1
|
Perumal Kannabiran B, Palaniappan NA, Manoharan T, Paramasivam PK, Saini JK, Ansari MS, Jayabal L, Aggarwal AN, Garg R, Subramanyam B, Thakur D, Pantula S, P M R, GS V, Natarajan S, Ammayappan RK, Manpreet B, Ganesan M, Angamuthu D, Chinnaiyan P, Singh M, Chandrasekaran P, Swaminathan S. Safety and Efficacy of 25 mg/kg and 35 mg/kg vs 10 mg/kg Rifampicin in Pulmonary TB: A Phase IIb Randomized Controlled Trial. Open Forum Infect Dis 2024; 11:ofae034. [PMID: 38444824 PMCID: PMC10914527 DOI: 10.1093/ofid/ofae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
Background Globally, no trial data are available on head-to-head comparison between 10 mg/kg and 25/35 mg/kg rifampicin in treating pulmonary tuberculosis during study initiation. Methods A multicentric, phase IIb randomized trial recruited 333 new culture-positive, drug-sensitive adult patients with pulmonary tuberculosis to compare safety and efficacy of high-dose rifampicin (R25/R35), against conventional dose (R10) given daily for 8 weeks followed by standard doses for 16 weeks. Main outcomes were treatment-emergent grade 3/4 adverse events (AEs) and time-to-culture conversion in liquid media, assessed by division of AIDS system for grading the severity of adverse events division of AIDS criteria and Kaplan-Meier methods. Results In a modified intention-to-treat population of 323 patients (R10: 105/R25: 112/R35: 106), grade 3/4 AEs were reported in 34 patients (R10: 9.5% [10/105], R25: 9.8% [11/112], R35: 12.3% [13/106]) during the intensive phase. Among 23 patients (R10: 3.8% [4/105], R25: 6.3% [7/112], R35: 11.3% [12/106]) with grade 3/4 hepatotoxicity, 15 (R10: 1.9% [2/105], R25: 3.6% [4/112], R35: 8.5% [9/106]) had grade 3/4 hyperbilirubinemia and 9 patients (R10: 1.0% [1/105], R25: 0.9% [1/112], R35: 6.6% [7/106]) developed clinical jaundice. Significant differences observed only between R10 and R35 with hepatotoxicity (P = .039), hyperbilirubinemia (P = .031), clinical jaundice (P = .032), and treatment interruption (P = .039). Eighteen serious AEs and 6 deaths (R10: 3/R25: 1/R35: 2) occurred during study period. Time to stable culture conversion in liquid media was faster in R25 (adjusted hazard ratio, 1.71; 95% confidence interval [CI], 1.26-2.31 [solid: 1.97; 95% CI, 1.46-2.67]) and R35 (1.81; 95% CI, 1.33-2.48 [solid: 2.24; 95% CI, 1.64-3.06]), than R10 (34 vs 44 days). R25 had no failure/relapse. Conclusions Hepatotoxicity, clinical jaundice, and treatment interruptions occurred significantly higher with R35 than R10. Because R25 was comparably safe as R10 and also highly efficacious than R10, it may be considered for implementation. Clinical Trials Registration. CTRI/2017/12/010951.
