Linfadenitis y absceso subcutáneo por Complejo Mycobacterium avium como manifestación de síndrome inflamatorio de reconstitución inmune luego de un segundo esquema de terapia antirretroviral de gran actividad

El síndrome inflamatorio de reconstitución inmune (SIRI) es una reacción atípica e inesperada relacionada con el tratamiento antirretroviral de gran actividad (TARGA) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). El SIRI representa una respuesta inflamatoria frente a un patógeno oportunista (generalmente Mycobacterium tuberculosis, Complejo Mycobacterium avium, citomegalovirus y herpes varicela-zóster) en pacientes que responden a la TARGA con una marcada reducción de la carga viral en plasma y evidencia de una recuperación inmunológica expresada por el incremento de los niveles de linfocitos T CD4+. Presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida que desarrolló un absceso subcutáneo en muslo derecho y una adenitis supraclavicular izquierda como manifestación de SIRI por Complejo Mycobacterium avium luego del inicio de un segundo esquema de TARGA.Immune reconstitution inflammatory syndrome (IRIS) is an atypical and unexpected reaction related to highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients. IRIS includes an atypical response to an opportunistic pathogen (generally Mycobacterium tuberculosis, Mycobacterium avium complex, cytomegalovirus and herpes varicella-zoster), in patients responding to HAART with a reduction of plasma viral load and evidence of immune restoration based on increase of CD4+ T-cell count. We reported a case of a patient with AIDS which, after a first failure of HAART, developed a subcutaneous abscess and supraclavicular lymphadenitis as an expression of IRIS due to Mycobacterium avium complex after starting a second scheme of HAART

Outbreaks of mycobacterium tuberculosis MDR strains induce high IL-17 T-cell response in patients with MDR tuberculosis that is closely associated with high antigen load

Fil: Basile, Juan I. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: Geffner, Laura J. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: Romero, María M. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: Balboa, Luciana. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: Sabio y García, Carmen. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: Ritacco, Viviana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: García, Ana. Hospital Muñíz. Instituto de Tisioneumonologías; Argentina.Fil: Cuffré, Mónica. Hospital Muñíz. Instituto de Tisioneumonologías; Argentina.Fil: Abbate, Eduardo. Hospital Muñíz. Instituto de Tisioneumonologías; Argentina.Fil: López, Beatriz. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Barrera, Lucía. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Ambroggi, Marta. Hospital Muñíz. Instituto de Tisioneumonologías; Argentina.Fil: Alemán, Mercedes. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: Sasiain, María C. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Fil: de la Barrera, Silvia S. Academia Nacional de Medicina. Instituto de Investigaciones Hematológicas Mariano R. Castex; Argentina.Background. The proinflammatory cytokine interleukin 17 (IL-17) plays an important role in immune responses but it is also associated with tissue-damaging inflammation. So, we evaluated the ability of Mycobacterium tuberculosis clinical isolates to induce IL-17 in tuberculosis (TB) patients and in healthy human tuberculin reactors (PPD1HD). Methods. IL-17, interferon c (IFN-c), and interleukin 23 (IL-23) receptor expression were evaluated ex vivo and cultured peripheral blood mononuclear cells from TB and PPD1HD stimulated with irradiated clinical isolates from multidrug resistant (MDR) outbreaks M (Haarlem family) and Ra (Latin American–Mediterranean family), as well as drug-susceptible isolates belonging to the same families and laboratory strain H37Rv for 48 hours in T-cell subsets by flow cytometry. Results. We observed that: (1) MDR strains M and Ra are stronger IL-17 inducers than drug-susceptible Mtb strains of the Haarlem and Latin American–Mediterranean families, (2) MDR-TB patients show the highest IL-17 expression that is independent on the strain, (3) IL-17 expression is dependent on CD41 and CD81 T cells associates with persistently high antigen load. Conclusions. IL-17–producing T cells could play an immunopathological role in MDR-TB promoting severe tissue damage, which may be associated with the low effectiveness of the second-line drugs employed in the treatment

Drug Susceptibility Testing of Mycobacterium tuberculosis by a Nitrate Reductase Assay Applied Directly on Microscopy-Positive Sputum Samples

