MyMedR

Diagnosis and treatment of tuberculosis in rural Malaysia

Marks A

Can J Public Health, 1974 7 1;65(4):305-9.

PMID: 4851355

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Fulltext Differences in patient profiles of abdominal and pulmonary tuberculosis: a comparative study

Chong VH

Med J Malaysia, 2011 Oct;66(4):318-21.

PMID: 22299550

Objectives: Tuberculosis remains a common infection and is often associated with non-specific constitutional symptoms or laboratory investigations regardless of site of manifestations. This study compares the profiles of abdominal tuberculosis (ATB) and pulmonary tuberculosis (PTB).
Methods: Patients with ATB (n=34, male-21, mean age 43.3 ± 16.0 years) diagnosed over a nine year period were identified from the National Tuberculosis registry and retrospectively reviewed. Comparisons were made with patients treated for PTB (n=163).
Results: The most commonly affected sites were the ileocecal regions, peritoneum and hepatobiliary system. Common clinical presentations were abdominal pain (61.8%), anorexia (44.1%), weight loss (55.9%), fever (41.1%) and abdominal distension (29.4%). Four patients had concomitant active PTB. Compared to PTB, patients with ATB had significantly lower serum haemoglobin (11.6 ± 2.4 vs. 12.6 ± 2.0 gm/dL, p=0.036) and higher rate of adverse events of antituberculous treatment (50% vs. 15.4%, p<0.001). There were no difference in prevalence of constitutional symptoms (fever, weight loss and anorexia), platelet level, albumin, total protein and erythrocyte sedimentation rate. Importantly, there was no difference in the treatment
response. More patients with ATB and concomitant active PTB had reported weight loss (100% vs. 36.7%, p=0.017).
Conclusion: There are differences in the profiles of ATB and PTB. Awareness of such differences can help to improve the understanding and management of this infection.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Fluoroquinolones for treating tuberculosis

Ziganshina LE, Vizel AA, Squire SB

Cochrane Database Syst Rev, 2005.

PMID: 16034951

Fluoroquinolones are sometimes used to treat multiple-drug-resistant and drug-sensitive tuberculosis. The effects of fluoroquinolones in tuberculosis regimens need to be assessed.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Fulltext A case of primary drug resistant tuberculosis

Jeyakumar D

Med J Malaysia, 2000 Mar;55(1):129-31.

PMID: 11072497

A young man presented with primary multi-drug resistant tuberculosis. The institution of second-line regimes with insufficient efficacy due to clinical inexperience, unreliable sensitivity reports and the inavailability of second-line drugs led to the development of an organism that was resistant to ten anti-tuberculous drugs. Accurate sensitivity testing done in an overseas laboratory enabled the institution of a six-drug regimen that has resulted in clinical cure.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Factors associated with poor patient compliance with antituberculosis therapy in Northwest Perak, Malaysia

Chuah SY

Tubercle, 1991 Dec;72(4):261-4.

PMID: 1811356

A retrospective study of factors associated with poor patient compliance with antituberculosis therapy was conducted in Taiping, Perak. 219 patients were studied. Male patients and hospital referrals were significantly more likely to default. Patients with tuberculous lymphadenitis alone had a greater rate of default, but this just failed to reach significance (0.05 less than p less than 0.10). Six of 7 male hospital referrals with tuberculous lymphadenitis alone defaulted. Patients treated as outpatients from the start were more compliant. Housewives were also highly compliant. It was noticed that patients who defaulted tended to do so during early stages of treatment.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Fulltext A prospective study of socio-demographic, clinical characteristics and treatment outcomes of children with tuberculosis in Sindh, Pakistan

Laghari M, Sulaiman SAS, Khan AH, Memon N

BMC Infect Dis, 2019 Jan 24;19(1):82.

