Mycobacterium Tuberculosis In Patients Research Articles

Time to Sputum Culture Conversion in Multidrug-Resistant Tuberculosis: Predictors and Relationship to Treatment Outcome

Conversion of sputum mycobacterial cultures from positive growth to negative growth of Mycobacterium tuberculosis in patients with pulmonary tuberculosis (TB) is considered the most important interim indicator of the efficacy of anti-TB pharmacologic treatment for multidrug-resistant disease. To evaluate and compare time to and predictors of initial sputum culture conversion with predictors of treatment outcome for patients with multidrug-resistant TB. Retrospective cohort study. Latvia. All civilian patients with multidrug-resistant TB treated with the DOTS-Plus strategy between 1 January and 31 December 2000. Individualized treatment for confirmed sputum culture-positive pulmonary multidrug-resistant TB. Time to initial sputum culture conversion and treatment outcome. Among 167 patients who were sputum culture-positive at initiation of second-line therapy, 129 (77%) converted in a median time of 60 days (range, 4 to 462 days) and 38 (23%) did not convert. Independent predictors of a longer sputum culture conversion time, using an accelerated failure time regression model, included previous treatment for multidrug-resistant TB, high initial sputum culture colony count, bilateral cavitations on chest radiography, and the number of drugs the initial isolate was resistant to at treatment initiation. Treatment outcomes were statistically significantly worse for patients who did not convert their sputum culture within 2 months. Twenty-five percent of patients missed 5 or more monthly sputum collections. Under program conditions in Latvia, most patients with multidrug-resistant TB achieved sputum culture conversion within 12 weeks of starting treatment. Chest radiography and sputum culture drug susceptibility testing can assist physicians in predicting which patients will convert more slowly. Sputum culture conversion is a useful and appropriate interim indicator of treatment outcome in patients with multidrug-resistant TB.

NiVeLeS de ReSiStenCia a dRoGaS antitUbeRCULoSaS en PaCienteS Con CoinFeCCiÓn ViH / tUbeRCULoSiS, LiMa, 1998-2001.

global adquirida y MDR adquirida fueron 93,0% y 74,8%. La resistencia primaria por drogas fue H (42,1%), R (35,0%), S (35,3%), E (19,0%) y Z (24,5%) respectivamente; y la resistencia adquirida por drogas fueron H (85,3%), R (78,3%), S (64,4%), E (42,0%) y Z (46,2%). Conclusion: Los niveles resistencia a drogas antituberculosas y la MDR en pacientes con coinfeccion VIH-TB provenientes de hospitales de Lima son elevados. Palabras clave: Mycobacterium tuberculosis; VIH; Resistencia a drogas; Peru (fuente: DeCS BIREME). abStRaCt Objective:�Todetermineresistanceratestofirst-lineantituberculousdrugsinclinicalsamplesfrompatientsco-infected� withthehumanimmunodeficiencyvirus�(HIV)�andM.�tuberculosis�(TB)�infivehospitalsinLimabetween�1998-2000.� Materials and methods: A descriptive study including samples sent for culturing Mycobacterium tuberculosis in patients co-infected with HIV-TB. Susceptibility tests for isoniazid (H), streptomycin (S), ethambutol (E), and rifampin (R) were performed using the proportion method and Wayne's method for pyrazinamide (Z). Results: Out of 523 samples, 78,2% were from male patients, and 72,7% were from naive patients. Overall primary resistance and multidrug-resistance (MDR) rates were 55,8% and 32,1%, respectively; and overall acquired resistance and MDR rates were 93,0% and 74,8%, respectively. Primary resistance rates were: H, 42,1%; R, 35,0%; S, 35,3%; E, 19.0%, and Z, 24,5%, respectively; and acquired resistance rates were: h, 85,3%; R, 78,3%; S, 64,4%; E, 42,0%; and Z, 46,2%. Conclusion: There are high resistance rates to antituberculous drugs and MDR TB in patients co-infected with HIV and TB in Lima hospitals.

