P 50

DEXAMETHASONE IN TBC MENINGITIS

M. Hurmuzache, V. Luca, O. Mihoc, D. Teodor, D. Chiselita
UNIV. MED & PH, Iasi, Romania

Objective: To compare the efficiency of Dexamethasone (DXM) in TBC meningitis (TBCM) as prime manifestation of BK infection to those in which TBCM is secundar or are not treated with DXM.

Methods: Combined retro-prospective study for a period of 10 years (1993-2002), including 258 patients admitted at Univ. Hosp. of Inf. Diseases, Iasi, Romania, most of them aged 16-60=148 cases (57.4%), 74 (28.6%) = < 16 years and 36 (14%) = > 60 years old. There were selected for the study only those patients who were admitted the first 10 days of illness and tuberculostatic treatment + DXM begun the first 24 hours after.
Of them, 196 were treated with DXM (0.15 mg/kg/day) and 62 not. We followed the evolution of patients: recoveringR, deathsD and sequalaeS.
In the 196 cases treated with DXM, TBCM was prime manifestation of BK infection in 85 patients (group A1) = no TBC antecedents, in the other 111 cases the BK infection being known before (group B1). Among the 62 untreated DXM patients in 21 (group A2) TBCM was prime manifestation of BK infection and in 41 (group B2) TBCM happened during a known BK infection. DXM was administred for a medium period of 7-8 days at high doses, after it was slowly decreased.

Results: group A1 (85 patients, DXM+, primar TBCM): R=76 (89.5%), D=6 (7%), S=3 (3.5%)
group B1 (111 patients, DXM+, secundar TBCM): R=88 (79.3%), D=11 (9.9%), S=12 (10.8%)
group A2 (21 patients, DXM-, primar TBCM): R=14 (66,6%), D=4 (19%), S=3 (14.4%)
group B2 (41 patients, DXM-, secundar TBCM): R=26 (63.5%), D=8 (19.5%), S=7 (17%)
As it can be seen DXM seems to be most effective in group A1.

Conclusion: DXM in high doses is most effective in TBCM appeared as prime manifestation of BK infection, especially when corticotherapy is administred in the first 10 days of the illness (simultanously with 4 tuberculostatics), for a medium period of 7-8 days, so it seems to lower significantly the number of deaths and sequalae.

P 51

SENSITIZATION OF LYMPHOCYTES TO M. TUBERCULOSIS ANTIGENS IN PATIENTS WITH PULMONARY TUBERCULOSIS AFTER VACCINATION FOR INFLUENZA

I.V. Kuchko, V.M. Semenov
Vitebsk State Medical University, Republic Belarus

Aim: To assess the lymphocytes sensitization degree to the antigens of M. tuberculosis in patients with pulmonary tuberculosis after the application of inactivated purified split-vaccine “Fluarix” produced by “SmithKlineBeecham” company, USA. This preparation contaims antigenes of the following viruses types: A/Panama/2007/99 (H3N2) similar to A/Moscow/10/99 (H3N2), A/New Caledonia/20/99 (H1N1), B/Yamanashi/166/98 similar to B/Pekin/184/93. This content was recommended by WHO for influenza prevention for the season of 2000/2001 and 2001/2002.

Methods: We have vaccinated 62 patients with the different clinical forms of pulmonary tuberculosis. Cell immune response was studied by application of lymphocytes blast-transformation reaction (RLBT) with the morphological account of the results.

Results: It was revealed that sensitization to M. tuberculosis antigens took place in 75% of immunized patients, what corresponds the level of lymphocytes sensitization before vaccination.

Conclusion: Thus, the injection of influenza vaccine “Fluarix” didn’t influence the state of cell immunity to the antigens of M. tuberculosis.

P 52

VACCINATION FOR INFLUENZA PREVENTION IN PATIENTS WITH PULMONARY TUBERCULOSIS

V.M. Semenov, I.V. Kuchko
Vitebsk State Medical University, Republic Belarus

Aim: To assess the immunological and adverse effects of influenza vaccine “Fluarix” produced by “SmithKlineBeecham” company, USA, in patients with pulmonary tuberculosis.

Methods: Antigenic content of vaccine was determined by WHO and corresponded to the following viruses types and subtypes: A/Panama/2007/99 (H3N2) similar to A/Moscow/10/99 (H3N2), A/New Caledonia/20/99 (H1N1), B/Yamanashi/166/98 similar to B/Pekin/184/93. Vaccine was injected intramuscularly into the deltoid muscule in the dose of 0.5 ml. The antibodies to A type (H0N1, H1N1, H2N2, H3N2 serotypes) and B type viruses were determined for the 14 day after vaccination using RPHA. Vaccination was performed to 62 patients with the different clinical forms of pulmonary tuberculosis (43 cases of infiltrative tuberculosis (69.4%), 7 cases of focal tuberculosis (11.3%), 5 patients with disseminated tuberculosis (8.1%), fibrous-cavernous tuberculosis in 3 patients (4.8%), tuberculosis pleuritis in 2 patients (3.2%), tuberculoma in 1 patient (1.6%), and cavernous tuberculosis in 1 patient (1.6%)). The people with bacterial abjection composed 61.3% (38) of the all group.

