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PubMedDate not supplied

Effect of valsartan on renal handling of uric acid in healthy subjects.

OBJECTIVE: To evaluate the effect of valsartan on renal handling of uric acid in healthy subjects. METHODS: A randomized, single-blind, placebo-controlled clinical trial was performed in twelve healthy volunteers. Six received a morning dose of valsartan 80 mg orally during 14 to 21 days and the other six received placebo. Before and after valsartan or placebo, clearance, fractional excretion and excretion uric acid rates were calculated. Presecretory reabsorption, tubular secretion and postsecretory reabsorption of uric acid were assessed by pharmacological tests using pyrazinamide or probenecid. RESULTS: There were no differences in clearance, fractional excretion and excretion uric acid rates with valsartan and placebo. Valsartan did not affect presecretory reabsorption (p = 0.92), tubular secretion (p = 0.62) or postsecretory reabsorption (p = 0.52) of uric acid. CONCLUSION: Valsartan did not significantly affect renal handling of uric acid in healthy subjects.

Adult↗
PubMed2000

Effect of combined therapy of oral anti-tubercular agents on theophylline pharmacokinetics.

To evaluate the effects of combined therapy of anti-tubercular agents with theophylline during treatment of concurrent pulmonary tuberculosis and chronic obstructive pulmonary disease or asthma, the clearance and half life of theophylline was estimated in a control group not treated with anti-tubercular agents, a group treated with isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide (PZA), and a group treated with INH, RMP and EMB. Clearances of theophylline in the treated groups were significantly lower than in the control group, and the half-life of theophylline was longer than in the control. These results suggest that patients administered combinations of anti-tubercular agents with theophylline require lower doses of theophylline.

Antitubercular Agents↗
PubMed2000

[The role of bacteriology in the treatment of tuberculosis; the Hungarian program].

A positive result of the bacteriological examination of Mycobacterium tuberculosis is signal to start treatment. The response to antituberculosis chemotherapy in patients with positive bacteriology is best evaluated by repeated examinations. The recommendation of the Hungarian National Tuberculosis Programme for the initial intensive phase of chemotherapy of previously untreated patients is based on the frequency of primoresistance determined by the National Reference Laboratory. The treatment of multidrug resistant tuberculosis can be supported by the result of previous susceptibility test and/or by the outcome of multicenter validated Bactec 460 susceptibility test of second-line antimicrobial drugs. The presence of a mutation within a gen is predictive of rifampicin resistance of M. tuberculosis. The results are available within 48 h. 92.4% of rifampicin resistant and nearly 100% of pyrazinamid resistant isolates in the Reference Laboratory were resistant to isoniazid. On the other hand streptomycin resistant strains were susceptible to amikacin in a rate of 38:1. Some rifampicin resistant strains are susceptible to rifabutin. The Reference Laboratory observed among the first that some ofloxacin resistant strains are susceptible to ciprofloxacin. It was the first which demonstrated effectivity of amikacin in the treatment of pulmonary tuberculosis. It was drawn attention to the importance of the PAS infusion therapy of multidrug resistant tuberculosis cases by observing bacteriological conversion.

Antibiotics, Antitubercular↗
PubMed2000

[A case of multidrug-resistant pulmonary tuberculosis].

A 44-year-old woman with multidrug-resistant pulmonary tuberculosis was admitted to our hospital in August 1998. She had been treated with the anti-tuberculosis agents isoniazid (INH), rifampicin (RFP), pyrazinamide and streptomycin (SM) for two months. However, tubercule bacilli found in a sputum culture on admission showed resistance to INH, RFP and SM, and so these agents were replaced with kanamycin (KM), ethionamide, cycloserine and levofloxacin. Unfortunately, the bacilli persisted in the sputum smears, and the patient complained of prolonged pain in the sites of intramuscular injection of KM. In January 1999, inhalation of KM was begun, resulting in the disappearance of the bacilli from the sputum and in improvements in chest radiographs. Inhalation of KM could be an effective therapy, with fewer adverse effects, in cases of multidrug-resistant pulmonary tuberculosis.

Administration, Inhalation↗
PubMed2000

Efficacy of an unsupervised 8-month rifampicin-containing regimen for the treatment of pulmonary tuberculosis in HIV-infected adults. Uganda-Case Western Reserve University Research Collaboration.

SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. OBJECTIVE: To assess the efficacy of a daily, self-administered 8-month rifampicin-containing regimen for the treatment of pulmonary tuberculosis (TB) in human immunodeficiency virus (HIV) infected adults. DESIGN: Treatment outcomes in patients with pulmonary TB treated with a single 8-month regimen and followed in a prospective epidemiological study. RESULTS: Two hundred and sixty-five HIV-infected and 26 non-HIV-infected adults with initial episodes of pulmonary tuberculosis were treated with 2 months of daily isoniazid (INH), rifampicin (RMP), ethambutol and pyrazinamide followed by 6 months of daily INH + RMP. Median follow-up was 17.8 months. Ninety-five per cent of the HIV-infected and all of the non-HIV-infected patients who had sputum examined were sputum culture negative after 2 months of treatment. Twenty-two HIV-infected and no non-HIV-infected patients died during treatment. Relapse rates were 8.4% (5.9 per 100 person-years of observation [PYO], 95%CI 3.2-8.6) among HIV-infected patients and 4.5% (2.1/100 PYO, 95%CI 0-7.8) for non-HIV-infected patients. Adverse drug reactions occurred in 37% of the HIV-infected patients; most were minor and self-limiting. CONCLUSION: An 8-month RMP-containing regimen was well tolerated and effective in the treatment of HIV-infected adults with initial episodes of pulmonary TB. Relapse rates were similar to those reported with 6-month short-course regimens in HIV-infected individuals. Decisions about the duration of anti-tuberculosis treatment for HIV-infected adults must balance programme resources and the likelihood of poor compliance with longer regimens with the potential for a modest decrease in relapses with longer treatment.

AIDS-Related Opportunistic Infections↗
PubMed2000

[A case of psoas cold abscess in a young tuberculosis patient].

A 28-year-old man was referred to our hospital with a complaint of painful induration of right epididymis accompanied with right back pain and persistent low-grade fever. He was finally diagnosed with tuberculosis by sputum culture. Abdominal computed tomography (CT) revealed right psoas abscess and vertebral caries. He underwent a percutaneous drainage of the abscess followed by multidrug (streptomycin, pyrazinamide, refanpicin, isoniazide) combination therapy. Immediately after the drainage, symptoms began to improve with these therapies. However, four months later, abdominal CT showed a worsening of the abscess. Recently there is a stagnation in the decline of incidence of tuberculosis. It is still necessary to examine young people carefully bearing urogenital tuberculosis in mind. The pathogenesis and management of this rare condition are discussed.

Adult↗
PubMed2000

Scrofula revisited: an update on the diagnosis and management of tuberculosis of superficial lymph nodes.

Lymph node tuberculosis is a disease of great antiquity. It is the commonest form of extra-pulmonary tuberculosis, and is probably the commonest cause of chronic lymphadenitis in children. Even after the advent of effective chemotherapy for tuberculosis, it still poses considerable problems in diagnosis and management. The disease usually presents as a painless lymphadenopathy of the superficial lymph nodes of insidious onset, which may proceed to abscess and sinus formation if neglected. Cervical nodes are most commonly affected, but multiple node involvement is common. Differential diagnosis include other infections, neoplasia, congenital conditions in the head and neck and rarely, drug reactions. Diagnosis, whenever feasible, should be made on the basis of histological evidence after lymph node biopsy. Diagnosis made on clinical grounds has poor specificity and will result in a great degree of over diagnosis. Recently, the role of fine needle aspiration cytology as an initial screening procedure has been recognized. The Tuberculosis Research Centre carried out the first clinical trial which established the efficacy of short course chemotherapy in the treatment of childhood lymph node tuberculosis. In 168 children with biopsy confirmed lymph node tuberculosis treated with an intermittent six month regimen, the cure rate after five years was 95%. The Revised National Tuberculosis Control Programme recommends that patients with lymph node tuberculosis (Category 3) should be treated with rifampicin and isoniazid three times a week for six months, with pyrazinamide for the first two months.

Antitubercular Agents↗
PubMed2001

[Two children with extrapulmonary symptoms due to tuberculosis].

Two patients came to their general practitioner for relatively minor problems: a 4-year-old boy came with a red eye and a 10-year-old girl with red foot soles. They came from Pakistan and Vietnam respectively. Their symptoms were due to tuberculosis, which diagnosis was established by Mantoux test and culture of a stomach aspirate. They were treated accordingly with isoniazid, rifampicin and pyrazinamide and with isoniazid, rifampicin and ethambutol respectively. These cases stress the importance of knowledge of the extrapulmonary manifestations of tuberculosis. As treatment exists and adequate treatment can diminish the reservoir of tuberculosis bacteria, early diagnosis can prevent the morbidity, spread and mortality of tuberculosis.

Antitubercular Agents↗
PubMedDate not supplied

Mycobacteria: treatment approaches and mechanisms of resistance.

