1.Color-vision abnormalities among patients undergoing tuberculosis treatment
Emerson M. Cruz ; Frances G. Puentespina ; Karlo Paolo L. Alejo ; Evelyn T. Santos-Morabe ; Ma. Lourdes R. Nañ ; agas
Philippine Journal of Ophthalmology 2010;35(1):3-9
Objective:
This study determined the incidence of and risk factors for color-vision
abnormalities among Filipino patients undergoing directly observed treatment
short-course (DOTS) for tuberculosis.
Methods:
A prospective single-cohort study involving newly diagnosed patients with
category-1 tuberculosis, recruited from DOTS health centers in Manila, was
conducted. All patients were given a fixed-dose combination of rifampicin,
isoniazid, ethambutol, and pyrazinamide for 60 days, after which treatment
was continued with rifampicin and isoniazid for 4 more months. The
participants underwent complete eye evaluation including color-vision testing
and were followed up every month up to the conclusion of treatment.
Results:
Out of 93 patients initially enrolled, 64 completed the prescribed follow-up
and constituted the study group. Baseline color vision was normal. After 1 month
of therapy, color vision tested with the Ishihara plates remained normal in all
patients, but one failed the Farnsworth Panel D 15 and was classified as tritan
while 30 (47.88%) failed the Lanthony Desaturated test. The type of abnormality
was unclassified in 20 (66.67 %)patients and tritan in 10 (33.3%). Visual acuity
remained unchanged from baseline. Repeat testing after ethambutol and
pyrazinamide were stopped showed that color vision was normal using the
Ishihara plates and the Farnsworth test, while 5 failed the Lanthony test. Of
these, 3 were unclassified and 2 were tritan. In the 3rd to 6th months follow-up,
no color-vision abnormalities were noted in the 3 tests. The only risk factor
identified was age (p = 0.01) with older patients having a higher risk.
Conclusion
The incidence of color-vision abnormalities among patients undergoing
DOTS was 47.88% using the Lanthony Desaturated test after an average of
39.66 days on quadruple anti-TB therapy. Age was the only significant risk
factor observed. The color-vision abnormalities returned to normal within an
average of 37.85 days after discontinuing ethambutol and pyrazinamide.
Ethambutol
;
Tuberculosis
;
Color Vision
2.Baseline retinal nerve fiber layer thickness and visual outcomes of eyes with ethambutol toxic optic neuropathy
Philippine Journal of Ophthalmology 2018;43(2):60-64
Objectives:
To determine the retinal nerve fiber layer thickness (RNFL) in eyes with ethambutol-induced toxic
optic neuropathy (ETON) at the time of diagnosis and to describe the visual outcomes at 1, 3, and 6 months after
discontinuation of ethambutol
Methods:
This was a retrospective chart review of 8 patients (15 eyes) diagnosed with ETON that had RNFL
thickness measurements using Cirrus® spectral-domain optical coherence tomography (OCT) at the time of
diagnosis. Visual function was measured on initial visit and at 1, 3, and 6-month follow-up. Snellen visual acuity was
converted to logMAR. Color vision was measured using Ishihara 14-plate test chart.
Results:
The mean duration from commencement of ethambutol intake to onset of visual symptoms was 16
weeks (range: 8-24). While, the mean duration from onset of visual symptoms to discontinuation of ethambutol
was 4 weeks (range: 2-14). The mean global RNFL thickness at time of diagnosis was 101.2 ± 17.0 microns. Mean
RNFL in the temporal, superior, nasal, and inferior sectors were as follows: 79.2 ± 15.4, 119.7 ± 27.9, 71.7 ± 9.2,
and 136.7 ± 25.8 microns. Global and sectoral RNFL thicknesses were either normal or thick when compared to
age-matched normal database. No eye displayed global or sectoral RNFL thinning. Mean baseline visual acuity and
color vision were logMAR 1.2 and 5 plates, respectively. At 1, 3, and 6 months after discontinuation of ethambutol,
mean visual acuity and color vision were 0.96 and 6, 0.63 and 11, and 0.44 and 13, respectively.
