Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of additional oral ofloxacin administration was evaluated in 19 HIV-negative patients with multidrug-resistant tuberculosis (MDR-TB). Their mean duration of illness was 3.6 years. Based on chest roentgenograms, 13 patients had advanced disease and 6 had moderate disease. In addition to 'second-line drugs', patients were treated with oral ofloxacin; high dose 800 mg per day (12 patients), low dose 400 mg per day (2 patients) and intermittent twice a week regimen of 800 mg a day (5 patients). With treatment, there was a significant clinical improvement. Sputum smear conversion occurred in 18 patients (mean duration 15 weeks) and this sputum smear negativity persisted for a mean duration of 7 months. Chest roentgenograms revealed regression of lesions in 18 patients. Reversible side effects were encountered in four patients. Results of present study suggest that additional administration of oral ofloxacin is both effective and safe for the treatment of MDR-TB.
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PMID:Effect of additional oral ofloxacin administration in the treatment of multidrug-resistant tuberculosis. 882 40

Tuberculosis (TB) is the leading cause of death attributable to a single infectious pathogen with one-third of the world population infected. In the USA, TB rates have fallen 3 years in succession after a sustained rise since 1985. More important are the multidrug-resistant tuberculosis (MDR-TB) cases, which are thought to be largely due to the breakdown in the delivery of health care in the USA in conjunction with HIV infection. In countries facing the HIV epidemic, the overlap of these two populations leads to a rapid acceleration of active TB and the emergence of MDR-TB. In the USA the most recent published survey (1991) revealed that 3.5% of strains were resistant to isoniazid and rifampin. Worldwide, MDR-TB is also thought to be highly prevalent, not only because of a breakdown in health infrastructure but also because of inappropriate prescription, lack of drug availability and the use of combination capsules in which the drugs are not bioavailable. Key points in therapy are to order susceptibility tests, obtain a complete drug history, treat with an adequate number of effective drugs and never, ever add a single drug to a failing regimen.
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PMID:Multidrug resistance in the world: the present situation. 898 Aug 61

Mycobacterium avium-intracellulare complex (MAC) is a ubiquitous environmental microorganism whose pathogenicity ranges from innocuous colonization to disease, in immunocompetent as well as immunocompromised individuals. We sought to determine the clinical significance of MAC in sputum cultures of patients with pulmonary tuberculosis (TB). A retrospective analysis between January 1994 and March 1995 at Bellevue Hospital Center revealed both Mycobacterium tuberculosis and MAC in 35 patients (11% of all patients with TB). Of 27 patients reviewed, 52% were HIV-1 infected (median CD4 + 25 cells per microliter). Radiographic manifestations in patients with TB and MAC were similar to those seen in patients with TB alone. Both mycobacteria were cultured primarily from respiratory sources. M tuberculosis was usually cultured first or concurrent with MAC, and in nearly all cases, both species were recovered within 2 months of each other. Most patients improved clinically, bacteriologically, and radiographically with standard antituberculous therapy, except those with advanced AIDS, multidrug-resistant TB (MDR-TB), or disseminated MAC. We conclude that recovery of MAC in sputum is common in patients with pulmonary TB, regardless of HIV-1 infection, MDR-TB, or other clinical, bacteriologic, or radiographic attributes. MAC cultivation in most of these patients likely represents transient colonization, and in most cases is not clinically significant.
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PMID:The significance of Mycobacterium avium complex cultivation in the sputum of patients with pulmonary tuberculosis. 899 8

In much of the world, tuberculosis (TB) remains the leading killer of young adults, in spite of the fact that effective chemotherapy has existed for 50 years. The epidemiology of TB, with its persistence in poor countries and resurgence among the poor of many industrialized nations, causes consternation among those charged with protecting the public's health. Two factors, ostensibly biological in nature, are commonly cited to explain this setback: the advent of HIV and the emergence of TB strains resistant to multiple drugs (MDR TB). But the strikingly patterned occurrence of MDR TB-in the United States afflicting those in homeless shelters and in the inner city, for example-speaks to some of the large-scale social forces at work in the new epidemic, which began before the advent of HIV. These forces (which include poverty, economic inequality, political violence, and racism) are examined through the experience of a young Haitian man with MDR TB, a disease never before described in Haiti. Insights from this case, and from other research on TB and HIV disease, are considered in the light of past anthropological writings on TB. It is argued that, often, social scientists mar contributions to an understanding of TB by making "immodest claims of causality" regarding its distribution and course. Alternative strategies for future sociomedical research on MDR TB are proposed.
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PMID:Social scientists and the new tuberculosis. 935 Nov 50

