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Int J Infect. 2015 April; 2(2): e25753. DOI: 10.17795/iji-25753

Puli!"e# $nline 2015 April 20. Research

Article

%i!& 'ct$r! n# Pttern $f "n*e! in +i,er ne! A$n* t"e Pti

ent!

it" Anti-uercul$!i! Dru*-In#uce# eptiti!

1 14 1 1

6ei#e" 7etnt 1

1Infecti$u! Di!e!e! n# r$picl e#icine %e!erc" enter4 8"e#n ni,er!it $f e#icl 6cience!4 8"e#n4 I% Irn

*Corresponding author : t$$l 6"rifi $$#4 Infecti$u! Di!e!e! n# r$picl e#icine %e!erc" enter4 8"e#n ni,er!it $f e#icl 6cience!4 8"e#n4 I% Irn.

el: 9<-5=132297924 9<-9155=1=0034 -il: t$$l!"rifi$$#>"$$.c$

Received: Deceer 14 201=; Revised: Deceer 54 201=; Accepted: Deceer 214 201=

Background:

ept$t$?icit

i!

$ne

$f

t"e

$!t

fre@uent

#,er!e

e,ent!

t"t

$ccur!

#urin*

tuercul$!i!

tretent

n#

i!

!!$cite#

it" $rtlit $f BC - 12C if #ru*! re c$ntinue# fter t"e ppernce $f !pt$!. In $!t $f t"e c!e!4 "eptiti! i! e,i#ent it"in t"ree

$nt"! fter in#ucti$n $f nti-tuercul$!i! tretent.

Objectives: "e current !tu# ie# t$ #efine t"e pttern $f c"n*e! in li,er trn!in!e! n# t"e !!$cite# ri!& fct$r! $n* t"e

ptient! it" nti-tuercul$!i! #ru*-in#uce# "eptiti! "$ #itte# t$ $$-Ali $!pitl in 8"e#n4 6$ut"e!tern Irn.

PatientsandMethods:"ecurrent#e!cripti,ecr$!!-!ecti$nl!tu#re,iee#llfile!$f t"eptient!it"nti-tuercul$!i!Dru*-In#uce#

eptiti!

(DI)

"$

referre#

t$

$$-Ali

$!pitl

in

8"e#n4

6$ut"e!tern

Irn4

in

fi,e

er!.

All

ptient!

ere

$,e

1=

er!4

n#

ere

trete# it" t"e !tn#r# re*ien ( c$inti$n $f i!$nii#4 rifpin4 prini#e4 n# et"ut$l !trept$cin). ept$t$?icit

! #efine# "en t"e li,er trn!in!e! ere $re t"n fi,e4 t"e pper +iit $f E$rl (+E)4 $r "# clinicl !pt$! it" n

incre!e

$f

li,er

trn!in!e!

F

3

+E.

Results:

A$n*

t"e

9=B

ptient!

it"

tuercul$!i!

#i!e!e

(==C

en;

5BC

$en)4

52

(5.5C)

c!e!

"#

#ru*-in#uce#

"ept$t$?icit.

Onl

25C

$f

t"e

ptient!

it"

nti-tuercul$!i!

#ru*-in#uce#

"eptiti!

ere

el$

52;

50C

$f

t"e

c!e!

$ccurre#

it"in

t"e

fir!t

t$

ee&!

fter

t"e tretent $n!et.

Conclusions:Anti-tuercul$!i!#ru*!-in#uce#"ept$t$?icitcu!e#tretentinterrupti$nin5.5C$f t"eptient!it"tuercul$!i!."e

j$rit

$f

t"e

ptient!

it"

DI

ere

$,e

fift4

n#

50C

t"e

c!e!

$ccurre#

#urin*

t"e

fir!t

t$

ee&!

fter

tretent

$n!et.

P"!icin!u!t crefull n# cl$!el $nit$r !uc" ptient!.

Keywords:+i,er; Dru*!; ept$t$?icit; uercul$!i!

1. Background

pl$in* ulti#ru* re*ien! !uc" ! t"e c$in-

ti$n

$f

i!$nii#4

rifpin

n#

prini#e

(IE4

%I'

n#

P8A)

t$

tret

uercul$!i!

()

i!

!!$cite#

it"

n

incre!e#

inci#ence

$f

#ru*-in#uce#

"eptiti!

(DI)

(1-3).

%i!&

fct$r!