Results: The protective titer of antibodies to A virus of H1N1 serotype was found in 89.8% of patients, to H3N2 serotype – in 98.3%, to B virus – in 91.5% of patients. In 6 patients (10.2%) protective titer of the antibodies to A type virus of H1N1 serotype was not revealed (< 1:40). Side effects (short-termed fever) were detected in 4 (6.5%) of patients. Local reaction was not seen. The deferred complications weren’t noted for the follow-up period. Nobody from the examined group has fallen ill with influenza.

P 53

SENSITIZATION OF T-LYMPHOCYTES TO INFLUENZA VIRUS ANTIGENS IN PATIENTS ILL WITH PULMONARY TUBERCULOSIS AFTER THE APPLICATION OF INFLUENZA VACCINE

V.M. Semenov, I.V. Kuchko
Vitebsk State Medical University, Republic Belarus

Aim: To assess the development of specific immunity to influenza viruses in patients with pulmonary tuberculosis after the application of “Fluarix” vaccine produced by “SmithKlineBeecham” company, USA. This preparation contents antigenes of the following viruses types: A/Panama/2007/99 (H3N2) similar to A/Moscow/10/99 (H3N2), A/New Caledonia/20/99 (H1N1), B/Yamanashi/166/98 similar to B/Pekin/184/93. This content was recommended by WHO for influenza prevention for the season of 2000/2001 and 2001/2002.

Methods: We have injected vaccine described above to 62 patients with the different clinical variants of tuberculosis. Immune response was investigated by using of the reaction of lymphocytes blast-transformation (RLBT) for the month after vaccination.

Results: Positive RLBT results with the antigens of influenza viruses were revealed in 33 patients (63.5% of the all clinical group). The majority of patients with bacterial abjection (72.9%) had positive RLBT with influenza virus antigens.

Conclusion: Thus, application of “Fluarix” vaccine in patients with pulmonary tuberculosis results in sensitization of lymphocytes to influenza virus antigens indicating the possibility of development of immunity to influenza.

P 54

RHODOCOCCUS EQUI AND MYCOBACTERIUM AVIUM COMPLEX INFECTION: CASE REPORT

H. Alves, L. Malcata, J. Velez, V. Duque, J. Oliveira, A.A. Meliço-Silvestre
Department of Infectious Diseases of University Hospital Coimbra, Portugal

Introduction: Rhodococcus equi is emerging as an important opportunistic pathogen in immunocompromised hosts, particularly those infected with HIV. Pleuropulmonary infection is the most common clinical presentation and relapses are frequent. The AA report a case of Rhodococcus equi and MAC infection in a severely immunosuppressed AIDS patient.

Case Presentation: A 38 year-old male with HIV1 infection was admitted to our Department with high fever (39ºC), productive cough, chest pain, diarrhea and weight loss lasting for two weeks. The chest X-ray showed a cavitary lesion with air-fluid level in the left lower lobe; cultures of blood, stools and sputum were negative; CD4 T-cell count was 14/mm³ and HIV viral load 10 000 000 copies/ml. A percutaneous transthoracic aspiration was performed and culture of the specimen yielded Rhodococcus equi. The patient was started on Imipenem and Vancomycin with clinical and radiological improvement and was discharged on suppressive therapy and antiretrovirals. Three months later he was readmitted with the same clinical picture; he had abandoned all medications. The chest X-ray showed multiple nodular infiltrates in the right upper lobe and the same cavitary lesion in the left lower lobe; blood cultures yielded Rhodococcus equi (with similar pattern of antibiotic sensitivity assays) and MAC. He began antimicrobial therapy with Imipenem and Vancomycin plus Rifabutin and Ethambutol, but because of persistent fever with clinical worsening Levofloxacin was added to the previous regimen; subsequently he restarted antiretrovirals. A gradual improvement in his clinical status was observed and he was discharged.

Conclusion: R. equi infection requires prolonged antibiotic therapy and coinfection with other opportunistic pathogens are expected in deeply immunosuppressed patients. The progressive immunological reconstitution induced by HAART may influence the outcome of these infections.

P 55

CHEMOTHERAPY IN CHILDREN WITH TUBERCULOSIS

M. Chirila
Ftiziopediatrics Hospital, Laculbucura No. 40, Sector 5, Bucharest, Romania

Background: Unless properly treated, tuberculosis, a chronic infectious disease, could be associated with a high mortality rate. In Romania, infection in pediatric ages progresses rapidly and also, diagnosing tuberculosis in children is difficult since they are not likely to present the same specific type of symptoms as the adults. So, TB may be suspected in a child who has had close contact with an adult with TB, is not gaining weight properly, is not recovering from a respiratory infection or has a persistent cough or wheeze.

Methods: We studied three cases of TB in children that represented contacts of infected adults. All of them lacked obvious symptoms of tuberculosis, but the radiographic abnormalities of the lungs were specific. Two cases presented cavitary lung lesions and one case presented miliary tuberculosis.
According to the principles of multiple drug chemotherapy, the patients have been treated with Isoniazid, Rifampin, Pyrazinamide and Streptomycin for 3 months, followed by a 3 months course of Isoniazid, Rifampin and Pyrazinamide.

Results: All the cases presented a good tolerance of the therapy and only minimal complications occurred. After 6 month of treatment, the patients were fully recovered and the chest radiographs showed that the pulmonary lesions were healed.

Conclusion: Early examination of pediatric contacts in infected adults and epidemiological investigation after the diagnosis of pediatric tuberculosis are important in order to diagnose tuberculosis and to start the treatment. By doing that, we can stop the spread of tuberculosis and we can save children’s lives.