No abstract available.
Aminosalicylic Acid* ; Cycloserine* ; Prothionamide* ; Retreatment* ; Tuberculosis, Pulmonary*

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.
Cycloserine ; Diagnosis ; Drug Eruptions* ; Drug Hypersensitivity ; Humans ; Lichenoid Eruptions ; Lymphocyte Activation* ; Lymphocytes* ; Patch Tests

BACKGROUND: The purposes of the current study were to evaluate the concordant rates of anti-mycobacterial drug susceptibility test (DST) results in different solid media performed in different institutes, and to determine reliable susceptible testing methods. METHODS: One hundred and twenty two Mycobacterium tuberculosis strains were isolated from patients in A Hospital in 2005. DSTs were performed by the absolute concentration method using L?wenstein Jensen medium in both A Hospital (method A-1) and B Institute (method B-1) and by the proportion method using Middlebrook 7H10 agar in B Institute (method B-2). Nine drugs were used including isoniazid and rifampin. Sensitivity and specificity of each method were estimated by using the acceptable standard of 90% for isoniazid and rifampin and 80% for other drugs. The therapeutic outcomes of quinolone-administered patients were evaluated according to ofloxacin susceptibility results. RESULTS: Method B-1 showed sensitivity and specificity levels over the acceptable standard levels for all drugs. Method B-2 showed specificity lower than the acceptable levels for rifampin and cycloserine. Method A-1 showed specificity lower than the acceptable levels for isoniazid, streptomycin, p-aminosalicylic acid, and ofloxacin and sensitivity lower than the acceptable levels for prothionamide and cycloserine. The concordance rates of therapeutic outcomes with method B-1, method B-2, and method A-1 were 77%, 74%, and 65%, respectively. CONCLUSION: The drug susceptibility results for some drugs were discordant between the testing laboratories and media, requiring an urgent application of quality control programs to raise the reliability of anti-mycobacterial DST.
Academies and Institutes ; Agar ; Aminosalicylic Acid ; Culture Media ; Cycloserine ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Quality Control ; Rifampin ; Sensitivity and Specificity ; Streptomycin

BACKGROUND: Tuberculosis is still one of the most seriously threatening infections in Korea, because of multidrug resistant tuberculosis. Results of antituberculosis drug susceptibility test can provide clinicians very important informations for selection of proper regimens for treatment. METHODS: In this study the results of antituberculosis drug susceptibility test of 298 cases at Kyunghee Medical Center from 2000 to 2003 were retrospectively analysed to evaluate the trend of antituberculosis drug susceptibility. The procedure of drug susceptibility test was based on the absolute concentration method using Lowenstein-Jensen solid media. RESULTS: The resistance rate of Mycobacterium tuberculosis to one or more drugs was increased from 29.3% in 2000 to 48.2% in 2003, and the rates of multiple resistance to two or more drugs increased from 13.3% in 2000 to 20.5% in 2003. The increase in resistance rate to individual drug during study period were 20.0% to 24.1% in isoniazid, 9.3% to 19.3% in rifampicin, 5.3% to 15.7% in ethambutol, 4.0% to 10.8% in para-aminosalicylic acid, 2.7% to 6.0% in kanamycin, 1.3% to 7.2% in ethionamide, 1.3% to 6.0% in capreomycin, 1.3% to 7.2% in prothionamide, 0.0% to 12.1% in ofloxacin, 6.7%to 3.6% in streptomycin, 6.7% to 7.2% in cycloserine, 10.7% to 8.4% in pyrazinamide, respectively. CONCLUSIONS: The resistance rate of M. tuberculosis has been increased with years and multidrug resistant M. tuberculosis was commonly encountered in the specimens from the patients visited Kyunghee Medical center.
Aminosalicylic Acid ; Capreomycin ; Cycloserine ; Ethambutol ; Ethionamide ; Humans ; Isoniazid ; Kanamycin ; Korea ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Pyrazinamide ; Retrospective Studies ; Rifampin ; Streptomycin ; Tuberculosis