$f

"ept$t$?icit

pr$*re!!i$n

#ue

t$

nti-

tuercul$!i! (nti-) tretent inclu#e c"r$nic li,er

#i!e!e4 cti,e lc$"$l u!e4 e?ten!i,e pul$nr tuercu-

l$!i!

(P)4

$l#

*e4

n#

*enetic

fct$r!

(3).

Infecti$n

it""eptiti! n# ,iru!e! re c$$n cu!e! $f c"r$nic

li,er #i!e!e fre@uentl $!er,e# in p$pulti$n! t ri!&

f$r

infecti$n

(1-3).

"e

ec"ni!!

$f

#ru*-in#uce#

"ept$t$?icit fr$ nti- *ent! re t"$u*"t t$ in-

,$l,e

#irect

ct$t$?icit

(

t"e

#ru*!

$r

t"eir

et$-

lite!) n# n iune-relte# c$p$nent e!pecill

t$ in #ru*!( IE n# %I') (=). Acc$r#in* t$ #ifferent

p$pulti$n!4

t"e

inci#ence

$f

cute

li,er

injur

#urin*

!tn#r#

nti-

tretent

i!

rep$rte#4

,rin*

fr$

1C

t$ $re t"n 31C (3-9).

2. Objectives

"e current !tu# ie# t$ e!tite t"e inci#ence $f

DI

in

8"e#n

(6$ut"e!tern

Irn)4

"ere

t"e

pre,-

lence

$f

i!

"i*".

. Patients and Methods

"e current #e!cripti,e cr$!!-!ecti$nl !tu# re,iee#

e#icl "i!t$r rec$r#! $f t"e ptient! it" uercul$!i!

(pul$nr

n#

e?tr

pul$nr)

#itte#

t$

$$-Ali

$!pitl in 8"e#n4 Irn4 fr$ April 200B t$ rc" 200<

n# fr$ April 2011 t$ rc" 201=. uercul$!i! ! #i-

*n$!e# t"r$u*" cteri$l$*icl n# "i!t$pt"$l$*icl

et"$#!.

cteri$l$*icl

te!tin*

!

!e#

$n

t"ree

!pu-

tu !ple! $r if t"e ptient c$ul# n$t *i,e t"e !ple4

t"ree *!tric !pirti$n !ple! ere e?ine#. "e !pu-

tu n# *!tric !pirti$n !ple! ere e,lute# f$r

Aci# '!t cilli (A') 8eil-Eel!$n !tinin* n# +$en-

!tein-Jen!en e#iu ! u!e# t$ culture Mycobacterium

tuberculosis.

Ptient!

it"

?tr

Pul$nr

uercul$!i!

$pri*"t

G

20154

Infecti$u!

Di!e!e!

n#

r$picl

e#icine

%e!erc"

enter.

"i!

i!

n

$pen-cce!!

rticle

#i!triute#

un#er

t"e

ter!

$f

t"e

reti,e

$$n!

Attriuti$n-E$n$ercil =.0 Internti$nl +icen!e ("ttp://creti,ec$$n!.$r*/licen!e!/-nc/=.0/) "ic" perit! c$p n# re#i!triute t"e teril ju!t in

li"e" etnt ; t$$l 6"rifi $$# ; !$u# 6le"i ; $"# %&"!"ni ;



n$nc$ercilu!*e!4pr$,i#e#t"e$ri*inl$r&i!pr$perlcite#.

Metanat M et al.

ere e,lute# cteri$l$*icll $r "i!t$pt"$l$*icll.

All ptient! ere trete# it" t"e !tn#r# re*ien (

c$inti$n $f IED4 %I'4 P8A n# et"ut$l ()

!trept$cin).

Dru*

relte#

"ept$t$?icit

!

#efine#

! incre!e in !eru lnine in$trn!fer!e F 3 +E

it" !pt$! $f "eptiti!4 $r $re t"n fi,e tie! $f

+E

it"

$r

it"$ut

!pt$!

$f

"eptiti!.

"e

ri!&

fc-

t$r!

n#

$t"er

c$-$ri#itie!

!uc"

!

eptiti!

Hiru!

(H)4 eptiti! Hiru! (H)4 n# un Iun$#e-

ficienc

Hiru!

(IH)

infecti$n4

#iete!4

n#

u!e

$f

$t"er

"ept$t$?ic #ru*!4 n# clinicl c$ur!e $f #ru* "eptiti!

ere

l!$

!tu#ie#.

