RESUMEN
A proportion of patients with drug-resistant and drug-susceptible tuberculosis (TB) have sputum that is smear and culture positive for Mycobacterium tuberculosis for a prolonged period of time, despite conventional therapy. Among such patients with refractory TB, an unblinded, observational study was undertaken that used conventional TB therapy and adjunctive aerosol aminoglycosides. Patients with persistent smear- and culture-positive sputum for M. tuberculosis (despite > or =2 months of optimal systemic therapy) were selected for adjunctive treatment via inhalation with aminoglycosides, and microbiological responses were monitored. Thirteen of 19 patients converted to smear negativity during the study: 6 of 7 with drug-susceptible TB and 7 of 12 with drug-resistant TB. Among patients with drug-susceptible TB, the median time to sputum conversion was 23 days, a shorter time than for a population of historical control patients. Recurrent infection was not observed. Adjunctive aerosol aminoglycosides may expedite sterilization of sputum among certain patients with refractory TB and diminish the risk of transmission.
Asunto(s)
Antibacterianos/uso terapéutico , Terapia Recuperativa/métodos , Tuberculosis Pulmonar/tratamiento farmacológico , Administración por Inhalación , Adulto , Aminoglicósidos , Antibacterianos/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Pulmonar/microbiologíaRESUMEN
Intracranial tuberculomas are a rare complication of tuberculosis that typically occurs in immunocompromised patients not treated previously for tuberculosis. We identified tuberculomas in 12 patients (11 of whom were infected with human immunodeficiency virus) at a hospital in Johannesburg, South Africa. Responses to antituberculous therapy were good, often despite the presence of large lesions, and surgery was not considered necessary in any of the patients.