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Payam Tabarsi,
Ehsan Chitsaz,
Parvaneh Baghaei,
Masoud Shamaei,
Parisa Farnia,
Majid Marjani,
Mehdi Kazempour, Majid Amiri,
Davood Mansouri,
Mohammad R Masjedi,
Ali A Velayati,
Jose A Caminero
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ABSTRACT: The limited experience in treating patients with extensively drug-resistant tuberculosis (XDR-TB) shows a therapeutic success rate under 50-60% and there are no publications regarding the outcome of these patients treated with standardized regimens. All multidrug-resistant tuberculosis (MDR-TB) patients hospitalized at the Masih Daneshvari Hospital in Tehran, Iran, during 2004-2007 were recruited. Drug susceptibility testing to 14 drugs (including eight second-line drugs) was performed and a standardized regimen with ofloxacin, cycloserine, prothionamide, and amikacin was administered for all patients. Outcome of the patients was studied, comparing between the MDR-TB non-XDR-TB and the XDR-TB. Fifty-one patients were included, 12 with XDR-TB criteria. Of 51, 48 were HIV negative and HIV status was unknown in three cases. All 12 were HIV negative. XDR-TB infection was significantly associated only with age (p = 0.039). The success rates for the total 51 MDR-TB, the 39 MDR-TB non-XDR-TB, and the 12 XDR-TB patients were 76.5% (39 patients), 87.2% (34 patients), and 41.7% (5 patients), respectively. Resistance to ofloxacin, ciprofloxacin, and amikacin were found to be significantly associated with unsuccessful outcome. In this setting, a standardized second-line drugs regimen produces high treatment success rates in MDR-TB patients unless XDR-TB is present.
Microbial drug resistance (Larchmont, N.Y.) 03/2010; 16(1):81-6. · 1.99 Impact Factor
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ABSTRACT: Extensively drug-resistant tuberculosis (XDR-TB) has recently been identified as a major threat to global health. XDR-TB poses a risk of higher failure rates and death during TB treatment. We report herein the outcomes of XDR-TB in patients treated with the standardized regimen in Iran.
Between 2002 and 2006, seven patients were diagnosed with XDR-TB. All patients were treated with the standardized second-line regimen containing cycloserine, prothionamide, amikacin, and ofloxacin. First-line drugs, such as ethambutol and pyrazinamide, were added to the regimen if drug susceptibility testing showed sensitivity to these drugs.
Four (57.1%) patients were male. All seven patients were HIV-negative. The patient age range was 22-79 years. Of the seven cases, the final outcome was 'cure' in two (28.6%), 'relapse' in one, 'treatment failure' in one, and 'death' in two; the outcome for one patient was unknown.
Our study shows a poor prognosis in patients with XDR-TB. This indicates the necessity of detecting XDR-TB cases earlier, as well as the need to gain access to more second-line agents. This is particularly important in resource-limited settings in order to administer individualized regimens.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 10/2009; 14(5):e399-402. · 2.17 Impact Factor
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ABSTRACT: The overlapping drug toxicity profiles, drug-drug interactions and complications of management of both HIV and tuberculosis (TB) in patients with advanced HIV have not been fully delineated.
We conducted a retrospective chart review of the outcomes of tuberculosis treatment among 69 HIV-infected patients with TB, who were hospitalized in Masih Daneshvari Hospital in Tehran, Iran between 2002 and 2006, and who received standard category 1 (CAT-1) regimens. Group I (N = 47) included those treated from 2002 to 2005 with highly active antiretroviral therapy (HAART) initiated after eight weeks of TB treatment for those whose CD4 count was <200 cells/mm3. Group II (N = 22) included TB patients treated from 2005 to 2006, with HAART initiated after two weeks of TB treatment if their CD4 count was <100 cells/mm3 and eight weeks after initiation of TB treatment for those whose CD4 count was between 101 and 200 cells/mm3.
There were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns]. Death, however, occurred more frequently in Group I than in Group II [13 (27.7%) versus (4.5%), p = 0.03], where HAART was initiated earlier. Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).
This manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm3.
Journal of the International AIDS Society 07/2009; 12:14. · 3.26 Impact Factor
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Payam Tabarsi,
Parvaneh Baghaei,
Parisa Farnia,
Nahal Mansouri,
Ehsan Chitsaz,
Fatemeh Sheikholeslam,
Majid Marjani,
Nima Rouhani,
Mehdi Mirsaeidi,
Narges Alipanah, Majid Amiri,
Mohammad R Masjedi,
Davood Mansouri
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ABSTRACT: In this study, we intended to find the prevalence of nontuberculosis mycobacteria (NTM) among patients who are referred as suspected multidrug-resistant tuberculosis (MDR-TB) cases to the only referral center in Iran.
