11 research outputs found
Management of emerging multidrug-resistant tuberculosis in a low-prevalence setting
AbstractMultidrug-resistant (MDR) tuberculosis (TB) is an emerging concern in communities with a low TB prevalence and a high standard of public health. Twenty-three consecutive adult MDR TB patients who were treated at our institution between 2007 and 2013 were reviewed for demographic characteristics and anti-TB treatment management, which included surgical procedures and long-term patient follow-up. This report of our experience emphasizes the need for an individualized approach as MDR TB brings mycobacterial disease management to a higher level of expertise, and for a balance to be found between international current guidelines and patient-tailored treatment strategies
Asymptomatic prostatic tuberculous abscess in an immunocompetent 54-year-old man with peritoneal tuberculosis
International audienc
Severe laryngeal and pulmonary tuberculosis under anti-TNF-α therapy
International audienc
Clinical Presentation, Diagnosis, and Bacterial Epidemiology of Peritoneal Tuberculosis in Two University Hospitals in France
International audienceINTRODUCTION: Diagnosis of peritoneal tuberculosis (pTB) is difficult, even in developed countries, where data are lacking. The aim of the present study was to describe the clinical presentation, diagnosis, and bacterial epidemiology of pTB in France over a 10-year period. METHODS: A retrospective study was conducted on pTB in two university hospitals in France, between January 2004 and December 2014. RESULTS: Among the 34 patients, 76.5% were migrants from areas of endemic tuberculosis (TB), mainly Africa. The main presentation (85.3%) was a checkup of ascites or suspicion of peritoneal carcinomatosis. On abdominal computed tomography, ascites was found in 90.6% and peritoneal thickening in 75%. Surgery was required for diagnosis in 58.8% of patients. Six of the patients who did not undergo surgery had ultrasound-guided peritoneal biopsy. Bacteriology was positive for ascites in only 58.1% of cases, for peritoneal biopsy in 73.3%, while granuloma was found in 95.5%. TB polymerase chain reaction (PCR) was positive in 25% of peritoneal biopsy. Mycobacterium bovis was isolated in 23.1% of cases and Mycobacterium tuberculosis in 76.9%. Isolates were fully susceptible (except M.~bovis naturally resistant to pyrazinamide). Many (38%) belonged to the lineage T (genetic analysis by spoligotyping). Cure rate was high (76.5%), after a 6-9~months of anti-tuberculous therapy. CONCLUSION: In developed countries, early diagnosis of pTB is still a challenge. Ultrasound-guided peritoneal biopsy may facilitate diagnosis. TB PCR can be useful on peritoneal biopsy. The lineage T was the most prevalent lineage, but more data are required to directly incriminate this lineage in the pathophysiology of pTB
Enfants au contact dâindividus atteints dâune tuberculose multi-rĂ©sistante : quelles stratĂ©gies adopter ? Analyse de 46 enfants contacts et revue de la littĂ©rature
International audienceINTRODUCTION: Tuberculosis-related morbidity and mortality remain important. Emergence and diffusion of multidrug-resistance tuberculosis (MDR-TB) is a global public health concern. Cases of MDR-TB in children are a sentinel event indicating the spread of a mycobacterial strain within a community. Latent TB precedes MDR-TB and screening and follow-up of contact individuals are key points of TB infection control. METHODS: We performed the case-investigation of 20 adult cases of MDR-TB managed in our institution. RESULTS: Forty-six pediatric contact individuals were identified. A high proportion of these children were lost to follow-up (80% at 12 months), showing that monitoring this reservoir population with migrant history is challenging. Five (11%) children presented a secondary infection: one child was diagnosed with active TB infection (positive tuberculin skin test associated with abnormalities on chest computer tomography [CT] scan). Four children were diagnosed with latent TB infection (isolated positive tuberculin skin test with normal CT scan). Two of these children received a treatment adjusted to the strain of the index case. DISCUSSION: In the setting of emerging MDR-TB, tuberculin skin test may be likely replaced by specific interferon-gamma release assays (IGRA), independent of prior BCG vaccination. In addition, chest CT scan is preferred to chest X-ray to detect TB lesions. The management of latent TB infection is controversial: immediate treatment with second-line anti-TB drugs adapted to the index case strain or, consistently with WHO guidelines, a simple follow-up with subsequent treatment in case of active TB.IntroductionMalgrĂ© une incidence en lente dĂ©croissance, la morbi-mortalitĂ© de la tuberculose (TB) reste importante. LâĂ©mergence et la diffusion de souches multi-rĂ©sistantes (MR) constituent actuellement un problĂšme mondial majeur de santĂ© publique. Les cas pĂ©diatriques de TB-MR sont un Ă©vĂšnement sentinelle indiquant une circulation de souches au sein dâune communautĂ©. Lâinfection tuberculeuse latente (ITL) prĂ©cĂšde les cas de TB-MR. La dĂ©tection et le suivi des sujets contacts sont des axes clĂ©s de la lutte anti-TB.MĂ©thodesAutour de 20 cas adultes atteints de TB-MR pris en charge dans notre institution 46 enfants contacts ont Ă©tĂ© recensĂ©s.RĂ©sultatsDurant le suivi, le nombre dâenfants perdus de vue Ă©tait Ă©levĂ© (80 % Ă 1 an) attestant de la difficultĂ© de suivre une jeune population « rĂ©servoir » issue de lâimmigration. Le taux dâincidence dâune infection tuberculeuse secondaire Ă©tait de 11 % : un enfant a dĂ©veloppĂ© une TB-maladie (virage tuberculinique associĂ© Ă des anomalies tomodensitomĂ©triques thoraciques) ; quatre enfants ont dĂ©veloppĂ© une ITL (virage tuberculinique Ă tomodensitomĂ©trie thoracique normale). Deux enfants ont reçu un traitement adaptĂ© Ă la souche du cas index (prĂ©ventif ou curatif).DiscussionDans ce contexte dâĂ©mergence de la TB-MR, la substitution de lâIDR par les tests de libĂ©ration dâinterfĂ©ron (TLI), aussi sensibles et plus spĂ©cifiques (indĂ©pendants du BCG), semble pertinente. De mĂȘme, la TDM thoracique optimise la dĂ©tection de lĂ©sions infra-radiographiques. La stratĂ©gie de traitement de lâITL en post-exposition dâune TB-MR avec une combinaison adaptĂ©e Ă la souche du cas index est dĂ©battue au profit dâune stratĂ©gie proposĂ©e par lâOMS de surveillance prolongĂ©e avec traitement curatif dâune TB active le cas Ă©chĂ©ant
Clinical Presentation, Diagnosis, and Bacterial Epidemiology of Peritoneal Tuberculosis in Two University Hospitals in France
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Linezolid in the Starter Combination for Multidrug-Resistant Tuberculosis: Time to Move on to Group Four?
International audienceLinezolid (LNZ), a group 5 antituberculous drug (unclear efficacy), was used in the starter regimens of 23 adults with multidrug-resistant tuberculosis. The LNZ-containing regimens were effective in achieving culture conversions and relapse-free outcomes. The most frequent LNZ-related side effect was neuropathy. We propose that LNZ should be reclassified among bactericidal second-line drugs