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Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients.
Eur J Clin Microbiol Infect Dis. 2002 Nov; 21(11):803-9.EJ

Abstract

Paradoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) (P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy.

Authors+Show Affiliations

Division of Infectious Diseases, Center of Infection, Queen Mary Hospital, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Republic of China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

12461590

Citation

Cheng, V C C., et al. "Clinical Spectrum of Paradoxical Deterioration During Antituberculosis Therapy in non-HIV-infected Patients." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, vol. 21, no. 11, 2002, pp. 803-9.
Cheng VC, Ho PL, Lee RA, et al. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis. 2002;21(11):803-9.
Cheng, V. C., Ho, P. L., Lee, R. A., Chan, K. S., Chan, K. K., Woo, P. C., Lau, S. K., & Yuen, K. Y. (2002). Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 21(11), 803-9.
Cheng VC, et al. Clinical Spectrum of Paradoxical Deterioration During Antituberculosis Therapy in non-HIV-infected Patients. Eur J Clin Microbiol Infect Dis. 2002;21(11):803-9. PubMed PMID: 12461590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. AU - Cheng,V C C, AU - Ho,P L, AU - Lee,R A, AU - Chan,K S, AU - Chan,K K, AU - Woo,P C Y, AU - Lau,S K P, AU - Yuen,K Y, Y1 - 2002/11/07/ PY - 2002/12/4/pubmed PY - 2003/2/7/medline PY - 2002/12/4/entrez SP - 803 EP - 9 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur. J. Clin. Microbiol. Infect. Dis. VL - 21 IS - 11 N2 - Paradoxical deterioration during antituberculosis therapy, defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves, remains a diagnostic dilemma. Although different clinical presentations of paradoxical response have been described, a systematic analysis of the entity in non-HIV-infected patients is lacking. Reported here are two cases of paradoxical deterioration in which sequential changes in lymphocyte counts and tuberculin skin test results are emphasized. In addition, 120 episodes of paradoxical response after antituberculosis treatment were reviewed. Of the total 122 episodes, 101 (82.8%) were associated with extrapulmonary tuberculosis. The median time from commencement of treatment to paradoxical deterioration was 60 days. The median time to onset of central nervous system manifestations (63 days) was longer than the time to onset of manifestations at other sites (56 days) (P=0.02). Development of new lesions in anatomical sites other than those observed at initial presentation was observed in 31 (25.4%) episodes. A surge in the lymphocyte count, accompanied by an exaggerated tuberculin skin reaction, was observed in our patients during the paradoxical deterioration, analogous to the findings in HIV-positive patients. Treatment of the paradoxical response included surgical intervention (60.7%) and administration of steroids (39.3%). The use of steroids appeared to be safe in this series, as 95% of the Mycobacterium tuberculosis isolates were susceptible to first-line antituberculosis therapy. SN - 0934-9723 UR - https://www.unboundmedicine.com/medline/citation/12461590/Clinical_spectrum_of_paradoxical_deterioration_during_antituberculosis_therapy_in_non_HIV_infected_patients_ L2 - https://dx.doi.org/10.1007/s10096-002-0821-2 DB - PRIME DP - Unbound Medicine ER -