Cytokine responses induced by Mycobacterium tuberculosis in patients with HIV-1 infection and tuberculosis

Tuberculosis (TB) is an important opportunistic infection in HIV patients. Immune responses to Mycobacterium tuberculosis in HIV/TB patients were evaluated. Fifteen patients with HIV/TB, ten with HIV, four with TB, and five controls were enrolled. Peripheral blood mononuclear cells were isolated and stimulated with mycobacterial antigen (PPD). Interferon (IFN)-gamma and TNF-alpha in culture supernatants were measured by ELISA. IFN-gamma and TNF-alpha production after PPD stimulation was markedly decreased in HIV patients, but not in HIV/TB patients. In HIV patients with a CD4 cell count of less than 200/mm3, IFN-gamma and TNF-alpha production after PPD stimulation was higher in HIV/TB patients than in HIV patients. Cytokine responses to M. tuberculosis reconstituted after highly active antiretroviral therapy (HAART) and were prominent in HIV/TB patients. Cytokine responses to M. tuberculosis were retained in HIV-infected patients with tuberculosis, even in patients with a CD4 cell count of less than 200/mm3, and reconstituted after HAART.

Sensitivity of human gamma interferon assay and tuberculin skin testing for detecting infection with Mycobacterium tuberculosis in patients with culture positive tuberculosis

Nine university-affiliated chest clinics in Australia. To evaluate the sensitivity of a whole blood human gamma-interferon assay (HGIA, QuantiFERON-TB) for specific T lymphocyte responses and Tuberculin skin testing (TST) for the detection of Mycobacterium tuberculosis infection in subjects with culture-proven M. tuberculosis disease (TBCP). Prospective testing of 129 patients with recent TBCP and 100 patients with non-tuberculosis lung disease (NTBLD). Using a defined level of specific IFN-gamma production and TST 10mm as positive cut-offs, the sensitivity of HGIA was 81% compared to 89% for TST (p=0.06). When positive responses in both TST and HGIA were combined, 96% of TB patients were detected. For the NTBLD group, 43% of whom were born overseas, 73% were negative for both the HGIA and TST. Prior immunization with M. bovis (bacille Calmette-Guerin) (BCG) or the type of TB had no effect on the sensitivities of the assays. For those treated for <2 months, the sensitivities for both assays were 84%, but for those treated for >2 months the sensitivity of TST (90%) tended to be higher than for HGIA (81%) (p=0.07). The distribution of TST results in TB patients showed a broad peak between 10 and 25 mm, while the results in the HGIA were bimodal in both TB and NTBLD patients. HGIA may prove an alternative to skin testing for detecting M. tuberculosis infection in certain settings.

Issues in the treatment of Mycobacterium tuberculosis in patients with human immunodeficiency virus infection.

The HIV/AIDS pandemic has led to a rise in the incidence of tuberculosis and an epidemic of co-infection in many developing countries. Treatment of Mycobacterium tuberculosis in persons with HIV infection presents several challenges to the clinician particularly in resource-poor countries. As will be discussed in this paper diagnosis of latent tuberculosis relies on tuberculin skin testing which has poor sensitivity and reproducibility in immunocompromised patients. The World Health Organization (WHO) recommends treatment of active tuberculosis as the primary means of global tuberculosis control. In practice treatment of active tuberculosis typically requires that a symptomatic patient self-report to a health service for evaluation and management. Even if this approach to tuberculosis control were sufficient many logistic and clinical problems remain involving tuberculosis diagnosis and therapy in the patient with HIV/AIDS. Recognizing the significant clinical and public health challenges surrounding the treatment of tuberculosis in patients with HIV infection this paper will address a number of issues relevant to the care of co-infected patients. These include current guidelines for the treatment of active tuberculosis as well as the diagnosis and treatment of latent tuberculosis in HIV-positive patients. The paper concludes with a discussion of promising new drugs for tuberculosis treatment. (excerpt)

Infection of the central nervous system by Mycobacterium tuberculosis in patients infected with human immunodeficiency virus (the new neurotuberculosis).

Neurologic complications of HIV infection are numerous. This review focuses on the clinical presentation, diagnostic particularities and therapeutic issues of neurotuberculosis. The pertinent literature describing this important infection is succinctly summarized with a particular emphasis on the discussion of differences in clinical presentation between HIV-infected and -uninfected patients.

