Case Report
Multi-Drug Resistant Tuberculosis With Extensive Bilateral Lung Involvement Can be Cured With Just Three Drugs for 6 Months
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Dyspnoea measured by modified Medical Research Council dyspnoea scale.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Luna-Pardo, Dario Alexander Cruz-Chamorro, Raquel Martínez-Tomás, Andrés Briones-Gómez, Enrique Cases-Viedma" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Luna-Pardo" ] 1 => array:2 [ "nombre" => "Dario Alexander" "apellidos" => "Cruz-Chamorro" ] 2 => array:2 [ "nombre" => "Raquel" "apellidos" => "Martínez-Tomás" ] 3 => array:2 [ "nombre" => "Andrés" "apellidos" => "Briones-Gómez" ] 4 => array:2 [ "nombre" => "Enrique" "apellidos" => "Cases-Viedma" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004192?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000004/v1_202404020528/S0300289623004192/v1_202404020528/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289624000073" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.01.005" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "3469" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:238-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Foreign Body in the Posterior Mediastinum: Successful Minimally Invasive Removal of a Transesophageally Migrated Piece of Dishwashing Scourer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "238" "paginaFinal" => "241" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2713 "Ancho" => 2167 "Tamanyo" => 442198 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A metallic density foreign body is observed in the posterior mediastinum, adjacent to the esophagus. The circled area indicates the foreign body.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Güntuğ Batıhan, Soner Kına" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Güntuğ" "apellidos" => "Batıhan" ] 1 => array:2 [ "nombre" => "Soner" "apellidos" => "Kına" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624000073?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000004/v1_202404020528/S0300289624000073/v1_202404020528/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Multi-Drug Resistant Tuberculosis With Extensive Bilateral Lung Involvement Can be Cured With Just Three Drugs for 6 Months" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "242" "paginaFinal" => "243" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Belén Navas Bueno, José Antonio Caminero Luna" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Belén" "apellidos" => "Navas Bueno" "email" => array:1 [ 0 => "belnabu@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Caminero Luna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital General Básico de Motril, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 898 "Ancho" => 1675 "Tamanyo" => 151371 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray film of the patient. (A) Before starting treatment. (B) After ending the treatment (6 months).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Multi-drug resistant tuberculosis (MDR-TB), defined as resistance to at least rifampicin and isoniazid, has become one of the major obstacles to global TB control.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Until very recently, the MDR-TB treatment required multiple drugs (some of questionable efficacy) for a minimum of 18 months, with multiple adverse reactions and cure rates not exceeding 60%.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a> However, the arrival of new drugs with action against <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, much more bactericidal and sterilizing,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–5</span></a> has completely changed this landscape. Therefore, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) already advised, in its 2020 recommendations, that these cases of MDR-TB could be treated with a 6-month regimen of bedaquiline<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>levofloxacin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>linezolid.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However, it wasn’t until December 2022 that World Health Organization recommended (these) the shortened 6-month regimens for MDR-TB treatment, though with a combination of 4 drugs (bedaquiline<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>pretomanid<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>linezolid<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>moxifloxacin).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 37-year-old woman, regular smoker, originally from Russia, who had recently traveled to Italy and stayed there for several months. She reported a 6-mont-clinic of persistent cough, purulent sputum, minimal exertion dyspnea, hyporexia, and a weight loss of 20<span class="elsevierStyleHsp" style=""></span>kg. On physical examination, she exhibited only a low-grade fever and severe malnutrition (height 175<span class="elsevierStyleHsp" style=""></span>cm and 48<span class="elsevierStyleHsp" style=""></span>kg). Laboratory tests revealed anemia with a hemoglobin level of 9.4<span class="elsevierStyleHsp" style=""></span>g/dL, leukocytosis of 23,700/mm<span class="elsevierStyleSup">3</span> with lymphopenia (1020/mm<span class="elsevierStyleSup">3</span>, 4.3%), and thrombocytosis of 1,282,000/mm<span class="elsevierStyleSup">3</span>. Chest radiography showed extensive involvement of the lung parenchyma with bilateral micronodular pattern, cavities in both hemithorax (largest measuring 13 and 7<span class="elsevierStyleHsp" style=""></span>cm in right lung) and multiple mediastinal lymph nodes. Microbiological testing revealed positive smear (auramine staining) and PCR for Mycobacterium tuberculosis, with rifampicin resistance detected by GeneXpert MTB/RIF. Sensitivity molecular and phenotypic testing confirmed resistance to isoniazid (mutations in katG and inhA genes), ethambutol, and aminoglycosides, but without fluorquinolones resistance.