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Budong Chen - One of the best experts on this subject based on the ideXlab platform.

  • Primary Multidrug-Resistant Tuberculosis versus drug-sensitive Tuberculosis in non-HIV-infected patients: Comparisons of CT findings
    PloS one, 2017
    Co-Authors: Budong Chen
    Abstract:

    Background Multidrug-Resistant Tuberculosis has emerged as a global threat. The aim of this work was to compare the CT findings of primary Multidrug-Resistant Tuberculosis and drug-sensitive Tuberculosis in non-AIDS adults. Material and methods From January 2012 to February 2016, 89 patients with primary Multidrug-Resistant Tuberculosis were retrospectively reviewed, and 89 consecutive drug sensitive TB patients with no history of anti-tuberculous chemotherapy from January 2014 to November 2014 were enrolled as control group. All patients were seronegative for HIV. The patients’ demographic data and the locations, frequency and patterns of lung lesions on chest CT were compared. Results Gender and frequency of diabetes were similar between the two groups. The mean age of primary Multidrug-Resistant Tuberculosis patients was younger than that of drug-sensitive Tuberculosis (39.0 vs 47.5, P = 0.005). Lung cavitary nodules or masses were more frequently observed and also showed greater extent in primary Multidrug-Resistant Tuberculosis compared with drug-sensitive Tuberculosis. The extent of bronchiectasis was significantly greater in primary Multidrug-Resistant Tuberculosis than in drug-sensitive Tuberculosis. Calcification, large nodules and calcified lymph nodes were more frequent in drug-sensitive Tuberculosis. Conclusion Characteristic chest CT findings may help differentiate between primary multi-drug Resistant Tuberculosis and drug-sensitive Tuberculosis in patients without HIV infection.

Mercedes C. Becerra - One of the best experts on this subject based on the ideXlab platform.

  • time to culture conversion and regimen composition in Multidrug Resistant Tuberculosis treatment
    PLOS ONE, 2014
    Co-Authors: Dylan B Tierney, Cesar Bonilla, Felix Alcantara A Viru, Molly F. Franke, Mercedes C. Becerra, Epifanio Sanchez
    Abstract:

    Sputum cultures are an important tool in monitoring the response to Tuberculosis treatment, especially in Multidrug-Resistant Tuberculosis. There has, however, been little study of the effect of treatment regimen composition on culture conversion. Well-designed clinical trials of new anti-Tuberculosis drugs require this information to establish optimized background regimens for comparison. We conducted a retrospective cohort study to assess whether the use of an aggressive Multidrug-Resistant Tuberculosis regimen was associated with more rapid sputum culture conversion. We conducted Cox proportional-hazards analyses to examine the relationship between receipt of an aggressive regimen for the 14 prior consecutive days and sputum culture conversion. Sputum culture conversion was achieved in 519 (87.7%) of the 592 patients studied. Among patients who had sputum culture conversion, the median time to conversion was 59 days (IQR: 31–92). In 480 patients (92.5% of those with conversion), conversion occurred within the first six months of treatment. Exposure to an aggressive regimen was independently associated with sputum culture conversion during the first six months of treatment (HR: 1.36; 95% CI: 1.10, 1.69). Infection with human immunodeficiency virus (HR 3.36; 95% CI: 1.47, 7.72) and receiving less exposure to Tuberculosis treatment prior to the individualized Multidrug-Resistant Tuberculosis regimen (HR: 1.58; 95% CI: 1.28, 1.95) were also independently positively associated with conversion. Tachycardia (HR: 0.77; 95% CI: 0.61, 0.98) and respiratory difficulty (HR: 0.78; 95% CI: 0.62, 0.97) were independently associated with a lower rate of conversion. This study is the first demonstrating that the composition of the Multidrug-Resistant Tuberculosis treatment regimen influences the time to culture conversion. These results support the use of an aggressive regimen as the optimized background regimen in trials of new anti-TB drugs.

  • Community-based therapy for children with Multidrug-Resistant Tuberculosis.
    Pediatrics, 2006
    Co-Authors: Peter Drobac, Joia S. Mukherjee, J. Keith Joseph, Carole D. Mitnick, Jennifer Furin, Hernán Del Castillo, Sonya Shin, Mercedes C. Becerra
    Abstract:

    OBJECTIVES. The goals were to describe the management of Multidrug-Resistant Tuberculosis among children, to examine the tolerability of second-line antiTuberculosis agents among children, and to report the outcomes of children treated for Multidrug-Resistant Tuberculosis in poor urban communities in Lima, Peru, a city with high Tuberculosis prevalence. METHODS. A retrospective analysis of data for 38 children RESULTS. Forty-five percent of the children had malnutrition or anemia at the time of diagnosis, 29% had severe radiographic findings (defined as bilateral or cavitary disease), and 13% had extrapulmonary disease. Forty-five percent of the children were hospitalized initially because of the severity of illness. Adverse events were observed for 42% of the children, but no events required suspension of therapy for >5 days. Ninety-five percent of the children (36 of 38 children) achieved cures or probable cures, 1 child (2.5%) died, and 1 child (2.5%) defaulted from therapy. CONCLUSIONS. Multidrug-Resistant Tuberculosis disease among children can be treated successfully in resource-poor settings. Treatment is well tolerated by children, and severe adverse events with second-line agents are rare.