Collapse
Affiliation(s)
| | | | - Tamizhselvan Manoharan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Paul Kumaran Paramasivam
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Jitendra Kumar Saini
- Department of Pulmonary Oncology, National Institute for Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Mohammed Soheb Ansari
- Department of Respiratory Medicine, Bhagwan Mahavir Medical Hospital and Research Centre, Hyderabad, India
| | - Lavanya Jayabal
- District TB office, Greater Chennai Corporation, Chennai, India
| | - Ashutosh N Aggarwal
- Department of Respiratory Medicine, Post Graduate Institute of Medical Research, Chandigarh, India
| | - Rajiv Garg
- Department of Respiratory Medicine, King George's Medical University, Lucknow, India
| | - Balaji Subramanyam
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Deepika Thakur
- Department of Respiratory Medicine, Post Graduate Institute of Medical Research, Chandigarh, India
| | - Shilpa Pantula
- Department of Respiratory Medicine, Bhagwan Mahavir Medical Hospital and Research Centre, Hyderabad, India
| | - Ramesh P M
- Department of Respiratory Medicine, Government Thiruvotteeswarar Hospital of Thoracic Medicine, Chennai, India
| | - Vijayachandar GS
- Department of Respiratory Medicine, Institute of Thoracic Medicine, Chennai, India
| | - Saravanan Natarajan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Radha Krishnan Ammayappan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Bhalla Manpreet
- Department of Pulmonary Oncology, National Institute for Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Mangalambal Ganesan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Dhanalakshmi Angamuthu
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Ponnuraja Chinnaiyan
- Department of Clinical Resarch, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Manjula Singh
- Division of Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | | |
Collapse
|
2
|
Gopalan N, Senthil S, Prabakar NL, Senguttuvan T, Bhaskar A, Jagannathan M, Sivaraman R, Ramasamy J, Chinnaiyan P, Arumugam V, Getrude B, Sakthivel G, Srinivasalu VA, Rajendran D, Nadukkandiyil A, Ravi V, Hifzour Rahamane SN, Athur Paramasivam N, Manoharan T, Theyagarajan M, Chadha VK, Natrajan M, Dhanaraj B, Murhekar MV, Ramalingam SM, Chandrasekaran P. Predictors of mortality among hospitalized COVID-19 patients and risk score formulation for prioritizing tertiary care-An experience from South India. PLoS One 2022; 17:e0263471. [PMID: 35113971 PMCID: PMC8812932 DOI: 10.1371/journal.pone.0263471] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
Background We retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission. Methods and findings Data on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among ‘survivors’ and ‘non-survivors’. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets. Among 746 COVID-19 patients hospitalised [487 “survivors” and 259 “non-survivors” (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40–70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO2<95%; 2.96 (1.71–5.18), Urea ≥50 mg/dl: 4.51 (2.59–7.97), Neutrophil-lymphocytic ratio (NLR) >3; 3.01 (1.61–5.83), Age ≥50 years;2.52 (1.45–4.43), Pulse Rate ≥100/min: 2.02 (1.19–3.47) and coexisting Diabetes Mellitus; 1.73 (1.02–2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO2<95–11, Urea ≥50 mg/dl-15, NLR >3–11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as ‘OUR-ARDs score’ showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85. Conclusions The ‘OUR ARDs’ risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.
Collapse
Affiliation(s)
- Narendran Gopalan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
- * E-mail:
| | - Sumathi Senthil
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Narmadha Lakshmi Prabakar
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Thirumaran Senguttuvan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Adhin Bhaskar
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | | | - Ravi Sivaraman
- MDRU, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Jayalakshmi Ramasamy
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Ponnuraja Chinnaiyan
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Vijayalakshmi Arumugam
- Department of Microbiology, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Banumathy Getrude
- Department of Community Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Gautham Sakthivel
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Vignes Anand Srinivasalu
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Dhanalakshmi Rajendran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
