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corticosteroids therapy in tuberculosis

Bridget Hodkinson, Kingsley Ross Magomero, Mohammed Tikly
BACKGROUND: In resource-constrained settings where biologic agents are not widely available, there are limited therapeutic options for patients with rheumatoid arthritis (RA) refractory to other synthetic disease modifying antirheumatic (DMARD) therapies. The aim of this study is to evaluate the effectiveness and safety of leflunomide (LEF) with methotrexate (MTX) in refractory RA. METHODS: A retrospective record review of adult RA patients treated with LEF/MTX...
October 2016: Therapeutic Advances in Musculoskeletal Disease
Yesim Ozguler, Gulen Hatemi, Serdal Ugurlu, Emire Seyahi, Melike Melikoglu, Sermin Borekci, Ersan Atahan, Gul Ongen, Vedat Hamuryudan
The use of anti-TNF agents is associated with an increased risk of tuberculosis (TB) and anti-TNF agents are stopped when active TB develops. However, discontinuation of treatment can result in flare of the underlying disease. The charts of 22 patients who developed active TB among a cohort of 2754 patients using anti-TNF agents between 2001 and 2013 were reviewed retrospectively. Patients restarting biologics during further follow-up were identified. One patient with miliary TB died within 1 month. A biologic agent was restarted in 16 of the remaining 21 patients (76 %)...
October 3, 2016: Rheumatology International
Gopalan Narendran, Dhanasekaran Kavitha, Ramesh Karunaianantham, Leonardo Gil-Santana, Jilson L Almeida-Junior, Sirasanambatti Devarajulu Reddy, Marimuthu Makesh Kumar, Haribabu Hemalatha, Nagesh Nalini Jayanthi, Narayanan Ravichandran, Raja Krishnaraja, Angamuthu Prabhakar, Tamizhselvan Manoharan, Lokeswaran Nithyananthan, Gunasundari Arjunan, Mohan Natrajan, Soumya Swaminathan, Bruno B Andrade
BACKGROUND: Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an inflammatory phenomenon complicating HIV management in coincidental tuberculosis (TB) infection, upon immune reconstitution driven by antiretroviral therapy (ART). Leukotriene A4 hydroxylase (LTA4H), an enzyme which converts LTA4 to LTB4, regulates the balance between the anti-inflammatory lipoxins and pro-inflammatory LTB4, with direct implications in TB-driven inflammation. In humans, a single nucleotide polymorphism (SNP) in the LTA4H promoter which regulates its transcriptional activity (rs17525495) has been identified and described to impact clinical severity of TB presentation and response to corticosteroid therapy...
2016: PloS One
Alex Fonollosa, Sonia Valsero, Joseba Artaraz, Ioana Ruiz-Arruza
BACKGROUND: Continuous progression of lesions despite an adequate treatment has been described in tubercular multifocal serpiginoid choroiditis. Reported treatments for this paradoxical response include systemic steroids, immunosuppressive drugs, and intravitreal methotrexate. We describe the use of dexamethasone intravitreal implants in a patient presenting with this condition. FINDINGS: A 46-year-old woman sought medical attention for scotomas in her left eye...
December 2016: Journal of Ophthalmic Inflammation and Infection
Cari Stek, Charlotte Schutz, Lisette Blumenthal, Friedrich Thienemann, Jozefien Buyze, Christiana Nöstlinger, Raffaella Ravinetto, Edwin Wouters, Robert Colebunders, Gary Maartens, Robert J Wilkinson, Lutgarde Lynen, Graeme Meintjes
BACKGROUND: Early antiretroviral therapy (ART) initiation in patients diagnosed with HIV-associated tuberculosis (TB) reduces mortality among those with the lowest CD4 counts. At the same time, both early ART and a low CD4 count heighten the risk of paradoxical TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). TB is common in patients starting ART in sub-Saharan Africa. Safe interventions that reduce the incidence or severity of TB-IRIS are needed. Prednisone has been shown to reduce symptoms and markers of inflammation when used to treat TB-IRIS...
August 29, 2016: JMIR Research Protocols
Begoña Carazo Gallego, David Moreno-Pérez, Esmeralda Nuñez Cuadros, Alba Mesa Fernandez, María Martin Cantero, Pablo Obando Pacheco, Antonio Urda Cardona
BACKGROUND: A paradoxical reaction (PR) during anti-tuberculosis treatment is a phenomenon that is poorly studied in immunocompetent children. It is defined as a clinical or radiological worsening of pre-existing tuberculosis (TB) disease. METHODS: A retrospective descriptive study of children younger than 14 years of age was performed; these children developed PR during the years 2009 to 2014, following a diagnosis of TB. Demographic characteristics, microbiological results, treatment and outcome data were collected...