Current methods for drug susceptibility testing of Mycobacterium tuberculosis are either costly or slow. As the prevalence of multidrug-resistant strains increases, the need for fast, reliable, and inexpensive methods that can also be applied in settings with scarce resources is obvious. We evaluated a rapid colorimetric nitrate reductase assay (NRA) for direct drug susceptibility testing of M. tuberculosis directly from clinical sputum samples with positive microscopy results for acid-fast bacilli with more than 10 acid-fast bacilli per high-power field. We have saved valuable time by omitting the preisolation step. The sensitivity (ability to detect true drug resistance) and specificity (ability to detect true drug susceptibility) of the direct NRA, using the direct proportion method as the reference, were 100 and 100%, 93 and 100%, 76 and 100%, and 55 and 99% for rifampin, isoniazid, streptomycin, and ethambutol, respectively, when tested on M. tuberculosis strains present in 121 samples. The results were in most cases available in 14 days. The direct NRA could be used as a rapid, inexpensive, and accurate method to determine rifampin and isoniazid susceptibility directly from sputum. The technique might become a valid alternative to traditional methods, especially in low-income countries

Molecular Epidemiology of Mycobacterium tuberculosis, Buenos Aires, Argentina

To analyze the molecular epidemiology of Mycobacterium tuberculosis strains at a hospital in Buenos Aires, Argentina, and mutations related to multidrug-resistant and extensively drug-resistant tuberculosis, we conducted a prospective case–control study. Our findings reinforce the value of incorporating already standardized molecular methods for rapidly detecting resistance

Muitidrug-resistant tuberculosis in aids patients at the beginning of the millennium

Fil: Palmero, Domingo. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Ritacco, Viviana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Ambroggi, Marta. Hospital de Enfermedades Infecciosas Francisco Javier Muñiz. Laboratorio de Bacteriología de la Tuberculosis A. Cetrángolo; Argentina.Fil: Poggi, Susana. Hospital de Enfermedades Infecciosas Francisco Javier Muñiz. Laboratorio de Bacteriología de la Tuberculosis A. Cetrángolo; Argentina.Fil: Güemes Gurtubay, Jose L. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Alberti, Federico. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Waisman, Jaime. Sala 19; Argentina.La tuberculosis multirresistente (TBMR) asociada al sida emergió durante los años 90 en varios países del mundo. En Argentina, el brote más importante se originó en el Hospital Muñiz y sus consecuencias persisten hasta ahora. Con el objeto de evaluar la situación de la TBMR en este hospital, analizamos las características clínico-demográfico-epidemiológicas de los 53 pacientes masculinos con TBMR/sida internados por primera vez en el trienio 2001-2003 con relación al genotipo del polimorfismo de longitud de fragmentos de restricción (RFLP) IS6110 de los aislamientos. La edad promedio de los pacientes fue 32 años, 37 (70%) residían en el conurbano bonaerense, 36 (68%) eran usuarios de drogas ilícitas y 14 (26.4%) tenían antecedentes carcelarios. El 88% presentó grave inmunodepresión (CD4+<100/µl) y el 58.5% falleció. La mortalidad se asoció a baja adherencia al tratamiento y a comorbilidades, pero no a enfermedad por Mycobacterium tuberculosis cepa “M”, causante del brote original. De los 40 casos analizados por RFLP, 29 (72.5%) conformaron clusters y 24 presentaban el genotipo “M”. La resistencia a 5 o 6 drogas resultó un indicador de enfermedad por esa cepa. El genotipo “M” se asoció significativamente a internaciones previas en el Hospital Muñiz o encarcelamiento. En síntesis, 14 años después de ocurrido el primer caso de TBMR/sida, se constata la persistencia y predominancia en el hospital de la cepa responsable del brote. Se requiere una intensificación de las medidas de control de la diseminación institucional de la tuberculosis para consolidar la tendencia decreciente de la TBMR observada en el país en la última década. Aids-related multidrug-resistant tuberculosis (MDRTB) emerged during the 90s in several countries around the world. In Argentina, the most notorious outbreak was documented in the Hospital Muñiz, which is still undergoing its aftermaths. In order to evaluate the situation in this hospital regarding MDRTB, we analysed clinical, demographic and epidemiological traits of the 53 male MDRTB-aids patients admitted during 2001-2003 at a ward especially dedicated to their isolation. Patients’ mean age was 32 years, 70% lived in Buenos Aires suburbs. A history of illicit drug users or imprisonment was recorded in 68% and 26% of the patients, respectively. Severe immunodepression (CD4+ count <100/µl) was found in 88% of the patients and 58% died. Mortality was associated with non-adherence to treatment and co-morbidity, but not with the genotype of the “M” strain, responsible for the original outbreak. Of 40 cases available for restriction fragment length polymorphism (RFLP), 29 (72.5%) resulted in cluster. RFLP patterns of 24 matched the “M” genotype. In this study, resistance to 5 or 6 drugs was found to be an indicator of disease due to the “M” strain. The “M” genotype associated significantly to previous admission at the Hospital Muñiz or imprisonment. In brief, 14 years after the detection of the first MDRTB-aids case, we report here the persistence and predominance of the original outbreak strain at the hospital. Stronger TB infection control measures are urgently needed in hospitals and jails in order to strengthen the declining trend of the MDRTB observed in our country towards the end of the last decade

