Journal Article > LetterFull Text
Eur Respir J. 2015 December 1; Volume 46 (Issue 6); DOI:10.1183/13993003.01374-2015
Hughes J, Isaakidis P, Andries A, Mansoor H, Cox V, et al.
Eur Respir J. 2015 December 1; Volume 46 (Issue 6); DOI:10.1183/13993003.01374-2015
Journal Article > ResearchFull Text
Glob Health Action. 2014 July 30; Volume 7; DOI:10.3402/gha.v7.24861
Khan S, Das M, Andries A, Deshpande A, Mansoor H, et al.
Glob Health Action. 2014 July 30; Volume 7; DOI:10.3402/gha.v7.24861
There are limited data on the failure of second-line antiretroviral therapy (ART) and the use of third-line ART in people living with HIV in resource-limited settings. Since 2011, the Médecins Sans Frontières (MSF) HIV/tuberculosis programme in Mumbai, India, has been providing third-line ART to patients in care.
Journal Article > ResearchFull Text
Public Health Action. 2014 March 21; Volume 4 (Issue 1); DOI:10.5588/pha.13.0096
Albuquerque T, Isaakidis P, Das M, Saranchuk P, Andries A, et al.
Public Health Action. 2014 March 21; Volume 4 (Issue 1); DOI:10.5588/pha.13.0096
Background: Mumbai has a population of 21 million, and an increasingly recognised epidemic of drug-resistant tuberculosis (DR-TB). Objective: To describe TB infection control (IC) measures implemented in households of DR-TB patients co-infected with the human immunodeficiency virus(HIV) under a Médecins Sans Frontières programme. Methods: IC assessments were carried out in patient households between May 2012 and March 2013. A simplified,standardised assessment tool was utilised to assess the risk of TB transmission and guide interventions. Administrative, environmental and personal protective measures were tailored to patient needs. Results: IC assessments were carried out in 29 houses.Measures included health education, segregating sleeping areas of patients, improving natural ventilation by opening windows, removing curtains and obstacles to air flow, installing fans and air extractors and providing surgical masks to patients for limited periods. Environmental interventions were carried out in 22 houses. Conclusions: TB IC could be a beneficial component of a comprehensive TB and HIV care programme in households and communities. Although particularly challenging in slum settings, IC measures that are feasible, affordable and acceptable can be implemented in such settings using simplified and standardised tools. Appropriate IC interventions at household level may prevent new cases of DR-TB, especially in households of patients with a lower chance of cure.
Journal Article > LetterFull Text
Am J Trop Med Hyg. 2013 December 1; Volume 89 (Issue 6); DOI:10.4269/ajtmh.13-0526
Andries A, Das M, Isaakidis P, Saranchuk P
Am J Trop Med Hyg. 2013 December 1; Volume 89 (Issue 6); DOI:10.4269/ajtmh.13-0526
Journal Article > LetterAbstract
Eur Respir J. 2015 April 2; Volume 46 (Issue 1); DOI:10.1183/09031936.00188114
Hughes J, Isaakidis P, Andries A, Mansoor H, Cox V, et al.
Eur Respir J. 2015 April 2; Volume 46 (Issue 1); DOI:10.1183/09031936.00188114
Journal Article > Case Report/SeriesFull Text
BMC Research Notes. 2014 August 15; Volume 7 (Issue 1); 537.; DOI:10.1186/1756-0500-7-537
Khan S, Andries A, Pherwani A, Saranchuk P, Isaakidis P
BMC Research Notes. 2014 August 15; Volume 7 (Issue 1); 537.; DOI:10.1186/1756-0500-7-537
BACKGROUND
The second-line anti-tuberculosis drugs used in the treatment of multidrug-resistant tuberculosis often cause adverse events, especially in patients co-infected with the human immunodeficiency virus. Severe hypersensitivity reactions due to these drugs are rare and there is little published experience to guide their management.
CASE PRESENTATION
A 17-year old Indian female multidrug-resistant tuberculosis patient co-infected with human immunodeficiency virus developed a hypersensitivity reaction after starting second-line anti-tuberculosis treatment in Mumbai, India. The patient was being treated with kanamycin, moxifloxacin, para-aminosalicylic acid, cycloserine, clofazimine, and amoxicillin-clavulanic acid. Twenty-four hours later, the patient developed generalized urticaria, morbilliform rash and fever. All drugs were suspended and the patient was hospitalised for acute management. Skin patch-testing was used to identify drugs that potentially caused the hypersensitivity reaction; results showed a strong reaction to clofazimine, moderate reaction to kanamycin and mild reaction to cycloserine. An interim second-line anti-tuberculosis regimen was prescribed; cycloserine and kanamycin were then re-challenged one-by-one using incremental dosing, an approach that allowed clinicians to re-introduce these drugs promptly and safely. The patient is currently doing well.
CONCLUSIONS
This is the first case-report of a multidrug-resistant tuberculosis patient co-infected with the human immunodeficiency virus with hypersensitivity reaction to multiple second-line anti-tuberculosis drugs. Skin patch-testing and controlled re-challenge can be a useful management strategy in such patients. There is an urgent need for second-line anti-tuberculosis regimens that are more effective, safe and better tolerated.
The second-line anti-tuberculosis drugs used in the treatment of multidrug-resistant tuberculosis often cause adverse events, especially in patients co-infected with the human immunodeficiency virus. Severe hypersensitivity reactions due to these drugs are rare and there is little published experience to guide their management.
CASE PRESENTATION
A 17-year old Indian female multidrug-resistant tuberculosis patient co-infected with human immunodeficiency virus developed a hypersensitivity reaction after starting second-line anti-tuberculosis treatment in Mumbai, India. The patient was being treated with kanamycin, moxifloxacin, para-aminosalicylic acid, cycloserine, clofazimine, and amoxicillin-clavulanic acid. Twenty-four hours later, the patient developed generalized urticaria, morbilliform rash and fever. All drugs were suspended and the patient was hospitalised for acute management. Skin patch-testing was used to identify drugs that potentially caused the hypersensitivity reaction; results showed a strong reaction to clofazimine, moderate reaction to kanamycin and mild reaction to cycloserine. An interim second-line anti-tuberculosis regimen was prescribed; cycloserine and kanamycin were then re-challenged one-by-one using incremental dosing, an approach that allowed clinicians to re-introduce these drugs promptly and safely. The patient is currently doing well.
CONCLUSIONS
This is the first case-report of a multidrug-resistant tuberculosis patient co-infected with the human immunodeficiency virus with hypersensitivity reaction to multiple second-line anti-tuberculosis drugs. Skin patch-testing and controlled re-challenge can be a useful management strategy in such patients. There is an urgent need for second-line anti-tuberculosis regimens that are more effective, safe and better tolerated.