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Background : In preparation for pandemic HINI or H1N1 influenza (H1N1) it is necessary to identify factors associated with mortality of patients with HINI and hospital admissions to intensive care unit (ICU) of patients diagnosed in 2009 with HINI. Objectives : To describe the clinical and epidemiological features associated with 2009 HIN1 mortality and ICU patient admissions to Masih Daneshvari Teaching Hospital, Iran. Methods : A retrospective cross-sectional study was conducted among patients with mortality and admissions to ICU with confirmed HINI. Demographic, clinical, laboratory, radiological findings, and epidemiologic data were abstracted from medical records, using a standardized datasheet. Results : From June through December 2009, 20 out of the 46 confirmed hospitalized patients with confirmed H1NI were admitted to the ICU and 7 (15%) died. Among various variables, opium inhalation (P = 0.01), having productive cough, hemoptysis, chest pain, confusion, and loss of consciousness were significantly related to ICU admission (P < 0.05). Pleural effusion (P = 0.006), elevated liver enzymes, as well as CPK and LDH level were significantly relevant to ICU admission (P < 0.05). Delayed antiviral treatment was more common among patients who died and the elderly. Discussion : Patients who were admitted to ICU with confirmed H1N1 included the following risk factors: delayed initiation of antiviral therapy, history of opium inhalation and symptoms including; productive cough, hemoptysis, chest pain, confusion, and loss of consciousness. The mortality rate in the study population was high but compares favorably with other recent published studies.

Background 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. Patients and methods 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. Results 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. Conclusion 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.

Socioeconomic problems limit the access of drug users to health-care services. This descriptive cross-sectional study was carried out by making use of the medical records of new case tuberculosis (TB) patients hospitalized at Masih Daneshvari Hospital, the national referral centre in Iran, from 2003 to 2006. Demographic and personal characteristics of the patients and type of disease were collected and categorized. Of the 944 patients with confirmed TB, 143 (15.1%) were drug users, among whom 140 (97.9%) were men with just three women drug users. The mean age of the drug users group was 43.04 ± 13.81 years. The type of drug used was opium in 100 cases (69.9%), heroin in 29 (20.3%), opium and heroin together in four (2.8%) and all three, opium, heroin and crack, in two (1.4%). For 238 high-risk patients, an HIV test was performed and HIV infection was confirmed in 33 cases. Patient delay was longer in drug users ( P = 0.000) against other patients, whereas diagnosis delay was shorter ( P = 0.007). Drug susceptibility tests were performed for 515 patients with positive cultures. One hundred and thirty-three (14.1%) were found to have ‘any resistance’ to anti-TB drugs, and 10 (1.1%) individuals had multidrug-resistant TB. Twenty-six (19.5%) of the individuals who showed resistance to first-line agents were drug users. There was no significant relation between drug resistance and drug use ( P = 0.4). In conclusion, it seems that active case finding for TB and HIV in addict cases must be contained in harm reduction packages. Moreover, the manifestations of the disease should be considered seriously regardless of attributing them to drug use.

The clinical relevance of second-line drug susceptibility test (DST) results with respect to treatment outcome is unknown in non-XDR MDR patients. This study was carried out in the sole national referral centre for TB in Iran between 2002 and 2006. Multidrug-resistant tuberculosis (MDR-TB) patients who had DST to second-line drugs were included. For all MDR-TB patients the standard second-line regimen was initiated. Outcome of treatment based on DST to second-line drugs was analysed. 53 patients were included. DST for second-line drugs was available for 40 patients. Seven patients returned to Afghanistan during treatment. Among the remainder, 13 (30.4%) cases were Iranian. Mean age was 40.8 + 19.7 y. The relatively small sample size imposes some limitations on this study. However, in this study, there was no difference in resistance to second-line drugs by nationality. No significant correlation was seen between resistance to second-line drugs and outcome of treatment. In conclusion, the treatment outcome according to WHO definitions was appropriate in the study population by the use of standardized treatment regimens. Follow-up studies on a long-term basis are however needed in order to detect possible relapses.

