Lethal disseminated tuberculosis in patients under biological treatment – two clinical cases and a short review

Danteş, Elena; Tofolean, Doina Ecaterina; Fildan, Ariadna Petronela; Crăciun, Liviu; Dumea, Elena; Tofolean, Ioan Tiberiu; Mazilu, Laura

doi:10.1177/0300060518771273

Cited by 14 publications

(7 citation statements)

References 26 publications

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“…Drug resistant TB represents, all over the world, even in countries with a low burden of TB [14], a significant health problem and a real epidemiological challenge in obtaining reliable information on the real prevalence and spectrum of MTB resistant strains among TB patients. Delayed diagnosis of TB and/or severe comorbidities can have an important unfavourable impact on the survival [15][16][17]. In the particular case of MDR-TB, the delayed diagnosis of MDR-TB can influence dramatically the outcomes of any TB control program.…”

Section: Resultsmentioning

confidence: 99%

The Prevalence and Spectrum of Mycobacterium Tuberculosis Chemoresistance Among Tb Patients

Fildan¹

2020

FARMACIA

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Rapid detection of Mycobacterium tuberculosis (MTB) chemoresistance against anti-tuberculosis drugs is a major challenge of any Pulmonology department. The aim of the study was to synthesize the epidemiological features of multidrug resistant (MDR), rifampicin resistant (RR) or extensively drug resistant (XDR) TB, for estimating the extent of MTB resistance pattern and severity of tuberculosis (TB) disease. Between 1 st of March 2013 to 31 st of December 2017, all 1,643 inpatients with positive diagnosis of pulmonary TB active disease were evaluated by specific methods consisting in phenotypic and genotypic investigation of MTB strains. The frequency and pattern of MTB resistance to anti-TB drugs were assessed. The prevalence of MDR-TB was low (1.95%). Delayed diagnosis of MDR-TB was frequent (71.87%) and more common in active smokers (53.12%), unemployed and uninsured patients. The secondary pattern of chemoresistance was prevalent (62.5%), but primary resistance pattern of MTB was related to younger individuals mean aged 38 years (p < 0.03). The prevalent broad-spectrum of MTB resistance against first line of anti-TB drugs was noticed in majority of cases (87.5%), with the predominance of isoniazid (H) and rifampicin (R) pattern (53.1%), and supplementary gaining XDR profile. Although MDR-TB prevalence was low and HR pattern dominated the spectrum of MTB resistance, the progressive extension of MDR to XDR profile of resistance occurred. RezumatDetectarea rapidă a chimiorezistenței dezvoltate de Mycobacterium tuberculosis (MTB) la medicamentele antituberculoase este o provocare majoră pentru orice departament de pneumologie. Scopul studiului a fost evaluarea caracteristicilor epidemiologice ale tuberculozei multirezistente (TB-MDR), rifampicin rezistente (RR) sau extensiv rezistente (XDR), necesitând conturarea profilului chimiorezistenței și severității bolii tuberculoase. Intre 1 Martie 2013 si 31 Decembrie 2017, toate cazurile de TB pulmonara spitalizate si confirmate bacteriologic (n = 1.643) au fost evaluate prin metode fenotipice si genotipice. Au fost determinate frecvența și profilul chimiorezistenței MTB. Prevalența TB-MDR a fost scăzută (1,95%). Diagnosticul TB-MDR a fost frecvent tardiv (71,87%), mai ales la fumătorii activi (53.12%), persoane neasigurate și fără ocupație. Modelul chimiorezistenței secundare al MTB predomină (62,5%), iar chimiorezistența primară se asociază cu vârsta medie tânără (sub 38 ani) a adulților (p < 0,03). Prevalența crescută a chimiorezistenței la medicamentele antiTB de prima linie a fost observată la majoritatea cazurilor (87,5%), cu predominanța rezistenței la izoniazidă (H) și rifampicină ( R) (53,1%) și dobândirea chimiorezistenței extensive (XDR). Deși prevalența TB-MDR e redusă și HR domină spectrul chimiorezistenței, survine extensia progresivă de la MDR la XDR.