August 17, 2016: International Journal of Infectious Diseases: IJID
Rupesh Agrawal, Dinesh V Gunasekeran, Julio J Gonzalez-Lopez, Joao Cardoso, Bhaskar Gupta, Peter K F Addison, Mark Westcott, Carlos E Pavesio
PURPOSE: Describe the clinical features and outcomes of patients with peripheral retinal vasculitis (RV) and describe clinical characteristics of presumed tubercular RV in a nonendemic setting. METHODS: Retrospective cohort study of 110 consecutive patients with peripheral RV at a tertiary referral eye care center in the United Kingdom. Retinal vasculitis was defined as RV with vitritis associated with peripheral retinal ischemia. Patients who also had positive Quantiferon Gold in Tube test, positive tuberculin skin test, and/or other evidence of systemic tuberculosis such as biopsy were labeled with presumed tubercular RV...
August 2, 2016: Retina
Eliza Manea, Daniela Munteanu, Raluca Jipa, Ruxandra Moroti, Victoria Arama, Ioan-Alexandru Diaconu, Adriana Hristea
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) related to tuberculosis (TB) is an exacerbation of an inflammatory response that most often occurs in HIV-infected patients but it has also been observed in non-HIV immunocompromised hosts. We describe two cases of TB associated IRIS with CNS involvement, one in a patient diagnosed with HIV infection and the other in a patient with immunosuppression due to anti tumor necrosis factor treatment. CASE REPORT; The first case was a 40-year-old man, newly diagnosed with HIV infection, who developed right hemiplegia and expressive aphasia...
October 2015: Pneumologia: Revista Societății Române de Pneumologie
Deog Kyeom Kim, Yong Bum Park, Yeon-Mok Oh, Ki-Suck Jung, Ji Hong Yoo, Kwang-Ha Yoo, Kwan Hyung Kim
Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012)...
July 2016: Tuberculosis and Respiratory Diseases
H Dele Davies
Biologic response modifiers (BRMs) are substances that interact with and modify the host immune system. BRMs that dampen the immune system are used to treat conditions such as juvenile idiopathic arthritis, psoriatic arthritis, or inflammatory bowel disease and often in combination with other immunosuppressive agents, such as methotrexate and corticosteroids. Cytokines that are targeted include tumor necrosis factor α; interleukins (ILs) 6, 12, and 23; and the receptors for IL-1α (IL-1A) and IL-1β (IL-1B) as well as other molecules...
August 2016: Pediatrics
Anna Kempisty
Sarcoidosis is a rare multiorgan granulomatous disease of unknown etiology, mostly affecting young adults, with predilection for hilar lymph nodes and the lung. Despite clinical and histologic similarities between sarcoidosis and tuberculosis, the role of M. tuberculosis in the etiopathogenesis of sarcoidosis is still not clear. Over recent years numerous studies identifying peripheral blood T-cell response to various mycobacterial antigens were published. In parallel, there is no direct evidence for the role of alive M...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Norihito Omote, Yasuhiro Kondoh, Hiroyuki Taniguchi, Tomoki Kimura, Kensuke Kataoka, Ryuichi Hasegawa, Yoshinori Hasegawa
Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We report on a-48-year-old man with ARDS due to severe pulmonary tuberculosis who was rescued by extracorporeal membrane oxygenation (ECMO). He was initially hospitalized in the intensive care unit and noninvasive positive-pressure ventilation started. He was also administered anti-tuberculosis drugs and received systemic corticosteroid therapy. Six days later, further deterioration of gas exchange prompted the decision to intubate...
2016: Respiratory Medicine Case Reports
Katarzyna Kapelko-Slowik, Donata Urbaniak-Kujda, Anna Turno-Krecicka, Stanislaw Potoczek, Jaroslaw Dybko, Monika Biernat, Miroslaw Slowik
PURPOSE: Primary intraocular lymphoma (PIOL) is a rare malignancy with an aggressive clinical course. It is usually considered as a subset of primary central nervous system lymphoma. Differential diagnosis should include infectious and non-infectious aetiologies, particularly the common masqueraders sarcoidosis, tuberculosis, viral retinitis and syphilis. PATIENT: The article presents a case of bilateral vitreoretinal lymphoma manifesting as uveitis and vitritis resistant to corticosteroid therapy...