Muitidrug-resistant tuberculosis in aids patients at the beginning of the millennium

Fil: Palmero, Domingo. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Ritacco, Viviana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Ambroggi, Marta. Hospital de Enfermedades Infecciosas Francisco Javier Muñiz. Laboratorio de Bacteriología de la Tuberculosis A. Cetrángolo; Argentina.Fil: Poggi, Susana. Hospital de Enfermedades Infecciosas Francisco Javier Muñiz. Laboratorio de Bacteriología de la Tuberculosis A. Cetrángolo; Argentina.Fil: Güemes Gurtubay, Jose L. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Alberti, Federico. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Waisman, Jaime. Sala 19; Argentina.La tuberculosis multirresistente (TBMR) asociada al sida emergió durante los años 90 en varios países del mundo. En Argentina, el brote más importante se originó en el Hospital Muñiz y sus consecuencias persisten hasta ahora. Con el objeto de evaluar la situación de la TBMR en este hospital, analizamos las características clínico-demográfico-epidemiológicas de los 53 pacientes masculinos con TBMR/sida internados por primera vez en el trienio 2001-2003 con relación al genotipo del polimorfismo de longitud de fragmentos de restricción (RFLP) IS6110 de los aislamientos. La edad promedio de los pacientes fue 32 años, 37 (70%) residían en el conurbano bonaerense, 36 (68%) eran usuarios de drogas ilícitas y 14 (26.4%) tenían antecedentes carcelarios. El 88% presentó grave inmunodepresión (CD4+<100/µl) y el 58.5% falleció. La mortalidad se asoció a baja adherencia al tratamiento y a comorbilidades, pero no a enfermedad por Mycobacterium tuberculosis cepa “M”, causante del brote original. De los 40 casos analizados por RFLP, 29 (72.5%) conformaron clusters y 24 presentaban el genotipo “M”. La resistencia a 5 o 6 drogas resultó un indicador de enfermedad por esa cepa. El genotipo “M” se asoció significativamente a internaciones previas en el Hospital Muñiz o encarcelamiento. En síntesis, 14 años después de ocurrido el primer caso de TBMR/sida, se constata la persistencia y predominancia en el hospital de la cepa responsable del brote. Se requiere una intensificación de las medidas de control de la diseminación institucional de la tuberculosis para consolidar la tendencia decreciente de la TBMR observada en el país en la última década. Aids-related multidrug-resistant tuberculosis (MDRTB) emerged during the 90s in several countries around the world. In Argentina, the most notorious outbreak was documented in the Hospital Muñiz, which is still undergoing its aftermaths. In order to evaluate the situation in this hospital regarding MDRTB, we analysed clinical, demographic and epidemiological traits of the 53 male MDRTB-aids patients admitted during 2001-2003 at a ward especially dedicated to their isolation. Patients’ mean age was 32 years, 70% lived in Buenos Aires suburbs. A history of illicit drug users or imprisonment was recorded in 68% and 26% of the patients, respectively. Severe immunodepression (CD4+ count <100/µl) was found in 88% of the patients and 58% died. Mortality was associated with non-adherence to treatment and co-morbidity, but not with the genotype of the “M” strain, responsible for the original outbreak. Of 40 cases available for restriction fragment length polymorphism (RFLP), 29 (72.5%) resulted in cluster. RFLP patterns of 24 matched the “M” genotype. In this study, resistance to 5 or 6 drugs was found to be an indicator of disease due to the “M” strain. The “M” genotype associated significantly to previous admission at the Hospital Muñiz or imprisonment. In brief, 14 years after the detection of the first MDRTB-aids case, we report here the persistence and predominance of the original outbreak strain at the hospital. Stronger TB infection control measures are urgently needed in hospitals and jails in order to strengthen the declining trend of the MDRTB observed in our country towards the end of the last decade