Download PDF
Pneumologie 2021; 75(12): 971-980
DOI: 10.1055/a-1493-1206
Fallbericht

MDR-Tuberkulose, Alpha-1-Antitrypsin-Mangel, Husten bei Altenpflegerin

MDR tuberculosis, Alpha-1-anti-trypsin Deficiency, Cough in a Geriatric Nurse
Andreas Hoheisel
1   Universitätsspital Basel, Bereich für Pneumologie, Basel, Schweiz
,
Geert Vogt
2   Robert-Koch-Klinik, Klinikum Sankt Georg, Leipzig, Deutschland
,
Stephan Nagel
2   Robert-Koch-Klinik, Klinikum Sankt Georg, Leipzig, Deutschland
,
Andreas Bonitz
3   Praxis für Pneumologie/Allergologie, Leipzig, Deutschland
,
Christian Müller
4   Praxis für Neurologie, Leipzig, Deutschland
,
Thomas Köhnlein
5   Pneumologisches Facharztzentrum, Teuchern, Deutschland
,
Gerhard Hoheisel
3   Praxis für Pneumologie/Allergologie, Leipzig, Deutschland
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Multiresistente Tuberkulosen (MDR-TB) machen zwar einen nur geringen Anteil an der Gesamtzahl aller TB-Erkrankungen aus, durch die erforderliche komplexe Medikation mit potenziell schweren und lebensbedrohlichen Nebenwirkungen, Langzeitfolgen und ungünstigem Verlauf ist jedoch besondere Sorgfalt geboten. Wir berichten über eine 30-jährige Altenpflegerin mit chronischem Husten und angeborenem Alpha-1-Antitrypsin-Mangel (AATM), die an einer MDR-TB erkrankte und erhebliche Medikamenten-Nebenwirkungen erlitt.

Abstract

Multidrug-resistant tuberculosis (MDR-TB) is of low proportion in comparison to the total number of TB patients, however, due to the necessity of a complex medication with potentially severe and life threatening adverse reactions, long term sequelae, and unfavorable outcome special attention is essential. We report the case of a 30-year-old geriatric nurse with a history of chronic cough and hereditary alpha-1-anti-trypsin deficiency (AATD), who suffered from MDR-TB and experienced a number of severe adverse reactions.



