RESUMEN
A total of 624 respiratory specimens from 543 patients (418 Belgian, 110 Rwandan, and 15 Colombian patients) were tested for the presence of Mycobacterium tuberculosis by the Mycobacterium Tuberculosis Direct Test (MTDT, Gen-Probe). Compared to culture, the MTDT on 497 samples of sputum or broncho-alveolar lavage from Belgium had a sensitivity, specificity and positive and negative predictive value of 86.4%, 96.0%, 50.0% and 99.3% respectively. The pooled results for Rwanda (112 specimens) and Colombia (15 specimens) were 97.8%, 65.7%, 88.2%, 92% respectively. After resolution of discrepant results by taking into account the clinical data, the results for the Belgian patients were 86.9%, 96.2%, 52.6%, 99.3% respectively, and for the Rwandan-Colombian patients 98.1%, 100%, 100% and 92% respectively. Results could be improved by testing more than one specimen from each patient and the inclusion of an internal control to detect inhibitors of the reaction. Culture remains necessary for drug susceptibility tests and the isolation and identification of non-tuberculous mycobacteria.
Asunto(s)
Técnicas Genéticas , Mycobacterium tuberculosis/genética , Tuberculosis Pulmonar/microbiología , Bélgica , Colombia/etnología , Humanos , Valor Predictivo de las Pruebas , Rwanda/etnología , Sensibilidad y Especificidad , Tuberculosis Pulmonar/etnologíaRESUMEN
Multiresistant tuberculoses are on the increase. The conversion rates in "additional" therapy are only modest. 17 multiresistant patients and 6 treatment-refractory tuberculoses were treated by us with ofloxacin-cycloserin-protionamide-INH. 16 of these patients were HIV positive. 21 patients converted after 3 months of treatment by the latest. 3 patients died of HIV syndrome. There was otherwise no difference between HIV positive and HIV negative patients. As a rule, the combination was well tolerated. In multiresistant tuberculosis, it is mandatory to administer at least 3 drugs to which there is no resistance.
Asunto(s)
Cicloserina/administración & dosificación , Isoniazida/administración & dosificación , Ofloxacino/administración & dosificación , Protionamida/administración & dosificación , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Cicloserina/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Isoniazida/efectos adversos , Masculino , Persona de Mediana Edad , Ofloxacino/efectos adversos , Protionamida/efectos adversos , Recurrencia , Esputo/microbiologíaRESUMEN
This prospective randomised study compares 100 each HIV negative und HIV positive patients suffering from pulmonary tuberculosis, under hospital conditions. Both groups are similar in respect of age and sex. Tuberculin anergy exists in 24% of the patients of the HIV positive group. Symptomatology and complaints are analogous. HIV positive patients excrete a greater quantity of tuberculosis bacilli. There is no difference between both groups in respect of sputum conversion. The HIV negative group has a comparatively greater number of tuberculous cavities, whereas the positive group has more infiltrations. Radiological regression is more rapid and marked in the HIV-negative group, and weight increase is also superior, plus a definite regression of the sedimentation reaction and correction of anaemias. Drug tolerance is equally good in both groups. There is a difference in respect of social status and profession.