PMID: 30678656 DOI: 10.1186/s12879-019-3702-3

BACKGROUND: Understanding the explanations behind unsuccessful treatment outcomes in tuberculosis (TB) patients is important to improve treatment success. Treatment completion for TB is the mainstay of TB prevention and control. The study was aimed to assess the treatment outcomes and predictors for unsuccessful outcomes among children with TB.

METHODS: This was a prospective multicenter study conducted in Sindh. Children aged ≤14 years enrolled from June to November 2016 were included. A structured data collection tool was used to gather information with respect to patients' socio-demographic, clinical and microbiological data. Additionally, to collect the information related to socio-economic and education level of caregivers, validated questionnaire was administered to the caregivers. Treatment outcomes were assessed according to the World Health Organization (WHO) guidelines. The relationship of unsuccessful treatment outcome with socio-demographic and clinical attributes of TB patients was analyzed using logistic regression model.

RESULTS: Childhood TB represented 19.3% (508/2634) of all TB cases in selected hospitals. Of these, 268/508 (52.8%) were females and one third of the children were aged ≤2 years (34.3%). In multivariate analysis, pulmonary smear positive TB (PTB+) (AOR = 5.910, 95%CI = 1.64-21.29), those with adverse drug reactions (AOR = 11.601, 95%CI = 4.06-33.12) and those who had known TB contacts (AOR = 3.128, 95%CI = 1.21-8.06) showed statistically significant association with unsuccessful treatment outcomes.

CONCLUSIONS: The high proportion of childhood TB cases (19.3%) demonstrates the continuation of TB transmission in the study setting. Furthermore, an increased focus on PTB+ patients, those with adverse drug reactions and household contact with TB is warranted.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Fulltext A second international cooperative investigation into tioacetazone side effects

Miller AB, Nunn AJ, Robinson DK, Fox W, Somasundaram PR, Tall R

Bull World Health Organ, 1972;47(2):211-27.

PMID: 4118761

As part of a large-scale international cooperative investigation into the side effects of thioacetazone-containing regimens in the treatment of tuberculosis, an evaluation has been made of the variation in the frequency of side effects between different countries and between different centres in the same country and of the likely reasons for this variation. In 3 countries patients of different racial origin were under observation in the same hospital. Over a 12-week period of treatment there was considerable variation between the countries and centres in the overall frequency of side effects and of those leading to a major departure from prescribed treatment, the variation being similar for the two thioacetazone-containing regimens and for the streptomycin plus isoniazid control regimen, though at a lower level for the latter. In Malaysia, Singapore, and Trinidad, where different racial groups were under treatment, there was no clear indication that race was an important factor in explaining the differences between countries, except for cutaneous side effects in Trinidad and possibly in Malaysia.It is concluded that the differences in the frequency of side effects to thioacetazone-containing regimens probably result from variation in the closeness of supervision of patients, in the recording and interpretation of side effects, and in environmental factors including the previous use of other medicaments or exposure to sensitizing substances.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Treatment of 164 patients with chronic pulmonary tuberculosis by pneumonectomy in a developing country

Snelling MR, Kam CM

Tubercle, 1968 Jun;49(2):187-91.

PMID: 5664317

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Fulltext Tuberculosis--are we missing the diagnosis?

Ismail Y

Singapore Med J, 2002 Apr;43(4):172-6.

PMID: 12188060

We reviewed the 52 new cases of pulmonary tuberculosis diagnosed at Pusat Pakar Utara, Kedah in 1998. It was found that the majority of the patients had symptoms for many years. They had seen many doctors but were not diagnosed. In 40% of the patients, no investigations for tuberculosis were done and in the others tuberculosis was excluded because of negative sputum smear examination. Many had typical history and X-ray changes suggestive of tuberculosis but more sensitive investigations such as sputum culture for Mycobacterium or bronchoscopy were not performed. Cases are presented to illustrate the problems in the diagnosis.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

A thiacetazone toxicity trial in Sarawak

Webb AH

N Z Med J, 1973 Nov 14;78(502):490-12.