First-line drugs for tuberculosis treatment include isoniazid, rifampin, ethambutol, streptomycin, and pyrazinamide. Molecular mechanisms for resistance to each of these drugs have been elucidated. In every case, resistance is conferred by mutations in existing genes, not by the acquisition of new genetic material. Drug resistance is a major problem worldwide, but the rates vary widely among countries and within countries. Acquired resistance in previously-treated patients is much more common than primary resistance in patients with no previous treatment. High rates of acquired resistance have been reported from referral centers in Saudi Arabia and Lebanon. Successful TB treatment requires prolonged therapy with at least two active drugs. Directly-observed therapy (DOT) improves success rates and reduces the risk of acquired resistance. TB due to susceptible strains can be cured in over 95% of cases.

Adult↗
PubMed2001

Low rate of emergence of drug resistance in sputum positive patients treated with short course chemotherapy.

SETTING: Tuberculosis Research Centre, Chennai. OBJECTIVE: To study the emergence of drug resistance during treatment and relapse among sputum positive pulmonary tuberculosis patients treated with short-course chemotherapy regimens. DESIGN: Retrospective analysis of randomised clinical trials using the following regimens: 2HRZE7/6HE7, 2HRZE2/4HRE2, 2HRZE3/4HR2 and 3HRZE3/3HR2. Emergence of resistance was analysed in patients with unfavourable response/relapse based on culture and susceptibility reports. RESULTS: Of 1817 patients studied, 1435 (79%) had susceptible strains prior to treatment; 2% of these had an unfavourable response, 7% relapsed and 1% had emergence of resistance to isoniazid, rifampicin, or both. In 320 patients with initial isoniazid resistance, 19% had an unfavourable response and 13% relapsed, while resistance to rifampicin emerged in 11%. Treatment outcomes were similar whether patients received three or two drugs in the continuation phase. Data on resistance to ethambutol and pyrazinamide were not available. CONCLUSION: In this study, the overall emergence of resistance to rifampicin occurred in only 2% of patients, despite the high level (18%) of initial resistance to isoniazid. Thus, standardised short-course treatment carries only a minimal risk of emergence of rifampicin resistance.

Antitubercular Agents↗
PubMed2000

[Repeated deterioration of tuberculous meningitis due to a reduction in the corticosteroid dosage during chemotherapy].

A 17-year-old man with a high fever, confusion and neck stiffness was diagnosed to have tuberculous meningitis, and was immediately placed on prednisolone (40 mg/day) as well as standard antituberculosis drugs (isoniazid, rifampicin and pyrazinamide). The clinical symptoms improved rapidly and the number of cerebrospinal fluid(CSF) cells decreased from 1837/mm3 on admission to 76/mm3 on the 7th day. Thereafter the dosage of prednisolone was gradually reduced. As a result, however increased nuchal rigidity, papilloedema and an increase in the number of CSF cells of 934/mm3 were all observed on the 35th day. Prednisolone thus again administered at the original dosage and the patient quickly showed a clinical improvement. CSF cells decreased to 271/mm3 on the 70th day. When prednisolone was again tapered down, increased nuchal rigidity, abducent nerve palsy and papilloedema appeared again with a marked increase in the number of CSF cells of 1309/mm3 on the 91th day. Therefore, we continued to treat the patient with prednisolone, in addition to the standard antituberculosis treatment, at a dose of 80 mg/day and tapered off very slowly over six months. This treatment resulted in a marked recovery with no recurrence. In this case, prednisolone was indispensable for treating tuberculous meningitis in combination with appropriate antituberculosis drugs, though the role of corticosteroids has remained controversial over the years. This case might be an example of paradoxical progression in tuberculous meningitis.

Adolescent↗
PubMed2001

[Bronchiolo-alveolar cell carcinoma arising after active pulmonary tuberculosis' report of two cases].

We report on two patients diagnosed as having active pulmonary tuberculosis who later developed lung cancer. In both cases, the lung cancer was detected during the treatment of pulmonary tuberculosis. Both patients were initially considered to be experiencing exacerbation of pulmonary tuberculosis. Case 1 was seen in a 74-year-old man. His chest roentgenogram revealed microscopic cavitary lesions with infiltration into both lung fields. His sputum tested positive for acid-fast bacilli. Although he was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide (PZA), his general condition deteriorated, and the infiltrative shadows in the lung fields had expanded on subsequent chest radiography. Transbronchial lung biopsy (TBLB) yielded findings compatible with a diagnosis of bronchiolo-alveolar cell carcinoma. Case 2 occurred in a 52-year-old man. His chest radiograph revealed cavitary lesions with infiltration into both lung fields. His sputum also tested positive for acidfast bacilli. Despite medication with INH, RFP, EB and PZA, the infiltrative shadow in his chest radiograph increased in size. Bronchiolo-alveolar cell carcinoma was confirmed after examination of the sputum cytology. Case 1 was diagnosed as lung cancer 10 months after being admission to the hospital, and Case 2, seven months after hospitalization. Recent discussion concerning the simultaneous occurrence of pulmonary tuberculosis and bronchogenic carcinoma suggests a high frequency of coexistence of the two diseases. However, the coexistence of active tuberculosis with bronchiolo-alveolar cell carcinoma, as in our cases, is rare.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2001