- Division of Epidemiology and Operational Research, ICMR-Vector Control Research Centre, Puducherry, India
| | - Arunjith Nadukkandiyil
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Vaishnavi Ravi
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | | | - Nirmal Athur Paramasivam
- Department of General Medicine, Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
| | - Tamizhselvan Manoharan
- Department of Statistics, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Maheshwari Theyagarajan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Vineet Kumar Chadha
- Central Leprosy Teaching & Research Institute, Chengalpattu, Tamil Nadu, India
| | - Mohan Natrajan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Baskaran Dhanaraj
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
| | - Manoj Vasant Murhekar
- ICMR-National Institute for Research in Tuberculosis (Formerly Tuberculosis Research Centre), Chennai, Tamil Nadu, India
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Shanthi Malar Ramalingam
- Government Chengalpattu Medical College & Hospital, Chengalpattu, Tamil Nadu, India
- Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | | |
Collapse
|
3
|
Rajendran P, Padmapriyadarsini C, Vijayaraghavan V, Manoharan T, Lokanathan LM, Kadhar PB, Jayabal L, Sivaramakrishnan G. Drug susceptibility profiling of pulmonary Mycobacterium kansasii and its correlation with treatment outcome. Ann Thorac Med 2021; 16:323-328. [PMID: 34820019 PMCID: PMC8588942 DOI: 10.4103/atm.atm_45_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES: With the introduction of newer molecular diagnostic tools to identify Mycobacterium tuberculosis, an increasing number of nontuberculous mycobacterium (NTM) is being identified. However, the drug resistance pattern of the NTM species identified is less explored. The objective of this study is to study the drug resistance patterns of Mycobacterium kansasii species isolated in a tuberculosis-endemic setting at South India. METHODS: A wide profile of NTM species were reported earlier from a prospective cohort of adults during 2017–2020. Out of this profile, a total of 22 M. kansasii species were subjected to drug susceptibility testing by two different methods: proportion sensitivity testing method and Sensititre testing method. RESULTS: Out of the 18 strains of M. kansasii subjected to Sensititre method of testing, the resistance pattern was demonstrated to be high for doxycycline (13) followed by rifampicin and trimethoprim/sulfamethoxazole (7). Out of the 22 strains subjected to proportion sensitivity testing method, 20 and 10 were resistant to isoniazid and ethambutol, respectively. CONCLUSION: There was a poor correlation between the treatment outcome and the resistance pattern of the antibiotics tested. With increasing numbers of NTM being reported, early and correct identification of NTM species is essential for the prompt initiation of appropriate treatment to achieve better outcome.
Collapse
Affiliation(s)
- Priya Rajendran
- Department of Bacteriology, ICMR -National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Vaishnavee Vijayaraghavan
- Department of Bacteriology, ICMR -National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Tamizhselvan Manoharan
- Department of Statistics, ICMR -National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Lakshana Malla Lokanathan
- Department of Clinical Research, ICMR -National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Parveen Banu Kadhar
- Department of Bacteriology, ICMR -National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Gomathy Sivaramakrishnan
- Department of Bacteriology, ICMR -National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| |
Collapse
|
4
|
Gopalan N, Srinivasalu VA, Chinnayan P, Velayutham B, Bhaskar A, Santhanakrishnan R, Senguttuvan T, Rathinam S, Ayyamperumal M, Satagopan K, Rajendran D, Manoharan T, Lakshmanan S, Paramasivam P, Angamuthu D, Ganesan M, Easudoss Arockia JW, Venkatesan RB, Lakshmipathy V, Shanmugham S, Subramanyam B, Shankar S, Mohideen Shaheed J, Dhanaraj B, Paranji Ramiyengar N, Swaminathan S, Chandrasekaran P. Predictors of unfavorable responses to therapy in rifampicin-sensitive pulmonary tuberculosis using an integrated approach of radiological presentation and sputum mycobacterial burden. PLoS One 2021; 16:e0257647. [PMID: 34543329 PMCID: PMC8452066 DOI: 10.1371/journal.pone.0257647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the exalted status of sputum mycobacterial load for gauging pulmonary tuberculosis treatment and