Tuberculosis: A Clinical Practice Guide

Tuberculosis in Special Situations: Liver and Renal Disease, Pregnancy, Extrapulmonary Tuberculosis, Tuberculosis in Immunosuppressed Individuals other than HIV, Tuberculosis, and Diabetes

Author(s): Rafael Laniado-Laborín

Pp: 59-77 (19)

DOI: 10.2174/9789811488511120010010

* (Excluding Mailing and Handling)

Abstract

Although the underlying general principles of management of tuberculosis are the same for all cases, there are certain special situations in which the treatment regimen must be modified.

Uremia and post-renal transplant are both risk factors for tuberculosis due to the underlying immunodeficiency. Patients undergoing dialysis have a 10-25-fold higher risk of developing the disease than the general population.

Many antituberculosis drugs are hepatotoxic. If aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are increased more than three times the upper limit of normal in the presence of symptoms of hepatitis or >5 times the upper limit of normal, even if the patient is asymptomatic, all hepatotoxic drugs should be discontinued.

First-line drugs (HREZ) are safe during pregnancy, and regimen doses and duration are the same as in non-pregnant individuals. Pyridoxine (50 mg, vitamin B6) should be added to the regimen to prevent neuropathy in the mother and seizures in the fetus.

There is an increased risk of progression to active TB in subjects with latent infection TB and diabetes in comparison with the infected nondiabetic population. Also, outcomes for patients with TB and diabetes are worse than for TB patients without diabetes, and diabetes also increases the risk of drug-resistant TB.

Risk factors for extrapulmonary TB (EPTB) include advanced age, female gender, immunosuppression (including HIV) and chronic comorbidities. Symptoms and signs are usually non-specific, and except for miliary forms, the chest radiograph might be normal; therefore, the diagnosis of EPTB is frequently delayed with the consequent increase in morbidity and mortality.


Keywords: Diabetes, Hepatotoxicity, HIV, Pregnancy, Renal failure, Tuberculosis.Diabetes, Hepatotoxicity, HIV, Pregnancy, Renal failure, Tuberculosis.

