis. Owing to the small size of the lesions, a tissue biopsy could not be performed. Our patient responded well to a trial of anti-tuberculosis therapy, and there was clinical and radiological evidence of recovery. A paradoxical reaction with the initiation of anti-tuberculosis therapy was observed and this had to be countered with a prolonged course of steroids.ConclusionsOur experience and previous evidence from case reports suggest that high-dose steroids for a prolonged period (up to eight weeks) should be administered to counter the initial deterioration after starting anti-tuberculous chemotherapy for central nervous system tuberculomas.

Délais de signalement et d’entretien dans l’enquête autour d’un cas de tuberculose, Seine-Saint-Denis, avril–juin 2008

BackgroundIn France, one of the main components of the tuberculosis control program is contact investigation around all tuberculosis cases. For this purpose, all cases of tuberculosis are to be reported to the health authorities (Centre de lutte antituberculeuse) within 48hours of diagnosis. The Centre then conducts an initial patient interview within three days of the report in order to establish a list of contacts requiring evaluation. Given that a delay in action may play a role in the continued disease transmission, it appeared necessary to study more precisely this subject in a French area with a high annual new case rate, the Seine-Saint-Denis. MethodsA descriptive and retrospective study included all tuberculosis cases reported and received between April and June 2008. The two periods were statistically analyzed with socio-demographic, clinical-biological and investigations data. ResultsFor the 148 cases reported during this period, a first interview was required for 123. The average time period between initiation of anti-tuberculosis therapy and reception of the report was 11.08 days. The overly long delay could be explained in part by the inappropriate use of the notification form (45.5%) designed for non-urgent collection of epidemiological data, and in part by the underuse of telephone reporting (8.1%). The first interview was not performed for 19 cases and the average time between reception of the notification and the patient interview was 6.58 days. Having the patient's phone number appeared essential to meet the deadline (odds ratio: 5.3; 95% confidence interval [1.7–16.9]). Few interviews were made in person. Shortage in financial and human resources and the delayed case reporting could be part of the explanations. Deadlines were met much better for cases of pleuro-pulmonary tuberculosis compared with other localizations, for reporting (39.2% versus 13.5%, p<0.01) and for the first interview (48.8% versus 28.6%, p=0.03). ConclusionThis study reports some risk factors associated with delayed action and highlights the need for improved reporting of tuberculosis cases and contact investigations.

Pharmacokinetics of Dasatinib in a Patient with Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia During Treatment with Anti-Tuberculosis Therapy

Abstract 5006 Objectives:Dasatinib is a second generation protein-tyrosine kinase inhibitor (TKI) indicated for first line treatment of chronic myeloid leukemia (CML) and second line treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) in patients who are imatinib resistant or intolerant.In this study, we present the case of a patient with Philadelphia chromosome- positive ALL, intolerant to imatinib, who developed reactivated tuberculosis (TB) while receiving dasatinib during maintenance chemotherapy. The purpose of our study was to determine the effects of concomitant anti-TB therapy on dasatinib exposure by measuring plasma dasatinib levels using three different oral doses of the drug in this patient. Methods:The patient was treated with isoniazid, rifampin, ethambutol, pyrazinamide and pyridoxine for 2 months, followed by isoniazid, rifampin and pyridoxine for an additional 4 months. Dasatinib therapy was continued at the initiation of TB therapy using 100 mg po od, and titrated by 50 mg increments to 200 mg po od. Dasatinib plasma levels were measured prior to initiating anti-TB treatment and at regular intervals during concomitant treatment using three different dasatinib doses. Results:Eight days after initiation of anti-tuberculosis therapy, the apparent clearance of dasatinib had increased from 1410 to 2174 L/h at 100 mg. However, at 150 mg and 200 mg doses, apparent clearance had decreased to levels lower than baseline. As expected, the direction of peak plasma concentration changes was inverse to the changes in apparent clearance: Cmax values were 30 at baseline, and 22, 46, 102 ng/mL for the 3 doses of dasatinib during anti-TB therapy, respectively. Conclusions:Our findings suggest dasatinib clearance is increased by approximately 50% shortly after initiating anti-tuberculosis treatment and increasing the dose of dasatinib during anti-TB therapy was able to restore dasatinib plasma levels to those observed before initiation of anti-TB therapy.(This work was supported by an unrestricted grant from Bristol Myers Squib) Disclosures:No relevant conflicts of interest to declare.

Corticosteroids in the treatment of hepatic tuberculosis: Case report and review of the literature

The role of corticosteroid therapy in addition to anti-tuberculous agents in the treatment of hepatic tuberculosis is unclear. We describe a 54-y-old female with hepatic tuberculosis and worsening hepatitis after initiation of anti-tuberculosis therapy. She experienced considerable clinical improvement and ultimately a complete recovery upon the receipt of adjunctive corticosteroids.

