scholarly journals Correction of toxic impact of anti-tuberculosis drugs on the liver in patients with first-time diagnosis of pulmonary tuberculosis

2017 ◽  
Author(s):  
L. A. Hryshchuk ◽  
O. M. Okusok
Keyword(s):  
Liver Function ◽  
Pulmonary Tuberculosis ◽  
Clinical Manifestations ◽  
Newly Diagnosed ◽  
Duration Of Treatment ◽  
Intensive Phase ◽  
Group I ◽  
Healthy Donors ◽  
Hepatotoxic Effect ◽  
Severe Intoxication

Introduction. The liver, being the main organ of detoxification, is experiencing the greatest burden in the process of chemotherapy. Disorders of the liver function in patients with respiratory tuberculosis can occur due to various factors, leading to the development of toxic reactions up to acute and chronic hepatitis. Numerous studies point to pronounced hepatotoxic effect of all anti-TB drugs and development of toxic hepatitis in patients treated with these drugs. This suggests the need to use hepatotropic drugs in complex treatment of TB.The aim of the study – to learn biochemical markers of liver function abnormalities in patients with newly diagnosed pulmonary tuberculosis and with severe intoxication syndrome before and two months after TB inpatient treatment, and the feasibility of using domestically-produced “Antral“ medication to treat functional disorders of the liver in these patients.Research methods. Two groups of people were involved in the study. Group I (control) consisted of evidently healthy donors, 27 individuals; Group II (31 individuals) consisted of patients with newly diagnosed pulmonary tuberculosis and with severe intoxication syndrome before and two months after of anti-TB therapy. This group was randomly divided into two subgroups: IIA(15 individuals), patients that only received standard anti-TB treatment and IIB (16 individuals), patients along with the standard anti-TB therapy received “Antral“ medication in the dose of 200 mg 3 times a day for the duration of treatment intensive phase. Results and Discussion. Results of the study indicate that when examining patients with pulmonary tuberculosis and severe intoxication syndrome markers of cytolysis and cholestasis should be measured prior to start of the treatment. With the increase of such indicators, in particular, ALT, AST, general and direct bilirubin, LDH, GGTP should be appointed hepatoprotector, in particular "Antral" drug. The use of this drug during the intensive phase of treatment normalizes the parameters of not only cytolytic but also cholestatic syndromes of liver function disorders in patients. Use of this medication in the treatment of tuberculosis contributed to ceasing release of the bacteria after intensive phase of treatment in 71.2 % of cases in subgroup IIB (43.9 % in subgroup IIA), and disappearance of clinical manifestations of intoxication in subgroup IIB in 79.8 % of cases (49.6 % in subgroup IIA). Significant reduction in markers of cytolysis and cholestasis was observed in patients that received “Antral“ medication during intensive phase of the treatment.Conclusions. Patients with newly-detected pulmonary tuberculosis and severe intoxication syndrome had significantly increased markers of cytolysis and cholestasis even before start of the treatment. “Antral“ is a medication with hepatoprotective action. Use of this medication alongside with the complex therapy of pulmonary tuberculosis contributed to normalization of liver function, significant reduction in the markers of cytolysis and cholestasis, faster termination of bacterial release and disappearance of clinical manifestations of intoxication.

scholarly journals Efficacy of infusion chemotherapy in patients with pulmonary tuberculosis with treatment failure and malabsorption syndrome

2020 ◽  
pp. 46-47
Author(s):  
M.M. Kuzhko ◽  
D.O. Butov ◽  
T.V. Tlustova ◽  
L.I. Grechanyk
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Failure ◽  
Clinical Symptoms ◽  
Malabsorption Syndrome ◽  
Newly Diagnosed ◽  
Intensive Phase ◽  
Infusion Chemotherapy ◽  
Healthy Donors ◽  
Group 2 ◽  
Group 1