Background and objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement.

Background: To determine and compare serum concentration of rifampicin (RIF) and isoniazid (INH) in TB patients with and without diabetes (DM). Design: A prospective nested case- control study was conducted on adult TB patients with DM and age- and sex-matched TB patients without DM as controls treated at the National Research Institute of Tuberculosis and Lung Diseases from June 2014 to December 2014. Blood samples were collected 2 and 6 h after taking fixed dose combination of anti-TB drugs. Linear and multivariate analysis was performed to determine the impact of DM on drug concentration and treatment outcome. Results: 18 TB cases with DM and 18 TB cases without DM were included. Baseline demographic and clinical characteristics were similar, except that TB cases with DM had more likely weight (66 kg vs. 51 kg, p=0.001). No significant differences in the maximum concentration of INH and RIF in both groups were observed. In linear regression, by adjusting age, sex, weght, fasting blood glucose and glycolated hemoglubin (A1c), DM did not remained in association to low concentration of INH and RIF. By increasing 1 microgram/ dl of RIF and INH in diabetic patients, good outcome of TB treatment will be increased 12.1% and 38% respectively. Conclusion: Therapeutic drug monitoring is necessary to identify patients with subtherapeutic INH and RIF especially in DM patients.

The objectives of this study were to determine the impact of diabetes mellitus (DM) on antituberculosis drug resistance in new cases of tuberculosis (TB). A case-control study was conducted on all newly diagnosed pulmonary TB adult patients with DM as cases and without DM as controls who were hospitalised from May 2013 to October 2013 in Iran. A molecular resistance test for rapid detection of resistance to isoniazid and rifampicin was done. Multivariate analysis was performed to determine the impact of DM on any anti-TB drug resistance. In total, 62 TB cases with DM and 64 TB cases without DM were included. TB cases with DM were more likely to be older (59 years vs. 43 years; P=0.001). Two TB-DM patients had multidrug-resistant TB (MDR-TB) (3.2%) compared with no cases of MDR-TB in the control group, and more TB-DM cases had isolates that were resistant to at least one drug (12.9% vs. 10.9%). DM [odds ratio (OR)=4.82, 95% confidence interval (CI) 1-23.57], age

To screen for Tuberculosis (TB) in human immunodeficiency virus (HIV) people in an effort to improve early TB diagnosis and reduce TB transmission.A prospective study was conducted on adult HIV people from 2008 to 2011. Three samples of sputum, cell blood count, tuberculin skin test (TST) and chest X-ray were obtained from all patients. The characteristics of HIV patients with TB and HIV patients without TB were compared to each other.Of the 154 HIV patients included, 58 (38%) had tuberculosis with a mean CD4 cell count of 68 cells/mmThere was a high prevalence of TB within the HIV population. Screening for TB among these patients can be carried out at every clinic or health facility using a combination of symptoms, TST, chest X-ray and smear sample.

Objectives Pulmonary hypertension is a serious disorder with catastrophic outcomes. This study aimed to evaluate the effect of pulmonary arterial hypertension on the outcome among new cases of pulmonary tuberculosis. Novel modalities are available as therapeutic options, so early diagnosis of pulmonary arterial hypertension may be important. Methods In a cross-sectional study, 777 new cases of pulmonary tuberculosis were recruited in the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. Pulmonary arterial pressure was measured by resting transthoracic echocardiography on the beginning of tuberculosis treatment. Echocardiography was performed by a cardiologist expert in the field. Patients with systolic pulmonary arterial pressure more than 35 mmHg were defined as pulmonary hypertensive. The relationship between pulmonary arterial hypertension and mortality was assessed during six months of tuberculosis treatment. Results Seventy-four (9.5%) of 777 new cases of pulmonary tuberculosis had pulmonary arterial hypertension. Among them, 10 (13.5%) died during the treatment period. In comparison with 5% mortality among cases without pulmonary arterial hypertension, death was significantly associated with pulmonary hypertension ( P = 0.007). Logistic regression analysis showed that pulmonary arterial pressure more than 35 mmHg is an independent predictor of death among tuberculosis patients. Conclusion Among new cases of pulmonary tuberculosis, a significant association between mortality and pulmonary arterial pressure >35 mmHg was found. Therapeutic intervention may change the outcome of these patients.