progress, Chest X-rays supplement valuable information for taking instantaneous therapeutic decisions, especially during the COVID-19 pandemic. Even though literature on individual parameters is overwhelming, few studies have explored the interaction between radiographic parameters denoting severity with mycobacterial burden signifying infectivity. By using a sophisticated approach of integrating Chest X-ray parameters with sputum mycobacterial characteristics, evaluated at all the three crucial time points of TB treatment namely pre-treatment, end of intensive phase and completion of treatment, utilizing the interactive Cox Proportional Hazards model, we aimed to precisely deduce predictors of unfavorable response to TB treatment. MATERIALS AND METHOD We extracted de-identified data from well characterized clinical trial cohorts that recruited rifampicin-sensitive Pulmonary TB patients without any comorbidities, taking their first spell of anti-tuberculosis therapy under supervision and meticulous follow up for 24 months post treatment completion, to accurately predict TB outcomes. Radiographic data independently obtained, interpreted by two experienced pulmonologists was collated with demographic details and, sputum smear and culture grades of participants by an independent statistician and analyzed using the Cox Proportional Hazards model, to not only adjust for confounding factors including treatment effect, but also explore the interaction between radiological and bacteriological parameters for better therapeutic application. RESULTS Of 667 TB patients with data available, cavitation, extent of involvement, lower zone involvement, smear and culture grade at baseline were significant parameters predisposing to an unfavorable TB treatment outcome in the univariate analysis. Reduction in radiological lesions in Chest X-ray by at least 50% at 2 months and 75% at the end of treatment helped in averting unfavorable responses. Smear and Culture conversion at the end of 2 months was highly significant as a predictor (p<0.001). In the multivariate analysis, the adjusted hazards ratios (HR) for an unfavorable response to TB therapy for extent of involvement, baseline cavitation and persistence (post treatment) were 1.21 (95% CI: 1.01-1.44), 1.73 (95% CI: 1.05-2.84) and 2.68 (95% CI: 1.4-5.12) respectively. A 3+ smear had an HR of 1.94 (95% CI: 0.81-4.64). Further probing into the interaction, among patients with 3+ and 2+ smears, HRs for cavitation were 3.26 (95% CI: 1.33-8.00) and 1.92 (95% CI: 0.80-4.60) while for >2 zones, were 3.05 (95% CI: 1.12-8.23) and 1.92 (95% CI: 0.72-5.08) respectively. Patients without cavitation, zonal involvement <2, and a smear grade less than 2+ had a better prognosis and constituted minimal disease. CONCLUSION Baseline Cavitation, Opacities occupying >2 zones and 3+ smear grade individually and independently forecasted a poorer TB outcome. The interaction model revealed that Zonal involvement confined to 2 zones, without a cavity and smear grade up to 2+, constituting "minimal disease", had a better prognosis. Radiological clearance >50% along with smear conversion at the end of intensive phase of treatment, observed to be a reasonable alternative to culture conversion in predicting a successful outcome. These parameters may potentially take up key positions as stratification factors for future trials contemplating on shorter TB regimens.
Collapse
Affiliation(s)
- Narendran Gopalan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
- * E-mail:
| | - Vignes Anand Srinivasalu
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Ponnuraja Chinnayan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Banurekha Velayutham
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Adhin Bhaskar
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Ramesh Santhanakrishnan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Thirumaran Senguttuvan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Sridhar Rathinam
- Department of Thoracic Medicine, Government Hospital of Thoracic Medicine Tambaram, Chennai, Tamil Nadu, India
| | - Mahilmaran Ayyamperumal
- Department of Thoracic Medicine, Institute of Thoracic Medicine, Madras Medical College, Chennai, Tamil Nadu, India
| | - Kumar Satagopan
- Department of Thoracic Medicine, Government Hospital of Thoracic Medicine Tambaram, Chennai, Tamil Nadu, India
| | - Dhanalakshmi Rajendran
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Tamizhselvan Manoharan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Sekar Lakshmanan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Paulkumaran Paramasivam