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Section: Resultsmentioning

confidence: 99%

The Prevalence and Spectrum of Mycobacterium Tuberculosis Chemoresistance Among Tb Patients

Fildan¹

2020

FARMACIA

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“…In some diseases like boutoneuse fever, shigella or salmonella, evolution is related with environmental factors (21)(22)(23)(24), in other diseases evolution is related with outbreaks that can appear in absence of vaccination (25)(26)(27)(28). In other diseases like TB or HIV evolution and mortality changed over the years according with early or late diagnosis and also with availability and adherence of specific treatment (29)(30)(31)(32)(33)(34). If, at the onset of the HIV pandemic, both physicians and patients were concerned only with prolonged survival, as this was achieved through complex treatment and specialized care, new clinical and therapeutic challenges are emerging for these patients.…”

Section: Discussionmentioning

confidence: 99%

Remission of progressive multifocal leukoencephalopathy in HIV- positive patient after multidisciplinary rehabilitation: a case report

Dumea

Mihai²,

Mavrodin³

et al. 2020

BALNEO

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Introduction: One of the most common neurologic disease in Acquired Immunodeficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus (HIV) is represented by progressive multifocal leukoencephalopathy (PML), being caused by John Cunningham (JC) polyoma virus. Case presentation: We report a case of a 27 years old women, HIV-positive since childhood, under specific antiretroviral therapy with good adherence to it in that period but starting with adolescence adherence to highly active antiretroviral therapy (HAART) decreased. In this context her HIV viral load increased to a 690.000 copies/ml, and CD4 collapsed at 57 cells/mmc. She presented in our clinic with ataxic left hemiparesis, truncal ataxia and left hemi-hypoesthesia. Cerebrospinal fluid (CSF) showed a slightly pleocytosis and polymerase chain reaction performed from CSF diagnosed John Cunningham (JC) virus. Once diagnosis established, we reinitiated HAART, but some neurologic disorders persisted like difficulty of the left upper member, having the modified Rankin scale (mRS) of 5. The patient started a multidisciplinary rehabilitation (MDR) treatment, specifically adapted. It consisted of 4 sessions of neuromotor treatments, 20 sessions of massages, and 12 sessions of occupational therapy. According to MDR, the patient improved the ataxic walking, without support, presenting an improvement mRS of 3. Conclusions: AIDS patients with PML could require a prolonged MDR treatment for neurological disorders and rehabilitation treatment promptly should be applied when such diagnosis is suspected. Key words: progressive multifocal leukoencephalopathy, human immunodeficiency virus, neurological disorder, multidisciplinary rehabilitation,

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“…4 Indeed, while disseminated TB is fairly common in patients receiving TNF-a inhibitors, in this first case of ATBI during an anti-IL-23 antibody the presentation was quite different, with a cavitary pulmonary TB. 1,5 It may be advantageous to choose an IL-17 or IL-23 inhibitor for the treatment of psoriasis in regions where TB is endemic or in high-risk populations. Nevertheless, our case reinforces that screening for TB before and during biological therapy should continue regardless of biological class, especially in countries with a high prevalence of this infection.…”

Section: Cavitary Pulmonary Tuberculosis During Treatment With Guselk...mentioning

confidence: 99%

Cavitary pulmonary tuberculosis during treatment with guselkumab

Cerejeira

Canelas

Vide

et al. 2022

Acad Dermatol Venereol

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Lethal disseminated tuberculosis in patients under biological treatment – two clinical cases and a short review

Cited by 14 publications

References 26 publications

The Prevalence and Spectrum of Mycobacterium Tuberculosis Chemoresistance Among Tb Patients

The Prevalence and Spectrum of Mycobacterium Tuberculosis Chemoresistance Among Tb Patients

Remission of progressive multifocal leukoencephalopathy in HIV- positive patient after multidisciplinary rehabilitation: a case report

Cavitary pulmonary tuberculosis during treatment with guselkumab

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