"en

t"e

ptient!

!"$e#

DI4

t"eir

#ru*! ere #i!c$ntinue# n# cc$r#in* t$ t"e nti$nl

pr$t$c$l

f$r

t"e

tretent

$f

DI4

ll

#ru*!

ere

*r#ul-

l re!ue#. "e !tti!ticl nl!i! $f t"e re!ult! ! cr-

rie# $ut u!in* 6P66 ,er!i$n 17 t$ e,lute t"e !i*nificnt

#ifference!;

P

0.05.

!.

Results

"e current !tu# re,iee# ll file! $f t"e ptient!

it"

nti-

#ru*-in#uce#

"eptiti!

#itte#

t$

$$-Ali

$!pitl

in

8"e#n

#urin*

fi,e

er!.

A$n*

t"e

9=B

ptient!

it"

(==C

en;

5BC

$en)

52

ptient!

(27

le!4 25 fele!4 n# en $f *e 15 - <9 er!) ere

"$!pitlie#

#ue

t$

nti-

#ru*-in#uce#

"eptiti!.

Of

t"e 52 ptient! it" nti- #ru*-in#uce# "eptiti!4 75C

ere $,e 52 er!; 50C $f t"e c!e! $ccurre# it"in

t"e fir!t t$ ee&! fter t"e tretent $n!et. ie rn*e

f$r

#e,el$pin*

DI

!

3

-

150

#!

fter

t"e

ptient!

re-cei,e# nti- #ru*!. "ree ptient! "# p$!iti,e !er$l$*

r&er! f$r H (p$!iti,e re!ult f$r ! A* n# P%-H

te!t!).

E$$#

!

p$!iti,e

f$r

H

$r

IH.

'i,e

ptient!

"# #iete! ellitu!. A$n* t"e ptient! it" DI4 fi,e

ptient! ere trete# it" fi,e nti- #ru*! ecu!e $f

relp!e $r tretent filure; =5C "# A+4 A6 F B tie!

$f +E. "e!e ptient! "# l$!! $f ppetite (<BC)4 icteru!

(=BC)4 nu!e (<BC)4 ,$itin* (57C)4 li!e (2=C)4 ri*"t

upper @u#rnt ten#erne!! (2=C)4 n# l$!! $f c$n!ci$u!-

ne!! (5.7C). +i,er ene le,el! ere n$rl fter f$ur t$

30

#!.

E$

#et"

!

$ccurre#.

"e

en

$f

"$!pitli-

ti$n #urti$n ! 13 #!.

". #iscussion

"e current !tu# !"$e# t"t 5.5C $f t"e ptient!

it" trete# it" nti- #ru*! fce# "ept$t$?icit.

Dru*-in#uce# "ept$t$?icit i! $ne $f t"e $!t ip$r-

tnt !i#e effect! $f nti- tretent4 "ic" ,rie! in

#ifferent

c$untrie!

n#

t"e

inci#ence

,ri$u!

fr$

1C

t$ 31C (=-9). 're@uenc i! "i*"er in c$untrie! li&e In#i

(10C) n# tur&e (1<C)4 "ile it i! l$er in e!tern c$un-

trie!

(

1C

in

6A4

3.3C

in

6pin4

n#

=C

in

K)

(3-9).

Pu-

li!"e# rep$rt! fr$ Irn !"$ t"t DI i! "i*"er $n*

Irnin

ptient!

(6i!tni#

2<C

(<)4

n#

K"lili

31C

(9)).

Depen#in*

$n

t"e

fct$r!

!uc"

!

*e$*rp"icl

l$cti$n4*enetic

fct$r!4

*e4

rce4

p$$r

nutriti$nl

!ttu!4

"i*"

lc$"$l u!e4 e?ten!i,e #i!e!e4 pre-e?i!tin* li,er #i!e!e4

2



"eptiti! n# 4 "eptiti! crri*e4 "p$luine-

i n# cetlte# !ttu!4 t"e fre@uenc ! #e$n-

!trte# t$ e #ifferent (3-5). i*"er inci#ence $f "ept$-

t$?icit in $l#er *e e !ec$n#r t$ t"e incre!e#

pre,lence $f c$ $ri# #i!$r#er! ! ell ! u!e $f re-

lte#

##iti$nl

#ru*!

in

t"i!

*e

*r$up

(1-=).