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Dhanalakshmi Angamuthu
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Mangalambal Ganesan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - John Washington Easudoss Arockia
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Ramesh Babu Venkatesan
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Venkatesan Lakshmipathy
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Shivakumar Shanmugham
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Balaji Subramanyam
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Shakila Shankar
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Jawahar Mohideen Shaheed
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Baskaran Dhanaraj
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Narayanan Paranji Ramiyengar
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | | | - Padmapriyadarsini Chandrasekaran
- Department of Clinical Research, National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Indian Council of Medical Research, Chennai, Tamil Nadu, India
| |
Collapse
|
5
|
Narendran G, Jyotheeswaran K, Senguttuvan T, Vinhaes CL, Santhanakrishnan RK, Manoharan T, Selvaraj A, Chandrasekaran P, Menon PA, Bhavani KP, Reddy D, Narayanan R, Subramanyam B, Sathyavelu S, Krishnaraja R, Kalirajan P, Angamuthu D, Susaimuthu SM, Ganesan RRK, Tripathy SP, Swaminathan S, Andrade BB. Characteristics of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome and its influence on tuberculosis treatment outcomes in persons living with HIV. Int J Infect Dis 2020; 98:261-267. [PMID: 32623087 DOI: 10.1016/j.ijid.2020.06.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The influence of tuberculosis (TB)-immune reconstitution inflammatory syndrome (IRIS) on TB treatment outcomes and its risk factors were investigated among people with human immunodeficiency virus (HIV) and co-infected with TB. METHODS Newly diagnosed, culture-confirmed, pulmonary TB patients with HIV and enrolled in a clinical trial (NCT00933790) were retrospectively analysed for IRIS occurrence. Risk factors and TB outcomes (up to 18 months after initiation of anti-TB treatment [ATT]) were compared between people who experienced IRIS (IRIS group) and those who did not (non-IRIS group). RESULTS TB-IRIS occurred in 82 of 292 (28%) participants. Significant baseline risk factors predisposing to TB-IRIS occurrence in univariate analysis were: lower CD4+ T-cell count, CD4/CD8 ratio, haemoglobin levels, presence of extra-pulmonary TB focus, and higher HIV viral load; the last two retained significance in the multivariate analysis. After 2 months of ATT commencement, sputum smear conversion was documented in 45 of 80 (56.2%) vs. 124 of 194 (63.9%) (p=0.23), culture conversion was in 75 of 80 (93.7%) vs. 178 of 194 (91.7%) (p=0.57) and the median decline in viral load (log10copies/mm3) was 2.7 in the IRIS vs. 1.1 in the non-IRIS groups (p<0.0001), respectively. An unfavourable response to TB therapy was detected in 17 of 82 (20.7%) and 28 of 210 (13.3%) in the IRIS and non-IRIS groups, respectively (p=0.14). CONCLUSIONS TB-IRIS frequently occurred in people with advanced HIV infection and in those who presented with extra-pulmonary TB lesions, without influencing subsequent TB treatment outcomes.
Collapse
Affiliation(s)
- Gopalan Narendran
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Keerthana Jyotheeswaran
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Thirumaran Senguttuvan
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Caian L Vinhaes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Brazil
| | - Ramesh K Santhanakrishnan
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Tamizhselvan Manoharan
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Anbhalagan Selvaraj
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | | | - Pradeep A Menon
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Kannabiran P Bhavani
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Devarajulu Reddy
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Ravichandran Narayanan
- Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai, Tamil Nadu, India
| | - Balaji Subramanyam
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Sekhar Sathyavelu
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, Tamil Nadu, India
| | - Raja Krishnaraja
- Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai, Tamil Nadu, India
| | - Pownraj Kalirajan
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Dhanalakshmi Angamuthu
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | - Stella Mary Susaimuthu