Acid-alcohol fast bacilli in sputa of HIV-infected patients

We identified 34 HIV-infected patients with sputum smear positive for acid-alcohol fast bacilli (AAFB) to determine any factors predictive of subsequent species identification. There were 20 cases of Mycobacterium tuberculosis (MTB), 9 cases of Mycobacterium avium-intracellulare (MAI), 3 cases of Mycobacterium kansasii and one each of Mycobacterium malmoense and Mycobacterium fortuitum. Factors associated with isolation of MAI were lower CD4 cell count, a higher incidence of previous AIDS diagnosis, a history of dyspnoea and a normal chest X-ray. The organism was isolated from blood cultures in 58% of patients with MTB and 78% of patients with MAI infection. Disseminated disease was diagnosed in 45% of MTB patients and 33% of MAI patients.

Radiographic presentation of pulmonary tuberculosis in young children

Ten cases of pulmonary tuberculosis (TB) with the isolation of Mycobacterium tuberculosis in patients under 6 years of age occurring between July 1994 and June 1998 were retrospectively reviewed. Radiographs showed air-space consolidation (n=4), micronodular (n=3) and miliary lesions (n=1). Two patients showed non-specific bronchopneumonic infiltrations. Other uncommon radiographic findings include pneumatocele formation and pleural effusion. Lymphadenopathies were detected in 6 (60%) cases using chest radio graphs or computed tomography (CT), commonly with involvement of the paratracheal and hilar lymph nodes. However, most lymph node enlargement was not noted in routine postero-anterior (PA) radio graphs and usually required a chest CT scan for confirmation. Since lymphadenopathy is common in children with pulmonary TB in Taiwan, we suggest using chest CT scans to detect such pathology in cases of suspected TB if other diagnostic tests are not conclusive.

Is death inevitable with multiresistant TB plus HIV infection?

Tuberculosis (TB) remains the commonest infectious disease with almost 8 million new cases and 3 million deaths annually. 1 Drobniewski FA Pozniak AL Uttley AHC Tuberculosis and AIDS. J Med Microbiol. 1995; 43: 85-91 Crossref PubMed Scopus (26) Google Scholar Multidrug-resistant Mycobacterium tuberculosis disease (MDRTB)—ie, resistance to at least isoniazid and rifampicin–is increasing mainly because of patient non-compliance and poorly supervised treatment programmes. Outbreaks of MDRTB among patients co-infected with HIV in hospitals and other institutions 2 AnonNosocomial transmission of multidrug-resistant TB among HIV infected persons–Florida and New York, 1988–91. MMWR. 1991; 40: 585-591 PubMed Google Scholar , 3 Small PM Shafer RW Hopewall PC et al. Exogenous reinfection with multi-drug resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med. 1993; 328: 1137-1144 Crossref PubMed Scopus (478) Google Scholar reawakened international concern over the public health threat posed by such organisms. Miller's 1996 Lancet review of respiratory diseases in HIV-positive patients 4 Miller R HIV-associated respiratory disease. Lancet. 1996; 348: 307-312 Summary Full Text Full Text PDF PubMed Scopus (69) Google Scholar emphasised the poor prognosis of MDRTB in such patients, citing the work of Small et al, who demonstrated a median survival of only 2 months. 3 Small PM Shafer RW Hopewall PC et al. Exogenous reinfection with multi-drug resistant Mycobacterium tuberculosis in patients with advanced HIV infection. N Engl J Med. 1993; 328: 1137-1144 Crossref PubMed Scopus (478) Google Scholar

Finger printing of Mycobacterium tuberculosis in patients with intracranial tuberculomas by using in vivo, ex vivo, and in vitro magnetic resonance spectroscopy.

In vivo, ex vivo, and in vitro proton magnetic resonance spectroscopy was performed in 12 patients with intracranial tuberculomas with an aim of detecting the biochemical constituents of Mycobacterium tuberculosis in a granuloma. One dimensional (1D) single pulse and spin-echo sequences and 2D correlative spectroscopy were used for the ex vivo study to confirm the resonances seen on in vivo study. Spectroscopic studies of the perchloric acid and lipid extract of granuloma and M. tuberculosis were performed to look for similarity of resonance. In vivo study showed the presence of lipids at 0.9, 1.3, 2.0, 2.8 ppm, and phosphoserine at 3.7 ppm. All these resonances were confirmed on ex vivo study. In addition, distinct resonances of serine and phenolic lipids were seen on ex vivo and in vitro study of tuberculous granuloma, which have not been observed in other intracranial tumors. Lipid extract of granuloma and M. tuberculosis showed phenolic lipids at 7.1 and 7.4 ppm, a constituent of the cell wall of the bacteria in a tuberculoma. It appears that it may be possible to finger print the biochemicals of the cell wall of M. tuberculosis in a tuberculous granuloma and thus may help in detection and diagnosis of such lesions.