The nature of tuberculosis (TB), being one of the most common opportunistic infections, is different among HIV-infected patients than HIV-negative patients. A retrospective study was conducted on HIV-positive and HIV-negative patients with new TB pleural effusion who were admitted to the National Research Institute of Tuberculosis and Lung Diseases in Tehran, Iran from 2005 to 2012. The two groups were compared with respect to clinical, imaging, mycobacteriologic and histopathologic characteristics of TB pleural effusion. In all, 42 HIV-positive and 132 HIV-negative cases of TB pleural effusion were included. Bilateral pleural effusion was statistically more common in the HIV-positive group ( p = 0.004, OR = 3.81, 95% CI: 1.46–9.94) without any correlation with CD4 cell count. Pulmonary infiltration was found in 81% of HIV-positive and 49.2% of HIV-negative patients ( p = 0.001, OR = 4.38, 95% CI: 1.88–10.1). Mycobacteriologic studies led to the diagnosis of TB in 66.6% of HIV-infected and 49.2% of HIV-negative patients. In 23.8% of HIV-positive and 50.7% of HIV-negative patients TB was ultimately diagnosed by pleural biopsy. HIV remained significantly associated with positive culture of pleural fluid in multivariate analysis. The diagnostic approach to TB pleural effusion in HIV-infected patients may be different. The diagnostic yield of mycobacteriologic studies was higher among HIV-positive patients, which may help in reducing the need for invasive procedures like pleural biopsy.

Setting National Referral Centre for Tuberculosis (TB), Tehran, Iran. Objective To determine the impact of chronic renal failure (CRF) on TB treatment outcomes. Design A retrospective study was conducted among adult TB patients with CRF and age- and sex-matched TB controls without CRF treated at the National Research Institute of Tuberculosis and Lung Disease from 2004 to 2011. Multivariate analysis was performed to determine the impact of CRF on drug-induced hepatitis (DIH), treatment failure and all-cause mortality. Results A total of 55 TB cases with CRF and 165 TB cases without CRF were included in the study. Baseline demographic and clinical characteristics were similar, except that TB cases with CRF were more likely to be of Iranian nationality (94.5% vs. 83%, P = 0.04). During anti-tuberculosis treatment, 40 (18.2%) patients developed DIH, none failed treatment and 15 (6.8%) died. Patients with CRF were more likely to develop DIH (27.3% vs. 15.2%, P = 0.04) and to die during treatment (16.4% vs. 3.6%, P = 0.001). CRF remained significantly associated with all-cause mortality (HR 4.87, 95%CI 1.73-13.65) in multivariate analysis, whereas the relationship with DIH was not. Conclusion TB patients with CRF are at increased risk of death. More intensive monitoring of patients with CRF should be considered by the National TB Programme.

Background: This study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis. Methods: New cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥35 mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis. Results: Of 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥35 mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35 mm Hg (p = 0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR = 3.1; 95% CI: 1.44–6.75 and OR = 4.4; 95% CI: 2.35–8.17, respectively). Conclusion: A significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis. Keywords: Tuberculosis, Pulmonary hypertension, Echocardiography, Survival

Objectives This study sought to compare the sensitivities of serum galactomannan and bronchoalveolar lavage galactomannan in diagnosing invasive aspergillosis in solid-organ transplant recipients (lung and heart). Materials and methods This study took place in the lung transplant center of the National Research Institute for Tuberculosis and Lung Disease. All patients with clinical and radiologic manifestations suggestive of pulmonary infection were included. Serum and bronchoalveolar lavage galactomannan were measured. Results Seventeen patients were included (lung, 15; heart, 1; heart-lung, 1). Probable or definite invasive aspergillosis was diagnosed in 9 patients. With a cutoff ≥ 0.5, serum galactomannan sensitivity and specificity for diagnosing invasive aspergillosis were 77.18% and 100%. Negative predictive value and positive predictive value were 80% and 100%. The sensitivity and specificity of bronchoalveolar lavage galactomannan for diagnosing invasive aspergillosis with cutoff of ≥ 0.5 was 100%. Conclusions Regarding the high levels of mortality and problems in diagnosing this disease, using bronchoalveolar lavage galactomannan could be a suitable option.

