Relative Versus Absolute Noncontagiousness of Respiratory Tuberculosis on Treatment

2003 ◽  
Vol 24 (11) ◽  
pp. 831-838 ◽  
Author(s):  
Richard Long ◽  
Karen Bochar ◽  
Sylvia Chomyc ◽  
James Talbot ◽  
James Barrie ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Drug Susceptibility ◽  
Response To Treatment ◽  
Sputum Smear ◽  
Test Results ◽  
Drug Susceptibility Test ◽  
Canadian Hospital ◽  
Time To Detection ◽  
Culture Positive ◽  
Culture Conversion

AbstractObjective:To assess the validity of current estimates of the noncontagiousness of sputum smear-positive respiratory tuberculosis (TB) on treatment.Design:A descriptive analysis of the mycobacteriologic response to treatment.Setting:A TB inpatient unit of a Canadian hospital.Patients:Thirty-two HIV-seronegative patients with moderate to advanced sputum smear-positive respiratory TB were treated with uninterrupted, directly observed, weight-adjusted isoniazid, rifampin, and pyrazinamide. Each patient's initial isolate was drug susceptible and each patient's sputum mycobacteriology was systematically followed until 3 consecutive sputum smears were negative on 3 separate days.Results:The time to smear conversion varied remarkably (range, 8 to 115 days; average, 46 days) and was influenced by sputum sampling frequency. Only 3 patients (9.4%) had smear conversions by 14 days and only 8 (25%) had smear conversions by 21 days, the average time it took for drug susceptibility test results to become available. During the first 21 days of treatment, the semiquantitative sputum smear score decreased rapidly and the time to detection of positive cultures doubled. Within the time to smear conversion, virtually all smear-positive specimens (98%) were culture positive and only 34% of the patients had culture conversions (ie, 3 consecutive negative cultures).Conclusion:Current estimates of the noncontagiousness of sputum smear-positive respiratory TB on treatment (for 14 days, for 21 days, or until smear conversion) are estimates of relative noncontagiousness. They do not signal absolute noncontagiousness (culture conversion). Semiquantitative smear and time-to-detection data suggest that respiratory isolation beyond 21 days of optimal treatment should be selective.

scholarly journals Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Saulius Diktanas ◽  
Oleksandr Korotych ◽  
Yuliia Sereda ◽  
Ogtay Gozalov ◽  
Olga Rubcova ◽  
...  
Keyword(s):  
Cox Regression ◽  
Treatment Success ◽  
Scale Up ◽  
Secondary Analysis ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Culture Positive ◽  
Culture Conversion

The global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment success. No previous studies have been conducted to assess determinants of time to culture conversion for MDR/RR-TB patients in Lithuania. Secondary analysis of data of culture-positive MDR/RR-TB patients, treated in Republican Klaipeda Hospital between 1st July 2016 and 1st July 2019 was performed. Culture conversion was defined as two consecutive negative cultures on solid media submitted at least 30 days apart. Factors associated with culture conversion were estimated by crude and multivariable Cox regression accounting for competing risks. In total, 115 consecutive patients starting treatment were included in the study. Of them, the majority was male (86/115; 74.8%) with a mean age of 48 (standard deviation (SD) ±12) years and Human Immunodeficiency Virus (HIV) negative (105/115; 91.3%). Nearly two-thirds (72/115; 62.6%) had XDR (extensive drug resistance) or MDR/RR-TB with additional resistance to second-line injectables or fluoroquinolones. Of 115 culture-positive patients at baseline, 103 (89.6%) patients achieved culture conversion during 12 months of treatment. The median time to culture conversion was 1.1 months (interquartile range: 0.9-1.8). Patients aged ≥60 years compared with <40 years [adjusted hazard ration (aHR): 0.40, 95% confidence interval (CI): 0.18-0.86], smokers (aHR: 0.39, 95% CI: 0.2-0.73), patients with positive sputum smear microscopy at baseline (aHR: 0.40, 95% CI: 0.25-0.63), cavities on initial chest X-ray (aHR: 0.56, 95% CI: 0.35-0.88) and resistance to at least one fluoroquinolone drug (aHR: 0.52, 95% CI: 0.32-0.84) were slower to culture convert. In conclusion, we recommend providing additional counseling, treatment adherence interventions and scale up the use of new and repurposed TB drugs to patient groups at risk of worse interim treatment outcome: patients aged 60 and above, with resistance to fluoroquinolones, smear–positive, smokers, or with signs of extensive disease evident on initial chest radiography.

scholarly journals Plasma chemokines are baseline predictors of unfavorable treatment outcomes in pulmonary tuberculosis

2020 ◽  
Author(s):  
Nathella P Kumar ◽  
Kadar Moideen ◽  
Arul Nancy ◽  
Vijay Viswanathan ◽  
Kannan Thiruvengadam ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Validation Cohort ◽  
High Sensitivity ◽  
Sputum Smear ◽  
Newly Diagnosed ◽  
Characteristic Analysis ◽  
Increased Risk ◽  
Culture Positive ◽  
Culture Conversion