Objective. To investigate the effectiveness of infusion chemotherapy in patients with pulmonary tuberculosis (TB) with treatment failure and malabsorption syndrome. Materials and methods. We observed 52 patients with newly diagnosed pulmonary TB with treatment failure, who were diagnosed with malabsorption syndrome. Patients were divided into two groups: 1st group (main) included 24 patients who received rifampicin and ethambutol intravenously, pyrazinamide and isoniazid orally; 2nd group (control) – 28 patients who received standard therapy orally. The severity of malabsorption syndrome was determined by a violation of intestinal penetration. Intestinal penetration was determined by the concentration of lactulose and mannitol (lactulose-mannitol test) in urine. The concentration of rifampicin, isoniazid, ethambutol in the serum was determined by liquid chromatography on a chromatograph Perkin Elmer (USA). Results and discussion. The examination revealed a violation of the rate of intestinal penetration in all studied patients, compared with healthy donors. The concentration of anti-TB drugs in the serum was significantly lower than the therapeutic average in group 2 compared with group 1 (p<0,05). In patients of group 1 after the intensive phase of treatment, the disappearance of clinical symptoms of the disease was observed in 22 (91.3±5.8 %) and 17 (60.7±6.3 %) patients (p<0.05), cessation of mycobacterial excretion – in 20 (83.3±4.3 %) and 14 (50.4±4.6 %) (p<0.05), resorption of infiltrative changes and healing of destruction cavities in the lungs – in 12 (50.2±5.3 %) and 10 (35.7±4.7 %) (p<0.05) compared with group 2. Conclusions. In patients with malabsorption syndrome with ineffective treatment and low intestinal penetration, which leads to reduced serum concentrations of anti-TB drugs in the intensive phase of treatment, it is advisable to increase the effectiveness of intravenous rifampicin and ethambutol.

scholarly journals Діагностика цитолітичного синдрому у хворих на туберкульоз легень

2017 ◽  
Author(s):  
O. M. Okusok ◽  
L. A. Hryshchuk ◽  
Z. М. Nebesna ◽  
P. O Tabas ◽  
R. O. Klos
Keyword(s):  
Pulmonary Tuberculosis ◽  
Intensive Therapy ◽  
Fatty Degeneration ◽  
Prolonged Treatment ◽  
Control Group ◽  
Newly Diagnosed ◽  
First Line ◽  
Lung Tuberculosis ◽  
Healthy Donors ◽  
Hepatotoxic Effect

Introduction. The liver is one of the most important organs of the human body, performing a number of important functions. Among the common liver diseases, infiltrative pathologies we distinguished: fatty degeneration, lymphomas, amyloidosis, sarcoidosis and tuberculosis. Characterizing liver disease, the manifestations of disorders are divided into syndromes that help to diagnose a particular disease of the liver and determine its causes. In particular – the cytolytic syndrome (CS).The aim of the study – to examine the CS markers in the case of liver dysfunction in patients with newly diagnosed lung tuberculosis prior to treatment and after two months of therapy with first-line anti-tuberculosis drugs.Methods of the research. Two groups of people were examined: the 1st control group of practically healthy donors – 34 people; and the 2nd – patients with newly diagnosed pulmonary tuberculosis prior to treatment and after two months of therapy with first-line anti-tuberculosis drugs (31 people). All patients underwent standard biochemical blood tests, ultrasound of the liver in dynamics. The spectrum of biochemical blood test parameters included determination of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and γ-glutamyltranspeptidase (GGTP).Results and Discussion. The obtained data testifying to occurrence of CS in newly diagnosed tuberculosis patients before the start of treatment are confirmed by the tendency to increase the levels of AST and GGTP. Especially such changes are observed after intensive therapy with antituberculous drugs. There are likely changes in such markers as ALT, LDH and GGTP.Conclusions. It is established that tuberculous intoxication can affect the functional state of the liver. After prolonged treatment of patients with pulmonary tuberculosis, an increase in the indices of such markers of cytolysis as ALT, LDH and GGTP is observed. Disturbance of liver function during therapy may be due to the hepatotoxic effect of anti-tuberculosis drugs, which necessitates the appointment for patients hepatoprotectors.