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | | | - Srikanth P Tripathy
- National Institute for Research in Tuberculosis, Indian Council of Medical Research Chennai, Tamil Nadu, India
| | | | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências (UniFTC), Salvador, Brazil; Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
6
|
Gopalan N, Santhanakrishnan RK, Palaniappan AN, Menon PA, Lakshman S, Chandrasekaran P, Sivaramakrishnan GN, Reddy D, Kannabiran BP, Agiboth HKK, Krishnamoorthy V, Rathinam S, Chockalingam C, Manoharan T, Ayyamperumal M, Jayanthi N, Satagopan K, Narayanan R, Krishnaraja R, Sathiyavelu S, Kesavamurthy B, Suresh C, Selvachitiram M, Arasan G, Susaimuthu S, Rathinam P, Angamuthu P, Jayabal L, Murali L, Ramachandran R, Tripathy SP, Swaminathan S. Daily vs Intermittent Antituberculosis Therapy for Pulmonary Tuberculosis in Patients With HIV: A Randomized Clinical Trial. JAMA Intern Med 2018; 178:485-493. [PMID: 29507938 PMCID: PMC5885164 DOI: 10.1001/jamainternmed.2018.0141] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE The benefit of daily over thrice-weekly antituberculosis therapy among HIV-positive patients with pulmonary tuberculosis (TB) who are receiving antiretroviral therapy remains unproven. OBJECTIVE To compare the efficacy and safety of daily, part-daily, and intermittent antituberculosis therapy regimens in the treatment of HIV-associated pulmonary TB. DESIGN, SETTING, AND PARTICIPANTS This open-label, randomized clinical trial was conducted by the National Institute for Research in Tuberculosis, south India. Adults infected with HIV with newly diagnosed, culture-positive, pulmonary TB were enrolled between September 14, 2009, and January 18, 2016. INTERVENTIONS Patients were randomized to daily, part-daily, and intermittent antituberculosis therapy regimens, stratified by baseline CD4 lymphocyte count and sputum smear grade. Antiretroviral therapy was initiated as per national guidelines. Clinical and sputum microbiological examinations of patients were performed monthly until 18 months after randomization. Adverse events were recorded using standard criteria. MAIN OUTCOMES AND MEASURES The primary outcome was favorable response, defined as treatment completion with all available sputum cultures negative for Mycobacterium tuberculosis during the last 2 months of treatment. Unfavorable responses included treatment failures, dropouts, deaths, and toxic effects among regimens. RESULTS Of 331 patients (251 [76%] male; mean [SD] age, 39 [9] years; mean [SD] HIV viral load, 4.9 [1.2] log10 copies/mL; and median [interquartile range] CD4 lymphocyte count, 138 [69-248] cells/μL), favorable responses were experienced by 91% (89 of 98), 80% (77 of 96), and 77% (75 of 98) in the daily, part-daily, and intermittent regimens, respectively. With the difference in outcome between daily and intermittent regimens crossing the O'Brien-Fleming group sequential boundaries and acquired rifampicin resistance emergence (n = 4) confined to the intermittent group, the data safety monitoring committee halted the study. A total of 18 patients died and 18 patients dropped out during the treatment period in the 3 regimens. Six, 4, and 6 patients in the daily, part-daily, and intermittent regimens, respectively, had TB recurrence. CONCLUSIONS AND RELEVANCE Among HIV-positive patients with pulmonary TB receiving antiretroviral therapy, a daily anti-TB regimen proved superior to a thrice-weekly regimen in terms of efficacy and emergence of rifampicin resistance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00933790.
Collapse
Affiliation(s)
| | | | | | | | - Sekar Lakshman
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | | | | | | | | | | | | | | | | | | | - Kumar Satagopan
- Government Hospital of Thoracic Medicine, TB Sanatorium, Tambaram, Chennai, India
| | | | - Raja Krishnaraja
- Government Hospital of Thoracic Medicine, TB Sanatorium, Tambaram, Chennai, India
| | | | | | - Chandra Suresh
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | | | | | | | | | | | | | | | - Soumya Swaminathan
- Indian Council of Medical Research and Health Research, New Delhi, India
| |
Collapse
|
7
|
|
8
|