Culture of Mycobacterium tuberculosis is the gold standard for diagnosis of tuberculosis (TB) that is a much more sensitive test than smear examination. There is a need to use the new methods in order for fast diagnostic way. The aim of this research was to compare microscopic observation drug susceptibility culture with Ziehl-Neelsen stain and Lowenstein-Jensen culture of sputum. Therefore, a diagnostic test was designed. If the patient's history revealed clinical criteria compatible with tuberculosis and the infectious specialist judgment was that of "TB" suspected case, the patient was considered as a pulmonary TB suspect. We did sputum Ziehl-Neelsen stain, culture in Lowenstein-Jensen and MODS media. 100 patients with mean of 52.9 ± 21.83 were evaluated. 40% of patients revealed positive Ziehl-Neelsen stain while 30 and 47% showed positive results in Lowenstein-Jensen and MODS media respectively. In comparison with sputum smear and Lowenstein-Jensen culture, MODS had sensitivity of 82.5 and 86%, specificity of 77 and 70%, positive predictive value of 70 and 55%, negative predictive value of 86 and 92%, respectively. MODS culture demonstrated faster recovery and higher negative predictive value. Therefore, it could be a simple and rapid method in diagnosis of pulmonary tuberculosis. Key words: Tuberculosis, Ziehl-Neelsen stain, Lowenstein-Jensen culture, sensitivity.

We evaluated diagnostic yield of third sputum smear in patients co infected with HIV for detection of pulmonary tuberculosis. Among 139 pulmonary tuberculosis cases confirmed with positive sputum culture, diagnostic yield of first smear of sputum with acid fast staining was 83.5%. Incremental yield of 2nd and 3rd samples was 11.2% and 5.2% respectively. So two sputum smears may be enough for primary evaluation of HIV infected patients suspected to TB.

Pneumothorax is a well known complication of pulmonary tuberculosis (TB), particularly in patients with advanced TB.At our national TB-referral hospital, we compared the medical records of 53 TB patients with pneumothorax and 106 TB patients without pneumothorax, seen in 2003 to 2008. We analyzed data on demographics; TB type (smear-positive, smear-negative, extrapulmonary); patient type (new patient, relapse, treatment default, treatment failure); clinical and radiological manifestations; surgeries; and outcomes.Of the 53 pneumothorax patients, 34 (64%) were male. The pneumothorax group's mean age was 34 y (range 14-76 y). Thirty-six (68%) of the pneumothorax patients were new TB cases (ie, TB undiagnosed before they presented with pneumothorax). Pneumothorax was not significantly associated with sex, smoking, or drug use. Pneumothorax was significantly more common in patients30 years old (P.001). In terms of radiological manifestations, 20 pneumothorax patients (38%) had cavitary lesions, and pulmonary infiltration and effusion were present in 19 (36%) and 17 (32%) patients, respectively. Cavitary lesion was significantly more common among the pneumothorax patients (P = .006). Overall, 47 (89%) of the pneumothorax patients were relieved with chest-tube insertion; the other pneumothorax patients were only observed.In patients30 years old or with cavitary lesions, worsening of the patient's respiratory condition should prompt consideration of pneumothorax.

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.

