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

Coxitis due to multidrug-resistant mycobacterium tuberculosis in an HIV negative patient

Se presenta el caso de una paciente HIV negativa con artritis coxofemoral de etiología tuberculosa, cepa multirresistente, y colagenopatía asociada en tratamiento con glucocorticoides. Fue medicada con cicloserina, ácido p-aminosalicílico, etambutol y ofloxacina, mostrando regresión de sus lesiones articulares. Se efectúa una revisión de la literatura sobre el tema.A case of an HIV negative female patient with coxofemoral arthritis of tuberculous etiology, multidrugresistant strain, and connective tissue disease associated to glucocorticoid therapy is reported. The patient was treated with cycloserine, ethambutol, p-aminosalicylic acid and ofloxacin, with improvement of the joint lesions. Previous publications on this subject are reviewed.Fil: Palmero, Domingo J. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Simboli, Norberto. ANLIS Dr.C.G.Malbrán. Laboratorio de Micobacterias; Argentina.Fil: Alberti, Federico. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Francos, José L. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Guemes Gurtubay, Jose L. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Ochoa, Elio J. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Cardozo, Leonor. Hospital Argerich. Bacteriología; ArgentinaFil: Waisman, Jaime L. Hospital F.J. Muñiz. Sala 19; Argentina

Coxitis due to multidrug-resistant mycobacterium tuberculosis in an HIV negative patient

Se presenta el caso de una paciente HIV negativa con artritis coxofemoral de etiología tuberculosa, cepa multirresistente, y colagenopatía asociada en tratamiento con glucocorticoides. Fue medicada con cicloserina, ácido p-aminosalicílico, etambutol y ofloxacina, mostrando regresión de sus lesiones articulares. Se efectúa una revisión de la literatura sobre el tema.A case of an HIV negative female patient with coxofemoral arthritis of tuberculous etiology, multidrugresistant strain, and connective tissue disease associated to glucocorticoid therapy is reported. The patient was treated with cycloserine, ethambutol, p-aminosalicylic acid and ofloxacin, with improvement of the joint lesions. Previous publications on this subject are reviewed.Fil: Palmero, Domingo J. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Simboli, Norberto. ANLIS Dr.C.G.Malbrán. Laboratorio de Micobacterias; Argentina.Fil: Alberti, Federico. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Francos, José L. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Guemes Gurtubay, Jose L. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Ochoa, Elio J. Hospital F.J. Muñiz. Sala 19; Argentina.Fil: Cardozo, Leonor. Hospital Argerich. Bacteriología; ArgentinaFil: Waisman, Jaime L. Hospital F.J. Muñiz. Sala 19; Argentina

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN