Hsieh S M, Sheng W H, Chen M Y, Hung C C, Chang S C
Section of Infectious Disease, National Taiwan University Hospital, Taipei.
J Formos Med Assoc. 1999 Aug;98(8):550-5.
The pattern of fever response to empiric anti-tuberculosis therapy in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) infection, and the relationship between fever response patterns and anti-TB drug susceptibility profiles of Mycobacterium tuberculosis isolates are rarely described. In this study, we evaluated the fever responses to a four-drug anti-TB regimen in 26 HIV-infected patients with culture-proven extrapulmonary TB, and compared the results with those in 12 patients with disseminated Mycobacterium avium complex (DMAC) infection treated with a clarithromycin-containing regimen. The CD4 lymphocyte counts did not differ significantly between TB and DMAC patients (26 x 10(6)/L in TB patients vs 5 x 10(6)/L in DMAC patients). Drug susceptibility data were available for 22 patients with TB. Most TB patients had rapid defervescence after initiation of anti-TB therapy. Fever resolved within 1 week in 85% (22/26) of patients, including three of six (50%) with multidrug-resistant (MDR) TB. The median duration of fever in patients with drug-susceptible TB was similar to that in patients with drug-resistant TB (3 vs 4 days, p = 0.33). However, patients with MDR-TB were more likely than those with non-MDR TB to have fevers lasting longer than 1 week after initiating anti-TB therapy (3/6 vs 1/16, p = 0.046). Only 17% (2/12) of the patients with DMAC infection became afebrile within 1 week of beginning anti-MAC therapy (p < 0.001 vs those with TB). Our observations suggest that in HIV-infected patients with advanced immunosuppression, anti-TB regimens achieve significantly faster defervescence in TB patients than do anti-MAC regimens in DMAC patients. Rapid defervescence in patients with TB does not necessarily indicate that TB isolates are not MDR strains.
结核病（TB）合并人类免疫缺陷病毒（HIV）感染患者对经验性抗结核治疗的发热反应模式，以及发热反应模式与结核分枝杆菌分离株的抗结核药物敏感性谱之间的关系鲜有描述。在本研究中，我们评估了26例经培养证实为肺外结核的HIV感染患者对四联抗结核方案的发热反应，并将结果与12例接受含克拉霉素方案治疗的播散性鸟分枝杆菌复合体（DMAC）感染患者的结果进行比较。TB患者和DMAC患者的CD4淋巴细胞计数无显著差异（TB患者为26×10⁶/L，DMAC患者为5×10⁶/L）。有22例TB患者可获得药物敏感性数据。大多数TB患者在开始抗结核治疗后迅速退热。85%（22/26）的患者在1周内退热，其中包括6例耐多药（MDR）TB患者中的3例（50%）。药物敏感TB患者的发热中位持续时间与耐药TB患者相似（3天对4天，p = 0.33）。然而，MDR-TB患者在开始抗结核治疗后发热持续超过1周的可能性高于非MDR TB患者（3/6对1/16，p = 0.046）。只有17%（2/12）的DMAC感染患者在开始抗MAC治疗的1周内退热（与TB患者相比，p < 0.001）。我们的观察结果表明，在免疫抑制严重的HIV感染患者中，抗结核方案使TB患者退热的速度明显快于DMAC患者的抗MAC方案。TB患者迅速退热并不一定表明结核分离株不是MDR菌株。