The objective of this study was to determine the drug resistance prevalence and its pattern among tuberculosis (TB)–HIV patients in Iran. In this retrospective study, all admitted TB/HIV patients presenting to our tertiary centre during 2005–2007 were considered. After confirmation for TB–HIV, first-line DST was performed for culture-positive patients. The drug resistance patterns and the treatment outcomes were analysed. Of the total 92 TB/HIV patients, 27 were culture negative, and DST were available in 65. Intravenous drug abuse was seen in 59 (90.8%). Thirty-seven (57%) were ‘sensitive’ cases and 28 (43%) were ‘any drug resistance’ cases. Twenty-one (32.3%) were mono-drug, three (4.6%) poly-drug and four (6.1%) were multidrug-resistant TB patients. Previous anti-TB medication was significantly associated with any drug resistance ( P = 0.041; 95% confidence interval =0.086–0.984); however, having any drug resistance did not affect the treatment outcome ( P = 0.56). Streptomycin showed the highest resistance rate (27%) followed by isoniazid (20%), pyrazinamide (9.8%), rifampin (9.2%) and ethambutol (3%). Drug resistance to antitubercular agents in TB–HIV co-infected patients in Iran is high compared with other reports. Drug resistance is higher among those who have had prior anti-TB medication.

Drug-induced hepatitis (DIH) is an important issue in tuberculosis (TB) treatment. We intend to assess the incidence, risk factors, and outcome of hepatitis due to anti-TB drugs. The study is carried out at the national TB referral center 2006-2008 including all documented new cases of TB. All patients received standard anti-TB treatment. If DIH occurred, all drugs were discontinued and reinitiated after liver function tests (LFT) normalization in a stepwise way. Of total 761 patients, 99 (13.0%) patients developed DIH during anti-TB treatment. There was no difference in sex, nationality, smoking, or opium use history between the hepatitis group and the control group (P > 0.05). DIH was significantly higher in patients older than 65 years (P = 0.019). The mean duration of DIH from the beginning of treatment was 17.53 +/- 19.42 days (median = 12; 1-125 days). Also, the mean of the time elapsed from DIH till the (LFT) normalization was 10.26 +/- 5.95 (median = 9; 0-32 days). Anorexia, nausea, vomiting, abdominal pain, jaundice, diarrhea, decreased level of consciousness, and fever were significantly higher in patients with DIH. In DIH group, 13 patients (13.4%) died, whereas in the control group, death occurred just in 21 cases (3.2%) (P < 0.001, 95% confidence interval = 2.26-9.70, odds ratio = 4.7). After adjusting with logistic regression, all the anticipated factors retained the statistical significance. Our study indicated that DIH most often occurs during the first 2 weeks of anti-TB treatment. DIH development is associated with old age, certain clinical manifestations, and higher death rates.

Background 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. Methods 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. Results 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. Conclusion Based on the findings of this study, it is essential that such cases be identified before commencing MDR-TB treatment.

An approved treatment regimen for multi-drug resistant tuberculosis (MDR-TB) patients during pregnancy does not exist to this day. The main reason for the lack of information in this area is the small number of patients and insufficient studies regarding the safety of the second-line drugs during pregnancy on the mother and the fetus [1]. This case report highlights the difficulties associated with MDR-TB. In December 2003, an 18-year-old Afghan woman was admitted to our center on complaints of cough, sputum, and dyspnea. The patient had a history of two periods of anti-TB treatments (Cat I and Cat II) in the past two years. Despite two years of anti-TB treatment the patient’s mother died secondary to TB. The patient’s chest X-ray demonstrated opacity accompanied by a cavity in the middle-upper lobe of the right lung, and alveolar infiltration together with nodular densities in the lower lobe of the left lung. Sputum smear was positive for Koch’s Bacillus (BK). An empirical regimen for MDR-TB was commenced because of a positive smear of sputum for BK (Ofloxacin, high-dose Isoniazid, Amikacin, Clofazimin, Pyrazinamid, and B6). After completion of five months of therapy, sputum smear and culture results were negative again. The performed chest X-ray at this stage demonstrated a decrease in the size of the right cavitary lesion. Considering the results of the patient’s drug susceptibility test, which demonstrated resistance to the four drugs Isoniazid, Rifampin, Ethambutol, and Streptomycin, and sensitivity to Pyrazinamid, the treatment regimen was continued. Earlier in the treatment the patient was advised to refrain from becoming pregnant and educated regarding the potential teratogenic side effects of anti-TB medications on the fetus and the need for up to 18 months

