Search PubMed⌕ Search

Biomedical subjects

C M Nolan

Publications and source records attributed to C M Nolan.

At least 37 records · Page 2Linked to original sources
PubMed1997

Comparison of sensitivities to two commercially available tuberculin skin test reagents in persons with recent tuberculosis.

Discrepancies have been reported between results obtained with tuberculin skin tests (TSTs) performed with use of different reagents. We compared TST results and determined the sensitivities of the two commercially available TSTs in 51 human immunodeficiency virus-negative persons with culture-confirmed active tuberculosis. Simultaneous TSTs were done with use of the Mantoux method and 5-tuberculin unit purified protein derivative (PPD) tuberculin preparations from single lots of Aplisol and Tubersol. Aplisol skin test reactions ranged from 5 mm to 26 mm (median, 16.0 mm), and Tubersol reactions ranged from 7 mm to 23 mm (median, 15.0 mm). The mean difference in paired reaction sizes for the two reagents was 0.58 mm and was not statistically different from zero (P value, 0.26). The difference in reaction sizes was < or =2 mm in 55% and > or =5 mm in 18% of patients. With a cutoff of either 5 mm or 10 mm to define a positive reaction, all results were concordant, with sensitivity of 100% and 96%, respectively. We found indistinguishable reaction size distributions and median TST results for the two commercially available PPD TST reagents, Aplisol and Tubersol, in a population with recent culture-proven tuberculosis.

Adult↗
PubMed1997

Directly observed isoniazid preventive therapy for released jail inmates.

This study was designed to determine whether an integrated screening program could be implemented that identified persons with latent tuberculosis infection among jail inmates and produced a high rate of completion of isoniazid preventive therapy (IPT) in those persons after their discharge from short-term detention, by means of community-based directly observed preventive therapy (DOPT). From June 1, 1992 through December 31, 1994 inmates in the King County Jail who were from populations at high risk of tuberculosis were screened by means of the tuberculin skin test and those with latent tuberculosis infection were offered IPT. Among 262 inmates receiving IPT upon release from jail, 105 (40%) could not be located after release. Among another 105 enrolled on DOPT, 63 (60%) completed therapy. Among 52 who chose self-supervised isoniazid therapy after release, 15 (29%) completed therapy (chi-square = 13.50, p = 0.0002). Among persons with latent tuberculosis infection detected during screening at a county jail, a postrelease DOPT program resulted in a high rate of immediate loss to follow-up and a low rate of completion of therapy. Based on these results, we suggest that funds for TB control, if limited, should not be diverted to jail-based screening and postrelease DOPT.

Adult↗
PubMed1997

Tuberculosis prevention among foreign-born persons in Seattle--King County, Washington.

The purpose of this study was to evaluate the outcomes of classified immigrant and refugee (I&R) screening and of contact investigation (CI) of foreign-born TB cases in Seattle--King County (SKC), Washington. We reviewed I&R evaluations from the SKC TB clinic for 1992-1994 and contact evaluation records for 54 randomly selected U.S.-born and foreign-born pulmonary TB patients from 1993. Among 942 I&R evaluated, 693 (74%) had positive tuberculin skin tests (TST). Preventive therapy (PT) was prescribed for 324 (34%) and treatment for 49 (5%). The remaining 377 were dismissed, of whom 96% did not meet American Thoracic Society PT criteria. Contacts of foreign-born cases were more numerous (6.0 versus 3.4 per case, p = 0.04), and significantly more likely to be TST-positive (50% versus 18%) and to be started on PT (40% versus 23%). The large number of I&R eligible for treatment or PT emphasizes the benefit of prompt evaluation of new arrivals. CI provides an excellent opportunity to screen foreign-born persons at high risk for active TB.

Contact Tracing↗
PubMed1997

Evaluation of the MycoDot test for the diagnosis of tuberculosis in HIV seropositive and seronegative patients.