Publication History

Received: 10 March 2021

Accepted: 27 April 2021

Article published online:
07 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Lange C, Dheda K, Chesov D. et al. Management of drug-resistant tuberculosis. Lancet 2019; 394: 953-966 DOI: 10.1016/S0140-6736(19)31882-3.
    CrossrefPubMedGoogle Scholar
  • 2 WHO. Global tuberculosis report 2018. Geneva, Switzerland: World Health Organization; 2018
    Google Scholar
  • 3 Otto-Knapp R, Häcker B, Bauer T. et al. Tuberkulose – Die neuen WHO-Empfehlungen für schnelle Diagnostik und Behandlung. InFo Pneumologie & Allergologie 2020; 3: 6-11
    PubMedGoogle Scholar
  • 4 Otto-Knapp R, Knappik M, Häcker B. et al. Die neuen WHO-Empfehlungen für schnelle Diagnostik und Therapie resistenter Tuberkulose in Deutschland, Österreich und der Schweiz. Pneumologie 2020; 74: 742-749 DOI: 10.1055/a-1266-5207.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2018. Berlin: Robert Koch-Institut; 2019
    Google Scholar
  • 6 Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2019. Berlin: Robert Koch-Institut; 2020
    Google Scholar
  • 7 Jahresbericht 2018. Nationale Referenzzentrale für Tuberkulose: Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES); 2019
    Google Scholar
  • 8 Schaberg T. et al. S2k-Leitlinie: Tuberkulose im Erwachsenenalter. Eine Leitlinie zur Diagnostik und Therapie, einschließlich Chemoprävention und -prophylaxe des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose e.V. im Auftrag der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. Pneumologie 2017; 71: 325-397 DOI: 10.1055/s-0043-105954.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Seidler A, Nienhaus A, Diel R. Review of epidemiological studies on the occupational risk of tuberculosis in low-incidence areas. Respiration 2005; 72: 431-446 DOI: 10.1159/000086261.
    CrossrefPubMedGoogle Scholar
  • 10 Diel R, Loddenkemper R, Nienhaus A. Predictive value of interferongamma release assays and tuberculin skin testing for progression from latent TB infection to disease state: a meta-analysis. Chest 2012; 142: 63-75 DOI: 10.1378/chest.11-3157.
    CrossrefPubMedGoogle Scholar
  • 11 Dulon M, Lisiak B, Wendeler D. et al. Berufsbedingte Infektionskrankheiten bei Beschäftigten im Gesundheitsdienst 2014. Zbl Arbeitsmed 2015; 65: 210-216
    CrossrefPubMedGoogle Scholar
  • 12 Schaberg T, Bauer T, Castell S. et al. Empfehlungen zur Therapie, Chemoprävention und Chemoprophylaxe der Tuberkulose im Erwachsenen- und Kindesalter. Pneumologie 2012; 66: 133-171 DOI: 10.1055/s-0031-1291619.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis – 2011 update. 2011. 6. ed. WHO/HTM/TB/2011
    Google Scholar
  • 14 Falzon D, Jaramillo E, Schunemann HJ. et al. WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update. Eur Respir J 2011; 38: 516-528 DOI: 10.1183/09031936.00073611.
    CrossrefPubMedGoogle Scholar
  • 15 Bottasso O, Bay ML, Besedovsky H. et al. Immunoendocrine alterations during human tuberculosis as an integrated view of disease pathology. Neuroimmunomodulation 2009; 16: 68-77 DOI: 10.1159/000180261.
    CrossrefPubMedGoogle Scholar
  • 16 Bottasso O, Bay ML, Besedovsky H. et al. The immune-endocrine-metabolic unit during human tuberculosis. Current Immunol Rev 2010; 6: 314-322
    CrossrefPubMedGoogle Scholar
  • 17 Santucci N, DʼAttilio L, Besedovsky H. et al. A clinical correlate of the dysregulated immunoendocrine response in human tuberculosis. Neuroimmunomodulation 2010; 17: 184-187 DOI: 10.1159/000258719.
    CrossrefPubMedGoogle Scholar
  • 18 Santucci N, DʼAttilio L, Kovalevski L. et al. A multifaceted analysis of immune-endocrine-metabolic alterations in patients with pulmonary tuberculosis. PLoS One 2011; 6 (10) e26363 DOI: 10.1371/journal.pone.0026363.