  • Community-Based Therapy for Multidrug-Resistant Tuberculosis in Lima, Peru
    The New England journal of medicine, 2003
    Co-Authors: Carole D. Mitnick, Mercedes C. Becerra, Jennifer Furin, Sonya Shin, Jaime Bayona, Eda Palacios, Felix Alcántara, E. Sánchez, Madeleny Sarria, Mary C. Smith Fawzi
    Abstract:

    Background Despite the prevalence of Multidrug-Resistant Tuberculosis in nearly all low-income countries surveyed, effective therapy has been deemed too expensive and considered not to be feasible outside referral centers. We evaluated the results of community-based therapy for Multidrug-Resistant Tuberculosis in a poor section of Lima, Peru. Methods We describe the first 75 patients to receive ambulatory treatment with individualized regimens for chronic Multidrug-Resistant Tuberculosis in northern Lima. We conducted a retrospective review of the charts of all patients enrolled in the program between August 1, 1996, and February 1, 1999, and identified predictors of poor outcomes. Results The infecting strains of Mycobacterium Tuberculosis were Resistant to a median of six drugs. Among the 66 patients who completed four or more months of therapy, 83 percent (55) were probably cured at the completion of treatment. Five of these 66 patients (8 percent) died while receiving therapy. Only one patient continu...

James M. Brown - One of the best experts on this subject based on the ideXlab platform.

  • SURGERY IN THE TREATMENT OF Multidrug-Resistant Tuberculosis
    Clinics in chest medicine, 1997
    Co-Authors: Marvin Pomerantz, James M. Brown
    Abstract:

    Resectional surgery is recommended for patients with localized Multidrug-Resistant Tuberculosis if adequate pulmonary reserve is present. Appropriate drug specific therapy is employed for approximately 3 months preoperatively and for 18 to 24 months postoperatively. Nutrition is emphasized both pre- and postoperatively. Technically, the use of bronchoscopy, double lumen endotracheal tubes, and muscle or omental flaps is stressed. With the above, cure rates should be better than 90%.

Yuji Shiraishi - One of the best experts on this subject based on the ideXlab platform.

  • Aggressive surgical treatment of Multidrug-Resistant Tuberculosis
    The Journal of thoracic and cardiovascular surgery, 2009
    Co-Authors: Yuji Shiraishi, Naoya Katsuragi, Hidefumi Kita, Yoshiaki Tominaga, Kota Kariatsumari, Takato Onda
    Abstract:

    Objective Because extensively drug-Resistant Tuberculosis has emerged, adequate control of drug-Resistant Tuberculosis has become increasingly important. We report on our experience using liberal adjuvant resectional surgery as part of aggressive treatment for Multidrug-Resistant Tuberculosis. Methods We retrospectively reviewed the records of 56 consecutive patients who underwent pulmonary resections for Multidrug-Resistant Tuberculosis between January 2000 and June 2007. There were 42 males and 14 females (mean age, 46 years; range, 22-64 years). Isolates were Resistant to a mean of 5.6 drugs (range, 2-10 drugs). Multi-drug regimens employing 3 to 7 drugs (mean, 4.6 drugs) were initiated in all patients. Indications for surgery were a high risk of relapse for 37 patients, persistent positive sputum for 18, and 1 with associated empyema. Results The 56 patients underwent 61 pulmonary resections (3 completion pneumonectomies, 19 pneumonectomies, 33 lobectomies, and 6 segmentectomies). Bronchial stumps were reinforced with muscle flaps in 54 resections. Operative mortality and morbidity rates were 0% and 16%, respectively. All patients attained postoperative sputum-negative status. Relapse occurred in 5 patients; 3 were converted by a second resection, and 1 responded to augmentation of chemotherapy. Late death occurred for 2 patients without evidence of relapse. Among 54 survivors, 53 (98%) were considered cured. Conclusion Surgical treatment that complements medical treatment has proved safe and efficacious for patients with Multidrug-Resistant Tuberculosis. In an era with extensively drug-Resistant Tuberculosis, an aggressive treatment approach to Multidrug-Resistant Tuberculosis continues to be justified until a panacea for this refractory disease is available.