SETTING: Patients were recruited from Siriraj, Bamrasnaradura, and Central Chest Hospitals, the three major hospitals responsible for tuberculosis patients in Bangkok, Thailand, and vicinity. OBJECTIVE: To evaluate a new rapid serologic test, the MycoDot test, for diagnosis of tuberculosis (TB). DESIGN: The study was conducted as a cross-sectional survey. A total of 594 patients were tested with the MycoDot test. This included 142 human immunodeficiency virus (HIV) seropositive patients with active TB, 144 HIV seronegative patients with active TB, 153 HIV seropositive controls, and 155 HIV seronegative controls. RESULTS: The sensitivity of the MycoDot test for detection of TB was 40.1% in HIV seropositive patients, compared with 63.2% in HIV seronegative patients (P < 0.001). If only patients with laboratory proven TB were evaluated, the sensitivity was 40.6% in seropositive and in 70.8% seronegative patients. The sensitivity of the MycoDot test was similar in TB patients with pulmonary and extra-pulmonary disease. The sensitivity of the test in patients with CD4 counts > or = 200 cells/mm3 was significantly higher than in those with CD4 counts < 200 cells/mm3. The specificity of the test was 97.4%, and was identical in HIV seropositive and seronegative individuals. CONCLUSION: The MycoDot test had a higher sensitivity for the diagnosis of TB among HIV seronegative than HIV seropositive patients. Although the MycoDot test has a less than optimal sensitivity, the test specificity approaches 100%. It may be useful in patients with suspected TB and negative smears and in extra-pulmonary TB.

AIDS-Related Opportunistic Infections↗
PubMed1995

Tuberculosis in relation to a history of peptic ulcer disease and treatment of gastric hyperacidity.

Previous studies described an excess of tuberculosis among persons with a history of partial gastrectomy for the treatment of peptic ulcer disease. It is unknown if any contemporary therapies for peptic ulcer disease, such as histamine type 2 antagonists and antacids, are also associated with elevated risks of tuberculosis. A case-control study was conducted during 1988-1990 in the Seattle-King County Tuberculosis Clinic to address these questions. Self-administered questionnaires were completed by 135 cases with active tuberculosis and 380 controls. A history of daily antacid use was reported by 11 cases (8%) and 23 controls (6%), corresponding to an adjusted odds ratio of 0.9 (95% confidence interval 0.4-2.0). A history of daily histamine type 2 antagonist use was reported by nine cases (7%) and 18 controls (5%) with an adjusted odds ratio of 0.8 (95% confidence interval 0.3-2.1). Our results, while based on a relatively small number of subjects, suggest that treatment for peptic ulcer disease has no influence on the occurrence of tuberculosis.

Adult↗
PubMed1995

Evolution of rifampin resistance in human immunodeficiency virus-associated tuberculosis.

Acquired rifampin resistance without preexisting isoniazid resistance is highly unusual in patients with tuberculosis. The purpose of this report is to describe and characterize that unusual pattern of acquired drug resistance in three patients with human immunodeficiency virus (HIV) infection. The patients originally had Mycobacterium tuberculosis strains that were susceptible to isoniazid and rifampin. During treatment in two patients and after completion of therapy in the remaining one, each patient developed active, rifampin-resistant, isoniazid-susceptible tuberculosis. One patient subsequently developed isoniazid resistance also. Studies on patients' M. tuberculosis isolates using IS6110 restriction fragment length polymorphism typing and rpoB gene sequencing indicated that rifampin resistance in each patient arose during therapy by an rpoB gene mutation in the original M. tuberculosis isolate. Detection of this unusual drug-resistance phenotype in three patients with HIV infection suggests that acquired rifampin resistance is somehow associated with co-infection due to HIV and tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed1994

New developments in tuberculosis and HIV infection: an opportunity for prevention.

As we approach 2010, the year by which we were to have eliminated TB, we find this ancient disease is making a comeback. This comeback is due to many factors, but the role of HIV infection is clearly important. HIV infection can result in changes in the pathogenesis and presentation of infection with the tubercle bacillus. Consequently, as health care providers, we must respond with changes in our usual methods of prevention, treatment, and infection control. Whereas the increase in TB is currently limited to certain geographic areas, it is likely to spread more widely. All health care providers should be aware of the changing face of TB and have a high clinical index of suspicion for this disease.

AIDS-Related Opportunistic Infections↗
PubMed1994

Restriction fragment length polymorphism analysis detecting a community-based tuberculosis outbreak among persons infected with human immunodeficiency virus.

Analysis of restriction fragment length polymorphisms (RFLP) was used to investigate an increase in tuberculosis (TB) among noninstitutionalized human immunodeficiency virus (HIV)-infected persons in King County, Washington. Using the IS6110 insertion sequence, RFLP analysis was done on Mycobacterium tuberculosis isolates from 18 HIV-infected patients and 10 randomly selected patients without HIV risk factors. Six HIV-infected patients with the same M. tuberculosis strain had contact at one or more of three bars as their only common exposure. Two other HIV-infected persons, a patient and a health care worker who had close contact, had matching strains. Isolates from the 10 remaining HIV-infected patients and the 10 patients without HIV risk factors had different DNA patterns. Analysis of RFLP patterns revealed a community outbreak of TB among HIV-infected persons who had not been previously linked following conventional investigation by the health department. This technique deserves further evaluation as an epidemiologic tool in the investigation of TB.

