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A retrospective survey of 41 cases of culture-positive Mycobacterium marinum disease in Anne Arundel County, Maryland, showed that most infection was related to recreational exposure to the Chesapeake Bay and its tributaries. Three quarters of cases consisted of skin or joint/tendon infection of the upper extremity, particularly the hand. An empiric drug regimen for a granulomatous soft tissue infection in this context should include rifampin and ethambutol or cotrimoxazole (trimethoprim/sulfamethoxazole). A reactive tuberculin skin test in Anne Arundel County is more likely to represent M. marinum infection than tuberculous infection.
The patients with TBM diagnosed on the basis of clinical, cerebrospinal fluid (CSF) and MRI criteria were included. Children below 15 years, patients with pregnancy, seizures, liver failure, kidney failure and malignancy were excluded. The baseline clinical, CSF and MRI characteristics were noted and consciousness was evaluated by Glasgow Coma Scale (GCS). The patients were randomized to RHZE (rifampicin, isoniazid, pyrazinamide and ethambutol) and RHZEL (RHZE and levofloxacin) groups. Outcome was defined at 6 months. Primary outcome was death and secondary outcomes were disability as assess by Barthel Index score and adverse events.
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Tuberculosis remains a major public health problem throughout the world. Practically all adults in developing countries are infected with the organism Mycobacterium tuberculosis, but only about five percent suffer any ill effects. Morbidity and mortality are greatest during the economically and socially productive young adult years. Treatment requires multiple drugs and many months of compliance. Treatment both reduces transmission of the organism and allays suffering in the diseased individual. The efficacy of vaccination with BCG (bacille Calmette-Guérin) remains controversial, but several trials have demonstrated some reduction in clinical disease. At this point, the ideal disease control program entails several steps of epidemiologic assessment of the problem and resources, development of public health orientation in the professional community, treatment of infectious patients, and BCG vaccination of all those under 15-20 years of age.
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Chiang Rai Province in Northern Thailand, where human immunodeficiency virus (HIV) infection has been prevalent since the 1990s.
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Results from recent studies are shedding light on ways to prevent and treat Mycobacterium avium Complex (MAC) disease, a leading cause of death for people with AIDS. A two-drug combination treatment appears to be best. The Food and Drug Administration (FDA) has approved three drugs for the treatment of MAC disease: rifabutin (Mycobutin), clarithromycin (Biaxin), and azithromycin (Zithromax). Two studies using clarithromycin show promising results and indicate that clarithromycin is superior to rifabutin. Another study comparing azithromycin to rifabutin and then to a combination of the two showed azithromycin to be comparable to rifabutin, and the combination was significantly better than either drug alone. Other data show both rifabutin and clarithromycin have drug interactions with some, if not all, of the available protease inhibitors. Azithromycin has no known drug interactions with protease inhibitors and may be attractive for those taking a protease inhibitor. Many drug interactions are appearing so patients need to use caution when using rifabutin. Studies have shown that the optimum treatment for MAC disease is clarithromycin and ethambutol; the addition of clofazimine does not result in any additional benefit. Higher doses of clarithromycin (1000 mg twice a day) over the approved dose levels have proven to be life-threatening. Although the MAC treatment recommendations are to use either azithromycin or clarithromycin with ethambutol, azithromycin is not approved by the FDA for this use, despite many physicians' beliefs that azithromycin is as effective as clarithromycin for treating MAC.
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Tuberculosis was the major cause of cervical lymphadenopathy in the referral area. Culture of the biopsy tissue from the affected lymph nodes is a method of choice for laboratory diagnosis of tuberculous cervical lymphadenopathy.
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Mycobacterium genavense is a recently described fastidious mycobacterium identified as a pathogen causing disseminated infection in patients with advanced human immunodeficiency virus (HIV) disease. In this report, we describe the first reported case of disseminated M. genavense infection in a patient with acquired immunodeficiency syndrome (AIDS) in Taiwan. A 22-year-old Chinese man was found to be seropositive for HIV at age 18, in 1993. In 1997, he presented with abdominal pain, weight loss, low CD4 lymphocyte count, hepatomegaly, and generalized lymphadenopathy. Microscopic examination of a biopsy specimen from an inguinal lymph node showed both ill- and well-formed noncaseating granulomas. Numerous acid-fast bacilli were present in the histiocyte cytoplasm. Although the organism did not grow on conventional solid media used in our laboratory, two molecular biology techniques, including polymerase chain reaction (PCR) followed by sequencing of 16S rRNA, and PCR together with restriction enzyme fragment polymorphism analysis, confirmed the M. genavense infection. The patient's abdominal symptoms responded well to a chemotherapy regimen that included ethambutol, ciprofloxacin, and clarithromycin, and he survived more than 6 months after diagnosis. However, the lymphadenopathy was still present at his final follow-up. Our report indicates that disseminated infection with M. genavense should be added to the list of differential diagnoses of secondary infections in advanced AIDS patients in Taiwan.
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A 59-year-old female was complaining of sore throat, right otorrhea, and hearing impairment. There were no abnormal findings suggestive of pulmonary tuberculosis on her chest XP and CT. Nasopharyngoscopic examination detected a lesion coated with white mass on her nasopharynx, and a biopsy-specimen from this lesion revealed histopathological findings compatible with tuberculosis and the presence of acid-fast bacilli. PCR was positive for Mycobacterium tuberculosis complex. Therefore, we diagnosed the case as primary nasopharyngeal tuberculosis and treated her by 4-drug combination regimen with daily isoniazid, rifampicin, ethambutol and pyrazinamide. Later, low degree of resistance was noticed, isoniazid was replaced by levofloxacin. After the anti-tuberculosis chemotherapy, her symptoms almost completely diminished and the mass in her nasopharynx disappeared. As far as we can search, 23 Japanese cases of primary nasopharyngeal tuberculosis, including this case, have been reported in the literatures. We summarized the clinical features of these cases in Table. Nasopharyngeal tuberculosis is a rather rare disease. But, recently, due to the advances in diagnostic technology, the number of the case-reports has been increasing. Difficulties in detecting tubercle bacilli in nasopharyngeal lesion sometimes delayed definite diagnosis and treatment. If a patient complains the symptoms compatible with this disease, such as sore throat, pharyngeal pain and otorrhea, which are refractory to the general antibiotic therapy, we should be aware of the existence of this disease and repeat bacteriological and/or molecular examinations to prove tubercle bacilli to be able to start timely anti-tuberculosis chemotherapy.
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We report a skin Mycobacterium marinum infection presenting as wide ulcerative lesions of the arm (4 cm for the widest) in a hypoxic COPD patient who takes 4 mg methylprednisolone daily and higher doses during exacerbations. Diagnostic delay as well as glucocorticoid use could be responsible for the extension of the lesions. Clinical resolution occurred after three months of antibiotic therapy. Extensive ulcerative lesions are uncommon in Mycobacterium marinum infection in an immunocompetent host. This case emphasizes the potential and unusual harmful effect of long-term glucocorticoid therapy used in obstructive lung disease on the spread of Mycobacterium marinum infection.
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Isolates from 1,706 persons collected during 1,721 episodes of tuberculosis were genotyped. Cluster members from the selective DOT county were more than twice as likely than cluster members from the universal DOT county to have at least one isolate resistant to isoniazid, rifampin, and/or ethambutol (OR = 2.3, 95% CI: 1.7, 3.1). Selective DOT county isolates were nearly 5 times more likely than universal DOT county isolates to belong to clusters with at least 2 resistant isolates having identical resistance patterns (OR = 4.7, 95% CI: 2.9, 7.6).