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P302 Modified combined therapy for bladder tuberculosis
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
P300 Erythromycin monotherapy for Mycobacterium avium complex infection K. Komiya1 *, A. Kurashima2, T. Ihi3 , H. Nagai4 , N. Matsumoto5 , H. Ishii1 , K. Morimoto2 , O. Takahashi6 , S. Kudoh2 , J.-I. Kadota1 . 1 Oita University, Faculty of Medicine, Yufu, 2 Fukujuji Hospital, Kiyose, 3 National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, 4 National Hospital Organization Tokyo Hospital, Kiyose, 5 University of Miyazaki, Miyazaki, 6 St. Luke’s Life Science Institute, Chuo-ku, Japan E-mail address : [email protected] Introduction: The guidelines for the treatment of Mycobacterium avium complex (MAC) recommend multidrug regimens as standard therapy. However, immediate treatments following a diagnosis are hesitated occasionally because of concern about drug side effects and the difficulties of a completely cure. Therefore, some patients are observed without treatment, or receive an erythromycin monotherapy for its anti-inflammation effect. Objectives: To evaluate the outcomes of erythromycin monotherapy compared with untreated controls in patients with pulmonary MAC infection. Methods: This was a multicenter retrospective cohort study consisting of 33 patients treated with erythromycin monotherapy and 97 patients observed without any medication. Patients who had ever received the standard therapy were excluded. The propensity scores were estimated from the patients’ gender, age, radiological findings, symptoms, and bacterial content in their sputa on the first visit in order to reduce the selection bias of the administration of erythromycin. We defined exacerbation as worsening of radiological findings and/or clinical symptoms, which was strongly recommended the standard therapy. The time from diagnosis to exacerbation was analyzed as main outcome. The response rates to the multidrug regimens as standard therapy after exacerbation were also evaluated. Results: The patients treated with erythromycin were younger [median 64 (IQR 53–71) vs 70 (61–78) year-old, p = 0.005], had more symptoms [25 (76%) vs 42 (43%), p = 0.001], and had worse radiological scores than those observed without any medication [median 12 (IQR 7–9) vs 6 (4–11) points, p < 0.001], whereas there were no significant differences in the gender and bacteria counts in the sputum between the two groups. The propensity score predicted the use of erythromycin monotherapy with good C-statistics (0.829, p < 0.001). No significant differences were found in the overall exacerbation rates between the two groups (33% vs 32%, p = 0.566) during the observational period [median 1,289 (IQR 699–2212) days]. However, patients treated with erythromycin had fewer exacerbations in a Cox hazard proportional model (hazard ratio=0.399, p = 0.037), with a longer estimated time to progression [1,995 (95%CI, 1768–2223) vs 1569 (1356–1782) days, p = 0.041]. The response rates to the standard therapy after the exacerbation were nearly equal between the groups (80% vs 73%, p = 0.514). Conclusion: Erythromycin monotherapy for patients with pulmonary MAC infection may suppress exacerbations and extend the time to progression without any adverse effect on the response to the standard multidrug regimens after an exacerbation of the disease.
S137
Results: Most common complains were flank pain (68%), dysuria (48%) and renal colic (24%); among laboratory signs – pyuria (78%) and haematuria (34%). Patients were treated by urologists or GPs with misdiagnoses of pyelonephritis (27%), cystitis (43%), cancer (8%) or urolithiasis (22%) during 5.6 years on average. Positive smear was in 17% and positive culture of Mycobacterium tuberculosis was in 44%. 64% were diagnosed in late complicated cavernous stage, when surgery is necessary – and 90% of operations were nephrectomy due to total involvement of kidney tissue. Conclusion: Most common masks of UGTB are pyelonephritis, cystitis and urolithiasis. UGTB presents non-specific symptoms and laboratory findings, except for positive MBT culture, but only about 44% cases are culture-positive. This is one of the main reasons for late and poor diagnosis of UGTB. The significance of UGTB may be considerable when the high prevalence of overall TB and the asymptomatic nature of UGTB are taken into account. P302 Modified combined therapy for bladder tuberculosis E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected] Introduction: Bladder TB (BTB) is one of the most serious complications of renal TB, and it is diagnosed in 45.6% among urogenital tuberculosis (UGTB). Inadequate treatment of BTB resulted in severe complications (shrinkage of the bladder). Methods: 149 patients with BTB were enrolled in study. 76 patients (1st group) were treated with standard TB therapy. 73 patients (2nd group) received modified therapy, included trospium chloride. Results: Standard therapy was insufficient in more than half of the cases: 42.1% were cured, 57.9% developed complications: posttuberculous cystalgia (36.8%) and microcystis (21.1%). 16 patients with microcystis underwent enterocystoplasty. Incontinence developed in 8 patients (19.1%): three women (average age 60.3 years) and five men (average age 66.4 years); this symptom did not improve after chemotherapy. The 2nd group of patients responded in a favourable manner to the combined treatment: urinary frequency reduced about 75%, bladder capacity increased an average of 4.7 fold. Recovery was reached in 84.3%. Posttuberculous cystalgia developed in 15.7% only. None of the patients developed microcystis after the combined treatment. In 2nd group also 8 patients had incontinence; among them five reported no urgency urinary incontinence episodes after 3 months therapy with trospium chloride. Tolerance to the treatment was good: only one patient had light side effect (mouth dryness). Conclusion: Bladder tuberculosis is always secondary to renal TB, however quite often renal TB may start with voiding symptoms such as dysuria, frequent and painful urination and incontinence. Urinalysis reveals – pyuria, erythrocyturia and growth of unspecific bacteria is possible. In regions with endemic tuberculosis all patients with acute cystitis should be evaluated as suspicious to TB. Antituberculous therapy in combination with trospium chloride is high effective for bladder TB patients.