[A case of intracranial tuberculoma early diagnosed by open brain biopsy].

A 31-year-old man suffered from cough, sputum, slight fever, and loss of consciousness. He was tentatively diagnosed as epilepsy, and was transferred to our hospital. Brain CT demonstrated multiple intracranial lesions, which were homogeneously enhanced. Chest X-ray revealed retiform shadow in the right middle lung field. Pulmonary tuberculosis and intracranial tuberculomas were suspected and bacterial cultures, PCR, smear examination of sputum, blood, CSF, gastric juice, and urine were repeated. But no evidence of tuberculosis was obtained. Follow-up CT after 5 days of admission showed exacerbation of intracranial lesions. Finally, the open brain biopsy was carefully done from the right occipital lesion. The histological examination disclosed a typical pathology of tuberculoma and PCR also turned out to be positive from the brain tissue. We diagnosed him as intracranial tuberculoma and anti-tuberculous drugs(isoniazid, ethambutol, pyrazinamide) were administered. After 30 days under the medication, brain CT demonstrated a transient expansion of the intracranial lesions. While the same therapy was sustained, intracranial lesions gradually decreased and he discharged after 60 days of admission. Brain CT is known as a powerful tool for the diagnosis of intracranial tuberculoma. Its sensitivity is almost 100%, but some clinical reports have described that its specificity is not always so high(20-71%) as expected. In addition, it should be recognized that intracranial tuberculoma might show 'paradoxical expansion'. It is a phenomenon, which shows a paradoxical worsening in clinical aspect despite of the appropriate therapy. In such a progressing case as ours, it is desirable to make a definite diagnosis before anti-tuberculous drug is started. Therefore, it is recommended in possible cases to even consider the open brain biopsy from the early period when intracranial tuberculoma is highly suspected.

Adult↗
PubMedDate not supplied

[Ileocecal tuberculosis during hemodialysis simulating carcinoma of the colon].

Extrapulmonary tuberculosis is more frequent in hemodialysis patients than in the general population but intestinal localization is an unusual presentation of this infectious disease. We report a 60 year old patient on regular hemodialysis with intestinal tuberculosis masquerading as colon cancer. The patient presented with rectal bleeding, abdominal pain and fever and the radiological findings were compatible with ileocecal carcinoma. After surgery histological examination showed non-caseating granulomas but mycobacterial culture was not available. We performed a colonoscopy and obtained a biopsy of colonic mucosa for culture and other analyses. We identified acid-fast bacilli with Ziehl-Neelsen staining of formaldehyde preserved, paraffin-embedded tissue from the hemicolectomy and the colonic mucosal biopsy. Treatment with isoniazid, rifampicin and pyrazinamide for nine months was successful and well tolerated. Intestinal tuberculosis is a rare entity that we must keep in mind in a patient with abdominal pain, unexplained fever, digestive bleeding and particularly with a positive tuberculin reaction. When culture is not possible we can obtain intestinal samples by colonoscopy and use appropriate staining of paraffin-embedded tissues.

Adenocarcinoma↗
PubMed2000

Primary drug resistance pattern of mycobacterium tuberculosis in Dhaka, Bangladesh.

One thousand two hundred and eighty one clinically suspected untreated patients with pulmonary tuberculosis were studied from an urban tuberculosis clinic in Dhaka. Majority of the 1281 patients (77.6%) were from the age group of 14 to 44 years. Sputum, 106 (8.3%) were found positive for mycobacteria (both by Ziehl-Neelsen smear staining and culture to consider those as confirmed cases of mycobacterial infection. Out of these 106 cases, 101 (95.3%) were identified as M. tuberculosis and the rest 5 (4.7%) as Non-tuberculous Mycobacteria (NTM). Among the 101 M. tuberculosis strains, 30 (29.7%) were resistant to at least one drug; 16 (15.8%); to isoniazid, 11 (10.9%) to rifampicin, 07 (6.9%) to streptomycin, 03 (2.9%) to ethambutol and 04 (3.9%) to pyrazinamide. Multi-drug resistant tuberculosis (MDR-TB) was found in 5 (4.95%) cases. 5 (4.95%) cases were resistant to two drugs and 3 (2.97%) cases to three drugs. Ciprofloxacin was tested against 30 strains of M. tuberculosis; 2 (6.67%) of which were resistant. This is the first report of ciprofloxacin resistant Mycobacterium tuberculosis from Bangladesh. All the 5 strains of NTM tested for said 5 anti-tuberculous drugs, were found resistant to more than one.