Emergence of resistance of Candida albicans to antifungal triazoles is increasingly recognized as an important cause of refractory mucosal candidiasis in HIV-infected patients. Recently, CDR1, which is thought to be analogous to the human MDR-1 P-glycoprotein, has been cloned in C. albicans. It has been proposed that its expression is partially responsible for fluconazole resistance in C. albicans. This gene is characterized by the presence of an ATP binding cassette (ABC) region and is distinct from the BENr gene which does not encode such a functional domain. As the molecular basis for fluconazole resistance appears to be multifactorial, we considered that there may be other ATP binding cassette-containing MDR genes that may potentially contribute to antifungal azole resistance in C. albicans. We therefore sought to identify potential target sequences that may be derived from candidate genes that share homology with the ATP binding cassette region of the human MDR-1 P-glycoprotein. Degenerate oligonucleotide primers based on the known sequence from the ATP binding cassette region of the human MDR-1 P-glycoprotein were used to amplify PCR products within the range of 100 bp in length from C. albicans isolates (3 fluconazole-susceptible and 3 fluconazole-resistant). Sequence analysis of individually subcloned PCR products, derived from the six isolates revealed 34 sequences in total. The results of our study identified 14 clones (with at least one per isolate) with a high degree of homology to the ATP binding cassette of the human MDR-1 P-glycoprotein. The BLAST search did not disclose homology of these new sequences to the C. albicans CDR1 gene, suggesting that C. albicans may possess more than one MDR-like gene. We conclude that C. albicans may possess one or more additional genes encoding ATP binding cassette MDR-like proteins that are distinct from CDR 1 and which could participate in the development of fluconazole resistance.
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PMID:New evidence that Candida albicans possesses additional ATP-binding cassette MDR-like genes: implications for antifungal azole resistance. 914 73

The recent resurgence of TB together with the ongoing HIV epidemic has resulted in a larger number of infectious TB patients being admitted to US health care facilities. These patients have become a source for both nosocomial (patient-to-patient) and occupational (patient-to-health care worker) M. tuberculosis transmission. Infectious MDR-TB patients serve as even greater potential infectious sources because they often remain AFB smear and culture positive for months to years. The keys to the prevention of nosocomial and occupational transmission of M. tuberculosis is conducting a risk assessment for each area of the facility and instituting appropriate control measures, having a high index of suspicion by clinicians for infectious TB in those who present with consistent signs and symptoms, rapid triage of such patients to isolation areas and their appropriate clinical work-up, and the institution of effective antituberculous therapy. Infection control personnel should ensure that infectious TB patients are isolated in appropriate isolation rooms (i.e., negative pressure, greater than or equal to 6 ACH, and direct external exhaust of the room air). Health care workers with infectious TB patient contact should be instructed in the epidemiology of M. tuberculosis transmission, the role of respirators in protecting the health care worker from airborne inoculation, and the importance of periodic health care worker TST. The nosocomial TB outbreaks in the 1980s and 1990s document that M. tuberculosis can be transmitted to both patients and health care workers in US health care facilities when appropriate infection control measures are not fully implemented. Follow-up studies at some of these institutions, however, document that when infection control measures similar to the 1990 or 1994 CDC TB Guidelines are fully implemented, M. tuberculosis transmission to both patients and health care workers can be reduced or eliminated. Protection of both patients and health care workers from M. tuberculosis infection is dependent on an understanding and full implementation of the 1994 CDC TB Guidelines.
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PMID:Prevention of nosocomial transmission of Mycobacterium tuberculosis. 918 53

Multidrug-resistant tuberculosis (MDR TB) is prevalent in urban areas with large HIV-positive populations. We retrospectively evaluated the chest radiographs of MDR TB patients at presentation and compared them to patients with drug-sensitive tuberculosis (DS TB). Although the overall radiographic findings and patterns of MDR TB and DS TB were similar, there were significant differences among the MDR TB patients depending on how MDR TB was acquired. Patients who developed MDR TB during an outbreak showed noncavitary consolidations, pleural effusions, and a primary radiographic pattern (70%). On the other hand, patients who acquired MDR TB due to noncompliance with antituberculous therapy often had cavitary consolidations (50%) and generally demonstrated a postprimary radiographic pattern. Cavitation occurred equally in patients with MDR TB who are HIV positive regardless of CD4 cell count. Chest radiographic findings and patterns in MDR TB are most accurately interpreted in conjunction with clinical history, specifically prior TB treatment. Nevertheless, approximately one-third of patients did not show the "expected" radiographic pattern.
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PMID:Radiographic findings and patterns in multidrug-resistant tuberculosis. 944 Aug 43