In

t"e

cur-

rent

!tu#4

75C

$f

t"e

ptient!

ere

$re

t"n

52

er!.It ! rep$rte# t"t t"e #ini!trti$n $f rifpicin in

ulti#ru* tretent re*ien incre!e# t"e inci#ence

$f !i*nificnt "ept$t$?icit $n* #ult! fr$ 1.BC t$

2.55C (24 7). Prini#e l!$ c$ntriute# t$ incre!e#

inci#ence $r !e,erit $f "ept$t$?icit (2). In t"e current

!tu# ptient! recei,e# t"e !tn#r# re*ien (c$i-

nti$n

$f

I!$nii#4

rifpicin4

prini#e4

n#

et"-

ut$l !trept$cin). ?ten!i,e uercul$!i! it!elf

e ri!& fct$r f$r uercul$!i! DI (5-7). !e# $n

e#icl rec$r#!4 nerl $ne-t"ir# $f t"e ptient! it"

"eptiti!

l!$

!"$

n

?ten!i,e

uercul$!i!

$n

c"e!t

L-r. In !uc" !ituti$n4 cl$!e f$ll$-up i! re@uire# #ur-

in*

tretent

it"

peri$#icl

clinicl

c$ntr$l!

n#l$rt$r te!t!. It i! rec$en#e# t"t ptient! it"

e e,lute# f$r "ept$t$?icit e#icl "i!t$r4

p"!icl

e?inti$n4

l$rt$r

te!t!4

n#

t"e

!"$ul#

l!$ e re $f "ept$t$?icit n# "eptiti! !pt$!

!uc" ! l$!! $f ppetite4 nu!e4 ,$itin*4 icteru!4 n#

#$inl pin n# precuti$n! f$r u!e $f lc$"$l n#

$t"er

"ept$t$?ic

#ru*!

(10-1=).

Acc$r#in*

t$

t"e

$rl#

elt" Or*niti$n (O) rec$en#ti$n!4 if t"e

#i*n$!i! i! #ru*-in#uce# "eptiti!4 t"e nti- #ru*!

!"$ul# e !t$ppe# until t"e n$rliti$n $f t"e li,er

functi$n

te!t!

(1-3).

In

t"e

pre!ent

!tu#

tretent

!

re-initite# $nl fter n$rliti$n $f li,er ene!.

In t"e clinicl prctice4 in #ru* relte# "ept$t$?icit

!tep--!tep tretent ppr$c" ! re-!trte# e?clu-

!i$n

$f

re!p$n!ile

#ru*/!

fr$

t"e

tretent

re*ien.

Alt"$u*"4 "i*"er recurrence rte $f "ept$t$?icit in

t"e

retretent

$f

it"

full-#$!e

re*ien

inclu#-in* prini#e i! "i*"er t"n re*ien it"$ut t"i!

#ru* (134 1=)4 t"e current !tu# ttepte# t$ re-!trt ll

f$ur #ru*! if p$!!ile; t"e purp$!e i! inl t$ $!er,e

ultiple Dru* %e!i!tnce (D%) n# pre-e?ten!i,el

#ru*-re!i!tnt in t"i! re*i$n (15).

Alt"$u*" t"e fre@uenc $f DI in t"e current !tu#

! l$er t"n t"$!e $f $t"er !tu#ie! in t"i! re4 !ii-

lr

t$

$t"er

rep$rt!4

$!t

$f

t"e

c!e!

in

"ic"

"ep-

t$t$?icit #e,el$pe# $ccurre# in t"e !uject! $,e

52 er! $l# n# l$t $f t"e $ccurre# fter t"e fir!t

$nt"

$f

tretent.

It

!"$ul#

e

c$n!i#ere#

t"t

t"e!e

c!e! re@uire creful clinicl n# l$rt$r $nit$r-

in*.

Pri$ritie!

f$r

future

!tu#ie!

inclu#e

!ic

!tu#ie!t$ #efine *enetic ri!& fct$r4 t"e ec"ni! $f nti-

#ru*-in#uce# "ept$t$?icit4 n# t"e #e,el$pent $f

!fer #ru* re*ien!.

Ackno$ledge%ents

Aut"$r! $ul# li&e t$ t"n& ll t"e !tff eer! in

$$-Ali

$!pitl

f$r

t"eir

"elp!.

Int

J

Infect.

2015;2(2):e25753

Metanat M et al.