Influence of the Acetylation Type on the Incidence of Isoniazid-Induced Hepatotoxicity in Patients with Newly Diagnosed Pulmonary Tuberculosis

2020 ◽  
Vol 65 (7-8) ◽  
pp. 31-36
Author(s):  
N. M. Krasnova ◽  
N. E. Evdokimova ◽  
A. A. Egorova ◽  
O. I. Filippova ◽  
E. A. Alekseeva ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Normal Activity ◽  
Slow Acetylators ◽  
Nucleotide Polymorphisms ◽  
Newly Diagnosed ◽  
Single Nucleotide ◽  
Tuberculosis Chemotherapy ◽  
Genetically Determined

Introduction. Liver damage can be a dangerous side effect of using isoniazid. Individual susceptibility to isoniazid in humans is dependent on the presence of N-acetyltransferase 2 allelic variants in genome. It was imperative to assess the effect of genetically determined isoniazid acetylation rate in terms of risk of developing isoniazid-induced hepatotoxicity, as well as prevention of potential hepatopathy, and improvement of tuberculosis chemotherapy safety. Aim. To study the effect of acetylation type on the incidence of isoniazid hepatotoxicity in residents of the Sakha Republic (Yakutia) with newly diagnosed pulmonary tuberculosis. Methods. The study included 112 patients with newly diagnosed pulmonary tuberculosis. Genotyping was performed using real-time polymerase chain reaction. The following single nucleotide polymorphisms were studied: rs1801280, rs1799930, rs1799931, rs1799929, rs1208, rs1041983. Hepatotoxicity was determined based on the results of clinical laboratory monitoring and using the criteria developed by the European Association for the Study of the Liver (2019). Results. Hepatotoxic reactions developed more often in slow acetylators (43.2%), compared to fast acetylators (20.7%) and intermediate acetylators (10.9%); p=0.002. Serum alanine aminotransferase activity was 5 or more times above the upper limit of normal activity in 37.8% of slow acetylators, and in 8.7% of intermediate acetylators; p=0.001. Clinical manifestations of isoniazid hepatotoxicity were observed more often in slow acetylators (29.7%), than in fast acetylators (3.4%); p=0.000. Conclusion. Slow acetylation type ought to be considered an important risk factor for developing isoniazid hepatotoxicity in patients with pulmonary tuberculosis.

scholarly journals INSULIN RESISTANCE IN DRUG-SUSCEPTIBLE PULMONARY TUBERCULOSIS PATIENTS DURING THE FIRST MONTH OF ANTITUBERCULAR TREATMENT

2019 ◽  
Vol 1 (8(38)) ◽  
pp. 13-17
Author(s):  
Olga Mykolaivna Shvets ◽  
Olga Stanislavna Shevchenko ◽  
Hanna Leonidivna Stepanenko
Keyword(s):  
Insulin Resistance ◽  
Liver Function ◽  
Pulmonary Tuberculosis ◽  
Newly Diagnosed ◽  
Impaired Liver Function ◽  
Resistance Development ◽  
Antitubercular Drugs ◽  
Tuberculosis Patients ◽  
Antitubercular Treatment ◽  
Impaired Liver

The study was aimed to investigate insulin resistance development in drug-susceptible newly diagnosed pulmonary tuberculosis patients. Those patients who developed insulin resistance during the 30 days of antitubercular therapy have expressed metabolic changes, that may be associated with impaired liver function due to the toxic effects of antitubercular drugs.

scholarly journals CARBOHYDRATE AND LIPID METABOLIC PROFILES OF TUBERCULOSIS PATIENTS WITH BILATERAL PULMONARY LESIONS AND MYCOBACTERIA EXCRETION

2020 ◽  
Vol 73 (7) ◽  
pp. 1373-1376
Author(s):  
Olga M. Shvets ◽  
Olga S. Shevchenko ◽  
Liliіa D. Todoriko ◽  
Rostyslav S. Shevchenko ◽  
Volodumur V. Yakimets ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Pulmonary Tuberculosis ◽  
Control Group ◽  
Oral Glucose ◽  
Metabolic Profiles ◽  
Newly Diagnosed ◽  
Tuberculosis Patients ◽  
Pulmonary Lesions ◽  
Carbohydrate And Lipid Metabolism ◽  
Group I