The national and international emergence of drug-resistant M. tuberculosis has complicated both the programmatic control of the tuberculosis epidemic and the clinical management of individual cases. In the United States, the problem of MDR tuberculosis is regionalized and likely stems from multifactorial causes, including the concurrent HIV epidemic. The epidemic is propagated by two distinct entities, PDR and ADR tuberculosis, which result from different inadequacies in tuberculosis control programs. The clinical management of drug-resistant tuberculosis, MDR tuberculosis in particular, is complex, frequently results in adverse outcomes, and often necessitates consultation with a specialist in the field. Two important management principles are to always use at least two agents to which the organism is susceptible and to never add a single drug to a failing regimen. Selection of an appropriate treatment regimen and determination of the duration of therapy depend on the resistance pattern, toxicities of the drugs, and the patient's response to therapy. Measures to ensure patient adherence with therapy are of paramount importance in the setting of drug resistance. Preventive therapy should be considered in the management of close contacts to active cases of MDR tuberculosis, although there is little evidence to support this practice.
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PMID:Multiple drug-resistant tuberculosis. 949 36

Multidrug-resistant tuberculosis (MDR-TB) is defined as one that is resistant to both isoniazid and rifampicin regardless of its resistance to any other antituberculosis drugs. According to "Study on the incidence of drug resistance for new admissions" reported by TB Sanatorium Council in 1992 in Japan, no increase of incidence was observed in either the first treatment or re-treatment as compared with former reports. However, U.S.A. study indicates a significant increase of MDR-TB, which is supposed to have been caused by a primary drug resistance prevailed in an infected area, or an acquired (secondary) drug resistance due to incomplete and/or faulty treatment for active TB. Many incidences were also reported for mass nosocomial infection of MDR-TB with HIV patients. In spite of these serious issues in U.S.A., MDR-TB has not yet been a major concern in Japan, while Japan should work out countermeasures in advance with careful observation of its tend. One of the causes of mass nosocomial infection of MDR-TB observed in U.S.A. is reported due to a delayed treatment after long procedures of TB identification and susceptibility tests followed specimen sampling. Rapid tests of identification and susceptibility for TB, MDR-TB in particular, are long expected. The introduction of recent molecular genetics technology will help to develop new rapid tests. While a relationship between drug resistance and TB gene is recently known to certain extent, total mechanism of TB resistance cannot be fully explained with only certain gene identified in the connection with drugs. Early treatment is critical for MDR-TB with HIV patient, as their prognosis is far worse than MDR-TB with non-HIV. Aside from HIV infection, very limited drugs are available for the treatment of MDR-TB. Drugs should be carefully selected based on the resistance patterns of each strain as well as its side effects anticipated.
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PMID:[Multidrug-resistant tuberculosis]. 986 26

Outbreaks of multidrug-resistant tuberculosis (MDR-TB) among human immunodeficiency virus (HIV)-infected persons reported in the United States were very serious and the risks were increased by the delay of diagnosis, rapid progression from infection to active disease, inadequate therapy and poor tuberculosis (TB) control. Prevalence of drug-resistant TB among HIV-infected patients in Japan was studied. The results of drug susceptibility were collected through the nationwide working group for a survey of HIV-infected TB. Data of susceptibility for 39 cases were obtained. The isolates of two cases were resistant to isoniazid and rifampicin (including clinical failure of response), although no outbreak of MDR-TB was found in Japan. Case study of a patient who developed MDR-TB revealed that drug resistance might be selected by insufficient anti-TB therapy. The rate of resistance to any of the anti-TB drugs in HIV-infected patients seemed to be high, although strictly evaluation was difficult due to no standardization for drug susceptibility testing. Of 9 cases with resistance to any of the anti-TB drugs, 8 had extrapulmonary TB including 5 cases of disseminated TB. In contrast thirteen of 30 cases without drug resistance had extrapulmonary TB. Since it has been reported that HIV infection is related to increased rates of drug resistance of TB bacilli, treatment with four-drug regimen should be started and sufficient courses of therapy are needed in HIV-infected TB patients.
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PMID:[Multidrug-resistant tuberculosis. 5. Human immunodeficiency virus infection and multidrug-resistant tuberculosis]. 986 31


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