Introduction Nontuberculous mycobacterium (NTM) has clinical and radiological manifestations that are indistinguishable from mycobacterium tuberculosis (MTB). In an endemic area for tuberculosis (TB), limited data about prevalence and outcome of treatment of these patients is available. In this study the prevalence of different types of mycobacterium and response to treatment in a tertiary referral center in Iran will be evaluated. Materials and method All NTM cases from 2004 to 2013 at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Iran were extracted from the database. All NTM patients who were treated for NTM diseases entered this study, and the outcome of treatment was evaluated. Results A total of 104 cases were detected. The mean age was 56.34 ± 15.77 years. Half of the patients were male. Most of the patients had a history of prior TB treatment. The most common types of NTM were Mycobacterium simiae (44 [42.3%]), Mycobacterium kansasii (18 [17.3%]) , Mycobacterium abcessus (15 [14.4%]), and Mycobacterium chelonea (14 [13.5%]), respectively. The outcome of treatment was as follows: cure 61 (58.7%), failure 17 (16.3%), relapse 3 (2.9%), default 13 (12.5%) and death in 10 (9.6%) patients. Conclusion Treatment of NTM had a low cure rate despite low mortality.

Objectives Drug-resistant tuberculosis (TB) is a major challenge in controlling TB. HIV-positive patients are vulnerable to TB 100 times more than the general population. Drug-resistant TB leads to high morbidity and mortality in this population. In this study, the outcome of treatment of drug-resistant TB among HIV positive patients from 2003 to 2013 in a tertiary center in Iran will be reviewed. Materials and methods All HIV-positive patients with any drug-resistant TB from 2003 to 2013 were selected. The outcome of treatment was extracted from patients’ charts. Results Out of 269 TB-HIV patients, 34 patients were recruited. All patients were male and the mean age was 37.38 ± 7.03. Isoniazid (INH) resistant, rifampin (RIF) resistant and multi-drug resistant (MDR) was diagnosed in 11 (32.4%), 7 (20.6%) and 16 (47.1%), respectively. Mean CD4 count was 91.61 ± 23.55. Outcome of treatment in the INH-resistant cases was cured in 5 (45.5%), failure in 2 (18.2%) and death in 4 (36.4%). In the RIF-resistant group, outcome was as follows: cured 5 (71.4%) and failure in 2 (28.6%). In the MDR-TB patients’ group, cured, failure and death were 12 (75%), 2 (12.5%) and 2 (12.5%), respectively. Conclusion Treatment of drug-resistant TB can be achieved despite considerable mortality.

Background and objective Diabetes mellitus (DM) has an effect on many aspects of tuberculosis (TB). The aim of this study is to determine the impact of DM on anti-tuberculosis drug resistance in new cases of TB patients. Materials and methods A case-control study was conducted on all newly diagnosed pulmonary TB adult patients with DM as cases and without DM as controls who were hospitalized and treated at the National Research Institute of Tuberculosis and Lung Disease (NRITLD) from May 2013 to October 2013. A molecular resistance test for rapid detection of resistance to isoniazid and rifampin was done for all smear-positive TB patients. A multivariate analysis was performed to determine the impact of DM on any anti-TB drug resistance. Results 45 TB cases with DM and 45 TB cases without DM were included. TB cases with DM were more likely to be older (61 vs. 47 years, p = 0.001). Two TB–DM patients had multidrug-resistant TB (MDR-TB) (4.4%) compared with zero cases of MDR-TB in the control group, and TB–DM cases were resistant to at least one drug (11.1% vs. 4.4%, p = 0.43). DM remained significantly associated with any drug resistance (OR: 6.32, 95% CI: 1–40.72) in multivariate analysis. Conclusion New TB patients with DM are at increased risk of anti-TB drug resistance. More studies are needed to confirm these results.

