Drug-resistant TB can be contained

Lessem, Erica; Keshavjee, Salmaan

doi:10.1038/506295c

Cited by 4 publications

(3 citation statements)

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“…Further analysis revealed that drug-resistant TBM patients had a tendency to unfavorable response to anti-TB therapy and poor prognosis compared to drug-susceptible patients. Drug resistant tuberculosis, especially MDR-TB, was associated with long-term and complicated treatment, poor prognosis, and severe sequel 25 , and it also takes a huge toll on patients and medical workers 26 . Therefore, clinicians should consider the possibility of infection of drug resistant tuberculosis when TBM patients presented with heavier, recurrent condition, or the duration of delayed healing.…”

Section: Discussionmentioning

confidence: 99%

Clinical features, Outcomes and Molecular Profiles of Drug Resistance in Tuberculous Meningitis in non-HIV Patients

Zhang

et al. 2016

Sci Rep

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Tuberculous meningitis continues to be a serious problem for physicians because it is difficult to make an early diagnosis and the consequences of delaying treatment are severe. The objective of this study is to provide data for the optimization of diagnostic and timely treatment of tuberculous meningitis. Of the 401 human immunodeficiency virus (HIV)-negative tuberculous meningitis patients in our study, 332 were found to have an impaired blood brain barrier (82.8%). Nearly 17.0% of patients failed to be timely diagnosed. Headache (53.6%) and fever (48.6%) were the most common features, and Computed Tomography/Magnetic Resonance Imaging (CT/MRI) detected 96 patients (23.9%) with abnormal meningeal imaging. Cerebrospinal fluid real-time polymerase chain reaction was positive in 73.8% of the tuberculous meningitis patients, whereas, smears and cultures detected only 6.7% and 5.2%, respectively. Further analysis identified striking differences between drug-resistant and drug-susceptible tuberculous meningitis. Patients with drug resistance correlated with grave prognosis. Tuberculous meningitis diagnosis should overall embody clinical symptoms, laboratory and cerebral imaging findings, and more sensitive diagnostic approaches are still warranted. Our data suggest cerebrospinal fluid polymerase chain reaction for mycobacterial DNA and molecular drug susceptibility testing as routine assays for suspected tuberculous meningitis patients, and observation of the blood brain barrier function could be performed for individual management.

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Section: Discussionmentioning

confidence: 99%

Clinical features, Outcomes and Molecular Profiles of Drug Resistance in Tuberculous Meningitis in non-HIV Patients

Zhang

et al. 2016

Sci Rep

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“…Findings from this study emphasize the need for an increased focus on patient‐centred care and integration across specialities. In line with recent publications and recommendations [2,9,24–26], this should include offering all patients with TB an HIV test, regularly screening HIV‐positive patients for TB, making OST and rapid TB diagnostics available in HIV/TB treatment centres, and finally ensuring that adequate anti‐TB treatment and cART are widely available and initiated in a timely fashion. Linking regional differences in the organization and availability of HIV/TB health care described here to treatment outcomes is crucial for future care and warrants further analyses.…”

Section: Conclusion and Study Implicationsmentioning

confidence: 99%

Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

et al. 2015

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Objectives The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). Methods Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. Results Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). Conclusions Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.

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“…Drug-resistant TB, particularly MDR-TB, was associated with long-term and complicated treatment, poor prognosis, and severe sequels, 17 – 18 , 29 in addition to imposing a tremendous emotional burden on patients and medical workers. 30 Therefore, clinicians should consider the possible diagnosis of drug-resistant TB when UTB patients complain of heavier, retreated disease or delayed healing. In such cases, conducting DSTs immediately is advised.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China

Hu²,

Shi

et al. 2016

Medicine

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To investigate the epidemiology, clinical features, and drug-resistance profile of urinary tuberculosis (UTB) in south-western China to improve UTB diagnostics.After the screening of 1036 cases of suspected UTB, 193 patients with UTB were enrolled during 2009 to 2014. Urine samples were collected for routine urinalysis, smear, tuberculosis DNA (TB-DNA) detection, and drug-resistant analysis, whereas blood samples were collected for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and renal function evaluation. Clinical features (such as symptoms and outcome) and imageology results (such as B ultrasonic, computerized tomography, intravenous pyelography, and renography) were also collected and analyzed to investigate the epidemiology, clinical features, and drug-resistance profile.The most common presenting symptoms were urinary irritation (61.1%) and lumbago (49.2%). High proportions of microscopic hematuria (63.2%) and microscopic proteinuria (45.6%) were also observed. The positive rate for TB-DNA was 66.3%. The positive rate for culture was 13.1% and for smear it was 9.8%. The abnormal outcome rates of the computerized tomography, ultrasonography, intravenous pyelography, and the nephrogram were 76.9%, 70.1%, 29.8%, and 37.0%, respectively. The total rate of drug-resistant TB (resistant to at least 1 drug) was 39.7%, of which 20.7% was multidrug-resistance TB. The most prevalent mutation sites were katG S315T1, rpoB S531L, and gyrA D94G.We observed a serious epidemic of drug-resistant UTB and a substantial number of new UTB cases with multidrug resistance TB. Molecular diagnostics is crucial in the definite diagnosis of UTB, and our finding is a supplement and further confirmation of polymerase chain reaction usage for TB diagnosis. We recommend real-time polymerase chain reaction for TB-DNA identification instead of culture, and GenoType tests (MTBDRplus and MTBDRsl assay) for drug resistance as routine assays for patients with suspected UTB.

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Drug-resistant TB can be contained

Cited by 4 publications

References 0 publications

Clinical features, Outcomes and Molecular Profiles of Drug Resistance in Tuberculous Meningitis in non-HIV Patients

Clinical features, Outcomes and Molecular Profiles of Drug Resistance in Tuberculous Meningitis in non-HIV Patients

Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

Clinical Features and Drug-Resistance Profile of Urinary Tuberculosis in South-Western China

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