AIDS-Related Opportunistic Infections↗
PubMed1994

Characterization of rifampin-resistance in pathogenic mycobacteria.

The emergence of rifampin-resistant strains of pathogenic mycobacteria has threatened the usefulness of this drug in treating mycobacterial diseases. Critical to the treatment of individuals infected with resistant strains is the rapid identification of these strains directly from clinical specimens. It has been shown that resistance to rifampin in Mycobacterium tuberculosis and Mycobacterium leprae apparently involves mutations in the rpoB gene encoding the beta-subunit of the RNA polymerases of these species. DNA sequences were obtained from a 305-bp fragment of the rpoB gene from 110 rifampin-resistant and 10 rifampin-susceptible strains of M. tuberculosis from diverse geographical regions throughout the world. In 102 of 110 rifampin-resistant strains 16 mutations affecting 13 amino acids were observed. No mutations were observed in rifampin-susceptible strains. No association was found between particular mutations in the rpoB gene and drug susceptibility patterns of multidrug-resistant M. tuberculosis strains. Drug-resistant M. tuberculosis strains from the same outbreak and exhibiting the same IS6110 DNA fingerprint and drug susceptibility pattern contained the same mutation in the rpoB gene. However, mutations are not correlated with IS6110 profiling outside of epidemics. The evolution of rifampin resistance as a consequence of mutations in the rpoB gene was documented in a patient who developed rifampin resistance during the course of treatment. Rifampin-resistant strains of M. leprae, Mycobacterium avium, and Mycobacterium africanum contained mutations in the rpoB gene similar to that documented for M. tuberculosis. This information served as the basis for developing a rapid DNA diagnostic assay (PCR-heteroduplex formation) for the detection of rifampin susceptibility of M. tuberculosis.

Amino Acid Sequence↗
PubMed1994

Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug therapy for tuberculosis.

We report three patients who experienced hepatotoxic reactions in association with acetaminophen ingestion while undergoing treatment for active tuberculosis with isoniazid, rifampin, and other agents. All were young adult women. One patient intentionally took a large amount of acetaminophen and had typical signs and symptoms of acetaminophen overdosage; another took acetaminophen in combination form for a minor upper respiratory illness. She experienced no symptoms. The remaining patient took acetaminophen to ameliorate the symptoms of fever and malaise that were subsequently attributed to tuberculosis. She had the rapid onset of signs and symptoms of isoniazid hepatotoxicity. The patterns of liver function abnormalities were similar: each patient experienced pronounced serum elevations of hepatocellular enzymes with at most only modest rises in those of bilirubin. All antituberculous drugs were withheld until symptoms resolved and laboratory values became normal; then treatment for tuberculosis was resumed without isoniazid and was successfully completed in all three patients. These cases plus similar reports in the literature suggest that isoniazid or rifampin, or both, may potentiate the hepatotoxicity of acetaminophen, perhaps by induction of cytochrome P450 isozymes that oxidize acetaminophen to its toxic metabolites.

Acetaminophen↗
PubMed1994

Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990.

OBJECTIVES: Tuberculosis has become a resurgent public health problem in the United States. Because resources are limited, control programs frequently must target populations at greatest risk. The purpose of the study was to examine risk factors for tuberculosis in adults. METHODS: In King County, Washington State, from 1988 through 1990, the characteristics of patients with tuberculosis were compared with census data, and a case-control study was conducted. Self-administered questionnaires were completed by 151 patients with active tuberculosis and 545 control subjects. RESULTS: Infection with the human immunodeficiency virus, non-White race/ethnicity, and foreign birthplace were each associated with a sixfold or greater increase in risk. Each of the following was associated with at least a doubled risk: history of selected underlying medical conditions; low weight for height; low socioeconomic status; and age 70 years or older. Men had 1.9 times the risk of women, smokers of 20 years' or more duration had 2.6 times the risk of nonsmokers, and heavy alcohol consumers had 2.0 times the risk of nondrinkers. CONCLUSIONS: Intervention targeting easily identified groups may be an effective way to reduce the incidence of tuberculosis.

Adolescent↗