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• W3149299636 abstract "Global surveillance of drug resistance in tuberculosis strains shows that multidrug-resistant tuberculosis (MDRTB) now exists in most countries worldwide [1, 2, 3]. The risk factors for MDR-TB include (i) previous antituberculosis treatment or relapse, (ii) infection originating from a “hot spot” region, (iii) a history of imprisonment, (iv) homelessness and, possibly, (v) underlying immunosuppressive disease, such as HIV infection [4, 5, 6]. Hungary is a country characterized as having a low prevalence of both HIV and tuberculosis (TB). Saint L szl Hospital, in Budapest, is the only center for the treatment of HIV/ AIDS patients in the country. The present report highlights the first case of primary multidrug-resistant Mycobacterium tuberculosis infection occurring in a HIVinfected patient in Hungary. A 53-year-old, heterosexual male who had been diagnosed with HIV-1 infection in 2000 and had never received antiretroviral treatment was admitted to hospital because of fever, cough and night sweats. His medical history included syphilis and cardiomyopathy, but no underlying pulmonary disease was present, and annually performed chest radiographs had not shown any abnormalities. He lived in an urban area and had good living conditions, but he had frequently visited areas where the incidence of MDR-TB infection was relatively high. At admission, the patient’s CD4+ cell count was 561 cells/mm3, the CD8+ cell count was 833 cells/mm3 and the plasma viral load was 6,700 copies/ml. Results of the patient’s physical examination and clinical laboratory tests were unremarkable. A chest radiograph showed bilateral infiltrates with cavities on the upper lobe of both lungs. Microbiological examination of sputum was negative for acid-fast bacilli, a polymerase chain reaction (PCR)-based system to detect Mycobacterium tuberculosis complex in sputum was negative, and cultures were sterile for conventional bacteria and fungi. One week after admission, no changes were observed in the patient’s clinical symptoms, and bronchoscopic examination was performed. Smear of the bronchoalveolar lavage fluid was negative for acid-fast bacilli, but PCR testing to detect Mycobacterium tuberculosis complex resulted positive. Treatment with a four-drug regimen (rifampicin, isoniazid, ethambutol and pyrazinamide) was initiated following the diagnosis. Five weeks later, culture of the bronchoalveolar lavage specimen in L wenstein-Jensen medium was positive for Mycobacterium tuberculosis. Culture of two sputum specimens on L wenstein-Jensen medium also yielded Mycobacterium tuberculosis. Susceptibility testing was performed for the first-line treatment options using the proportion method. The results showed susceptibility to pyrazinamide, but resistance to isoniazid, rifampicin, streptomycin and ethambutol. Further susceptibility testing was performed using the Bactec system, and the following agents were identified as susceptible: p-aminosalicylic acid, ofloxacin, cycloserine, amikacin and ciprofloxacin. During the 6-month regimen of first-line, four-drug therapy (which was completed while awaiting results of susceptibility testing), the patient was occasionally subfebrile and moderate remission was observed on chest radiograph. Upon receipt of the susceptibility test results, however, a second-line four-drug therapy was introduced with ofloxacin, cycloserine, pyrazinamide and p-aminosalicylic acid. The patient became afebrile within 4 weeks of starting this therapy and significant improvement was seen on chest radiograph. Follow-up PCR tests and cultures of sputum were repeatedly negative. The CD4+ cell count was 693 cells/mm3, CD8+ cell count 1232 cells/mm3 and viral load 16,000 copies/ml. At last followup, the patient had still not received antiretroviral treatment. C. S rv ri ()) Department of Microbiology, Saint L szl Hospital, Gy li u. 5-7, 1097 Budapest, Hungary e-mail: csillas@freemail.hu Tel.: +36-1-4558181 Fax: +36-1-4558162" @default.
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• W3149299636 date "2003-01-01" @default.
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• W3149299636 title "First Case of Primary Multidrug-Resistant Pulmonary Tuberculosis in a HIV-Infected Patient in Hungary" @default.
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