June 2016: Indian Journal of Hematology & Blood Transfusion
Tsai-Ling Liao, Chin-Fu Lin, Yi-Ming Chen, Hung-Jen Liu, Der-Yuan Chen
Increasing evidence indicates that the risk of nontuberculous mycobacteria (NTM) disease is elevated in patients with rheumatoid arthritis (RA). However, the risk factors and outcomes for NTM disease among RA patients remain unclear. We conducted a case-control study and estimated odds ratios (ORs) for RA patients with NTM disease according to comorbidities and anti-rheumatic medications by using conditional logistic regression. Prior tuberculosis history (adjusted OR (aOR) =5.58, p < 0.001), hypertension (aOR = 2...
2016: Scientific Reports
Shahnawaz Majeed, Bishan D Radotra, Sadhna Sharma
Tuberculous meningitis (TBM) is an outcome of neuroinflammatory degeneration caused due to Mycobacterium tuberculosis infection and leads to death or neurological disabilities in the affected individuals. It causes the highest morbidity and mortality amongst all forms of tuberculosis. Matrix metalloproteinase-9 levels increase and cause inflammatory destruction during progression of the disease. Although corticosteroids are usually given as an adjuvant therapy to overcome these complications, treatment outcome is contradictory...
June 2016: International Journal of Experimental Pathology
R Lhote, L Raskine, J Gottlieb, F Mougari, M Lafaurie, M-D Vignon-Pennamen, M Bagot, A Petit, F Cordoliani
INTRODUCTION: Isolated cutaneous tuberculosis is uncommon, accounting for only 0.14 to 5% of Mycobacterium tuberculosis infections. We report a rare case of ear cutaneous tuberculosis due to Mycobacterium bovis in an immunocompetent woman. CASE REPORT: A 59-year-old woman presented an erythematous and scaly lesion of the ear present for two years. The histological findings were compatible with a diagnosis of sarcoidosis, with non-necrotic granuloma. After failure of dermal corticosteroid therapy, a further biopsy identified M...
June 30, 2016: Annales de Dermatologie et de Vénéréologie
B Hodkinson, N Osman, S Botha-Scheepers
We report the case of a 47-year-old female patient with rheumatoid arthritis and HIV infection presenting with a 3-week history of a painful swollen knee, increased serum inflammatory markers, and a low CD4 lymphocyte count. The diagnosis of TB arthritis was made by synovial fluid culture, GeneXpert/PCR, and confirmed by histopathology of a synovial biopsy. A mini literature review suggests that although HIV infection is associated with extrapulmonary TB, osteoarticular TB is a relatively unusual presentation in an HIV positive patient...
2016: Case Reports in Rheumatology
Andrea T Cruz, J Alberto Hernandez
Peripheral lymphadenopathy (scrofula) is the second most common site for childhood tuberculosis. Paradoxical reactions are commonly seen even in immunocompetent children after therapy is initiated, and this can lead to draining sinus tracts. We describe a multimodal therapeutic option of antituberculosis therapy, corticosteroids and therapeutic ultrasound-guided nodal aspiration in an adolescent with massive cervical adenopathy.
October 2016: Pediatric Infectious Disease Journal
Ana Filipa Miranda, João Cardoso, Nadine Marques, Sandra Barros, Paula Telles, Nuno Campos
Ocular tuberculosis (TB) is considered to be rare, although its incidence has varied widely over time and in different populations. Latent TB is diagnosed when a person is infected with Mycobacterium tuberculosis but does not have active TB. During the last decade, interferon-gamma release assay tests have been developed that allow identification of patients with latent TB infection with better specificity than the tuberculin skin test and can differentiate between infection and prior vaccination. Although rare, tuberculous scleritis should be considered in the differential diagnosis of posterior scleritis...
April 2016: Arquivos Brasileiros de Oftalmologia
K Walscheid, C Tappeiner, A Heiligenhaus
Sarcoidosis is an inflammatory multi-organ disease of unknown pathogenesis, characterised by non-necrotising granulomata. Sarcoidosis predominantly manifests in the lung, but any other organ may be affected. Ocular involvement is present in about 25 to 50 % of patients. The most common ocular manifestation is uveitis, especially of the anterior eye segment. If ocular sarcoidosis is suspected, interdisciplinary assessment of the patient is mandatory, including laboratory tests, chest X-ray, assessment by a specialist in internal medicine and, ideally, histological evidence of granuloma formation in a tissue specimen...
May 2016: Klinische Monatsblätter Für Augenheilkunde
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