Mycobacterial disease

Concurrent puimonary conditions Atovaquone is not effective therapy for concurrent pulmonary conditions such as bacterial, viral, or fungal pneumonia or mycobacterial diseases. Clinical deterioration in patients may be due to infections with other pathogens, as well as progressive PCP. 

Since the production of IFN-y is dependent on the production of IL-12, mutations in the chain and the signal transducing 2 chain of the IL-12 receptor, as well as in the P40 subunit of IL-12, can disrupt the IFN-y-IL-12 axis, and can expose subjects to atypical mycobacterial disease (100, 101). Patients with such mutations, however, respond to therapy with INF-y (102). 

Detection of Rifampicin-Resistant Strains of Tuberculosis Rifampicin is an important antibiotic used to treat tuberculosis, as well as other mycobacterial diseases. 

According to the CDC, the diagnosis of AIDS constitutes certain opportunistic infections, neoplasms, encephalopathy or wasting syndrome in the presence of HIV infection. In 1993, the CDC expanded the criteria to also include CD4+ T-cell count below 200 cells/p,l in the presence of HIV infection. The most common opportunistic infections includepneumocystis carinii pneumonia, pneumonitis, toxoplasmosis, mycobacterial disease, recurrent herpes simplex virus infection and/or cytomegalovirus infection. Kaposi s sarcoma is the most common form of cancer. HIV-related nervous system diseases include acute septic meningitis, AIDS dementia complex, subacute encephalitis, HIV encephalopathy and CNS opportunistic infections and neoplasm. 

Peloquin CA, Berning SE, Nitta AT, Simone PM, Goble M, Huitt GA, Iseman MD, Cook JL, Curran-Everett D. Aminoglycoside toxicity Daily versus thrice-weekly dosing for treatment of mycobacterial diseases. Clin Infect Dis 2004 38 1538M 4. 

A case of possible aciclovir-induced Stevens-Johnson syndrome has been reported in an HIV-positive patient with mycobacterial disease (21). However, Stevens-Johnson syndrome is associated with Herpes simplex infection and can be prevented by aciclovir (22). 

Identify the drugs used in leprosy and in atypical mycobacterial diseases and describe their major toxic effects. 

Background Tuberculosis (TB) and leprosy are perhaps the best known mycobacterial diseases. The development of antibiotics in the past fifty years has changed the therapy of tuberculosis from strict bed rest for a year or longer to oral antibiotics taken as an outpatient. In addition, antituberculosis drugs are now taken prophytactically to prevent fulminant TB in patients who may have been infected with mycobacteria. 

Studies of human genetic diversity clearly demonstrate a role for the host genome in control of immunity to TB. Compelling evidence comes from comparison of disease in monozygotic and heterozygotic twins (Comstock 1978), and from the identification of individuals with Mendelian susceptibility to mycobacterial disease (Alcais et al 2005). Several polymorphisms have been linked to TB a subset of these is shown in Table 1. Genes implicated in Mendelian susceptibility are involved in the central process of the interleukin (IL)12/interferon (IFN)y activation... 

TABLE 1 Examples of human gene polymorphisms associated with differential susceptibility to mycobacterial disease... 

Absolute hypersensitivity to the drug or any other component of the product. Active or suspected ocular or periocular infection (herpes simplex keratitis, vaccinia, varicella, mycobacterial disease or fungal infection), systemic fungal infections, advanced glaucoma or concurrent administration of live vaccines in patients receiving immunosuppressive doses. 

Mycobacteria, in addition to being responsible for human tuberculosis and leprosy, are important pathogens in other animals. Unlike most other bacteria, mycobacteria are able to survive ingestion by white cells and successfully parasitise the host. The extent to which each species is present within the phagocyte or extracellularly varies amongst mycobacterial diseases and the host species, for example in severe cases of... 

Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An Official ATS/IDSA Statement diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007 175 367-A16. 

Koskinen H (1985) Symptoms and clinical findings in patients with silicosis. Scand J Environ Health 11 101-106 Kuhhnan JE, Deutsch JH, Fishman EK, Siegehnan SS (1990) CT features of thoracic mycobacterial disease. Radiographics. 10 413-431... 

Infection with Mycobacterium tuberculosis and a variety of non-tuberculous mycobacteria has been observed in HSC transplant recipients (Navari et al. 1983 Mohite et al. 2001). Mycobacterium tuberculosis infection can occur after HSC transplantation, but the incidence in the reported series is lower than that of other infections (Roy and Weisdorf 1997 Aljurf et al. 1999 Mohite et al. 2001). Overall, the incidence of tuberculosis has bee reported to be between 0.19% and 5.5% of cases (Martino et al. 1996 Roy and Weisdorf 1997). Reports of non-tuberculous mycobacterial disease in both HSC and solid organ transplant recipients have also increased (Ozkaynak et al. 1990 Busch et al. 1991 Doucette and Fishman 2004). 

O Brien RJ, Lyle MA, Snider DE Jr. Rifabutin (ansamycin LM-427)-a new rifamycin S derivative for the treatment of mycobacterial diseases. Reviews of Infectious Diseases 1987 9(3) 519-530. 

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