PMID: 4129254

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

An apparently healthy young man with a peculiar-looking chest radiograph

Khajotia R, Manthari K

Can Fam Physician, 2011 Mar;57(3):311-3.

PMID: 21402968

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Pulmonary tuberculosis in a hospital setting: gender differences

Nissapatorn V, Kuppusamy I, Sim BL, Fatt QK, Anuar AK

Public Health, 2006 May;120(5):441-3.

PMID: 16545406 DOI: 10.1016/j.puhe.2005.11.005

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Pulmonary miliary tuberculosis with multiple intracerebral tuberculous granulomas--report of two cases

Muin IA, Zurin AR

Br J Neurosurg, 1998 Dec;12(6):585-7.

PMID: 10070474

Although intracerebral tuberculomas are common in countries where tuberculosis is still endemic, miliary tuberculosis with involvement of the central nervous system is exceptionally rare. We report two cases of pulmonary miliary tuberculosis with multiple intracerebral tuberculomas.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Fulltext Side effects of short course tuberculosis chemotherapy

Simon GK, Lye MS, Ahmad N

Med J Malaysia, 1991 Mar;46(1):88-94.

PMID: 1836044

A retrospective study of 300 tuberculosis patients on short course chemotherapy registered in 1985 at the Chest Clinic, General Hospital Alor Setar, Kedah was carried out with the purpose of identifying patient characteristics, determining incidence of side-effects and modifying treatment regimens in order to minimise these side-effects. One hundred and sixteen (38.7%) patients developed side effects. Twenty seven (9%) had side effects severe enough to warrant a change in treatment regimen. Treatment modifications and ways to minimise or control side effects are discussed.
Study site: Chest clinic, Hospital Alor Setar, Kedah, Malaysia

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Resistant hypertension during antituberculosis treatment: how is rifampicin implicated?

Lee SL, Lim WJ, Chai ST

Med J Malaysia, 2020 09;75(5):591-593.

PMID: 32918434

A 67-year-old mental institute resident was treated for smear-positive pulmonary tuberculosis. His background history included chronic essential hypertension which was well-controlled with amlodipine 10mg daily. However, his blood pressure became suboptimal one week into antitubercular treatment, necessitating escalation of antihypertensive therapy up to six medications. Following completion of antitubercular treatment, his blood pressure improved markedly. The number of antihypertensives was able to be reduced to only two after a month. We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Fulltext Vitamin D and activated vitamin D in tuberculosis in equatorial Malaysia: a prospective clinical study

Ralph AP, Rashid Ali MRS, William T, Piera K, Parameswaran U, Bird E, et al.

BMC Infect Dis, 2017 04 27;17(1):312.

PMID: 28449659 DOI: 10.1186/s12879-017-2314-z

BACKGROUND: Vitamin D deficiency (low plasma 25-hydroxyvitamin D [25D] concentration) is often reported in tuberculosis. Adjunctive vitamin D has been tested for its potential to improve treatment outcomes, but has proven largely ineffective. To better understand vitamin D in tuberculosis, we investigated determinants of 25D and its immunologically active form, 1,25-dihydroxyvitamin D (1,25D), their inter-relationship in tuberculosis, longitudinal changes and association with outcome.
METHODS: In a prospective observational study of adults with smear-positive pulmonary tuberculosis in Sabah, Malaysia, we measured serial 25D, 1,25D, vitamin D-binding protein (VDBP), albumin, calcium, parathyroid hormone, chest x-ray, week 8 sputum smear/culture and end-of-treatment outcome. Healthy control subjects were enrolled for comparison.
RESULTS: 1,25D was elevated in 172 adults with tuberculosis (mean 229.0 pmol/L, 95% confidence interval: 215.4 - 242.6) compared with 95 controls (153.9, 138.4-169.4, p drug resistant TB, to test its utility as a marker of tuberculosis severity and treatment response.
Study site: Chest clinic, Klinik Kesihatan Luyang, Kota Kinabalu, Sabah, Malaysia

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Appetite stimulation and weight gain with cyproheptadine (periactin) in tuberculosis patients (double-blind clinical study)

Rahman KM

Med J Malaysia, 1975 Jun;29(4):270-4.

