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Article: Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients

TitleClinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients
Authors
KeywordsAntitubercular Agents - administration & dosage
Skin Diseases - microbiology - therapy
Tuberculin Test
Tuberculosis, Lymph Node - diagnosis - drug therapy
Tuberculosis, Miliary - diagnosis - drug therapy
Issue Date2002
PublisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/10096/index.htm
Citation
European Journal Of Clinical Microbiology And Infectious Diseases, 2002, v. 21 n. 11, p. 803-809 How to Cite?
AbstractParadoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) (P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy.
Persistent Identifierhttp://hdl.handle.net/10722/48641
ISSN
2015 Impact Factor: 2.857
2015 SCImago Journal Rankings: 1.173
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheng, VCCen_HK
dc.contributor.authorHo, PLen_HK
dc.contributor.authorLee, RAen_HK
dc.contributor.authorChan, KSen_HK
dc.contributor.authorChan, KKen_HK
dc.contributor.authorWoo, PCYen_HK
dc.contributor.authorLau, SKPen_HK
dc.contributor.authorYuen, KYen_HK
dc.date.accessioned2008-05-22T04:19:49Z-
dc.date.available2008-05-22T04:19:49Z-
dc.date.issued2002en_HK
dc.identifier.citationEuropean Journal Of Clinical Microbiology And Infectious Diseases, 2002, v. 21 n. 11, p. 803-809en_HK
dc.identifier.issn0934-9723en_HK
dc.identifier.urihttp://hdl.handle.net/10722/48641-
dc.description.abstractParadoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) (P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy.en_HK
dc.format.extent79521 bytes-
dc.format.extent1902 bytes-
dc.format.mimetypeapplication/pdf-
dc.format.mimetypetext/plain-
dc.languageengen_HK
dc.publisherSpringer Verlag. The Journal's web site is located at http://link.springer.de/link/service/journals/10096/index.htmen_HK
dc.relation.ispartofEuropean Journal of Clinical Microbiology and Infectious Diseasesen_HK
dc.rightsThe original publication is available at www.springerlink.comen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subjectAntitubercular Agents - administration & dosageen_HK
dc.subjectSkin Diseases - microbiology - therapyen_HK
dc.subjectTuberculin Testen_HK
dc.subjectTuberculosis, Lymph Node - diagnosis - drug therapyen_HK
dc.subjectTuberculosis, Miliary - diagnosis - drug therapyen_HK
dc.titleClinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patientsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0934-9723&volume=21&issue=11&spage=803&epage=809&date=2002&atitle=Clinical+spectrum+of+paradoxical+deterioration+during+antituberculosis+therapy+in+non-HIV-infected+patientsen_HK
dc.identifier.emailHo, PL:plho@hkucc.hku.hken_HK
dc.identifier.emailWoo, PCY:pcywoo@hkucc.hku.hken_HK
dc.identifier.emailLau, SKP:skplau@hkucc.hku.hken_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityHo, PL=rp00406en_HK
dc.identifier.authorityWoo, PCY=rp00430en_HK
dc.identifier.authorityLau, SKP=rp00486en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturepostprinten_HK
dc.identifier.doi10.1007/s10096-002-0821-2en_HK
dc.identifier.pmid12461590-
dc.identifier.scopuseid_2-s2.0-0036449455en_HK
dc.identifier.hkuros80172-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036449455&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume21en_HK
dc.identifier.issue11en_HK
dc.identifier.spage803en_HK
dc.identifier.epage809en_HK
dc.identifier.isiWOS:000179939400006-
dc.publisher.placeGermanyen_HK
dc.identifier.scopusauthoridCheng, VCC=23670479400en_HK
dc.identifier.scopusauthoridHo, PL=7402211363en_HK
dc.identifier.scopusauthoridLee, RA=7408203830en_HK
dc.identifier.scopusauthoridChan, KS=7406031627en_HK
dc.identifier.scopusauthoridChan, KK=35073540100en_HK
dc.identifier.scopusauthoridWoo, PCY=7201801340en_HK
dc.identifier.scopusauthoridLau, SKP=7401596211en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK

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