Conclusion
Patients with early ETON have normal or thick RNFL at time of diagnosis. They display good visual
recovery 6 months following discontinuation of ethambutol.
Ethambutol
;
Toxic Optic Neuropathy
;
Tomography, Optical Coherence
3.Efficacy of vitamin supplementation in preventing color vision abnormalities among patients undergoing DOTS for Tuberculosis
Jan Michael R. Reyes ; Anne Marfe L. Tan ; Melizza T. Ramirez ; Roland B. Bagnes ; Evelyn S. Morabe ; Emerson M. Cruz
Philippine Journal of Ophthalmology 2013;38(1):50-55
Objective:
To determine if vitamin supplementation can prevent the development of color vision abnormalities
in patients taking ethambutol as part of DOTS for tuberculosis (TB).
Methods:
A randomized, placebo-controlled, single-blind clinical trial was conducted among newly diagnosed
category-1 TB patients enrolled in DOTS health centers in the third district of Manila from June 2011 to August
2012. Before starting therapy, the participants underwent a complete eye evaluation including baseline color vision
tests using the Ishihara Color Vision Plates (Ishihara), Farnsworth Panel D-15 (FD 15), and Lanthony Desaturated
D-15. Only subjects who passed the three color vision tests were included in the study. They were divided into 2
groups: Group A received vitamin supplementation and Group B received a placebo. Follow-up color vision testing
was done monthly for 3 months.
Results:
There were 105 patients included in the study, 77 males and 28 females, age ranging from 16 to 68 years with a
mean of 37 years. Forty three (43) patients received vitamin supplementation (group A) and 62 received placebo (group
B). After one month of DOTS, 5 of 43 patients (11. 6%) in group A and 10 of 62 patients (16.1%) in group B developed
color vision abnormalities, detected only with the Lanthony Desaturated test. The absolute risk reduction (ARR) of
color vision abnormalities by vitamin supplementation was 4.5%, with the number needed to treat (NNT) of 23. After
the second month of therapy, ARR was 7.4% and NNT was 14. ARR was highest in the third month at 8.3%, with
a corresponding decreased NNT of 12. Among patients who developed color vision abnormalities, reversal of the
abnormalities was observed in 80% of 5 subjects in group A, and 40% of 10 patients in group B. By the third month of
treatment, all in group A already had normal color vision, while 40% in group B still showed abnormal color vision.
Conclusion
This study showed that vitamin supplementation was effective in reducing the risk of, and in reversing
cases of, color vision abnormalities among patients undergoing DOTS therapy for tuberculosis.
Tuberculosis
;
Ethambutol
;
Color Vision
;
Optic Neuritis
4.Nine Cases of Ethambutol Toxicity on Human Eye.
Journal of the Korean Ophthalmological Society 1975;16(4):453-456
Author presented nine patients of eye toxicity from Ethambutol. They used daily the drug, 15~30mg per kilogram body weight during the period of one month to six months. With the relationship of drug induced toxic amblyopia and optic neuritis, seven patients out of nine showed severe visual disturbance. Five of them have the peripheral constriction. Three cases showed relative ring scotoma and one case showed relative central scotoma.
Amblyopia
;
Body Weight
;
Constriction
;
Ethambutol*
;
Humans*
;
Optic Neuritis
;
Scotoma
5.Lichenoid Drug Eruption due to Ethambutol.
Seong Jun SEO ; Chang Kwon HONG ; Byung In RO ; Chin Yo CHANG
Annals of Dermatology 1989;1(2):95-97
A 73-year-old female patient, who had been treated with antituberculous drugs for 4 months, was referred to our department because of generalized macules and papules present for 15 days. Clinical examination revealed polygonal, flat papules of erythematous to violaceous hue on the entire skin. Histopathologic findings were similar to those of lichen planus. In a provocation test with ethambutol, the skin lesions were aggravated and the new lesions developed. We considered this case to be a lichenoid drug eruption due to ethambutol. The skin lesions gradually cleared after ethambutol was eliminated from the patient's tuberculosis therapy.
