Tuberculosis treatment without rifampin in kidney/kidney-pancreas transplantation: A case series report

Prevalence, clinical reasons and associated factors of extended treatment duration for drug susceptible tuberculosis - a real-world experience

Limited research has been conducted on the prevalence and factors associated with extended drug-susceptible tuberculosis (TB) treatment. A retrospective study enrolled drug-susceptible TB patients (January 2018 to December 2020) from a hospital's registry to analyze prevalence, reasons, and factors for extended treatment (≥ 9 months) compared with standard course. Analyzing 221 TB patients, 80 patients received extended treatment. The extended group showed higher hepatitis B infection rates (12.5% vs. 5%, p = 0.043), recent cancer treatment (18.8% vs. 8.5%, p = 0.025), more adverse drug events (ADEs) (grade 3 or more severe ADEs 27.5% vs. 11.3%, p = 0.003), and treatment interruptions (46.3% vs. 18.4%, p < 0.001). Logistic regression highlighted hepatitis B infection (AOR 3.10, p = 0.039), recent cancer treatment (AOR 3.09, p = 0.013), and post-treatment elevated aminotransferase (AOR 2.40, p = 0.014) as independent factors for extended treatment. Extended anti-TB treatment affects 28.7% of patients, with host characteristics and adverse drug effects playing a role in treatment duration. Integrating these factors into treatment strategies is vital for optimal patient care.

Is it safe to proceed with heart transplant in a patient with active tuberculosis? Strategies and challenges based on a case report

Transplant candidates are at increased risk of developing active tuberculosis (TB), and its diagnosis and treatment may be especially challenging. Although screening and treatment for TB are recommended in heart transplant candidates, there is lack of evidence on how to manage active TB infection in this scenario. Herein, we report challenges of performing a heart transplant in a 69-year-old patient with progressive heart failure and active, symptomatic TB infection. We aimed to emphasize the importance of proper screening of TB in solid organ transplant candidates, as well as to suggest that, in selected patients, it may be safe to proceed with transplant after an initial period of treatment with antituberculous agents.

[Update on the treatment of tuberculosis]

Tuberculosis (TB) affects more than 10 million people each year. We have contested this burden with a paradoxically slow development of treatments, as compared to other infectious diseases. This review aims to update health care professionals on the last developments for the management of TB. The combination of drugs established more than 40years ago is still adequate to cure most people affected by TB. However, with the generalisation of regimens based on rifampicin and isoniazid for (only) 6months, resistance emerged. Resistant cases needed long treatments based on injectable drugs. Now, after an exciting decade of research, we can treat resistant TB with oral regimens based on bedaquiline, nitroimidazoles, and linezolid for (only) 6months, and we may soon break the 6-month barrier for treatment duration. However, these improvements are not enough to end TB without an engagement of people affected and their communities to achieve adherence to treatment, transmission control, and improve socioeconomic determinants of health.

HIV and Associated TB: A Lethal Association for Kidney Health?

Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading infectious causes of death globally. The combined brunt of these diseases is experienced mainly in low-income and lower-middle-income countries. HIV/TB have devastating effects on the kidneys, leading to accelerated decline of kidney function as well as mortality. Managing the triad of TB/HIV and kidney disease is challenging. We discuss the epidemiology of HIV/TB coinfection and the kidney and the key mechanisms of kidney disease including genetic susceptibility. The clinical presentation and pathology, as well as the challenges of diagnosing CKD in these patients, also are discussed. The strategies to prevent and manage HIV/TB-related kidney disease such as proper assessment, avoiding nephrotoxic regimens, drug dose adjustments, kidney function monitoring, avoidance of drug-drug interactions, and other interventions are explored. We also briefly discuss the complexities around HIV/TB patients on dialysis and kidney transplantation. HIV/TB coinfection presents an increased risk for kidney-related morbidity and mortality; patients with this triad need to be given special consideration for future research and management.