S N Yu1, O-H Cho2, K-H Park3, J Jung4, Y K Kim4, J Y Lee4, Y-P Chong4, S-O Lee4, S-H Choi4, Y S Kim4, J H Woo4, S-H Kim4. 1. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea. 2. Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. 3. Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea. 4. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
SETTINGS: A tertiary referral centre in South Korea. OBJECTIVE: To investigate the incidence, clinical characteristics and outcomes of late paradoxical response (>4 months after the initiation of anti-tuberculosis treatment) during and after anti-tuberculosis treatment in non-human immunodeficiency virus (HIV) infected patients with lymph node tuberculosis (TB). DESIGN: We retrospectively reviewed the medical records of non-HIV-infected patients with lymph node TB between 1997 and 2007, and prospectively enrolled patients with newly diagnosed lymph node TB between 2008 and 2013. RESULTS: Of 467 patients with confirmed and probable lymph node TB, 83 (18%) displayed a paradoxical response: 57 of these (69%) were classified as early and 26 (31%) as late paradoxical response. Patients with late paradoxical response (median 12 months) received more prolonged anti-tuberculosis treatment than those with early (median 9 months, P < 0.001) or no paradoxical response (median 9 months, P < 0.001). The frequency of post-treatment lymph node enlargement increased progressively from those without any paradoxical response (6%), through those with an early response (12%) to those with a late response (23%). CONCLUSIONS: Paradoxical response presents late in about one third of non-HIV-infected patients with lymph node TB who experience a response. Although anti-tuberculosis treatment is commonly prolonged in patients with late paradoxical response, post-treatment lymph node enlargement is more frequent in these patients.
SETTINGS: A tertiary referral centre in South Korea. OBJECTIVE: To investigate the incidence, clinical characteristics and outcomes of late paradoxical response (>4 months after the initiation of anti-tuberculosis treatment) during and after anti-tuberculosis treatment in non-human immunodeficiency virus (HIV) infectedpatients with lymph node tuberculosis (TB). DESIGN: We retrospectively reviewed the medical records of non-HIV-infectedpatients with lymph node TB between 1997 and 2007, and prospectively enrolled patients with newly diagnosed lymph node TB between 2008 and 2013. RESULTS: Of 467 patients with confirmed and probable lymph node TB, 83 (18%) displayed a paradoxical response: 57 of these (69%) were classified as early and 26 (31%) as late paradoxical response. Patients with late paradoxical response (median 12 months) received more prolonged anti-tuberculosis treatment than those with early (median 9 months, P < 0.001) or no paradoxical response (median 9 months, P < 0.001). The frequency of post-treatment lymph node enlargement increased progressively from those without any paradoxical response (6%), through those with an early response (12%) to those with a late response (23%). CONCLUSIONS: Paradoxical response presents late in about one third of non-HIV-infectedpatients with lymph node TB who experience a response. Although anti-tuberculosis treatment is commonly prolonged in patients with late paradoxical response, post-treatment lymph node enlargement is more frequent in these patients.
Authors: Hyeri Seok; Ji Hoon Jeon; Kyung Ho Oh; Hee Kyoung Choi; Won Suk Choi; Young Hen Lee; Hyung Suk Seo; Soon Young Kwon; Dae Won Park Journal: BMC Infect Dis Date: 2019-10-21 Impact factor: 3.090