Narendran G, Kavitha D, Karunaianantham R, Gil-Santana L, Almeida-Junior JL, Reddy SD, Kumar MM, Hemalatha H, Jayanthi NN, Ravichandran N, Krishnaraja R, Prabhakar A, Manoharan T, Nithyananthan L, Arjunan G, Natrajan M, Swaminathan S, Andrade BB. Role of LTA4H Polymorphism in Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome Occurrence and Clinical Severity in Patients Infected with HIV. PLoS One 2016; 11:e0163298. [PMID: 27643598 PMCID: PMC5028072 DOI: 10.1371/journal.pone.0163298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an inflammatory phenomenon complicating HIV management in coincidental tuberculosis (TB) infection, upon immune reconstitution driven by antiretroviral therapy (ART). Leukotriene A4 hydroxylase (LTA4H), an enzyme which converts LTA4 to LTB4, regulates the balance between the anti-inflammatory lipoxins and pro-inflammatory LTB4, with direct implications in TB-driven inflammation. In humans, a single nucleotide polymorphism (SNP) in the LTA4H promoter which regulates its transcriptional activity (rs17525495) has been identified and described to impact clinical severity of TB presentation and response to corticosteroid therapy. Notably, the role of LTA4H on TB-IRIS has not been previously evaluated. Here, we performed an exploratory investigation testing the association of LTA4H polymorphism with respect to frequency of TB-IRIS occurrence and severity of TB-IRIS presentation in HIV-TB co-infected individuals. Methods Genotypic evaluation of the LTA4H enzyme from available samples was retrospectively correlated with clinical data captured in case sheets including IRIS details. The cohort included patients recruited from a prospective cohort study nested within a randomized clinical trial (NCT0933790) of ART-naïve HIV+ patients with newly diagnosed rifampicin sensitive pulmonary TB in South India. Frequency of the wild type genotype (CC), as well as of the mutant genotypes (CT or TT) in the IRIS and non-IRIS patients was estimated. Comparative analyses were performed between wild genotype (CC) and the mutant genotypes (CT or TT) and tested for association between the LTA4H polymorphisms and IRIS incidence and clinical severity. Results A total of 142 eligible ART-naïve patients were included in the analyses. Eighty-six individuals exhibited the wild genotype (CC) while 56 had mutant genotypes (43-CT and only 13-TT). Variant allele frequency was 0.23 and 0.26 in non-IRIS group and in IRIS group, respectively. Upon ART initiation, 51 patients developed IRIS while 91 did not. IRIS incidence was 34% and 37% in the wild (CC) and mutant type (CT/TT), respectively (p = 0.858) with a higher frequency of severe IRIS presentation in the mutant genotype group compared to the wild type genotype (p = 0.0006). A logistic regression model confirmed the association between the presence of CT/TT genotypes and occurrence of severe IRIS. Corticosteroid therapy successfully resolved IRIS in all cases irrespective of the LTA4H genotype. Conclusion A higher incidence of severe IRIS among patients with mutant LTA4H genotypes (CT and TT) was observed compared to the wild type, despite similar IRIS incidence and immune restoration in both groups. Steroids were effective in alleviating IRIS in all the genotypes.
Collapse
Affiliation(s)
| | | | | | - Leonardo Gil-Santana
- Unidade de Medicina Investigativa, Laboratótio Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
| | - Jilson L. Almeida-Junior
- Unidade de Medicina Investigativa, Laboratótio Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
| | | | | | | | | | | | - Raja Krishnaraja
- Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Chennai, India
| | | | | | | | | | - Mohan Natrajan
- National Institute for Research in Tuberculosis, Chennai, India
| | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Chennai, India
- India Council of Medical Research, Health secretary, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Bruno B. Andrade
- Unidade de Medicina Investigativa, Laboratótio Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
- * E-mail:
| |
Collapse
|
9
|
Suresh B, Sriram S, Balasubramanian S, Manoharan T. Santolina volatile oil, a potential antifeedant for the control of the brown plant hopper, milaparvatha lugens. Anc Sci Life 1996; 15:166-8. [PMID: 22556739 PMCID: PMC3331208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/1995] [Accepted: 11/15/1995] [Indexed: 10/25/2022] Open
Abstract
The essential oil of santolina chamaecyparissus reduced the survival of Nilaparvatha lugens after 72 hours. The oil is found to be a good pesticide.
Collapse
Affiliation(s)
- B. Suresh
- Department of Pharmacology, J.S.S College of pharmacy, Ootacamund – 643 001.
| | - S. Sriram
- Department of Pharmacology, J.S.S College of pharmacy, Ootacamund – 643 001.
| | - S. Balasubramanian
- Department of Enviromental sciences, Bharathiar University, Coimbatore – 641 046.
| | - T. Manoharan
- Department of Enviromental sciences, Bharathiar University, Coimbatore – 641 046.
| |
Collapse
|