Clinical and epidemiological studies from a tuberculosis referral center in The Netherlands

Contains fulltext : 112906.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 19 september 2013Promotor : Dekhuijzen, P.N.R. Co-promotores : Boeree, M.J., Aarnoutse, R.E

Training and performance self-efficacy, affect, and performance in wheelchair road racers

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Therapeutic drug monitoring in the treatment of tuberculosis patients.

Item does not contain fulltextAt the University Centre for Chronic Diseases Dekkerswald, a tertiary tuberculosis (TB) referral hospital in The Netherlands, therapeutic drug monitoring (TDM) is used in patients in case of relapse TB, when there is delayed response to TB treatment, and when abnormal TB drug concentrations are suspected for other reasons. In this article, a case series is presented to illustrate the value of individualized TB drug dosing in four patients with low TB drug concentrations. Increased doses of the TB drugs, especially of rifampicin, resulted in adequate peak plasma concentrations and improved clinical response to treatment in these patients, while no adverse events occurred.1 februari 201

Treatment and outcome of non-tuberculous mycobacterial pulmonary disease in a predominantly fibro-cavitary disease cohort

BACKGROUND: The incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) has increased in the Netherlands. The fibro-cavitary disease manifestation predominates, as elsewhere in Europe. We studied treatment and outcome of this disease manifestation, as such data are scarce. METHODS: We conducted a retrospective study of all patients diagnosed with NTM-PD according to the American Thoracic Society statement between 2008 and 2013 in a reference clinic. RESULTS: Sixty-three patients were included. Thirty-two (51%) were females and mean age was 60.8 years. Most patients had underlying COPD (73%). M. avium complex pulmonary disease (MAC-PD) was most frequent (n = 38, 60.3%), followed by M. malmoense (n = 7) and M. kansasii (n = 6). Twenty-two patients had fibro-cavitary MAC-PD, 14 had nodular-bronchiectatic MAC-PD and 2 had other manifestations. Thirty-two (94%) patients treated for MAC-PD received a rifamycin-ethambutol-macrolide based regimen. Microbiological cure rates were lower for fibro-cavitary (52.4%) than for nodular bronchiectatic MAC-PD (100%; p = 0.03). Sixty-nine percent of treated patients experienced adverse events, most frequently gastrointestinal discomforts (71%), tinnitus (18%), hearing impairment (16%) and hepatotoxicity (18%). CONCLUSIONS: Fibro-cavitary NTM-PD remains predominant, but is now diagnosed more frequently in women. Fibro-cavitary disease is harder to cure than nodular-bronchiectatic disease. Adverse events are frequent and can necessitate cessation of treatment

Hypersensitivity pneumonitis caused by Mycobacterium avium subsp. hominissuis in a hot tub, as proven by IS1245 RFLP and rep-PCR typing

Contains fulltext : 108179.pdf (publisher's version ) (Open Access

[Characteristics and treatment of tuberculosis patients in Dekkerswald, 2000-2005]

Contains fulltext : 69331.pdf (publisher's version ) (Closed access)OBJECTIVE: To describe the patient population in Dekkerswald, Nijmegen, one of two tuberculosis (TB) centres in The Netherlands. DESIGN: Descriptive, retrospective study. METHOD: Examination of medical records for all TB patients hospitalised between 2000 and 2005, including demographic, social, clinical and follow-up data. RESULTS: Data from 166 patients were analysed. Tertiary referrals accounted for 98% of all hospitalisations. Most patients (68%) were referred for clinical reasons, and 32% were referred for social reasons. Drug resistance was encountered in 23% of patients; 9% had multidrug-resistant TB. Ten percent of patients were seropositive for HIV. Toxicity and side-effects of treatment often led to changes in treatment (40%). Patients had pulmonary TB (59%), extrapulmonary TB (23%) or both (17%). Overall, 141 patients (85%) completed treatment. The TB-related mortality rate was 5%. CONCLUSION: In Dekkerswald, there is a selected patient population that is characterised by drug-resistance, comorbidity, side-effects, extrapulmonary disease and social issues. Due to the low prevalence of TB in The Netherlands, knowledge and experience regarding complex types of TB are limited. Centralisation of patient care is important to preserve and optimise this expertise

Prevalence of nontuberculous mycobacteria in COPD patients with exacerbations

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Surgical treatment of non-tuberculous mycobacterial lung disease: strike in time.