Independent origin of mono-rifampin-resistant Mycobacterium tuberculosis in patients with AIDS.

Historically, infections caused by Mycobacterium tuberculosis have been treated simultaneously with isoniazid and rifampin. As a consequence of this combined therapy, strains resistant only to rifampin were rarely recovered. However, recently there has been an increasing number of reports describing HIV-positive patients infected with mono-rifampin-resistant M. tuberculosis strains. Organisms cultured from seven patients (including six with AIDS) with infections caused by mono-rifampin-resistant M. tuberculosis, and seen at one New York City hospital, were analyzed by molecular techniques to test the hypothesis that dissemination of a single clone had occurred. IS6110 DNA fingerprinting and automated DNA sequencing of a region of the RNA polymerase beta subunit structural gene (rpoB) containing mutations that confer rifampin resistance showed that all organisms independently acquired the mono-rifampin-resistant phenotype. Molecular analysis of mono-rifampin-resistant organisms cultured from 13 additional patients in New York City confirmed independent strain origin. The data rule out the possibility of person-to-person strain transmission among these patients, and they suggest that host factors such as poor compliance with antituberculosis medications or decreased absorption of rifampin have been a driving force in the origin of these strains.

Periprosthetic infections due to Mycobacterium tuberculosis in patients with no prior history of tuberculosis

Although uncommon, infection of prostheses with Mycobacterium tuberculosis can be managed successfully if it is diagnosed early and treated correctly. A case of M. tuberculosis infection of a prosthetic knee first diagnosed 4.5 years after initial arthroplasty is described. This case and a review of the literature led to the conclusion that there are two distinct patterns of M. tuberculosis infection following joint implant surgery in patients without a history of tuberculosis. (1) Mycobacterium tuberculosis infection may be an unexpected finding at the time of arthroplasty. These patients generally have favorable outcomes using standard antituberculous chemotherapy, without implant removal. (2) Late-onset M. tuberculosis joint infection may be identified in patients with painful, clinically infected, or malfunctioning prostheses. In these cases, medical treatment alone is usually unsuccessful; prosthesis removal is often required. With recent increases in the incidence of tuberculosis in the United States and the emergence of multidrug-resistant strains of M. tuberculosis, periprosthetic tuberculous infection is likely to become more common.

Institutional Control Measures for Tuberculosis in the Era of Multiple Drug Resistance: ACCP/ATS Consensus Conference

Institutional Control Measures for Tuberculosis in the Era of Multiple Drug Resistance: ACCP/ATS Consensus Conference

157-PA11 Drug resistance of Mycobacterium tuberculosis in patients in Zagreb, Croatia

157-PA11 Drug resistance of Mycobacterium tuberculosis in patients in Zagreb, Croatia

Detection of antigens of Mycobacterium tuberculosis in patients of infertility by monoclonal antibody based sandwiched enzyme linked immunosorbent assay (ELISA)

A sandwich ELISA to detect specific protein antigens of Mycobacterium tuberculosis was developed by using polyclonal anti-BCG rabbit antibodies as the primary capture antibodies. The mycobacterial antigens were detected with horseradish peroxidase conjugated monoclonal antibodies ( P 6) as secondary antibodies. The enzyme was detected by using 1,2 Phenylenediamine dihydrochloride (OPD) and Hydrogen peroxide as substrate. The antigen could be quantitated through linear regression analysis with lower detection limit of 1.25 μg/ml. 50 consecutive cases of infertility were examined by laparoscopy and tested for the presence of the antigen in the serum. Mycobacterial antigen could be detected in 9 of the 12 cases with definitive diagnosis of tuberculosis, 5 of the 23 where the diagnosis of tuberculosis was probable and in only 1 of 15 patients who had no laparoscopic abnormalities indicative of tuberculosis.

Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection.