Authors& Contributions

6tu#

c$ncept

n#

#e!i*n:

t$$l

6"rifi

$$#4

li"e"

7etnt; c@ui!iti$n $f #t: 7$"# %&"!"ni; !t-

ti!ticl nl!i! n# interpretti$n $f #t: 7!$u# 6le-

"i; #rftin* $f t"e nu!cript: 7li"e" 7etnt4 !ei#e"

7etnt; criticl re,i!i$n $f t"e nu!cript f$r ip$r-

tnt

intellectul

c$ntent:

t$$l

6"rifi

7$$#.

Re'erences

1. Mee D4 Hli@uette 4 Pelletier 4 Pri!ien I4 %$c"er I4 enie! D.

Inci#ence $f !eri$u! !i#e effect! fr$ fir!t-line ntituercul$!i!

#ru*! $n* ptient! trete# f$r cti,e tuercul$!i!. Am

J

Respir

Crit Care Med. 2003;1()(11):1=72N7.

2. urn

J4

%e,e!

%%.

ept$t$?icit

fr$

rifpin

plu!

pr-

ini#e: le!!$n! f$r p$lic&er! n# e!!*e! f$r cre pr$-

,i#er!. Am J Respir Crit Care Med. 2001;1(!(7):1112N3.

3. $!tnn A4 $eree J4 Arn$ut!e %4 #e +n*e 4 ,n #er Hen

AJ4 De&"uijen %. Antituercul$!i! #ru*-in#uce# "ept$t$?icit:

c$nci!e up-t$-#te re,ie. J Gastroenterol Hepatol. 200<;2(2):192N

202.

=. +rre D. pi#ei$l$* n# in#i,i#ul !u!ceptiilit t$ #,er!e

#ru* recti$n! ffectin* t"e li,er. emin !i"er #is. 2002;22(2):1=5N

55.

5. $!t J%4 Hi#l %4 l J4 Di-nel D4 Jiene A4 r$@uet!

J4 et l. 6e,ere "ept$t$?icit #ue t$ nti-tuercul$!i! #ru*! in

6pin. $nt J %uberc !ung #is. 2005;*(5):53=N=0.

B. Ki ter 4 $!&un$l I. ept$t$?icit #urin* t"e nti-tuercul$!i!

tretent:

retr$!pecti,e

!ur,e

$f

5-er-peri$#.

2000;!+:20N5.



Int J Infect. 2015;2(2):e25753

7. 6teele A4 ur& %'4 De!Pre %. $?ic "eptiti! it" i!$nii#

n# rifpin. A et-nl!i!. Chest. 1991;**(2):=B5N71.

<. 6i!tni# 4 Aii 4 K"lili 4 ji#$l*"i 4 "$li K4

"ju

%.

Antituercul$!i!

Dru*-In#uce#

ept$t$?icit

in

Ir-

ninuercul$!i! Ptient!: %$le $f I!$nii# et$lic P$l$r-

p"i!. $ran J &harm Res. 2011;1,(3):B33N9.

9. K"lili 4 D!"ti-K",i#&i 64 %!$$linej# 4 %eie +4 tinni

. Anti-tuercul$!i! #ru*! relte# "ept$t$?icit; inci#ence4

ri!&

fct$r!4

pttern

$f

c"n*e!

in

li,er

ene!

n#

$utc$e.

J &harm

ci.

2009;1)(3):1B3N7.

10. D$!!in* 4 ilc&e J4 A!&*r# D64 E$ . +i,er injur #urin*

ntituercul$!i! tretent: n 11-er !tu#. %uber !ung #is.

199B;))(=):335N=0.

11. un* M64 "ern D4 6u J4 u J4 +i 6+4 Mn* 6M4 et l. P$l/$r-

p"i!

$f

t"e

E-cetltrn!fer!e

2

*ene

!

!u!ceptiilit

ri!&

fct$r

f$r

ntituercul$!i!

#ru*-in#uce#

"eptiti!. Hepatology.

2002;"(=):<<3N9.

12. 6"& %4 %$ 64 6"re!t" . Inci#ence $f "ept$t$?icit #ue t$

ntituerculr

e#icine!

n#

!!e!!ent

$f

ri!&

fct$r!. Ann

&harmacother. 200=;+(B):107=N9.

13. elen D4 "ee 4 rne!t A4 n* M. ept$t$?icit $f tu-

ercul$!i!

c"e$t"erp

un#er

*enerl

pr$*re

c$n#iti$n!

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Risk Factor and Patter of Changes in Liver Enzymes Among the Patients With Anti-Tuberculosis...

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