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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Multi-drug resistant tuberculosis &#40;MDR-TB&#41;&#44; defined as resistance to at least rifampicin and isoniazid&#44; has become one of the major obstacles to global TB control&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Until very recently&#44; the MDR-TB treatment required multiple drugs &#40;some of questionable efficacy&#41; for a minimum of 18 months&#44; with multiple adverse reactions and cure rates not exceeding 60&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;5</span></a> However&#44; the arrival of new drugs with action against <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>&#44; much more bactericidal and sterilizing&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;5</span></a> has completely changed this landscape&#46; Therefore&#44; the Spanish Society of Pneumology and Thoracic Surgery &#40;SEPAR&#41; already advised&#44; in its 2020 recommendations&#44; that these cases of MDR-TB could be treated with a 6-month regimen of bedaquiline<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>levofloxacin<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>linezolid&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However&#44; it wasn&#8217;t until December 2022 that World Health Organization recommended &#40;these&#41; the shortened 6-month regimens for MDR-TB treatment&#44; though with a combination of 4 drugs &#40;bedaquiline<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>pretomanid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>linezolid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>moxifloxacin&#41;&#46;<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&#44; regular smoker&#44; originally from Russia&#44; who had recently traveled to Italy and stayed there for several months&#46; She reported a 6-mont-clinic of persistent cough&#44; purulent sputum&#44; minimal exertion dyspnea&#44; hyporexia&#44; and a weight loss of 20<span class="elsevierStyleHsp" style=""></span>kg&#46; On physical examination&#44; she exhibited only a low-grade fever and severe malnutrition &#40;height 175<span class="elsevierStyleHsp" style=""></span>cm and 48<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; Laboratory tests revealed anemia with a hemoglobin level of 9&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; leukocytosis of 23&#44;700&#47;mm<span class="elsevierStyleSup">3</span> with lymphopenia &#40;1020&#47;mm<span class="elsevierStyleSup">3</span>&#44; 4&#46;3&#37;&#41;&#44; and thrombocytosis of 1&#44;282&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#46; Chest radiography showed extensive involvement of the lung parenchyma with bilateral micronodular pattern&#44; cavities in both hemithorax &#40;largest measuring 13 and 7<span class="elsevierStyleHsp" style=""></span>cm in right lung&#41; and multiple mediastinal lymph nodes&#46; Microbiological testing revealed positive smear &#40;auramine staining&#41; and PCR for Mycobacterium tuberculosis&#44; with rifampicin resistance detected by GeneXpert MTB&#47;RIF&#46; Sensitivity molecular and phenotypic testing confirmed resistance to isoniazid &#40;mutations in katG and inhA genes&#41;&#44; ethambutol&#44; and aminoglycosides&#44; but without fluorquinolones resistance&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">With the confirmation of MDR-TB&#44; treatment was initiated with levofloxacin 1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; linezolid 600<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; and bedaquiline &#40;400<span class="elsevierStyleHsp" style=""></span>mg daily for two weeks and followed by 200<span class="elsevierStyleHsp" style=""></span>mg three days&#47;week for 6 months&#41;&#46; The patient received supervised home treatment for the scheduled six months&#44; with good compliance&#44; significant clinical improvement&#44; and negative smear and mycobacterial cultures at the 2nd&#44; 5th&#44; and 6th months of treatment&#44; leading to acceptance of cure of the disease&#46; The patient did not experience relevant side effects during treatment&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows radiological improvement at the end of treatment compared to the beginning&#46; One year after completing treatment&#44; the patient remained cured with no signs of potential relapse in subsequent visits &#40;clinically asymptomatic and negative mycobacterial culture every two months in the follow-up&#41;&#46;</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&#44; with good bactericidal and sterilizing activity&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> these forms of MDR-TB can be cured&#44; even in cases with cavitary and bilateral involvement&#44; as recommended by SEPAR in 2020&#46;<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&#46;<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&#44; which can help to greatly simplify the management of these complex MDR-TB cases&#44; especially in Spain and other countries where is very difficult to achieve pretomanid&#46; Anyway&#44; we support putting pressure on all levels to make pretomanid easy to obtain&#44; so that it can be used in these MDR&#47;pre-XDR-TB patients&#46;</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&#46;</p></span></span>"
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Journal Information
Vol. 60. Issue 4.
Pages 242-243 (April 2024)
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Vol. 60. Issue 4.
Pages 242-243 (April 2024)
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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Belén Navas Buenoa,
Corresponding author
belnabu@hotmail.com

Corresponding author.
, José Antonio Caminero Lunab
a Hospital General Básico de Motril, Granada, Spain
b Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain
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