Adolescent↗
PubMed2001

[Two cases of exercise-induced acute renal failure with idiopathic renal hypouricemia].

Acute renal failure without oliguria developed in a 25-year-old male and a 19-year-old male after exercise. Marked hypouricemia became apparent during improvement of their renal function. Increased excretion of uric acid into the urine, increased fractional excretion of uric acid(clearance ratio of uric acid against creatinine), and normal concentration of plasma xanthine and hypoxanthine were observed in both cases. Probenecid and pyrazinamide loading test suggesting decreased reabsorption of uric acid in the proximal convoluted tubules revealed that presecretory reabsorption defect of uric acid resulted in the hypouricemia in both cases. These two cases were diagnosed as having idiopathic renal hypouricemia.

Acute Kidney Injury↗
PubMed2001

Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994-1999.

UNLABELLED: This study evaluated the clinical characteristics of childhood and adolescent tuberculosis (TB) at the end of the twentieth century in a referral children's hospital in northern Taiwan. The hospital charts were reviewed retrospectively of children/adolescents aged less than 18 y who were seen in a children's hospital in northern Taiwan between 1994 and 1999 and diagnosed with TB. A total of 62 individuals was diagnosed during this period. The patients' demographic data, presenting symptoms, clinical features, bacteriological results, drug susceptibility and tuberculin skin-test results were analysed. Most diagnosed cases lay in one of two main age ranges, younger than 5 y and adolescents. The presenting symptoms of study subjects were typically non-specific. Bone involvement occurred for 21 patients (33.9%) and was the most common extrapulmonary manifestation. Mycobacterium tuberculosis was isolated from 47 patients (75.8%). Five isolates were resistant to pyrazinamide, three to streptomycin and one to isoniazid, but no multidrug resistant isolates of TB were detected from culture-proven cases. Seventeen of 47 (36.2%) culture-proven patients revealed negative acid-fast staining initially but, subsequently, M. tuberculosis was isolated from various clinical specimens using a standard method at a later date. The tuberculin skin test was positive for 24 of 32 patients (75%) who received such an examination. CONCLUSION: Extrathoracic TB was more common in children below 5 y of age than their adolescent counterparts, and chiefly involved the peripheral long bones. The potential drug resistance of M. tuberculosis in childhood and adolescent TB did not appear to have been a major problem in northern Taiwan before the year 2000.

Adolescent↗
PubMedDate not supplied

[Multiple intracranial tuberculomas in infancy].

INTRODUCTION: Tuberculous involvement of the CNS is most frequent in children aged between 6 months and 6 years, although it may occur at any age. It may present as meningoencephalitis, basal arachnoiditis or intracranial tuberculomas. Whilst meningitis is typical of infancy, tuberculomas and arachnoiditis are commoner in adults. It has been estimated that tuberculomas make up 3% of the cases of neurotuberculosis. The increasing use of CAT and MR has been a great help for diagnosis of this serious complication of tuberculosis. CLINICAL CASE: A 5 month old patient presented with tuberculous meningitis which had been treated with streptomycin, isoniazid, pyrazinamide and rifampicin at the usual dosage. One month later, after good initial progress, triventricular hydrocephaly was diagnosed and a ventriculoperitoneal shunt inserted. Three months after this, there was an episode of intracranial hypertension. Cranial CAT showed considerable zones of hypodense parenchyma without ventricle dilatation. On MR there were multiple, disseminated, rounded areas which were hyperintense on T2 and compatible with intracranial tuberculomas. After fresh insertion of a ventricular shunt, the patient progressed but still had a residual right hemiparesia and retarded development. CONCLUSIONS: Although intracranial tuberculomas usually occur in adults, they may be seen in children following meningoencephalitis. Occasionally, following a good initial response to tuberculostatic drugs, tuberculomas appear, although not present before, as happened in our patient. This usually occurs within the first three months, and although the mechanism is unknown, it is believed to be due to the accumulation of lymphocytes and macrophages at preexisting microscopic foci when treatment is started.

Female↗