Contains fulltext : 89124.pdf (publisher's version ) (Closed access)SETTING: The Netherlands. OBJECTIVE: To describe our experiences with the adjunctive role and benefits of surgery for lung disease due to non-tuberculous mycobacteria (NTM), specifically addressing its indications and timing. DESIGN: Retrospective medical file review of eight patients who underwent surgical treatment for NTM lung disease in the period January 2000 to January 2009, and review of the available literature. RESULTS: Therapy-resistant cavitary NTM disease was the most frequent indication for surgery; two patients underwent pneumonectomy for an infected destroyed lung. Mycobacterium avium was the most common causative agent. Surgery resulted in culture conversion in seven patients; one patient died 2 months after pneumonectomy. No relapses have been noted in the other seven after an average of 19 months of follow-up. CONCLUSIONS: Adjunctive surgical treatment for NTM lung disease yields encouraging results, similar to previously published case series. Careful patient selection, based on extent and type of disease as well as on cardiopulmonary fitness, is important. Potential benefits of surgery should be considered for every individual patient in whom NTM lung disease is diagnosed and re-evaluated after 6 months of treatment. Where possible, surgery should be pursued and conducted in a timely fashion.1 januari 201

[Nontuberculous mycobacteria: clinically relevant].,Nontuberculous mycobacteria : clinically relevant

Contains fulltext : 87354.pdf (publisher's version ) (Closed access)The nontuberculous or atypical mycobacteria (NTM) are a group of largely opportunistic pathogens, which are increasingly being detected in patients and being associated with clinical disease. Various host factors are responsible for this, such as the ageing population with the accompanying increase in the number of patients with chronic diseases, but NTM are also detected more often as a result of improvements in diagnostic laboratory techniques. The clinical relevance, i.e. the percentage of patients in whom the detected NTM is actually the cause of the clinical disease, differs enormously per species. Pulmonary NTM disease, which resembles pulmonary tuberculosis, is the most frequent, followed by lymphadenitis in children. Treatment of these infections is time-consuming, complicated and often ineffective. Therefore, prompt consultation with one of the specialized centres of expertise is warranted. We should also consider formulating national guidelines for diagnosis and treatment

The antipsychotic thioridazine shows promising therapeutic activity in a mouse model of multidrug-resistant tuberculosis.

Multidrug- and extensively drug-resistant tuberculosis have emerged as grave threats to public health worldwide. Very few active drugs are available or likely to become available soon. To address these problems we revisited a classical observation, the applicability of phenothiazines as antimicrobial drugs. Within this pharmacological class we selected thioridazine, which is most efficacious and least toxic, when used as an antipsychotic drug. We tested thioridazine monotherapy in the Balb/c mouse model for its activity to treat both susceptible and multidrug-resistant tuberculosis by a two months daily oral administration of 32 and 70 mg/kg. In addition, we tested its additive value when combined with a standard first-line regimen for susceptible tuberculosis. Thioridazine treatment resulted in a significant reduction of colony-forming-units of the susceptible (-4.4 log CFU, p<0.05) and multidrug-resistant tuberculosis bacilli (-2.4 log CFU, p<0.009) in the lung both at one and two months after infection, compared to controls. Moreover, when thioridazine was added to a regimen containing rifampicin, isoniazid and pyrazinamide for susceptible tuberculosis, a significant synergistic effect was achieved (-6.2 vs -5.9 log CFU, p<0.01). Thioridazine may represent an effective compound for treatment of susceptible and multidrug-resistant tuberculosis. The phenothiazines and their targets represent interesting novel opportunities in the search for antituberculosis drugs