Abstract Background Plasma chemokines are biomarkers of greater disease severity, higher bacterial burden and delayed sputum culture conversion in pulmonary tuberculosis (PTB). Whether plasma chemokines could also serve as biomarkers of unfavorable treatment outcomes in PTB is not known. Methods A cohort of newly diagnosed, sputum smear and culture positive adult individuals with drug-sensitive PTB were recruited under the Effect of diabetes on Tuberculosis Severity study in Chennai, India. Plasma chemokine levels measured before treatment initiation were compared between 68 cases with unfavorable outcomes (treatment failure, death or recurrence) and 136 control individuals who had recurrence-free cure. A second validation cohort comprising of newly diagnosed, culture positive adults with drug-sensitive TB was used to measure plasma chemokine levels in 20 cases and 40 controls. Findings Six chemokines (CCL2, CCL3, CCL4, CXCL8, CXCL10 and CX3CL1) were associated with increased risk, while CXCL1 was associated with decreased risk of unfavorable outcomes in unadjusted and adjusted analyses in the test cohort. Similarly, CCL3, CXCL8 and CXCL10 were associated with increased risk of unfavorable treatment outcomes in the validation cohort. Receiver operating characteristic analysis revealed combinations of CCL3, CXCL8 and CXCL10 exhibited very high sensitivity and specificity in differentiating cases versus controls. Conclusions Our study reveals a plasma chemokine signature that can be used as a novel biomarker for predicting adverse treatment outcomes in PTB.

scholarly journals Molecular and Growth-Based Drug Susceptibility Testing ofMycobacterium tuberculosisComplex for Ethambutol Resistance in the United States

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Mitchell A. Yakrus ◽  
Jeffrey Driscoll ◽  
Allison McAlister ◽  
David Sikes ◽  
Denise Hartline ◽  
...  
Keyword(s):  
Dna Sequencing ◽  
Molecular Detection ◽  
Susceptibility Testing ◽  
The United States ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Test Results ◽  
Drug Susceptibility Test ◽  
Control And Prevention ◽  
Drug Regimens

Ethambutol (EMB) is used as a part of drug regimens for treatment of tuberculosis (TB). Susceptibility ofMycobacterium tuberculosiscomplex (MTBC) isolates to EMB can be discerned by DNA sequencing to detect mutations in theembBgene associated with resistance. US Public Health Laboratories (PHL) primarily use growth-based drug susceptibility test (DST) methods to determine EMB resistance. The Centers for Disease Control and Prevention (CDC) provides a service for molecular detection of drug resistance (MDDR) by DNA sequencing and concurrent growth-based DST using agar proportion. PHL and CDC test results were compared for 211 MTBC samples submitted to CDC from September 2009 through February 2011. Concordance between growth-based DST results from PHL and CDC was 88.2%. A growth-based comparison of 39 samples, where anembBmutation associated with EMB resistance was detected, revealed a higher percentage of EMB resistance by CDC (84.6%) than by PHL (59.0%) which was significant (Pvalue = 0.002). Discordance between all growth-based test results from PHL and CDC was also significant (Pvalue = 0.003). Most discordance was linked to false susceptibility using the BACTEC™MGIT™960 (MGIT) growth-based system. Our analysis supports coalescing growth-based and molecular results for an informed interpretation of potential EMB resistance.

scholarly journals Time to culture conversion in smokers with pulmonary tuberculosis

2016 ◽  
Vol 71 (3) ◽  
Author(s):  
J.A. Gullón ◽  
I. Suárez ◽  
M. Lecuona ◽  
R. Fernández ◽  
G. Rubinos ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pulmonary Tuberculosis ◽  
Univariate Analysis ◽  
Female Gender ◽  
Drug Susceptibility ◽  
Sputum Culture ◽  
Smoking History ◽  
Sputum Smear ◽  
P Value ◽  
Culture Conversion

Background and objective. It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. Methods. Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of &lt;0.05 was considered to be statistically significant. Results. Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). Conclusion. In current smokers with pulmonary tuberculosis, the ‘time to culture’ conversion relates only to the female gender.

Comparison of Anti-mycobacterial Drug Susceptibility Test Results by Institutes and Methods

2008 ◽  
Vol 11 (1) ◽  
pp. 43 ◽  
Author(s):  
Seung Hwan Oh ◽  
Young Jin Kim ◽  
Seung Kyu Park ◽  
Sang Hyun Hwang ◽  
Hyung Hoi Kim ◽  
...  
Keyword(s):  
Drug Susceptibility ◽  
Susceptibility Test ◽  
Test Results ◽  
Drug Susceptibility Test

scholarly journals Top Questions in the Diagnosis and Treatment of Pulmonary M. abscessus Disease

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Ruvandhi R Nathavitharana ◽  
Luke Strnad ◽  
Philip A Lederer ◽  
Maunank Shah ◽  
Rocio M Hurtado
Keyword(s):  
Drug Resistance ◽  
Drug Susceptibility ◽  
Mycobacterium Abscessus ◽  
Test Results ◽  
Limited Data ◽  
Drug Susceptibility Test ◽  
Airway Clearance ◽  
Intrinsic Drug Resistance ◽  
Repurposed Drugs

Abstract Mycobacterium abscessus disease is particularly challenging to treat, given the intrinsic drug resistance of this species and the limited data on which recommendations are based, resulting in a greater reliance on expert opinion. We address several commonly encountered questions and management considerations regarding pulmonary Mycobacterium abscessus disease, including the role of subspecies identification, diagnostic criteria for determining disease, interpretation of drug susceptibility test results, approach to therapy including the need for parenteral antibiotics and the role for new and repurposed drugs, and the use of adjunctive strategies such as airway clearance and surgical resection.

Identification and drug susceptibility test results for Mycobacterium spp.

1985 ◽  
Vol 7 (18) ◽  
pp. 133-136 ◽  
Author(s):  
Robert C. Good ◽  
Vella A. Silcox ◽  
James O. Kilburn ◽  
Brian D. Plikaytis
Keyword(s):  
Drug Susceptibility ◽  
Susceptibility Test ◽  
Test Results ◽  
Drug Susceptibility Test ◽  
Mycobacterium Spp
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