</p><p id="par0015" class="elsevierStylePara elsevierViewall">With the confirmation of MDR-TB, treatment was initiated with levofloxacin 1000<span class="elsevierStyleHsp" style=""></span>mg/day, linezolid 600<span class="elsevierStyleHsp" style=""></span>mg/day, and bedaquiline (400<span class="elsevierStyleHsp" style=""></span>mg daily for two weeks and followed by 200<span class="elsevierStyleHsp" style=""></span>mg three days/week for 6 months). The patient received supervised home treatment for the scheduled six months, with good compliance, significant clinical improvement, and negative smear and mycobacterial cultures at the 2nd, 5th, and 6th months of treatment, leading to acceptance of cure of the disease. The patient did not experience relevant side effects during treatment. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows radiological improvement at the end of treatment compared to the beginning. One year after completing treatment, the patient remained cured with no signs of potential relapse in subsequent visits (clinically asymptomatic and negative mycobacterial culture every two months in the follow-up).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The present case supports that with a shortened 6-month treatment and only 3 drugs, with good bactericidal and sterilizing activity,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> these forms of MDR-TB can be cured, even in cases with cavitary and bilateral involvement, as recommended by SEPAR in 2020.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> This approach could further streamline the treatment of these complex MDR-TB patients compared to the latest recommendations by the WHO.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We believe it is important that these evidences are known, which can help to greatly simplify the management of these complex MDR-TB cases, especially in Spain and other countries where is very difficult to achieve pretomanid. Anyway, we support putting pressure on all levels to make pretomanid easy to obtain, so that it can be used in these MDR/pre-XDR-TB patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 898 "Ancho" => 1675 "Tamanyo" => 151371 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray film of the patient. (A) Before starting treatment. (B) After ending the treatment (6 months).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "World tuberculosis report 2022" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2022" "editorial" => "World Health Organization" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actualización de la normativa SEPAR «Diagnóstico y tratamiento de la tuberculosiscon resistencia a fármacos»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Caminero" 1 => "J.M. García-García" 2 => "J.A. Caylà" 3 => "F.J. García-Pérez" 4 => "J.J. Palacios Gutiérrez" 5 => "J. Ruiz-Manzano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2020.03.021" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2020" "volumen" => "56" "paginaInicial" => "514" "paginaFinal" => "521" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32446667" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Module 4: treatment drug-resistant tuberculosis treatment 2022 update" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "WHO operational handbook guidelines on tuberculosis 2022 update" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2022" "editorial" => "World Health Organization" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multi-drug resistant tuberculosis, ten years later" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Caminero Luna" 1 => "G. Párez Mendoza" 2 => "F. Rodríguez de Castro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2020.08.018" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2021" "volumen" => "156" "paginaInicial" => "393" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33531151" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The future of drug-resistant tuberculosis treatment: learning from the past and the 2019 World Health Organization consolidated guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Caminero" 1 => "A.L. García-Basteiro" 2 => "A. Rendon" 3 => "A. Piubello" 4 => "E. Pontali" 5 => "G.B. Migliori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01272-2019" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2019" "volumen" => "54" "paginaInicial" => "1901272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31601719" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000004/v1_202404020528/S0300289624000103/v1_202404020528/en/main.assets" "Apartado" => array:4 [ "identificador" => "93562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000004/v1_202404020528/S0300289624000103/v1_202404020528/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624000103?idApp=UINPBA00003Z" ]
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