Aged
;
Drug Eruptions*
;
Ethambutol*
;
Female
;
Humans
;
Lichen Planus
;
Skin
;
Tuberculosis
6.Evaluation of Mycobacteria Growth Indicator Tube for Drug Susceptibility Testing of Mycobacterium tuberculosis Using MGIT 960 System.
Korean Journal of Clinical Microbiology 2002;5(1):47-51
BACKGROUND: Multidrug resistant tuberculosis (MDRTB) strains rely on the prompt availability of drug susceptibility test results. We evaluated the reliability and turnaround time of MGIT 960 system, automated version of the MGIT, for antimicrobial susceptibility test of Mycobacteria tuberculosis. METHODS: Ninety six isolates have been tested for susceptibility to isoniazid (INH), rifampin (RIF), ethambutol (EMB) and streptomycin (SM). Results were compared with those obtained by traditional solid media (absolute concentration method, indirect method). RESULTS: There was no statistically significant difference between the susceptibility testing results of the two methods except for EMB. Discrepant results were obtained for 8 isolates (8.3%) with INH, for 3 isolates (3.1%) with RIF, for 13 isolates (13.5%) with EMB, for 10 isolates (10.4%) with SM. Using the indirect method as the gold standard, the sensitivity of INH, RIF, EMB and SM susceptibility testing by the MGIT system were 94.1%, 98.8%, 86.7% and 90.0%, respectively. The specificity were 85.7%, for INH and RIF and 83.3%, for EMB and SM. Turnaround times were significant shorter in MGIT (average 12 days) than in solid media (average 57 days) (P < 0.05) CONCLUSIONS: These data demonstrate that the MGIT system is accurate and rapid for INH, RIF and SM susceptibility test of M. tuberculosis, but EMB susceptibility testing requires further evaluation.
Ethambutol
;
Isoniazid
;
Mycobacterium tuberculosis*
;
Mycobacterium*
;
Rifampin
;
Sensitivity and Specificity
;
Streptomycin
;
Tuberculosis
7.A Case of Tuberculous Pneumonitis With Continuous High Spiking Fever.
Hee Seung LEE ; Jung Cheol RYU ; Tae Koon PARK ; Tae Joon PARK ; Eun Soo YANG ; Soo Jeon CHOI ; Young Tace KWAK ; Bong Su CHA ; Se Kyu KIM
Tuberculosis and Respiratory Diseases 1994;41(3):299-302
A 33-year old male was admitted due to continuous high spiking fever for 2 months via local clinic. He had been diagnosed pulmonary tuberculosis at local clinic. However, spiking fever had not been controlled by anti-tuberculous medications. Chest PA showed confluent consolidation on right upper & mid-lung field. 5 anti-tuberculous regimens (Streptomycin, Isoniazid, Rifampin, Ethambutol, Pyrazinamaide) were administered initially and steroid therapy was followed for relieving toxic symptoms Very slowly resolved chest X-ray lesion and continuous fever suggested the possibility of misdiagnosis. After 60th hospital day, the chest X-ray lesion was resolved gradually and fever subsided almost completely. He was discharged on 76th hospital day with anti-tuberculous drugs and steroid(prednisolon), without any other problems except sustained mild fever.
Diagnostic Errors
;
Ethambutol
;
Fever*
;
Humans
;
Isoniazid
;
Male
;
Pneumonia*
;
Rifampin
;
Thorax
;
Tuberculosis, Pulmonary
8.A Case of Lichenoid Drug Eruption Caused By Antituberculosis Drugs.
Jee Ook KIM ; Young Wook RYOO ; Kyu Suk LEE
Korean Journal of Dermatology 2000;38(12):1686-1687
Lichenoid drug eruption is lichenoid skin eruptions caused by certain drugs and compounds, and can be similar to lichenoid planus. A 59-year-old man who had taken antituberculosis drugs(Isoniazid, Rifampin, Ethambutol, Pyrazinamide) for 2months developed pruritic erythematous papules and plaques with silvery scales on the face, trunk and extremities. Histopathologic findings were hyperkeratosis, parakeratosis, hypergranulosis, band like lymphohistiocytic infiltration in the upper dermis and perivascular lymphohistiocytic infiltration in the deep dermis. He was treated with antihistamines and topical corticosteroid and then skin lesions slightly improved. 1 month after the termination of antituberculosis medication, skin lesions improved leaving hyperpigmentation.