Successful Liver Transplantation in Antituberculosis Therapy–Induced Acute Fulminant Hepatic Failure

The antituberculosis drugs isoniazid, rifampin, and pyrazinamide expose patients to the risk of hepatotoxicity ranging from an asymptomatic increase in aminotransferase concentrations to fulminant hepatic failure. Herein, we report a case of acute fulminant hepatic failure that developed at 3 weeks after initiation of antituberculosis therapy (ATT) in a 31-year-old man with acute pulmonary tuberculosis in whom pretreatment liver function had been normal. The ATT regimen was changed to include less toxic substances, and an urgent orthotopic liver transplantation was performed successfully. Despite immunosuppression therapy with tacrolimus, mycophenolate mofetil, steroids, and antithymocyte globulin, clinical symptoms and radiologic signs of TB improved. Twelve months posttransplantation, graft function was normal. Acute TB should not be considered a contradiction to liver transplantation if effective ATT can be administered.

Acute Kidney Disease Due to Immune Reconstitution Inflammatory Syndrome in an HIV-Infected Patient With Tuberculosis

This study reports the case of an HIV-infected patient with disseminated tuberculosis who presented an immune reconstitution inflammatory syndrome (IRIS) revealed by an acute kidney disease 45 and 15 days after initiation of antituberculosis therapy and HAART, respectively. Prednisone therapy and the transient withdrawal of HAART improved the renal function and the clinical condition of this patient. All published case reports of IRIS revealed by acute renal failure in HIV-infected patients are also reviewed.

Clinical Aspects of Rifampicin-associated Pseudomembranous Colitis

Pseudomembranous colitis (PMC) is known to develop after antibiotic administration, but antituberculosis agents are rarely associated with this disorder. We report 6 cases of PMC after rifampicin administration; the clinical manifestations, laboratory findings, imaging findings, and clinical course are described. The median age of patients was 68 years (range, 54 to 82 y). All patients were diagnosed with active pulmonary tuberculosis by sputum smear and culture, and 2 suffered from type 2 diabetes mellitus. The average interval between initiation of antituberculosis therapy and the onset of diarrhea was 19.8 days. The anatomic distribution of PMC included the rectum and sigmoid colon in 5 cases and up to the hepatic flexure in 1 case. All patients were cured with medical treatment, which include discontinuation of rifampicin and oral metronidazole and vancomycin. PMC recurred in 1 patient after retreatment with rifampicin. Our findings suggest that patients who are treated with antituberculosis agents, who develop acute diarrhea during or after therapy, should be evaluated for PMC.

Tuberculous infection in southern Chinese renal transplant recipients

A retrospective study of the prevalence and pattern of tuberculosis among renal transplant patients in a single centre in southern China was performed. Twenty-three cases of tuberculosis were diagnosed among 440 patients between January 1991 and December 2002. There were 18 men and five women. The mean age of the patients was 39.3 +/- 13.4 yr. There were 13 living-related and 10 cadaveric renal transplants. The interval between renal transplantation and the development of tuberculosis ranged from 3 to 127 months with a median of 46 months. There were 18 cases of pulmonary tuberculosis, two cases of pulmonary plus laryngeal tuberculosis, two cases of disseminated tuberculosis, and one case of tuberculosis involving the urinary tract. Diagnosis was established by positive culture for Mycobacterium tuberculosis in 21 patients and response to empirical anti-tuberculosis treatment in two patients. The duration of symptoms before the diagnosis of tuberculosis was 27 +/- 12 d. The patients were treated with standard anti-tuberculosis drugs for 11 +/- 3 months. The anti-tuberculosis treatment was in general well-tolerated. Five patients developed transient hepatitis, three patients developed thrombocytopenia and five patients developed gouty arthritis. One patient died 2 months after initiation of anti-tuberculosis therapy. All other patients completed anti-tuberculosis treatment. No recurrence of tuberculosis was observed after a median follow-up of 90 months. We concluded that (i) tuberculosis is prevalent among southern Chinese renal transplant recipients; (ii) high index of suspicion for tuberculosis among renal transplant recipients is warranted to ensure early diagnosis and prompt initiation of treatment; and (iii) treatment with standard anti-tuberculosis drugs for an extended period of time is well-tolerated and is associated with favourable outcome.

Fluoroquinolone resistance in patients with newly diagnosed tuberculosis.

Fluoroquinolones are widely used for the treatment of bacterial infections and are also second-line therapy for tuberculosis. However, fluoroquinolone resistance in patients with newly diagnosed cases of tuberculosis is not routinely assessed. We performed in vitro susceptibility testing of Mycobacterium tuberculosis to fluoroquinolones for all culture-confirmed tuberculosis cases in adults that were diagnosed at Johns Hopkins Hospital (Baltimore) between January 1998 and March 2002. Fifty-five patients were included in the study; 19 received fluoroquinolone monotherapy before the initiation of antituberculosis therapy. Two of 55 M. tuberculosis isolates (4%; 95% CI, 1%-13%) had decreased susceptibility to fluoroquinolones, including 2 of 19 of those from patients who had received fluoroquinolones (11%; 95% CI, 1%-33%) and 0 of 36 isolates from those who had not (95% CI, 0%-10%). The 2 fluoroquinolone-resistant M. tuberculosis strains were both from patients with acquired immunodeficiency syndrome and a CD4+ lymphocyte count of <50 cells/mm3. The incidence of M. tuberculosis fluoroquinolone resistance in this small sample of patients with newly diagnosed tuberculosis was high, particularly among patients with prior fluoroquinolone exposure.