Despite global efforts to control tuberculosis (TB), multidrug-resistant TB (MDR-TB) is still a serious problem worldwide. The diagnosis of MDR-TB is based on mycobacterial culture followed by drug susceptibility testing, with results available in weeks to months. This requirement calls for rapid direct tests, especially genotypic tests, in which specimens are amplified directly for the detection of MDR-TB. The treatment of MDR-TB is challenging because of the high toxicity of second-line drugs and the longer treatment duration required compared to drug-susceptible TB. The selection of drugs in MDR-TB is based on the treatment history, drug susceptibility results, and TB drug resistance patterns in each region. Recent World Health Organization guidelines recommend the use of at least four second-line drugs (i.e., a newer fluoroquinolone, an injectable agent, prothionamide, and cycloserine or para-aminosalicylic acid) in addition to pyrazinamide. Kanamycin is the initial choice of an injectable drug, and newer fluoroquinolones include levofloxacin and moxifloxacin. For extensively drug-resistant TB, group 5 drugs such as linezolid and clofazimine need to be included. New drugs such as delamanid and bedaquiline have recently been approved for treating MDR-TB and other agents with novel mechanisms of action that can be given for shorter durations (6-12 months) for MDR-TB are under investigation.
Clofazimine ; Cycloserine ; Diagnosis* ; Drug Resistance ; Fluoroquinolones ; Kanamycin ; Levofloxacin ; Prothionamide ; Pyrazinamide ; Tuberculosis ; Tuberculosis, Multidrug-Resistant* ; World Health Organization

Clinical study was made on 102 cases of renal tuberculosis who visited the urological department, Kyungpook University Hospital during the 4 year period from July. 1951 to June, 1970. Fourteen cases were chosen at random, and culture and sensitivity test for tuberculous bacilli were performed. Results: 1. Incidence of renal tuberculosis patients tended to decrease from 2.22% of 1966 to 19. 3% of 1970. 2. Age and sex distribution showed that 31 cases (30. 3%) were in 20 ~ 29 years, 27(26. 5%) in 30 ~ 39, 17 (16.7%) in 10 ~ 19. Regarding the sex, 69 cases (57.8%) were male and 43 cases (42.2%) were female. 3.48.8% of the cases visited the hospital within 3 months to one year after the onset of symptoms 4. Initial symptom was mostly those of vesical symptom and hematuria. Hematuria in 64.7%. frequency in 53.9%, pain on urination in 36.3%. 5.38 cases (37.3%) were affected in right, 35 (34.3%) in left, and 27 (26.5%) in both sides. 6. Urinary findings revealed pyuria in 84 cases (82.4%), hematuria in 79 cases (77.4%), proteinuria in 87 cases (86.3%). 7. Tuberculous bacilli were found by staining only in 42.2%. Patient who have had a previous anti-tuberculous treatment were found to be positive staining in only 25% and those who have not were to be 47.5%. 8. The pyelogram showed that 50% of the cases with unilateral lesions were in far advanced, 12% in moderately advanced, while 70% of the cases with bilateral lesions in far advanced changes. 9. Other tuberculous lesions were found in 32. 3% cases of which 27.7% had genital tuberculosis 25% tuberculous pleurisy, and 22.2% lung tuberculosis. 10.14 cases (70%) were found positive in culture for tuberculous bacilli 11. Drug sensitivity test was carried out in 14 cases among which resistance was shown to SM in 3 cases at 100 r to INH in 3 cases at 0.1 r and to cycloserine in 12 cases at 10 r however, there was no resistant strain to PAS.
Cycloserine ; Female ; Gyeongsangbuk-do ; Hematuria ; Humans ; Incidence ; Lung ; Male ; Proteinuria ; Pyuria ; Sex Distribution ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Renal* ; Urination

BACKGROUND: The natural history of bacillary tuberculosis was studied in India and results showed that at the end of the 5-year period, 49% of the patients were dead, 33% were cured and 18% remained sputum-positive. The aim of this survey is to observe the natural course of the patients with intractable tuberculosis disease who were incurable with all drug regimens of the national tuberculosis programme(NTP). METHOD: Of the patients who have been found as intractable cases in Kang-Weon Province by the supervisory medical officer during the period from January 1,1987 to December 31,1992, 179 were eligible for this study. Sputum examination was done for those who were survived until October in 1993 at the Kang-Weon provincial laboratory of KNTA. 49 out of 179 patients were transferred to the private sectors and retreated with the combination of prothionamide, cycloserine, ofloxacin, enviomycin, etc. They seemed to have been bacteriologically cured, and so they were excluded from the study. Finally 130 patients were analyzed by modified life table method to calculate the fatality rate and the survival rate during the period of 7 years. RESULTS: 1) 80.8% of intractable cases were male and 19.2%,female. 2) More than 94% of intractable cases showed moderately or far advanced Tb findings on their X-rays at the time of registration at health centres. 3) The cumulative case-fatality rate was 19.74% at the end of 1-year period and has risen to 34.55% by the end of 4-year period(increasing by 4.9% a year on an average). The case-fatality rate has shown no appreciable rise since then until the end of 7-year period. 4) The case-survival rate was 80.26% at the end of 1-year period and has decreased to 65.45% by the end of 4-year period. And then there was no appreciable change in the survival rate until the end of 7-year observation. CONCLUSION: The case-survival rate of intractable cases was higher than that of untreated pulmonary tuberculosis patients and they may have risk of spreading multidrug resistant organisms. It is time we made an effort to improve case-management qualitatively.
Cycloserine ; Enviomycin ; Humans ; India ; Life Tables ; Male ; Natural History ; Ofloxacin ; Private Sector ; Prothionamide ; Sputum ; Survival Rate ; Tuberculosis* ; Tuberculosis, Pulmonary

