Thank you Denise!
We have also seen some
rifampin resistance acquired in diabetic patients who had poor rifampin absorption (these pts had INH resistance to start with) and do check drug levels in patients where
gastroparesis is suspected or if there is slow clinical improvement.
Another question I have is regarding the GeneXpert result. We follow these up with additional molecular testing to confirm a “real” mutation (not a silent
mutation) and would be curious if a previous GenXpert was done on initial specimens to confirm this is a new development. Not knowing the full clinical picture, I would also wonder about the possibilities that these could be dead bugs.
Fun to use the new listserv! Thanks to Lorna and NTCA for setting up. We will send out more information about how to use and email etiquette separately.
Lisa
________________________________
Lisa True, RN, MS
MDR Nurse Coordinator/Program Liaison
TB Control Branch Center for Infectious Diseases
California Department of Public Health
850 Marina Bay Parkway
Richmond, CA 94804
(510) 620-3054
Confidential FAX (510) 620-3035
From: tbnurses@ntca.simplelists.com [mailto:tbnurses@ntca.simplelists.com]
On Behalf Of Dodge, Denise (VDH)
Sent: Monday, March 06, 2017 7:39 AM
To: tbnurses@ntca.simplelists.com
Subject: RE: Daily digest for tbnurses@ntca.simplelists.com
The poor outcome may be more related to Crohn’s and malapsorption rather than Remicaid. We include clients with GI co-morbidities as those who might benefit
from early Therapeutic Drug monitoring however, I must admit I only have ‘off the top of my head’ memory of whether or not this has proven beneficial. I could explore more deeply if you would like.
We do early TDM on our diabetics who have experienced better outcomes when doses were adjusted after testing revealed low Cmax range. We are believing they
malabsorb due to gastroparesis. There have been several papers published about this that I could share if you would like.
Additionally, last year we had a similar experience as you had with a co-infected client: Client started out pan-sensitive, then became MDR. His Cmax on both
Rifampin and Isoniazid was low. We have explored other explanation for the change in susceptibilities and could not come up with a better one than malabsorption…. common in the HIV population. As a result of this experience we now due routine early TDM for
HIV/ TB clients just as we do for our Diabetic population.
Give me a call if you would like to talk further.
D
Denise Dodge, RN
Assistant Director, Nurse Consultant
TB Control and Newcomer Health
Virginia Department of Health
804-864-7968 - Desk
804-864-7906 - Main line
804-371-0248 - Secure Fax
From: ntca.simplelists.com listserve [mailto:nobody@simplelists.com]
Sent: Friday, March 03, 2017 5:49 PM
To: tbnurses@ntca.simplelists.com
Subject: Daily digest for tbnurses@ntca.simplelists.com
|
Treatment for TB after Remicade? - Lorna Will
(02 Mar 2017 20:24 EST) |
Treatment
for TB after Remicade? by Lorna Will
(02 Mar 2017 20:24 EST)
Reply to list
From: Patricia Woods [mailto:paw101@njms.rutgers.edu]
Sent: Thursday, March 02, 2017 7:12 AM
To: True, Lisa (CDPH-CID-DCDC-TCB)
Cc: cherie.helfrich@maryland.gov
Subject: FW: TB and Remicade
Hi Lisa,
Please see below. This is a case that Maryland is brainstorming on to get feedback from others that may have had a similar experience. Can we put this out to the members for discussion.
Thanks,
Patty
From: Cherie Helfrich -DHMH- [mailto:cherie.helfrich@maryland.gov]
Sent: Tuesday, February 28, 2017 10:00 AM
To: Patricia Woods <paw101@njms.rutgers.edu>
Cc: Dorothy Freeman -DHMH- <dorothy.freeman@maryland.gov>
Subject: TB and Remicade
Good Morning Patty,
I hope all is well in New Jersey!
Maryland has a puzzling TB case and we are looking for advice for patients who have been on Remicade prior to beginning TB treatment.
In August 2016 the case started out as pansensitive miliary TB. The hospital sent a lymph sample which has come back TB+ resistant to RIF. We are brainstorming to try and find issues that may have contributed to the poor outcomes
this case is experiencing.
The case was on biweekly Remicade for Crohns which was d/c'd in August upon starting RIPE.
The case then received 8 weeks of RIPE. Do you know of any studies or recommendations that suggest that RIPE should be continued for longer than 8 weeks for patients who recently took Remicade prior to beginning TB treatment?
Any and all guidance you can offer is greatly appreciated!
--
Cherie Helfrich, MSN, RN
Nurse Consultant
TB Control and Prevention
Infectious Disease Bureau
Prevention and Health Promotion Administration
Maryland Department of Health and Mental Hygiene
500 N. Calvert Street, 5th Fl.
Baltimore MD 21202
(email) cherie.helfrich@maryland.gov
(office) 410-767-6983
(fax) 410-383-1762
Lorna Will RN, MA
The archives for this list are at http://ntca.simplelists.com/tbnurses.
If you have problems with the listserve, please contact Lorna
Will@lwill@tbcontrollers.org
The archives for this list are at http://ntca.simplelists.com/tbnurses.
If you have problems with the listserve, please contact Lorna
Will@lwill@tbcontrollers.org