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      • 11. app/Models/ContentAccess.php:647
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316312588 and j.to_ip >=316312588 )) and ((j.from_date <= 1740526040 and j.to_date >= 1740526040 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14369) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316312588 and j.to_ip >=316312588 )) and ((j.from_date <= 1740526040 and j.to_date >= 1740526040 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14369) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316312588 and j.to_ip >=316312588 )) and ((j.from_date <= 1740526040 and j.to_date >= 1740526040 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 14369)
      610μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2923 and `b`.`banner_from_date` <= 1740526040 and `b`.`banner_to_date` >= 1740526040 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.41msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2923
      • 3: 1740526040
      • 4: 1740526040
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='5b20841d425aba207fd1979eb782756c'
      250μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    11Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        Dg9jVI5HIoEwpPoSY4JzLNaoR3ZiYMmMvWc14GmV
        uc_cart_id
        5b20841d425aba207fd1979eb782756c
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14369" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/14369
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6ImtqdjZ4MVFRRFZNbVNyQXhjRW1BRmc9PSIsInZhbHVlIjoiV3lSTnF4NnA4R2tXTDBCaWZTZHNDaFlrYS9UaTBzQklTdGZiRUNGWmNLcz0iLCJtYWMiOiJlMDBjMWY2ZmJjMWQwYWE3YmFlN2U2OGJlMDZjNzJhNzY0NDYzNTkwMWRkMGJmZGQwYTk1YzI3YTNkOGRlN2MyIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6ImtqdjZ4MVFRRFZNbVNyQXhjRW1BRmc9PSIsInZhbHVlIjoiV3lSTnF4NnA4R2tXTDBCaWZTZHNDaFlrYS9UaTBzQklTdGZiRUNGWmNLcz0iLCJtYWMiOiJlMDBjMWY2ZmJjMWQw" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 25 Feb 2025 23:27:20 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Ims4MmlWdVgzUVNyVHk2VWlvRkc0Q2c9PSIsInZhbHVlIjoiS3hYb1B2cmd1K2JqcVJjdjNjeUlnOGtTZi9zQTlPaVoyRjdkOEtKV3M1blJXaktpNG9lRG1NcHV0azdTNVNoVnZpa0dMcXZGQXZkcGJCcnFDVTJyeXNiUE0yTzNwcS9iV1Rid3ZCSXdKU3hxOGQ4bkRZRitCWitmdDJ1UTdHZXUiLCJtYWMiOiJlNWFkMzRhNmEwNmJjNzViMjIxMGUwMTExMWYzNjYwNTJhMTZkNmU3Mzk4MzU4MTc1NDhlZDEyNjk0ZTVkMDMyIiwidGFnIjoiIn0%3D; expires=Fri, 28 Feb 2025 11:27:20 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6Ims4MmlWdVgzUVNyVHk2VWlvRkc0Q2c9PSIsInZhbHVlIjoiS3hYb1B2cmd1K2JqcVJjdjNjeUlnOGtTZi9zQTlPaVoyRjdkOEtKV3M1blJXaktpNG9lRG1NcHV0azdTNVNoVnZpa0dMc" 1 => "alphaeurekaselectnet_session=eyJpdiI6Ikg0c2NKSkkzMmJseXQ1SEluQ3pBZ3c9PSIsInZhbHVlIjoicklid3RMTFhDQ0lLNWU3bDBMSWdTVVdNdVk3dXRWOFhkTXZUalhHODZ6L0ZDNkVaejZ4WW8zYXNHQVJMRkNqdXJxUkkweFUyZ3kzSm02MkRBaVFpMDhaL2dtSUNoNlA5NDZUOFRYejBSVS94VnhIL1BNT2RjY3RzZmpzdFU1OEkiLCJtYWMiOiIwYjIzOTNkNWRkMjRiYmQ3NTBkMDVmOWNiN2M2NjZhNTIyZTI3MDVhOGVhY2MyYzRiY2UzYmNhMGI1OTA3ZjdmIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6Ikg0c2NKSkkzMmJseXQ1SEluQ3pBZ3c9PSIsInZhbHVlIjoicklid3RMTFhDQ0lLNWU3bDBMSWdTVVdNdVk3dXRWOFhkTXZUalhHODZ6L0ZDNkVaejZ4WW8zYXN" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Ims4MmlWdVgzUVNyVHk2VWlvRkc0Q2c9PSIsInZhbHVlIjoiS3hYb1B2cmd1K2JqcVJjdjNjeUlnOGtTZi9zQTlPaVoyRjdkOEtKV3M1blJXaktpNG9lRG1NcHV0azdTNVNoVnZpa0dMcXZGQXZkcGJCcnFDVTJyeXNiUE0yTzNwcS9iV1Rid3ZCSXdKU3hxOGQ4bkRZRitCWitmdDJ1UTdHZXUiLCJtYWMiOiJlNWFkMzRhNmEwNmJjNzViMjIxMGUwMTExMWYzNjYwNTJhMTZkNmU3Mzk4MzU4MTc1NDhlZDEyNjk0ZTVkMDMyIiwidGFnIjoiIn0%3D; expires=Fri, 28-Feb-2025 11:27:20 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6Ims4MmlWdVgzUVNyVHk2VWlvRkc0Q2c9PSIsInZhbHVlIjoiS3hYb1B2cmd1K2JqcVJjdjNjeUlnOGtTZi9zQTlPaVoyRjdkOEtKV3M1blJXaktpNG9lRG1NcHV0azdTNVNoVnZpa0dMc" 1 => "alphaeurekaselectnet_session=eyJpdiI6Ikg0c2NKSkkzMmJseXQ1SEluQ3pBZ3c9PSIsInZhbHVlIjoicklid3RMTFhDQ0lLNWU3bDBMSWdTVVdNdVk3dXRWOFhkTXZUalhHODZ6L0ZDNkVaejZ4WW8zYXNHQVJMRkNqdXJxUkkweFUyZ3kzSm02MkRBaVFpMDhaL2dtSUNoNlA5NDZUOFRYejBSVS94VnhIL1BNT2RjY3RzZmpzdFU1OEkiLCJtYWMiOiIwYjIzOTNkNWRkMjRiYmQ3NTBkMDVmOWNiN2M2NjZhNTIyZTI3MDVhOGVhY2MyYzRiY2UzYmNhMGI1OTA3ZjdmIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6Ikg0c2NKSkkzMmJseXQ1SEluQ3pBZ3c9PSIsInZhbHVlIjoicklid3RMTFhDQ0lLNWU3bDBMSWdTVVdNdVk3dXRWOFhkTXZUalhHODZ6L0ZDNkVaejZ4WW8zYXN" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "Dg9jVI5HIoEwpPoSY4JzLNaoR3ZiYMmMvWc14GmV" "uc_cart_id" => "5b20841d425aba207fd1979eb782756c" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/14369" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-25 23:27:20GET/chapter/143691121913