BACKGROUND: Clostidium difficile is one of the most important pathogens responsible for nosocomial diarrhea; therefore, we compared the efficacy of laboratory tests for diagnosing C. difficile diarrhea. METHODS: We evaluated 107 stool specimens using a latex agglutination test (LA) (BD CDT, Culturette CDT, Becton, Dickison and Company, USA) and an enzyme linked fluorescent immunoassay (ELFA) (VIDAS C. difficile Toxin A II, Bio-Merieux sa, Marcy-l'Etoile, France). Stool specimens were cultured using cycloserine cefoxitine fructose agar in anaerobic condition. For identification of C. difficile, spore stain and Vitek ANA identification card (Bio-Merieux sa) were used. Toxin A and toxin B genes were analysed by PCRs using primers NK3-NK2 and NK104N-K105 respectively. RESULTS: The concordance rate between LA and ELFA was 68.2%. Based on the culture results, the sensitivity/specificity of LA and ELFA were 54.8%/100% and 17.8%/100%, respectively. The positive rates of toxin A and B genes were both 90.4%(66/73). Based on the results of PCR assays for toxin A and B genes, the sensitivity/specificity of LA and ELFA were 37.9%/85.7% and 19.7%/100%, respectively. CONCLUSION: Based on C. difficile culture and toxin A and B gene PCR results, the sensitivity of LA was apparently higher than that of ELFA. However, it should not be simply estimated that ELFA has lower capability for detecting toxin A of C. difficile because the possibility of emerging variant strains of C. difficile could not be ruled out. The prevalence of toxigenic strains of C. difficile including variant strains should be studied in Korea.
Agar ; Agglutination* ; Cefoxitin ; Clostridium difficile* ; Clostridium* ; Cycloserine ; Diarrhea ; Fluorescence* ; Fructose ; Immunoassay ; Immunoenzyme Techniques ; Korea ; Latex Fixation Tests ; Latex* ; Polymerase Chain Reaction* ; Prevalence ; Spores

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Desensitization, Immunologic ; Drug Hypersensitivity Syndrome* ; Hepatic Encephalopathy ; Humans ; Hypersensitivity ; Kanamycin ; Levofloxacin ; Male ; Methylprednisolone ; Middle Aged ; Patient Dropouts ; Pyrazinamide ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

BACKGROUND: Clostridium difficile is one of the most important pathogens responsible for nosocomial diarrhea. Recently, we have frequently experienced culture positive, toxin A enzyme immunoassay negative strains. Therefore, we evaluated the strains with several PCR primer sets to characterize them. METHODS: A total of 351 stool specimens were examined for toxin A using enzyme linked fluorescent immunoassay (ELFA) and also cultured for C. difficile using cycloserine cefoxitine fructose agar incubated under anaerobic conditions. Spore stain and Vitek ANA identification card (BioMerieux, France) were used for identification of C. difficile. We amplified toxin A and toxin B genes in 81 isolates using primers NK1- NK2, NK3-NK2, NK9- NK11, and NK104-NK105. RESULTS: The concordance rate between ELFA and culture was 65.2% (229/351). PCR for the toxin A gene using NK1-NK2, NK3-NK2 and for the toxin B gene using NK104-NK105 showed almost the same results. However, toxin A gene PCR using NK9-NK11 showed that 45.7% (37/81) of the evaluated strains were toxin A (-)/ toxin B(+) variant strains; thus, the corrected sensitivity and specificity of the ELFA based on the PCR results for toxin A and B genes were 65.6% and 100%, respectively. CONCLUSIONS: The low sensitivity of the ELFA results for toxin A was due to the toxin A(-)/toxin B(+) variants of C. difficile, suggesting that the prevalence of the variant strains could be higher in Korea than was expected.
Agar ; Cefoxitin ; Clostridium difficile* ; Clostridium* ; Cycloserine ; Diarrhea ; Fructose ; Genes, vif ; Immunoassay ; Immunoenzyme Techniques ; Korea ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity ; Spores