    CrossrefPubMedGoogle Scholar
  • 19 Bottasso O, Bay ML, Besedovsky H. et al. Adverse neuro-immune-endocrine interactions in patients with active tuberculosis. Mol Cell Neurosci 2013; 53: 77-85 DOI: 10.1016/j.mcn.2012.11.002.
    CrossrefPubMedGoogle Scholar
  • 20 DʼAttilio L, Díaz A, Fernández RDV. et al. The neuro-endocrine-immune relationship in pulmonary and pleural tuberculosis: a better local profile in pleural fluid. Int J Tuberc Lung Dis 2018; 22: 321-327 DOI: 10.5588/ijtld.17.0270.
    CrossrefPubMedGoogle Scholar
  • 21 Díaz A, Bongiovanni B, DʼAttilio L. et al. The clinical recovery of tuberculosis patients undergoing specific treatment is associated with changes in the immune and neuroendocrine responses. Pathog Dis 2017; 75 DOI: 10.1093/femspd/ftx087.
    CrossrefPubMedGoogle Scholar
  • 22 Mase SR, Ramsay A, Ng V. et al. Yield of serial sputum specimen examinations in the diagnosis of pulmonary tuberculosis: a systematic review. Int J Tuberc Lung Dis 2007; 11: 485-495
    PubMedGoogle Scholar
  • 23 WHO. Operational handbook on tuberculosis. Module 3: diagnosis – rapid diagnostics for tuberculosis detection. Geneva: World Health Organisation; 2020
    Google Scholar
  • 24 Conradie F, Diacon AH, Ngubane N. et al. Nix-TB Trial Team. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis. N Engl J Med 2020; 382: 893-902 DOI: 10.1056/NEJMoa1901814.
    CrossrefPubMedGoogle Scholar
  • 25 Nunn AJ, Phillips PPJ, Meredith SK. et al. A trial of a shorter regimen for rifampin-resistant tuberculosis. N Engl J Med 2019; 380: 1201-1213 DOI: 10.1056/NEJMoa1811867.
    CrossrefPubMedGoogle Scholar
  • 26 Alsultan A, Peloquin CA. Therapeutic drug monitoring in the treatment of tuberculosis: an update. Drugs 2014; 74: 839-854 DOI: 10.1007/s40265-014-0222-8.
    CrossrefPubMedGoogle Scholar
  • 27 Lange C, Abubakar I, Alffenaar JW. et al. Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement. Eur Respir J 2014; 44: 23-63 DOI: 10.1183/09031936.00188313.
    CrossrefPubMedGoogle Scholar
  • 28 Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO
    Google Scholar
  • 29 Olaru ID, Heyckendorf J, Andres S. et al. Bedaquiline-based treatment regimen for multidrug-resistant tuberculosis. Eur Respir J 2017; 49: 1700742 DOI: 10.1183/13993003.00742-2017.
    CrossrefPubMedGoogle Scholar
  • 30 Heyckendorf J, van Leth F, Kalsdorf B. et al. Relapse-free cure from multidrug-resistant tuberculosis in Germany. Eur Respir J 2018; 51: 1702122 DOI: 10.1183/13993003.02122-2017.
    CrossrefPubMedGoogle Scholar
  • 31 WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organisation; 2019
    Google Scholar
  • 32 WHO Consolidated guidelines on tuberculosis. Module 4: treatment – drug-resistant tuberculosis treatment. Geneva: World Health Organisation; 2020
    Google Scholar
  • 33 Maurer FP, Bauer T, Diel R. et al. Gemeinsame Stellungnahme zur neuen Empfehlung der WHO zur Behandlung der multiresistenten und Rifampicin-resistenten Tuberkulose. Pneumologie 2019; 73: 270-273 DOI: 10.1055/a-0880-9987.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Gillespie SH, Crook AM, McHugh TD. et al. Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis. N Engl J Med 2014; 371: 1577-1587 DOI: 10.1056/NEJMoa1407426.
    CrossrefPubMedGoogle Scholar
  • 35 Jindani A, Harrison TS, Nunn AJ. et al. High-dose rifapentine with moxifloxacin for pulmonary tuberculosis. N Engl J Med 2014; 371: 1599-1608 DOI: 10.1056/NEJMoa1314210.
    CrossrefPubMedGoogle Scholar
