ethionamide and Peripheral-Nervous-System-Diseases

Drug-resistant tuberculosis is an increasing healthcare challenge. Drug regimen building demands the use of different therapeutic groups, many of which harbor neurotoxicity as a side-effect, whether central or peripheral. Peripheral neuropathy is a major concern as it tends to be severe and usually irreversible. Anti-tubercular drugs that may contribute to peripheral neuropathy include INH, ethambutol, linezolid, cycloserine and para-amino salicylic acid. This potential adverse effect must be balanced against the intrinsically grave prognosis that drug resistant tuberculosis harbors. We present such a clinically challenging case of a 25 years-old female with extremely drug resistant tuberculosis whose treatment necessitated the use of several neurotoxic anti-tubercular drugs, leading to severe sensory peripheral neuropathy who did not improve despite the withdrawal of culprit drugs. She developed positive and negative sensory symptoms in both lower limbs. Nerve conduction studies were suggestive of sensory neuropathy affecting both lower limbs. Alternate causes of peripheral neuropathy including HIV, vasculitis, B12 deficiency and diabetes were ruled out. Despite drug withdrawal, the patient did not improve significantly. This case emphasizes the irreversibility of anti-tubercular therapy-induced peripheral neuropathy, demanding more rigorous clinical screening for the same while managing such patients.

Topics: Adult; Aminosalicylic Acid; Antitubercular Agents; Clofazimine; Cycloserine; Deprescriptions; Diarylquinolines; Ethionamide; Extensively Drug-Resistant Tuberculosis; Female; Humans; Kanamycin; Linezolid; Neural Conduction; Neurotoxicity Syndromes; Peripheral Nervous System Diseases; Pyrazinamide; Pyridoxine; Tuberculosis, Pulmonary

The aim of the study was to elucidate the profile of adverse drug reactions (ADRs) associated with second-line anti-tubercular treatment for drug-resistant tuberculosis.. ADR profile of diagnosed drug-resistant tuberculosis cases on supervised second-line anti-tubercular drug regimen under Programmatic Management of Drug-resistant Tuberculosis under Revised National Tuberculosis Control Programme, were studied over two years' period. Adverse reactions were categorised into mild, moderate and severe types with subsequent systematic data-analysis.. Out of total 207 patients in the study, 81.16% reported with adverse drug reactions. Out of total 195 adverse events, 63.58%, 18.46% and 17.94% were of mild, moderate and severe types respectively. Gastrointestinal events, hepatitis, hearing impairment, arthralgia, psychosis, hypothyroidism, visual disturbances, giddiness, peripheral neuropathy, skin reactions, swelling or pain at injection site, anorexia and sleep disturbances were important amongst these. High proportion of drug and/or alcohol abuse was an important observation. The offending drug(s) had to be terminated in 12.08% of the patients.. Early detection, management and pharmaco-vigilance reporting of ADRs remain key factors in the management of drug-resistant tuberculosis with remarkable relevance of the need for early diagnosis and treatment of 'drug-sensitive tuberculosis', to prevent emergence of drug-resistant tuberculosis.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Arthralgia; Ataxia; Chemical and Drug Induced Liver Injury; Child; Cycloserine; Drug Eruptions; Drug Therapy, Combination; Ethambutol; Ethionamide; Female; Gastrointestinal Diseases; Hearing Loss; Humans; Hypothyroidism; India; Kanamycin; Levofloxacin; Male; Middle Aged; Peripheral Nervous System Diseases; Psychoses, Substance-Induced; Pyrazinamide; Severity of Illness Index; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary; Vision Disorders; Young Adult

Topics: Anxiety; Depression; Ethionamide; Feeding and Eating Disorders; Isoniazid; Mental Disorders; Niacin; Nicotinic Acids; Pellagra; Peripheral Nervous System Diseases; Psychoses, Substance-Induced; Psychotic Disorders; Toxicology; Tuberculosis; Tuberculosis, Pulmonary; Vitamin B 6 Deficiency; Vitamin B Complex

Topics: Antitubercular Agents; Ethionamide; Humans; Neurologic Manifestations; Peripheral Nervous System Diseases

Topics: Antitubercular Agents; Ethionamide; Peripheral Nerves; Peripheral Nervous System Diseases