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  • Title: [Isolation of Mycobacterium tuberculosis with primary resistance to chemotherapeutic agents in patients with HIV infection].
    Author: Sesma P, Esteban J, Gegundez MI, Manrique A, Espinosa P, Fernández-Guerrero ML.
    Journal: Enferm Infecc Microbiol Clin; 1992; 10(7):416-20. PubMed ID: 1450261.
    Abstract:
    BACKGROUND: To evaluate the resistance of Mycobacterium tuberculosis in subjects with simultaneous infection by the human immunodeficiency virus. METHODS: Isolation of Mycobacterium tuberculosis was carried out in a University hospital over a period of 7 years with selection of those corresponding to subjects with HIV infection. The isolation of Mycobacterium tuberculosis with resistance to one or more chemotherapeutic drugs was identified and is described herein. RESULTS: A total of 287 subjects were identified having tuberculous disease, 39 (13.59%) of them presented a simultaneous infection by the human immunodeficiency virus. In 4 of the latter (10.26%) Mycobacterium tuberculosis resistant to one or more chemotherapeutic drugs was isolated with the most frequent resistance being to isoniazide (3/4). CONCLUSIONS: A high degree of diagnostic suspicion must be maintained in patients with the human immunodeficiency virus with respect to tuberculosis, not only because of frequent endogenous activation but also because of the danger of in-hospital transmission. The possibility of resistance makes systematic antibiograms in these cases advisable. In these patients recommendations regarding treatment should be followed avoiding shortened or simplified therapeutic periods which have occasionally been demonstrated as ineffective. A retrospective study of drug resistance of Mycobacterium tuberculosis in patients simultaneously affected by tuberculosis (TB) and HIV was conducted in a Spanish university hospital. 39 of the 287 patients (13.6%) were also HIV seropositive. Mycobacterium tuberculosis with primary resistance to at least one of the major antitubercular drugs was isolated in 4 of the 39 (10.3%). The 4 patients (3 males, 1 female) demonstrating primary drug resistance were intravenous drug users aged 23-30 years. 3 were resistant to isoniazid, 1 to rifampin, 1 to streptomycin, and 1 to pyrazinamide. None was resistant to ethambutol. 2 were resistant to one drug and 2 were resistant to 2 drugs. Resistance to streptomycin in 1 patient may have been secondary to treatment with aminoglucosides for endocarditis. It is recommended that diagnostic suspicion of TB be maintained in management of HIV infected patients because of the possibility of drug resistance and of in-hospital transmission. Shortened or simplified treatment regimens should be avoided in seropositive patients.
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