⁎ Corresponding author. Masih Daneshvari Hospital, Darabad, Niavaran Tehran, Iran. E-mail address: s.mirzendehdel@gmail.com (S. Mirzendehdel). Understanding the prevalence of HIV and HPV infection among drug-addictedwomen and detecting high-risk HPV types could lead to integration of prevention and treatment into public health planning. This cross-sectional study of HPV and HIV prevalence was performed between 2007 and 2008 among women attending a drop-in center in Southern Tehran, Iran, that provides food and methadone to drugaddictedwomen.All addictedwomenattending the centerwere included in the study. All study participants were interviewed and their method of drug use was determined. After obtaining consent, a gynecological exam was conducted and a cervical swab sample was obtained for laboratory studies. If participants had vaginal discharge or there was clinical suspicion of pelvic infection, appropriate tests and treatment were provided. A 2 mL-sample of blood was obtained from the study participants and tested for HIV using an ELISA test (Adaltis Inc, Montreal, Canada). Positive screens were followed by western blot for confirmation. If test results were positive for HIV, referral was made to specialty clinics for further evaluation and possible treatment. Cervical swabs and scrapes obtained for HPV detection in all cases were transferred into tubes and transported at 8°C to the Virology Research Center of the National Research Institute of Tuberculosis and Lung Disease, Tehran. At the laboratory the cervical samples were resuspended in 500 μL of phosphate-buffered saline, immediately centrifuged, and the pellet was stored at −70 °C until further processing. For detection of HPV genotypes, nested polymerase chain reaction (PCR) analysis was performed using MY09/MY11 as the outer primers and GP5+/GP6+ as the inner primers, as previously described and with minor modification [1]. The positive samples were genotyped using a GP-E6/E7 nested multiplexPCRassay [1].HPVgenotypesweredivided into3groups: highrisk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68); lowrisk genotypes (6–11, 42, 43, 44); and genotypes that could not be identified. The study protocol was approved by the scientific and ethics committee of the National Research Institute of Tuberculosis and Lung disease, Tehran. Data were analyzed using SPSS version 15.0 (SPSS, Chicago, IL, USA). Continuous variables were expressed as group means±SD. The χ test without Yates correction and a Fisher exact test were used as appropriate. All reported P values are two-sided. Pb0.05was considered statistically significant. Multivariate logistic regression was used to determine the independent risk factors for HPV and high-risk genotypes. A total of 118 women were included in the study. The average age of the participants was 35.06±1.16 years (range, 15–61 years). There were 15participantswithahistoryof intravenousdruguse.A total of 91 (77.1%) women had a history of crack cocaine use. Ten (8.5%) participants had a history of crack cocaine abuse and intravenous drug use. A total of 29 (24.6%) women had multiple sexual partners. Five (4.2%) women were unmarried, 51 (43.2%) were married, 51 (43.2%) were divorced, and 11 (9.3%) were widowed. Seventeen (14.4%) women were illiterate, 89 (75.4%) had a level of education below diploma level, and 12 (10.2%) participants had a diploma or higher level of education. Vaginal discharge was reported by 64 (54.2%) women. Candidiasis was found in 22 (18.6%) women and discharge caused by other infection was found in 44 (35.6%) participants. A total of 8 participants (6.8%) tested positive for HIV. The vaginal swab samples of 59 (50%)women testedpositive forHPV. More than one type of HPV virus was identified in 16 (13.6%) women. There were 26 (22%) cases of high-risk HPV, 9 (7.6%) cases of both high

Introduction 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. Methods 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