Dermis
;
Drug Eruptions*
;
Ethambutol
;
Extremities
;
Histamine Antagonists
;
Humans
;
Hyperpigmentation
;
Middle Aged
;
Parakeratosis
;
Rifampin
;
Skin
;
Weights and Measures
9.Effect of Anti-tuberculous Drugs on Liver Fuctionin in Children.
Journal of the Korean Pediatric Society 1978;21(11):771-777
Elevatio of serum transaminase were observed in 17.1% of patients administered isoniazid, and in 30.8% of patients administered isoniazid and rifampicin, from 2 weeks to 10 months after the administration of these drugs. Two cases of symptomatic hepatitis were observed in patients administered isoniazid and rifampicin during the same period. Patients in whom isoniazid was interrupted or rifampicin was replaced to ethambutol showed a return of the serum transaminase level to normal over a variable period of time(from 4 to 8 weeks). Isoniazid was not interrupted in 4 subjects receiving isoniazid only for chemoprophylaxis. In three of these, this reactin was self-limited with spontaneous return of serum transaminase level to normal In this study, sex and age incidence of hepatic dysfunction were not significant. Further study with more large subject group is required to evaluate exact incidence and time of onset of hepatic dysfunction due to isoniazid or rifampicin or both. It was recommended that patient given anti-tuberculous drug therapy should be contacted monthly interval to monitor for possible hepatotoxicity.
Chemoprevention
;
Child*
;
Drug Therapy
;
Ethambutol
;
Hepatitis
;
Humans
;
Incidence
;
Isoniazid
;
Liver*
;
Rifampin
10.A Clinical Study of the Treatment of Tuberculous Cervical Lymphadenitis.
Journal of the Korean Surgical Society 1999;56(3):442-448
BACKGROUND: Tuberculous cervical lymphadenitis is a granlomatous lymphadenitis which is the most common extra-plumonary tuberculosis in Korea. There are several controversies about the methods and the duration for the treatment of the disease. METHODS: We have studied 208 cases of tuberculous cervical lymphadenitis which were treated at Chung-Goo Sung-Shim Hospital from January 1992 to December 1996. RESULTS: The result of the study are as follows: The most prevalent age group was the third decade followed by the fourth decade. For the sexual distribution, females predominated over males by 1.9 to 1. the unilateral location was the most common one (76.2%). The most frequent lesion was on the anterior cervical triangle (28.6%) Simple excision was performed in 194 cases and incision plus drainage in 14 cases. Antituberculous medication was applied to the patients in two different groups. Isoniazid, Rifampin and Ethambutol were administered every day to the patients in one of the groups. To the other group, Pyrazinamide was additionally administered - Isoniazid, Rifampin, Ethambutol, and Pyrazinamide were administered every day. The average duration of medication for the former group was 13 months, and that for the latter group was 11 months. We experienced 17 cases of recurrence in both groups. The recurrence rate was 3.7% (4 cases) for the group with Pyrazinamide included and 13.0% (13 cases) for the other. For the patients with recurrence who were treated with the pyrazinamide, extending the medication from 6 to 12 months brought about a complete treatment for all cases. However, for the cases of recurrence in the other group, in which Pyrazinamide were not applied, only 8 cases were treated completely by 12 months after the additional administration of Pyrazinamide. Surgical treatment was performed for the remaining 5 cases, and all 5 cases were cured completely after additional antituberculous medication for 6 months. CONCLUSIONS: We conclude that the best choice for the treatment of tuberculous cervical lymphadenintis is the use of both surgical excision and antituberculous medication. In addition, the use of Pyrazinamide is recommended for the antituberculous medication.
Drainage
;
Ethambutol
;
Female
;
Humans
;
Isoniazid
;
Korea
;
Lymphadenitis*
;
Male
;
Pyrazinamide
;
Recurrence
;
Rifampin
;
Tuberculosis