Pulmonary tuberculosis in a patient with cystic fibrosis

Respiratory Medicine Case Reports

Beebe

Chaudhury³

et al. 2015

Self Cite

Mycobacterium tuberculosis (MTB) and human immunodeficiency virus (HIV) coinfection remains a global public health challenge. We report a 40 year old African American male who is a known HIV-positive patient, non-compliant with his antiretrovirals and developed pulmonary tuberculosis. His chief complaints were chronic cough, fever, night sweats and undocumented weight loss. He had a prior positive T-SPOT-TB test; however, chest radiograph and sputum smear examination revealed normal results. PCR-based GeneXPERT MTB/RIF assay was ordered and confirmed MTB infection. The sputum cultures grew MTB and sensitivities showed susceptibility to all primary anti-tuberculosis medications. A delay in diagnosis and initiation of MTB therapy, in the setting of HIV or AIDS, may result in rapid disease progression and worse clinical outcome.

Section: Discussionmentioning

confidence: 99%

Mycobacterium tuberculosis infection in a HIV-positive patient

Respiratory Medicine Case Reports

Beebe

Chaudhury³

et al. 2015

Self Cite

“…In 2013, the Food and Drug Administration (FDA) in the U.S. approved the GeneXpert MTB/RIF assay (Cepheid Inc., Sunnyvale, CA, USA), a NAAT-based diagnostic platform. WHO endorsed the use of this assay as the initial test for TB diagnosis in PLHIV or who are suspected of multidrug-resistant TB (MDR-TB) and has since been extensively used ( 41 – 44 ). The cost of the test, despite being subsidized, has been a barrier in many TB endemic countries to be used as a first line diagnostic tool.…”

Section: Diagnosis Of Mycobacterium Tuberculosis Imentioning

confidence: 99%

“…However, this possible advantage of delayed ART must be weighed against the potential benefit of earlier ART in improving immune function and preventing progression of HIV disease and mortality. Importantly, immune reconstitution with ART may result in unmasking LTBI (i.e., conversion of a previously negative TST to a positive TST or a positive IGRA for MTB-specific proteins) ( 44 ). A positive IGRA, similar to a positive TST, is indicative of LTBI in the absence of evidence of active TB disease.…”

Section: Complications Arising Out Of Therapy For Hiv–mtb Coinfectionmentioning

confidence: 99%

HIV-Associated TB Syndemic: A Growing Clinical Challenge Worldwide

Chaudhury

Beebe

et al. 2015

Front. Public Health

Self Cite

The association of tuberculosis (TB) with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome over the past several years has become an emerging syndemic. Approximately 10% of people living with HIV (PLHIV) with latent TB infection will develop active TB disease each year. In this review, we highlight that this phenomenon is not limited to high endemic regions, such as Afro-Asian nations, but globalization/migration is causing increased case detection even in developed nations, such as the United States. Active screening should be performed for TB in PLHIV. A high degree of clinical suspicion for TB is warranted in PLHIV presenting with fever, cough, and unintentional weight loss. HIV–Mycobacterium tuberculosis (MTB) coinfection is often paucibacillary, precluding diagnosis by conventional diagnostics and/or smear microscopy/culture. Improved detection of pulmonary and extrapulmonary TB is now possible by incorporation of the GeneXPERT MTB/RIF assay (Cepheid Inc., Sunnyvale, CA, USA). The World Health Organization recommends instituting immediate therapy for MTB, in conjunction with ongoing or newly introduced anti-retroviral therapy. Vigilance is required to detect drug-induced organ injuries, and early-treatment-induced immune reconstitution inflammatory syndrome. Collaborating MTB and HIV activities in concentrated HIV epidemic settings should become a high public health priority.

“…However, despite having multiple risk factors such as malnutrition, diabetes mellitus, steroid use and chronic lung disease, MTB is rarely seen among CF patients [4] , [6] . The etiology for this rarity is not well defined, but several pathways have been suggested that point to a genetic component of the disease or a defect in enzyme activity [7] , [8] . It was reported in one study that carriers of this recessive gene are resistant to Mycobacterium tuberculosis infection, which is attributed to the production of excessive amounts of hyaluronic acid in these individuals [8] .…”

Section: Discussionmentioning

confidence: 99%

“…It is recommended that molecular drug susceptibility testing of the initial MTB isolate be conducted for all patients and should be repeated at three months if no significant clinical improvement is observed [15] . Failure to complete MTB therapy is associated with high recurrence rate and drug resistance, thus ensuring medication compliance of all patients with MTB infection is essential [7] .…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis reinfection in a pregnant cystic fibrosis patient

Marco

Respiratory Medicine Case Reports

Mittadodla

et al. 2015

Self Cite

Cystic Fibrosis (CF) is a multisystem disease predominantly affecting the airways and predisposing patients to recurrent infections with various multidrug resistant organisms. Mycobacterium tuberculosis (MTB) infection is rarely seen, but considered a potential pathogen in CF patients. We report a 26 year old pregnant CF patient on Ivacaftor who was admitted with symptoms suggestive of tuberculosis. Three years prior to the current admission, she had completed four drug anti- MTB therapy for pulmonary tuberculosis and was considered cured as her sputum cultures after six months of treatment were negative. Genotype analysis revealed the current MTB strain to be different from the strain causing the previous infection. After receiving first line anti-tuberculous regimen for nine months, the patient's condition markedly improved culminating in an uneventful pregnancy and delivery. To our knowledge, this is the only reported case of reinfection tuberculosis in a CF patient.