P301 Masks of urogenital tuberculosis
P303 Specific complication of antituberculous chemotherapy
E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected]
E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected]
Introduction: Urogenital tuberculosis (UGTB) is the second most common form of TB in countries with a severe epidemic situation and the third most common form in regions with low incidence of TB. 77% of men who died from tuberculosis of all localizations had prostate tuberculosis which had mostly been overlooked during their life time. In actual figures, this means about 11,000 men yearly in Russia. The main reason for late diagnosis is an atypical clinical feature of UGTB, it courses under the mask of another disease. Methods: We analyzed 816 history cases of UGTB patients to estimate clinical features.
Introduction: Majority of TB patients are young men for whom sexual viability is very important. The aim was to estimate the frequency of ejaculatory disorders in men suffering from tuberculosis and to determine the effect of TB treatment on the ejaculation. Methods: 98 pulmonary TB patients were enrolled in study. The intravaginal latency time before onset of TB was estimated retrospectively and in 3 months of anti-TB therapy. Results: Before anti-TB therapy 14.3% of pulmonary TB patients had ejaculatory disorders: 10.2% had premature ejaculation, and 4.1% delayed ejaculation. The rest 85.7% of patients had normal ejaculation.
P300 Erythromycin monotherapy for Mycobacterium avium complex infection K. Komiya1 *, A. Kurashima2, T. Ihi3 , H. Nagai4 , N. Matsumoto5 , H. Ishii1 , K. Morimoto2 , O. Takahashi6 , S. Kudoh2 , J.-I. Kadota1 . 1 Oita University, Faculty of Medicine, Yufu, 2 Fukujuji Hospital, Kiyose, 3 National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, 4 National Hospital Organization Tokyo Hospital, Kiyose, 5 University of Miyazaki, Miyazaki, 6 St. Luke’s Life Science Institute, Chuo-ku, Japan E-mail address : [email protected] Introduction: The guidelines for the treatment of Mycobacterium avium complex (MAC) recommend multidrug regimens as standard therapy. However, immediate treatments following a diagnosis are hesitated occasionally because of concern about drug side effects and the difficulties of a completely cure. Therefore, some patients are observed without treatment, or receive an erythromycin monotherapy for its anti-inflammation effect. Objectives: To evaluate the outcomes of erythromycin monotherapy compared with untreated controls in patients with pulmonary MAC infection. Methods: This was a multicenter retrospective cohort study consisting of 33 patients treated with erythromycin monotherapy and 97 patients observed without any medication. Patients who had ever received the standard therapy were excluded. The propensity scores were estimated from the patients’ gender, age, radiological findings, symptoms, and bacterial content in their sputa on the first visit in order to reduce the selection bias of the administration of erythromycin. We defined exacerbation as worsening of radiological findings and/or clinical symptoms, which was strongly recommended the standard therapy. The time from diagnosis to exacerbation was analyzed as main outcome. The response rates to the multidrug regimens as standard therapy after exacerbation were also evaluated. Results: The patients treated with erythromycin were younger [median 64 (IQR 53–71) vs 70 (61–78) year-old, p = 0.005], had more symptoms [25 (76%) vs 42 (43%), p = 0.001], and had worse radiological scores than those observed without any medication [median 12 (IQR 7–9) vs 6 (4–11) points, p < 0.001], whereas there were no significant differences in the gender and bacteria counts in the sputum between the two groups. The propensity score predicted the use of erythromycin monotherapy with good C-statistics (0.829, p < 0.001). No significant differences were found in the overall exacerbation rates between the two groups (33% vs 32%, p = 0.566) during the observational period [median 1,289 (IQR 699–2212) days]. However, patients treated with erythromycin had fewer exacerbations in a Cox hazard proportional model (hazard ratio=0.399, p = 0.037), with a longer estimated time to progression [1,995 (95%CI, 1768–2223) vs 1569 (1356–1782) days, p = 0.041]. The response rates to the standard therapy after the exacerbation were nearly equal between the groups (80% vs 73%, p = 0.514). Conclusion: Erythromycin monotherapy for patients with pulmonary MAC infection may suppress exacerbations and extend the time to progression without any adverse effect on the response to the standard multidrug regimens after an exacerbation of the disease.