Background : Venous thromboembolism is a serious complication among hospitalized patients. Infectious diseases are known as a risk factor for thrombo-embolic events Objectives: The aim of the study is to evaluate incidence, characteristic pattern, and risk factors for thrombo-embolic events among patients hospitalized with pulmonary and extra-pulmonary tuberculosis . Patients and Methods: This cohort study was performed among 1,153 new cases of tuberculosis. Suspected patients for DVT (deep venous thrombosis) or PTE (pulmonary thromboembolism) were investigated by Doppler sonography and pulmonary CT angiography. Another 100 tuberculosis patients without thromboembolism were also observed as control group. Results: The incidence of diagnosed thrombo-embolic complication was 32 of 1,153 admitted patients (2.8%; 95% confidence interval: 1.9 to 3.9) with a median interval of 14 days after anti-TB treatment initiation. The incidence of DVT and PTE was 2% and 1%, respectively. Thrombo-embolic events and DVT were more common in men than in women: 4.2% versus 1.3% (P = 0.003) and 3.5% versus 0.4%, respectively (P < 0.001). Hypertension and opium addiction were significantly correlated with thromboembolism . Conclusions: Incidence of DVT and PTE is noticeable among patients with tuberculosis

We report the case of a 23-year-old asthmatic woman who had clinical and radiological deterioration due to Mycobacterium szulgai infection and good response to anti-mycobacterial treatment without any structural abnormalities in previous lung imaging studies. M. szulgai may be considered a pathogen able to cause deterioration of respiratory health even in patients with previously normal lungs.

Tuberculosis (TB) is a frequently encountered infection among organ transplant recipients in developing countries, and the incidence of infection after the first year of transplantation is considerably high. In this study, the impact of rifabutin treatment on organ transplant recipients with TB infection was evaluated with respect to the trend of infection, management and outcome. The medical records of 26 post-transplant patients who received an organ transplant between 2004 and 2012 and later diagnosed with TB of different organs were reviewed retrospectively. We retrieved data regarding clinical features as well as treatment and outcomes. The median time interval between transplantation and TB was 36 months (IQR 12-101 months). The most common form of infection was pulmonary/pleural TB. All our subjects received rifabutin instead of rifampin in the anti-TB treatment regime as rifabutin is a less-potent inducer of cytochrome P-450. All patients responded satisfactorily to the treatment and maintained excellent allograft function. Moreover, we did not have any mortality among our recipients. Drug-induced hepatitis was observed in nine (35%) patients. Rifabutin is an excellent alternative medication to rifampin in the setting of TB management. Hepatotoxicity is a potential risk for treatment because of the potential additive toxicity of immunosuppressive drugs.

Introduction: Several species of non-tuberculosis mycobacteria (NTM) can affect humans and can cause either symptomatic or asymptomatic infection. This study aimed to determine the clinical and radiological manifestation, as well as the treatment, of M. simiae in patients in Masih Daneshvari Hospital, a TB referral hospital in Iran. Methodology: This retrospective study involved all patients presenting to our referral center from 2002 to 2009, with confirmation of M. simiae pulmonary infection. For all patients, sputum smear and culture for identification was performed, as was drug susceptibility testing. Additionally, PCR identification methods for NTM, and high-resolution CT scan were conducted. All patients were treated according to American Thoracic Society recommendations.Results: In total, 26 cases of M. simiae were identified in our center. The mean age of the patients was 58.23 ± 16.9years. Only one patient was HIV positive, and all but one were Iranian. The most frequent symptom was coughing (92.3%), and 100% of the patients had nodular lesions. In addition, bronchiectasis and cavitation were present in 84.6% and 88.5% respectively. All the patients were resistant to every first-line drug. Two patients failed the treatment, and twenty-four were cured, after which no recurrence of the disease was observed.Conclusion: M. simiae may present with clinical and radiological manifestations consistent with tuberculosis, and be resistant to anti-TB agents. A more efficient treatment for NTMs such as M. simiae is needed, to shorten the period of treatment and proved fewer adverse effects than current therapies.

Tuberculosis (TB) and diabetes mellitus (DM) are both important health issues. A bidirectional association between them has been demonstrated by many researchers. The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of diabetes mellitus is increasing. The association between diabetes and tuberculosis may be the next challenge for global tuberculosis control worldwide. Proper planning and collaboration are necessary to reduce the dual burden of diabetes and TB. One model similar to the TB-HIV program for prevention, screening and treatment of both diseases can be the best approach. In this paper, we review existing data and discuss the matters of controversy that would be helpful for determining research priorities in different countries.