The aim: To assess carbohydrate and lipid metabolic profiles of tuberculosis patients with bilateral injuries of the lungs and mycobacteria excretion. Materials and methods: Seventy two newly diagnosed pulmonary TB patients were examined. Group I – 17 newly diagnosed TB patients who had unilateral pulmonary lesions and had no mycobacteria excretion. Group II – 55 newly diagnosed TB patients who had bilateral pulmonary lesions and mycobacteria excretion. The control group included 20 healthy persons. Fasting insulin level, indices of lipidogram were measured, oral glucose tolerance test was performed. Statistical processing of the obtained results was carried out by analyzing the contingency tables using the StatisticaBasicAcademic 13 for Windows software package. Results: Tuberculosis patients develop insulin resistance – condition that is a precursor to developing type 2 diabetes and metabolic disorder of lipid exchange – dyslipidemia. Patients with bilateral pulmonary lesions and mycobacteria excretion have the most pronounced disorders of carbohydrate and lipid metabolism compared to patients with limited lesions of the lungs. Conclusions: We suppose that mycobacteria excretion and bilateral lesions of lungs may be the markers of the degree of carbohydrate and lipid metabolism disorders in patients with pulmonary tuberculosis. KEY WORDS: pulmonary tuberculosis, mycobacteria excretion, glucose metabolism, lipidogram

scholarly journals Reparation of lung tissue in newly detected pulmonary tuberculosis as genetically determined process

2020 ◽  
Vol 98 (8) ◽  
pp. 7-13
Author(s):  
K. Yu. Samsonov ◽  
A. V. Mordyk ◽  
A. R. Аroyan ◽  
T. L. Batischeva ◽  
O. G. Ivanova
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lung Tissue ◽  
Newly Diagnosed ◽  
Tissue Destruction ◽  
Intensive Phase ◽  
X Ray ◽  
Genetically Determined

The objective of the study is to assess the effect of rs6707530 polymorphism of the FN1 gene and rs1150754 polymorphism of the TNXB gene on the healing of lung tissue destruction in patients with newly detected pulmonary tuberculosis.Subjects and methods. 82 patients older 18 years with newly diagnosed pulmonary tuberculosis with destruction were enrolled in the study. X-ray data were assessed on the 2nd, 4th and 6th months of the study. Patients were divided into 2 groups depending on the efficacy of chemotherapy intensive phase.Results. In the group of patients with an effective course of chemotherapy, the frequency of carriers of G allele (p < 0.001) and T/G genotype (p = 0.01) in rs6707530 locus of the FN1 gene was higher. While T/T genotype (p = 0.002) and T allele (p < 0.001) prevailed among the patients with persisting destruction of lung tissue after the intensive phase of chemotherapy.

scholarly journals A Prospective, Randomized Controlled Study for the Efficacy and Safety of the Substitution of Pyrazinamide and Ethambutol With Moxifloxacin During the Intensive Phase of Treatment of Pulmonary Tuberculosis

2021 ◽  
Author(s):  
Yuqi Shang ◽  
Xi Liu ◽  
Yuanli Chen ◽  
Xiaoqing Luo ◽  
Hongqiong Zhu ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Control Group ◽  
Trial Group ◽  
Newly Diagnosed ◽  
Efficacy And Safety ◽  
Standard Regimen ◽  
Intensive Phase ◽  
One Year ◽  
Negative Conversion

Abstract Background: Moxifloxacin (MFX, M) is currently a second-line antituberculosis drug as initial therapy of pulmonary tuberculosis and one of the main anti-TB drugs in drug-resistant TB, which can kill both intracellular and extracellular Mycobacterium tuberculosis. We started a trial to study the efficacy and safety of the substitution of pyrazinamide and ethambutol with moxifloxacin during the intensive phase of treatment of newly diagnosed susceptive pulmonary tuberculosis. Methods/design: This is a prospective, open, randomized, parallel-controlled, single-center clinical study. The study consists of three phases: a screening period, a treatment period of 6 (or 7) months, and a follow-up period of 1 year. Patients selected for the study will be allocated to the trial group or the control group randomly. The control group will be given six months of a standard regimen(2HRZE/4HR). The trial group will be given a total of six months of treatment with substitution of pyrazinamide and ethambutol with moxifloxacin during the intensive phase(2HRM/4HR). The primary outcome is the rate of adverse outcomes within one year of completion of therapy. The Secondary outcomes include the rate of treatment success at the 2nd, 3rd, 5th and 6th months, the rate of sputum Mtb(Mycobacterium tuberculosis) negative conversion at the 2nd, 3rd, 5th and 6th months, the time of sputum Mtb negative conversion at the 2nd, 3rd, 5th and 6th months, and the number of patients with adverse events within one year of completion of therapy. Comparisons will be performed using two-sided tests with a statistical significance level of 5%.Discussion: This trial will reveal the effectiveness and safety of 2months of use of moxifloxacin instead of pyrazinamide and ethambutol during the intensive phase of treatment for newly diagnosed susceptive pulmonary tuberculosis. If the new regimen including isoniazid, rifampicin and moxifloxacin during the intensive phase of treatment (2HRM/4HR) is no less effective and safe than the standard regimen(2HRZE/4HR), it could be a new alternative treatment for newly diagnosed susceptive pulmonary tuberculosis in the future. Trial registration: ClinicalTrials.gov, NCT04187469. Registered on 5 December 2019.