In the United States there have been recent outbreaks of multidrug-resistant tuberculosis. These outbreaks have primarily involved persons infected with the human immunodeficiency virus (HIV). We collected clinical information on 17 patients seen at a New York City hospital who had repeatedly positive cultures for Mycobacterium tuberculosis. Analysis of restriction-fragment--length polymorphisms (RFLPs) was performed on serial isolates of M. tuberculosis obtained from these patients. Six patients had isolates that remained drug-susceptible, and the RFLP patterns of these isolates did not change over time. Eleven patients had isolates that became resistant to antimicrobial agents. The RFLP patterns of the isolates from six of these patients remained essentially unchanged (two strains showed one additional band) despite the development of drug resistance. In five other patients, however, the RFLP patterns of the isolates changed dramatically at the time that drug resistance was detected. The change in the RFLP pattern of the isolate from one patient appeared to be the result of contamination during processing in the laboratory. In the remaining four patients, all of whom had advanced HIV disease, the clinical and microbiologic evidence was consistent with the presence of active tuberculosis caused by a new strain of M. tuberculosis. Resistance to antituberculous drugs can develop not only in the strain that caused the initial disease, but also as a result of reinfection with a new strain of M. tuberculosis that is drug-resistant. Exogenous reinfection with multidrug-resistant M. tuberculosis can occur either during therapy for the original infection or after therapy has been completed.

Tuberculous meningitis in patients with and without human immunodeficiency virus infection

objective: To characterize the symptoms, signs, laboratory findings, and outcome of culture-proven meningitis due to Mycobacterium tuberculosis in patients with and without human immunodeficiency virus (HIV) infection.design: Retrospective chart review.setting: Urban public general hospital in the United States.patients: Fifteen patients with and 16 without HIV infection.measurements: Demographics, symptoms, physical exam findings, serum sodium, complete blood cell count, CD4+ cell count, cerebrospinal fluid findings, imaging data, and in-hospital mortality.main results: Symptoms, signs, chest radiograph appearance, cerebrospinal fluid cell counts and chemistries, and mortality were similar in both groups (p = NS). Median CD4+ cell counts were lower in HIV-infected patients (median 99/mm3, range 7 to 251, versus 384/mm3, range 171 to 724 in those without HIV infection, p = 0.007). Intracerebral mass lesions were more common in the HIV-infected group (60% versus 14% in the uninfected group, p = 0.01), although the presence of a mass did not correlate with focal neurologic deficits, altered level of consciousness, or mortality.conclusion: With the exception of an increased incidence of intracerebral mass lesions in HIV-infected individuals, HIV infection appears to have little impact on the findings and in-hospital mortality of tuberculous meningitis.

Humoral response to Mycobacterium tuberculosis in patients with human immunodeficiency virus infection

The effect of the human immunodeficiency virus (HIV) on mycobacterial antibody production was investigated. Using an enzyme-linked immunosorbent assay (ELISA) for detecting IgG against Mycobacterium tuberculosis PPD, it was observed that individuals at risk of HIV infection show a pattern of humoral response to the tubercle bacillus similar to that previously found in the immunocompetent population not exposed to risk factors: 6 of 12 (50.0%) tuberculosis cases had elevated levels of antibodies to PPD and 27 of 30 (90.0%) asymptomatic individuals had antibody levels within the normal range. In an HIV-seropositive group without AIDS indicator diseases, 8 of 22 (36.4%) tuberculous patients had detectable mycobacterial antibodies whereas 156 of 164 (95.1%) non-tuberculous subjects did not. Among AIDS cases, only 1 of 20 (5.0%) patients with tuberculosis and none of 53 non-tuberculous subjects showed a positive result. The study evidenced an increasing humoral unresponsiveness to PPD in the progression of HIV infection to AIDS. Thus, a serodiagnostic method for detecting tuberculosis such as the ELISA here employed noticeably decreases its utility in the latency stage of the HIV infection, and it is practically useless in clinical AIDS.

Hematogenous Dissemination of Mycobacterium tuberculosis in Patients with AIDS

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.

Splenic Abscesses Due to Mycobacterium tuberculosis in Patients with AIDS: Is Splenectomy Necessary?

Splenic Abscesses Due to Mycobacterium tuberculosis in Patients with AIDS: Is Splenectomy Necessary?