S137
Results: Most common complains were flank pain (68%), dysuria (48%) and renal colic (24%); among laboratory signs – pyuria (78%) and haematuria (34%). Patients were treated by urologists or GPs with misdiagnoses of pyelonephritis (27%), cystitis (43%), cancer (8%) or urolithiasis (22%) during 5.6 years on average. Positive smear was in 17% and positive culture of Mycobacterium tuberculosis was in 44%. 64% were diagnosed in late complicated cavernous stage, when surgery is necessary – and 90% of operations were nephrectomy due to total involvement of kidney tissue. Conclusion: Most common masks of UGTB are pyelonephritis, cystitis and urolithiasis. UGTB presents non-specific symptoms and laboratory findings, except for positive MBT culture, but only about 44% cases are culture-positive. This is one of the main reasons for late and poor diagnosis of UGTB. The significance of UGTB may be considerable when the high prevalence of overall TB and the asymptomatic nature of UGTB are taken into account. P302 Modified combined therapy for bladder tuberculosis E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected] Introduction: Bladder TB (BTB) is one of the most serious complications of renal TB, and it is diagnosed in 45.6% among urogenital tuberculosis (UGTB). Inadequate treatment of BTB resulted in severe complications (shrinkage of the bladder). Methods: 149 patients with BTB were enrolled in study. 76 patients (1st group) were treated with standard TB therapy. 73 patients (2nd group) received modified therapy, included trospium chloride. Results: Standard therapy was insufficient in more than half of the cases: 42.1% were cured, 57.9% developed complications: posttuberculous cystalgia (36.8%) and microcystis (21.1%). 16 patients with microcystis underwent enterocystoplasty. Incontinence developed in 8 patients (19.1%): three women (average age 60.3 years) and five men (average age 66.4 years); this symptom did not improve after chemotherapy. The 2nd group of patients responded in a favourable manner to the combined treatment: urinary frequency reduced about 75%, bladder capacity increased an average of 4.7 fold. Recovery was reached in 84.3%. Posttuberculous cystalgia developed in 15.7% only. None of the patients developed microcystis after the combined treatment. In 2nd group also 8 patients had incontinence; among them five reported no urgency urinary incontinence episodes after 3 months therapy with trospium chloride. Tolerance to the treatment was good: only one patient had light side effect (mouth dryness). Conclusion: Bladder tuberculosis is always secondary to renal TB, however quite often renal TB may start with voiding symptoms such as dysuria, frequent and painful urination and incontinence. Urinalysis reveals – pyuria, erythrocyturia and growth of unspecific bacteria is possible. In regions with endemic tuberculosis all patients with acute cystitis should be evaluated as suspicious to TB. Antituberculous therapy in combination with trospium chloride is high effective for bladder TB patients.
P301 Masks of urogenital tuberculosis
P303 Specific complication of antituberculous chemotherapy
E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected]
E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected]
Introduction: Urogenital tuberculosis (UGTB) is the second most common form of TB in countries with a severe epidemic situation and the third most common form in regions with low incidence of TB. 77% of men who died from tuberculosis of all localizations had prostate tuberculosis which had mostly been overlooked during their life time. In actual figures, this means about 11,000 men yearly in Russia. The main reason for late diagnosis is an atypical clinical feature of UGTB, it courses under the mask of another disease. Methods: We analyzed 816 history cases of UGTB patients to estimate clinical features.
Introduction: Majority of TB patients are young men for whom sexual viability is very important. The aim was to estimate the frequency of ejaculatory disorders in men suffering from tuberculosis and to determine the effect of TB treatment on the ejaculation. Methods: 98 pulmonary TB patients were enrolled in study. The intravaginal latency time before onset of TB was estimated retrospectively and in 3 months of anti-TB therapy. Results: Before anti-TB therapy 14.3% of pulmonary TB patients had ejaculatory disorders: 10.2% had premature ejaculation, and 4.1% delayed ejaculation. The rest 85.7% of patients had normal ejaculation.