scholarly journals Management of pulmonary tuberculosis on the background of intestinal malabsorption syndrome

2021 ◽  
pp. 39-43
Author(s):  
L.D. Todoriko ◽  
O.V. Pidverbetska
Keyword(s):  
Pulmonary Tuberculosis ◽  
Group Treatment ◽  
Standard Treatment ◽  
Group Versus ◽  
Main Group ◽  
Control Group ◽  
Newly Diagnosed ◽  
Intestinal Malabsorption ◽  
Intensive Phase ◽  
And Control

OBJECTIVE. To investigate the frequency of malabsorption in newly diagnosed sensitive pulmonary tuberculosis (TB) and to establish the effectiveness of treatment correction in these patients. MATERIALS AND METHODS. In the first stage of the study, 73 patients with new drug-susceptible TB underwent lactulose-mannitol test. Individuals with intestinal permeability index <3 were selected and divided into main group which received injectable forms of isoniazid, rifampicin, ethambutol and oral pyrazinamide and control group which received standard treatment orally. RESULTS. Bacterial excretion stopped in 88.2 % of patients in the main group and in only 61.5 % of patients in the control group. In 46.1 % of cases in the control group treatment failure was diagnosed. The frequency of positive radiological dynamics at the end of the intensive phase of treatment was 64.7 % in the main group versus 30.8 % in the control group. The total efficacy of treatment at the end of the main course of chemotherapy was 88.2 % in the main group against 53.9 % in the control group (p <0.05). CONCLUSIONS. Malabsorption, which requires correction of treatment, occurs in about one-fifth of patients with new TB. Usage of injectable anti-TB drugs in such patients increases the effectiveness of treatment by 34 % (p <0.05).

scholarly journals _PROGNOSTIC MARKER OF TUBERCULOSIS SEVERITY AND TREATMENT EFFECTIVENESS IN PULMONARY TUBERCULOSIS

2021 ◽  
Vol 74 (8) ◽  
pp. 1839-1843
Author(s):  
Olha O. Pohorielova ◽  
Olga S. Shevchenko
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Effectiveness ◽  
Clinical Manifestations ◽  
Life Quality ◽  
Lung Lesion ◽  
Intensive Phase ◽  
Sputum Microscopy ◽  
Treatment Onset ◽  
High Level ◽  
Healthy Persons

The aim: Was to investigate human-beta-defensin-1 level in blood serum depending on tuberculosis severity and treatment effectiveness. Materials and methods: 100 patients with pulmonary tuberculosis and 20 healthy persons were included to the study. HBD-1 level was measured by ELISA in all the healthy persons and in all the patients at the treatment onset and at the end of initial phase of treatment. Additionally, the patients were examined with chest X-ray, sputum microscopy and culture, blood test and blood biochemistry. Results: HBD-1 level was higher in patients with tuberculosis (21.5 ± 2.9 μmol/L) compared with healthy individuals (8.9 ± 2.5 μmol/L). A positive correlation of middle strength was found between the size of lung lesion and the level of HBD-1 and between the level of HBD-1 and the massiveness of bacterial excretion. We found weakly negative correlations between the level of HBD-1 at the beginning of treatment and parameters of life quality rated on sf-36 scale. Patients with initially high level of HBD-1 had preservation of bacterial excretion, as well as signs of inflammatory activity. In patients with an effective intensive phase of treatment, the initial level of HBD-1. Conclusions: The larger pulmonary tuberculosis lesion, as well as the more pronounced clinical manifestations lead to the higher level of HBD-1. The possibility of using human-beta-defensin-1 as a prognostic marker of treatment effectiveness is confirmed by the fact that human-beta-defensin-1 level prevails at the beginning of treatment in patients with subsequently non-effective intensive phase of treatment.

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