PMID: 1105100

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Isoniazid-induced encephalopathy in an end-stage renal disease patient - A case report and literature review

Low JM, Wong KW

Med J Malaysia, 2019 12;74(6):553-554.

PMID: 31929489

Patients with end stage renal disease have higher risk of tuberculosis due to lower cell-mediated immunity. Standard regime of anti-tuberculosis contains isoniazid where neurological side effects such as seizure and encephalopathy have been documented. We present a case of isoniazid-induced encephalopathy in a haemodialysis patient. A literature review on isoniazid-induced encephalopathy was done. Recognition of this condition is important as it is reversible with cessation of isoniazid and institution of high dose pyridoxine.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

Fulltext Lady Windermere syndrome: an inappropriate eponym for an increasingly important condition

Kasthoori JJ, Liam CK, Wastie ML

Singapore Med J, 2008 Feb;49(2):e47-9.

PMID: 18301826

Non-tuberculous mycobacterial infection (NMI) occurs in elderly women with no pre-existing lung disease, and this has been termed the Lady Windermere syndrome. NMIs are increasing in prevalence and an increasing number of pulmonary mycobacterial infections is due to non-tuberculous mycobacteria. The diagnosis is often difficult because the organism is not readily isolated or cultured, and the condition may not be considered by the radiologist. We report NMI in a 64-year-old woman, based on clinical and radiological findings. Although termed the Lady Windermere syndrome, the name does not correspond to the character in Oscar Wilde's play; hence the eponym is not widely used.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy

Fulltext Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study

Khan AH, Sulaiman SAS, Hassali MA, Khan KU, Ming LC, Mateen O, et al.

BMC Public Health, 2020 Jun 04;20(1):854.

PMID: 32498682 DOI: 10.1186/s12889-020-08856-6

BACKGROUND: Smoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of poor TB treatment prognosis and outcomes. The current study was conducted to determine the prevalence of smoking and to assess the effects of smoking on treatment outcomes among TB patients.

METHODS: A multi-center retrospective study design was used to collect data from TB patients in four different states of Malaysia, namely Penang, Sabah, Sarawak, and Selangor. The study included medical records of TB patients admitted to the selected hospitals in the period from January 2006 to March 2009. Medical records with incomplete data were not included. Patient demographics and clinical data were collected using a validated data collection form.

RESULTS: Of all patients with TB (9337), the prevalence of smokers was 4313 (46.2%). Among smokers, 3584 (83.1%) were associated with pulmonary TB, while 729 (16.9%) were associated with extrapulmonary TB. Male gender (OR = 1.43, 95% CI 1.30-1.58), Chinese ethnicity (OR = 1.23, 95% CI 1.02-1.49), Sarawak indigenous ethnicity (OR = 0.74, 95% CI 0.58-0.95), urban residents (OR = 1.46, 95% CI 1.33-1.61), employed individuals (OR = 1.21, 95% CI 1.09-1.34), alcoholics (OR = 4.91, 95% CI 4.04-5.96), drug abusers (OR = 7.43, 95% CI 5.70-9.60) and presence of co-morbid condition (OR = 1.27, 95% CI 1.16-1.40) all showed significant association with smoking habits. This study found that 3236 (75.0%) patients were successfully treated in the smokers' group, while 4004 (79.7%) patients were non-smokers. The proportion of deaths (6.6%, n = 283), defaulters (6.6%, n = 284) and treatment interruptions (4.7%, n = 204) was higher in the smokers' group.

CONCLUSIONS: Smoking has a strong influence on TB and is a major barrier towards treatment success (OR = 0.76, 95% CI 0.69-0.84, p drug resistance.

Matched MeSH terms: Tuberculosis, Pulmonary/drug therapy*

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