  • Resectional surgery combined with chemotherapy remains the treatment of choice for Multidrug-Resistant Tuberculosis
    The Journal of thoracic and cardiovascular surgery, 2004
    Co-Authors: Yuji Shiraishi, Naoya Katsuragi, Yutsuki Nakajima, Makoto Kurai, Nobumasa Takahashi
    Abstract:

    Objective Multidrug-Resistant Tuberculosis remains a significant health problem. The best available treatment for Multidrug-Resistant Tuberculosis is the combination of pulmonary resection and antituberculous chemotherapy. We herein report the results of pulmonary resection combined with chemotherapy for Multidrug-Resistant Tuberculosis at our institution during the years 2000 through 2002. Methods Between 1983 and 2002, 87 patients underwent 95 pulmonary resections for Multidrug-Resistant Tuberculosis. Of these, the 30 (34%) patients operated on from January 1, 2000, to December 31, 2002, are reviewed in the present study. All patients were maintained on Multidrug regimens preoperatively and postoperatively. Indications for surgical intervention included persistently positive sputum and a high risk of relapse. Thirty-three pulmonary resections were performed, consisting of pneumonectomy (n = 12), lobectomy (n = 17), and segmentectomy (n = 4). The bronchial stump was reinforced with a latissimus dorsi muscle flap in 29 resections. Results There was no operative mortality. Bronchopleural fistulas occurred in 2 patients. Five patients had a space problem. All patients attained sputum-negative status after the operation. Relapse occurred in 3 patients: 2 had a relapse at the bronchial stump, and the remaining patient had a relapse in the postlobectomy space. One late death occurred. Of the 29 survivors, 27 (93%) were free from disease, with a median follow-up of 24 months (range, 8-47 months). Conclusions An increasing number of patients with Multidrug-Resistant Tuberculosis are requiring resectional surgery in the 21st century. Pulmonary resection combined with chemotherapy achieves high cure rates with acceptable morbidity and remains the treatment of choice for Multidrug-Resistant Tuberculosis.

Michael D Iseman - One of the best experts on this subject based on the ideXlab platform.

  • treatment and outcome analysis of 205 patients with Multidrug Resistant Tuberculosis
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Edward D Chan, Valerie Laurel, Matthew Strand, Julanie F Chan, Mailan N Huynh, Marian Goble, Michael D Iseman
    Abstract:

    Multidrug-Resistant Tuberculosis, a disease caused by Mycobacterium Tuberculosis strains that are Resistant at least to rifampin and isoniazid, entails extended treatment, expensive and toxic regimens, and higher rates of treatment failure and death. We retrospectively analyzed the outcomes in 205 patients treated at our center for Multidrug-Resistant Tuberculosis, with strains Resistant to a median of six drugs, and compared the results with those of our previous series. Logistic regression and survival analysis were used to evaluate short- and long-term outcomes, respectively. Initial favorable response, defined as at least three consecutive negative sputum cultures over a period of at least 3 months, was 85% compared with 65% in the prior cohort. The current cohort had greater long-term success rates, 75% versus 56%, and lower Tuberculosis death rates, 12% versus 22%, than the earlier one. Surgical resection and fluoroquinolone therapy were associated with improved microbiological and clinical outcomes in the 205 patients studied after adjusting for other variables. The improvement was statistically significant for surgery and among older patients for fluoroquinolone therapy.

  • treatment of Multidrug Resistant Tuberculosis
    The New England Journal of Medicine, 1993
    Co-Authors: Michael D Iseman
    Abstract:

    The modern era of effective Tuberculosis chemotherapy began in 1952. Since then, strains of Mycobacterium Tuberculosis have acquired resistance to various drugs. The rising prevalence of Multidrug-Resistant strains (Resistant to isoniazid and rifampicin, with or without resistance to other drugs) is most ominous and has resulted in many cases of marginally treatable, often fatal, disease. The World Health Organization (WHO) noted in 1997 that not only is Tuberculosis a global emergency, but that several “hot spots” exist where Multidrug-Resistant Tuberculosis (MDRTB) prevalence is so high that control programs are threatened [1]. These “hot spots”, in conjunction with rising HIV prevalence, pose a serious threat to Tuberculosis control programs. Many still consider MDRTB a focal problem that need not be addressed on a global scale. The contrary view, eloquently stated by Farmer et al, is that “... in choosing to ignore MDRTB as a global priority, we are setting our sights too low. Unambitious goals will insure millions of deaths and the persistence, in the human population, of Resistant M. Tuberculosis ” [2]. In this chapter we will focus on the care of patients with MDRTB as well as examine the origins, biologic mechanisms, and epidemiology of drug resistance, its impact on the outcome of therapy, and the implications of MDR-TB for standard initial therapeutic regimens.