Tuberculosis: a resurgent disease in immunosuppressed patients
A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 2...
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| Online Access: | http://eprints.um.edu.my/4162/1/Tuberculosis-_a_resurgent_disease_in_immunosuppressed_patients.pdf http://eprints.um.edu.my/4162/ http://www.ncbi.nlm.nih.gov/pubmed/17547073 |
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| author | Nissapatorn, V. Kuppusamy, I. Josephine, F.P. Jamaiah, I. Rohela, M. Khairul Anuar, A. |
| author_facet | Nissapatorn, V. Kuppusamy, I. Josephine, F.P. Jamaiah, I. Rohela, M. Khairul Anuar, A. |
| author_sort | Nissapatorn, V. |
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| content_provider | Universiti Malaya |
| content_source | UM Research Repository |
| continent | Asia |
| country | Malaysia |
| description | A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 21-62 (mean 37.6 +/- 8.3 years) in TB/HIV patients. TB was significantly found in younger and single HIV patients, but in older and married DM patients (p<0.05). Male patients in both groups were strongly associated with TB, while females more commonly had TB with DM (p<0.05). The majority of these patients were Malays, unemployed, and resided in Kuala Lumpur territory; however, no statistically significant difference was found between the 2 groups. Smoking, IVDUs and hepatitis C virus (HCV) infection were more significantly found in TB/HIV patients and further analysis showed that pulmonary TB was strongly associated with HCV infection in these patients (p<0.05). Pulmonary TB (62; 89.9) was the most common type found in both groups and was a markedly more common disease location in TB/DM patients, while extrapulmonary TB (21; 31.3) and miliary TB (14; 21) were significantly higher in TB/HIV patients. Cough with or without sputum, fever and loss of appetite and/or weight were common clinical presentations in both groups. Nevertheless, fever (54; 80.6) and lymphadenopathy (17; 25.4) were significantly related to TB/HIV patients (p<0.05). Interestingly, the presence of BCG vaccination and positive tuberculin skin test were stronger in TB/HIV (27; 40.3) and TB/DM (20; 29) patients, respectively (p<0.05). Overall, regular 6-, 9- and 12-months' anti-tubercular therapy (ATT) were routine practice, and EHRZ+B6 was the most common regimen used. The highest percentage of patients with treatment success were in both groups with 6 months' ATT; however, a significantly higher percentage was found in TB/DM (24; 34.8) than TB/HIV (13; 19.4) (p<0.05). A success rate of 15 (21.7) was noted for TB/DM patients with 9 months' ATT, which was similar to both groups with the 12-month regimen. A higher percentage failure rate (lost to follow-up) was seen in TB/HIV (19; 28.4) patients. Nine patients were reported to have anti-tubercular-drug side-effects, such as drug-induced hepatitis, blurred vision, and skin rash. No cases of drug resistance or death were notified among these patients. |
| format | Article |
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| institution | Universiti Malaya |
| language | en |
| publishDate | 2006 |
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| spelling | my.um.eprints-41622012-12-12T04:01:48Z http://eprints.um.edu.my/4162/ Tuberculosis: a resurgent disease in immunosuppressed patients Nissapatorn, V. Kuppusamy, I. Josephine, F.P. Jamaiah, I. Rohela, M. Khairul Anuar, A. R Medicine A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 21-62 (mean 37.6 +/- 8.3 years) in TB/HIV patients. TB was significantly found in younger and single HIV patients, but in older and married DM patients (p<0.05). Male patients in both groups were strongly associated with TB, while females more commonly had TB with DM (p<0.05). The majority of these patients were Malays, unemployed, and resided in Kuala Lumpur territory; however, no statistically significant difference was found between the 2 groups. Smoking, IVDUs and hepatitis C virus (HCV) infection were more significantly found in TB/HIV patients and further analysis showed that pulmonary TB was strongly associated with HCV infection in these patients (p<0.05). Pulmonary TB (62; 89.9) was the most common type found in both groups and was a markedly more common disease location in TB/DM patients, while extrapulmonary TB (21; 31.3) and miliary TB (14; 21) were significantly higher in TB/HIV patients. Cough with or without sputum, fever and loss of appetite and/or weight were common clinical presentations in both groups. Nevertheless, fever (54; 80.6) and lymphadenopathy (17; 25.4) were significantly related to TB/HIV patients (p<0.05). Interestingly, the presence of BCG vaccination and positive tuberculin skin test were stronger in TB/HIV (27; 40.3) and TB/DM (20; 29) patients, respectively (p<0.05). Overall, regular 6-, 9- and 12-months' anti-tubercular therapy (ATT) were routine practice, and EHRZ+B6 was the most common regimen used. The highest percentage of patients with treatment success were in both groups with 6 months' ATT; however, a significantly higher percentage was found in TB/DM (24; 34.8) than TB/HIV (13; 19.4) (p<0.05). A success rate of 15 (21.7) was noted for TB/DM patients with 9 months' ATT, which was similar to both groups with the 12-month regimen. A higher percentage failure rate (lost to follow-up) was seen in TB/HIV (19; 28.4) patients. Nine patients were reported to have anti-tubercular-drug side-effects, such as drug-induced hepatitis, blurred vision, and skin rash. No cases of drug resistance or death were notified among these patients. 2006 Article PeerReviewed application/pdf en http://eprints.um.edu.my/4162/1/Tuberculosis-_a_resurgent_disease_in_immunosuppressed_patients.pdf Nissapatorn, V. and Kuppusamy, I. and Josephine, F.P. and Jamaiah, I. and Rohela, M. and Khairul Anuar, A. (2006) Tuberculosis: a resurgent disease in immunosuppressed patients. The Southeast Asian Journal of Tropical Medicine and Public Health, 37 Sup. pp. 153-160. ISSN 01251562 , DOI 17547073. http://www.ncbi.nlm.nih.gov/pubmed/17547073 17547073 |
| spellingShingle | R Medicine Nissapatorn, V. Kuppusamy, I. Josephine, F.P. Jamaiah, I. Rohela, M. Khairul Anuar, A. Tuberculosis: a resurgent disease in immunosuppressed patients |
| title | Tuberculosis: a resurgent disease in immunosuppressed patients |
| title_full | Tuberculosis: a resurgent disease in immunosuppressed patients |
| title_fullStr | Tuberculosis: a resurgent disease in immunosuppressed patients |
| title_full_unstemmed | Tuberculosis: a resurgent disease in immunosuppressed patients |
| title_short | Tuberculosis: a resurgent disease in immunosuppressed patients |
| title_sort | tuberculosis: a resurgent disease in immunosuppressed patients |
| topic | R Medicine |
| url | http://eprints.um.edu.my/4162/1/Tuberculosis-_a_resurgent_disease_in_immunosuppressed_patients.pdf http://eprints.um.edu.my/4162/ http://www.ncbi.nlm.nih.gov/pubmed/17547073 |
| url_provider | http://eprints.um.edu.my/ |