  • 36 Merle CS, Fielding K, Sow OB. et al. A four-month gatifloxacin-containing regimen for treating tuberculosis. N Engl J Med 2014; 371: 1588-1598 DOI: 10.1056/NEJMoa1315817.
    CrossrefPubMedGoogle Scholar
  • 37 Helgren ME, Cliffer KD, Torrento K. et al. Neurotrophin-3 administration attenuates deficits of pyridoxine-induced large-fiber sensory neuropathy. J Neurosci 1997; 17: 372-382 DOI: 10.1523/JNEUROSCI.17-01-00372.1997.
    CrossrefPubMedGoogle Scholar
  • 38 Vrolijk MF, Opperhuizen A, Jansen EHJM. et al. The vitamin B6 paradox: Supplementation with high concentrations of pyridoxine leads to decreased vitamin B6 function. Toxicol In Vitro 2017; 44: 206-212 DOI: 10.1016/j.tiv.2017.07.009.
    CrossrefPubMedGoogle Scholar
  • 39 Lan Z, Ahmad N, Baghaei P. et al. Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment 2017. Drug-associated adverse events in the treatment of multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet Respir Med 2020; 8: 383-394 DOI: 10.1016/S2213-2600(20)30047-3.
    CrossrefPubMedGoogle Scholar
  • 40 Merkblatt zur BK Nr. 3101: Infektionskrankheiten, wenn der Versicherte im Gesundheitsdienst, in der Wohlfahrtspflege oder in einem Laboratorium tätig oder durch eine andere Tätigkeit der Infektionsgefahr in ähnlichem Maße besonders ausgesetzt war. Merkblatt für die ärztliche Untersuchung (Bek. des BMA v. 1.12.2000, BArbBl. 1/2001, S. 35).
    Google Scholar
  • 41 Dummer J, Dobler CC, Holmes M. et al. Diagnosis and treatment of lung disease associated with alpha one-antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25: 321-335 DOI: 10.1111/resp.13774.
    CrossrefPubMedGoogle Scholar
  • 42 Silverman EK, Sandhaus RA. Clinical practice. Alpha1-antitrypsin deficiency. N Engl J Med 2009; 360: 2749-2757 DOI: 10.1056/NEJMcp0900449.
    CrossrefPubMedGoogle Scholar
  • 43 McElvaney NG, Stoller JK, Buist AS. et al. Baseline characteristics of enrollees in the National Heart, Lung and Blood Institute Registry of alpha 1-antitrypsin deficiency. Alpha 1-Antitrypsin Deficiency Registry Study Group. Chest 1997; 111: 394-403 DOI: 10.1378/chest.111.2.394.
    CrossrefPubMedGoogle Scholar
  • 44 Needham M, Stockley RA. Alpha 1-antitrypsin deficiency. 3: Clinical manifestations and natural history. Thorax 2004; 59: 441-445 DOI: 10.1136/thx.2003.006510.
    CrossrefPubMedGoogle Scholar
  • 45 Eden E, Hammel J, Rouhani FN. et al. Asthma features in severe alpha1-antitrypsin deficiency: experience of the National Heart, Lung, and Blood Institute Registry. Chest 2003; 123: 765-771 DOI: 10.1378/chest.123.3.765.
    CrossrefPubMedGoogle Scholar
  • 46 Demeo DL, Sandhaus RA, Barker AF. et al. Determinants of airflow obstruction in severe alpha-1-antitrypsin deficiency. Thorax 2007; 62: 806-813 DOI: 10.1136/thx.2006.075846.
    CrossrefPubMedGoogle Scholar
  • 47 Greulich T, Nell C, Herr C. et al. Results from a large targeted screening program for alpha-1-antitrypsin deficiency: 2003–2015. Orphanet J Rare Dis 2016; 11: 75 DOI: 10.1186/s13023-016-0453-8.
    CrossrefPubMedGoogle Scholar
  • 48 Makino S, Chosy L, Valdivia E. et al. Emphysema with hereditary alpha-1 antitrypsin deficiency masquerading as asthma. J Allergy 1970; 46: 40-48 DOI: 10.1016/0021-8707(70)90060-2.
    CrossrefPubMedGoogle Scholar
  • 49 Propst T, Vogel W, Dietze O. et al. Primary hepatic tuberculosis in homozygous alpha-1-antitrypsin deficiency. Ital J Gastroenterol 1992; 24: 126-128
    PubMedGoogle Scholar
  • 50 Habibzadeh S, Shahi JM, Ghobadi H. et al. The first report of two cases of fatal liver injury due to anti-tuberculosis drugs in the presence of alpha-1 antitrypsin deficiency. Int J Mycobacteriol 2017; 6: 187-190 DOI: 10.4103/ijmy.ijmy_60_17.
    CrossrefPubMedGoogle Scholar