RESUMEN
It is important that surgeons are familiar with the various manifestations of tuberculosis (TB). Although TB has been declining in incidence in the developed world, it remains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.
RESUMEN
BACKGROUND: Tuberculosis is the commonest infection among HIV/AIDS patients. This co-infection constitutes a major death threat in the world. There is paucity of data about renal disease amongst patients on HAART and DOTS therapy in Cameroon. METHODS: This was a hospital-based cross-sectional study in the Buea, Limbe and Kumba government Hospitals. Spectrophotometric method was used for the quantitative determination of serum creatinine, urea, albumin and total protein levels. Glomerular filtration rate was estimated using the MDRD method. The student's t test, ANOVA and logistic regression were used to analyse the data. RESULTS: Out of 200 participants, 101 (50.5 %) were males. The ages ranged from 21 to 65 years with a mean age of 38.04 ± 10.52 years. Compared to adults on DOTS alone, adults on HAART alone had a significantly higher prevalence of eGFR <60 ml/min/1.73 m(2) (10/70 (14.3 %) vs. 1/70 (1.4 %), OR = 11.5 [1.4-92.5], p = 0.02) while more participants on HAART/DOTS had significantly higher serum creatinine (18/60 (30 %) vs 10/70 (14.3) OR = 2.57 [1.08-6.12], p = 0.033). Though participants on HAART/DOTS combined therapy had low eGFR, the association was not statistically significant (OR = 6.27, 95 % CI;0.71-55.27, p = 0.098). Participants on the Zidovudine, Lamivudine, Nevirapine regimen showed a statistically significant difference in the mean serum creatinine and albumin levels between the HAART/DOTS combined therapy and HAART group (p = 0.0219 and 0.0001 respectively). CONCLUSION: Compared to adults on DOTS, adults on HAART were more likely to have renal dysfunction (eGFR <60 ml/min per 1.73 m(2)). Adult on a combination of HAART and DOTS had a similar prevalence of renal dysfunction as those on HAART alone. This study showed that the use of the HAART regimen (Tenofovir, Lamivudine and Efavirenz combination) among the HAART treated adults was nephrotoxic. However, other combined HAART and DOTS regimens had no nephrotoxic effect. Abnormal kidney function can be associated with HAART use.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Coinfección/embriología , Coinfección/epidemiología , Enfermedades Renales/epidemiología , Tuberculosis Pulmonar/epidemiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Anciano , Camerún/epidemiología , Enfermedades Transmisibles/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Enfermedades Renales/tratamiento farmacológico , Pruebas de Función Renal , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nevirapina/uso terapéutico , Prevalencia , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto JovenRESUMEN
Among the disadvantages of smear microscopy for detection of tuberculosis cases is its inability to differentiate between Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM). This study evaluated two, new immunochromatographic assays - Capilia TB-Neo and SD Bioline - on unheated and heated cultures at 80°C for 30min respectively for their ability to discriminate between MTB complex and NTM as compared with the molecular Genotype assay. Mycobacteria used in the study were obtained from smear-positive specimens collected from patients at four major hospitals in Cross River State, Nigeria. Capilia TB-Neo and SD Bioline showed sensitivities of 98.8% and 93.8% respectively and 100% specificity for both assays. Heating the isolates did not significantly impact the test performance. Both tests are recommended for use in rapid differentiation of strains isolated in Nigeria.
RESUMEN
SETTING: Nigeria has the world's fourth largest tuberculosis burden, and multidrug resistant tuberculosis (MDR-TB) represents a serious public health problem. OBJECTIVES: To describe the demography of TB patients and determine the susceptibility of Mycobacterium tuberculosis isolates to the major TB drugs. METHODS: 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. RESULTS: Of the 97 pure mycobacterial cultures on LJ medium, 81 (83.5%) isolates were identified as M. tuberculosis complex, while 16 (16.5%) were Capilia negative. DST was carried out on 58 isolates. The drug susceptibility pattern showed that resistance occurred in 16 (27.6%) for streptomycin, 11 (19%) for isoniazid, 9 (16%) for rifampicin, and 10 (17.2%) for ethambutol. Rifampicin monoresistance occurred in 2 (3.4%) cases. MDR (combined resistance to isoniazid and rifampicin), also involving resistance to streptomycin and ethambutol, occurred in 6/58 (10.3%) isolates; although laboratory cross-contamination could not be excluded in 4/6 MDR strains with identical MIRU patterns characterized by consecutive strain numbers. Considering that first out of these 4 isolates was not due to laboratory carryover, the results of this study still report a minimal MDR-TB rate of 3/58 (5.2%) among newly diagnosed TB patients in Cross River State, Nigeria. CONCLUSIONS: An increase in drug resistance was observed in this study as compared with previous studies in the country. Hence, introduction of culture in routine diagnostic mycobacteriology laboratories will prevent the emergence and dissemination of MDR-TB, while improved quality control strategies would in parallel prevent laboratory cross-contamination, thereby reducing mislabeling, unnecessary treatment, and drug toxicity for patients.
RESUMEN
The information on the contribution of non tuberculous mycobacteria (NTM) to mycobacterial infections in Africa is scarce due to limited laboratory culture for its isolation and identification. One hundred and thirty-seven sputum smear positive patients were recruited into a study on the molecular epidemiology of Mycobacterium tuberculosis in Cross River State. Following sputum culture, 97 pure isolates were obtained and identified using Capilia TB-Neo and further confirmed by the GenoType Mycobacterium CM kit. Of the 97 isolates, 81 (83.5%) isolates were Capilia TB-Neo positive while 16 (16.5%) were Capilia TB-Neo negative. Further confirmation with the GenoType Mycobacterium CM kit revealed that 4 (25%) of the 16 isolates belonged to NTM and included M. fortuitum I, M. fortuitum II/M magaritense, M. abscessus, and M. avium ssp. The remaining 12 (75%) Capilia TB-Neo negative isolates were not members of the genus Mycobacterium despite their AFB appearance. Six (33.3%) of the Capilia TB-Neo negative were from HIV positive tuberculosis patients. All subjects in this study were placed on DOTS shortly after the AFB results were obtained. The implication of isolation of 16.5% nontuberculous isolates further emphasizes the need for culture of sputum specimen especially in HIV positive patients prior to administration of antituberculosis therapy.