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Drug resistance among new cases to any drug was found to be 43.0% and any resistance: S, 32.5%; H, 31.0%; R, 20.7%; and E, 10.3%. Drug resistance among previously treated cases to any drug was 68.2% and any resistance: S, 52.2%; H, 49.3%; R, 48.3%; and E, 20.4%. The cure rate for new cases was 43.3% and 29.4% for previously treated cases. The poor cure rate resulted mainly from a high defaulter rate.
To examine the effect of first-line and second-line anti-tuberculosis agents on the ability of fluoroquinolones to kill mycobacteria.
Ethambutol is known to cause optic neuropathy and, more rarely, axonal polyneuropathy. We characterize the clinical, neurophysiological, and neuroimaging findings in a 72-year-old man who developed visual loss and paresthesias after 11 weeks of exposure to a supratherapeutic dose of ethambutol. This case demonstrates the selective vulnerability of the anterior visual pathways and peripheral nerves to ethambutol toxicity.
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One hundred and thirty-seven newly diagnosed TB patients (26 (19%) being HIV positive) from all age groups were recruited into the study. Each specimen was cultured using BACTEC MGIT960, followed by inoculation and growth on Lowenstein-Jensen (LJ) medium. Primary identification was carried out using an immunochromatographic technique (Capilia TB-Neo), and further confirmed by genotyping. Drug susceptibility testing (DST) was carried out by the agar proportion method.
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Compared with recent US surveys in 1991 and 1992, isoniazid resistance has remained relatively stable. In addition, the percentage of MDR TB has decreased, although the national trend was significantly influenced by the marked decrease in New York City. Foreign-born and HIV-positive patients and those with prior TB have higher rates of resistance. The widespread extent of isoniazid resistance confirms the need for drug susceptibility testing to guide optimal treatment of patients with culture-positive disease.
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The authors examined during the period 2003-2004 in an eye practice 652 patients who were hospitalized due to active lung tuberculosis. All patients were treated with combination of 3-4 antituberculotic drugs and the examination was performed to observe the possible side effects of ethambutol to the optic nerve. The most interesting was the ocular finding in a young man treated due to acute lung tuberculosis in whom during the antituberculotic therapy with combination of 4 antituberculotics, the acute retinal vasculitis developed. This type of vasculitis is rare demonstration of ocular tuberculosis. The ocular finding resolved after starting the systemic corticoid therapy.
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The response to ATD was achieved in all the patients who completed the therapy. Four (26.6%) patients on regimen A developed hepatotoxicity as compared to none on regimen B (P = 0.043). None of these patients could be restarted on ATD using the same regimen A because of the persistently deranged liver functions.
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The rise in isoniazid resistance reflects increasing numbers of patients from sub-Saharan Africa and the Indian subcontinent, who might have acquired resistance abroad, and inadequate control of transmission in London. The observed increases highlight the need for early case detection, rapid testing of susceptibility to drugs, and improved treatment completion.
Genotyping of Mycobacterium tuberculosis helps to understand the molecular epidemiology of tuberculosis and to address evolutionary questions about the disease spread. Certain genotypes also have implications for the spread of infection and treatment. Indonesia is a very diverse country with a population with multiple ethnicities and cultures and a history of many trade and tourism routes. This study describes the first attempt to map the molecular epidemiology of TB in the Indonesian archipelago.
Mycobacterium tuberculosis isolates from 1,105 patients with smear-positive pulmonary tuberculosis admitted to 46 randomly stratified treatment centres all over mainland Portugal were submitted to susceptibility testing with four drugs. Human immunodeficiency virus (HIV) testing was included in the patients' evaluation scheme.
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Discordant results in conventional susceptibility testing of ethambutol against Mycobacterium tuberculosis may lead to underreporting of drug resistance.
Effective antituberculosis drugs have radically improved the prognosis of the patient with active tuberculosis. Surgical therapy is rarely needed, and sanatoria have largely vanished. Initially, triple-drug therapy is indicated in cavitary pulmonary disease and severe renal disease and it is generally used in miliary tuberculosis and meningitis. Use of one of the three drugs may be discontinued after there is evidence that the bacillary population has been decreased. Two-drug therapy is indicated for other active disease. Isoniazid alone is adequate for prophylaxis. The major cause of therapeutic failure is failure of the patient to take the antituberculosis medication regularly. The second major cause of treatment failure is resistance of tubercle bacilli to the antimicrobials used. When treatment failure is apparent, careful reassessment by experienced physicians is indicated. A single drug should never be added to a failing regimen.