All patients referred to our center in 2002-2006 as MDR-TB with histories of treatment with standard and CAT II World Health Organization regimens were included in the study. Sputum smear and culture for acid-fast bacilli were performed for all patients 3 times. Sputum polymerase chain reaction was also performed for all patients. Mycobacterial identification was performed via polymerase chain reaction and routine identification tests for all culture-positive cases.
Of the 105 patients in the study, 12 (11.43%) were identified to have NTM infection. The identified mycobacteria were classified in order of prevalence as Chelonae (8 cases), Simiae (2 cases), Aloei (1 case), and Farcinogen (1 case). Based on radiologic findings, most of the cases demonstrated bilateral nodularity (83.3%) and also multifocal bronchiectasis (75%). Notably, cavitary lesions were present in 41.7% of the cases.
Based on the findings of this study, it is essential that such cases be identified before commencing MDR-TB treatment.
The American Journal of the Medical Sciences 04/2009; 337(3):182-4. · 1.39 Impact Factor
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Saudi medical journal 02/2008; 29(1):148-50. · 0.52 Impact Factor
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Payam Tabarsi,
Azar Nooraki,
Mehdi Mirsaeidi, Majid Amiri,
Parvaneh Baghaei,
Parisa Farnia,
Mehdi Kazempour,
Hassan Heidarnazhad,
Narges Alipanah,
Davood Mansouri,
Mohammad R Masjedi
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ABSTRACT: The prevalence of multidrug-resistant tuberculosis (MDR-TB) has increased substantially in the past 20 years, however, there are no data specific to Iran. This study investigated patients suspected to have MDR-TB, attending the TB referral hospital in Iran.
All patients suspected of having MDR-TB on hospital admission in the period 2003-2005 were included in this study. Sputum from all patients was tested for smear and culture, and drug sensitivity testing was performed using the proportion method. Patients were categorized into three groups based on their history of medical treatment. Group I consisted of patients with CAT I regimen failure; Group II consisted of patients with a history of CAT II regimen failure and Group III comprised patients with a history of more than two courses of irregular CAT I anti-TB regimen.
There were 105 patients recruited; 32 in Group I, 53 in Group II and 20 in Group III. There were no significant differences between the three groups in their resistance to first-line anti-TB drugs. Fifty-five patients were diagnosed with MDR-TB. The prevalence of MDR-TB was 56% (18 cases) in group I, 49% (26 cases) in group II and 55% (11 cases) in group III. No significant difference in the pattern of drug resistance was observed between the three groups.
The prevalence of MDR-TB was high in this study. The lack of response of MDR-TB patients to CAT II treatment indicates that antibiotic sensitivity testing is essential in patients with CAT I treatment failure.
Respirology 02/2008; 13(1):108-11. · 2.42 Impact Factor
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Mehdi Seyed Mirsaeidi,
Payam Tabarsi,
Omid Radpour,
Davood Mansouri, Majid Amiri,
Zarnaz Bagheri,
Ali Akbar Velayati,
Kaveh Khoshnood,
Ali Rowhani-Rahbar,
Parisa Farnia,
Golnaz Ebrahimi
International Journal of Infectious Diseases 04/2007; 11(2):180-2. · 1.94 Impact Factor
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Davood Mansouri,
Parisa Adimi,
Mehdi Mirsaedi,
Nahal Mansouri,
Payam Tabarsi, Majid Amiri,
Hamid R Jamaati,
Masoud Motavasseli,
Noushin Baghaii,
Ali Cheraghvandi, [......],
Navid A Roozbahany,
Soheila Zahirifard,
Forouzan Mohammadi,
Mohammad R Masjedi,
Ali A Velayati,
Jean L Casanova,
David P Speert,
R Kevin Elwood,
Robert Schellenberg,
Stuart E Turvey
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ABSTRACT: Primary immunodeficiencies (PIDs) are not solely diseases of childhood. We describe the clinical presentation and outcome for 55 adult patients with previously unrecognized PIDs. This series provides unique data regarding PIDs presenting in adulthood, and serves as a timely reminder that physicians must consider the diagnosis of PIDs in their adult patients. Using the experience gained from these patients, we outline key "warning signs" suggestive of an underlying PID. Only through increased physician awareness will patients with PIDs receive timely diagnosis and optimal management.
Journal of Clinical Immunology 08/2005; 25(4):385-91. · 3.08 Impact Factor
