Letter to the Editor
First case report in Latin America: Oral treatment of multidrug-resistant tuberculosis with delamanid and bedaquiline in combination with linezolid, moxifloxacin and clofazimine following a DRESS syndrome in a peruvian patient
Read
4287
Timeswas read the article
1900
Total PDF
2387
Total HTML
Share statistics
array:24 [ "pii" => "S2531043720300441" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.03.005" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1470" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2021;27:77-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S2531043720301318" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.05.014" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1501" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2021;27:80-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Alpha-1-antitrypsin deficiency (AATD) and spontaneous pneumothorax: Guidelines do not recommend screening for AATD in patients with pneumothorax – What did we find in 10 years of clinical evidence?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "80" "paginaFinal" => "81" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Dias, I. Farinha, F. Costa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Dias" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Farinha" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Costa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720301318?idApp=UINPBA00004E" "url" => "/25310437/0000002700000001/v1_202012270743/S2531043720301318/v1_202012270743/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2531043720301367" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.06.002" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1507" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Pulmonol. 2021;27:75-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "<span class="elsevierStyleItalic">Rhodococcus equi</span> infection as inaugural manifestation of idiopathic CD4<span class="elsevierStyleSup">+</span> lymphopenia: A rare entity and a therapeutic challenge" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "75" "paginaFinal" => "77" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1545 "Ancho" => 1500 "Tamanyo" => 223169 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sites of <span class="elsevierStyleItalic">Rhodococcus equi</span> infection. (A) Lung as a consolidation in the left pulmonary field on posteroanterior X-ray; (B) lung as a mass on the periphery of the left upper lobe on chest computed tomography; (C) trachea as a protruding lesion leading to obstruction of about 50% of the lumen; (D) brain as an abscess in the left parasagital occipitoparietal location on magnetic resonance.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Alves, E. Silva, T. Teixeira, C. Figueiredo, A. Lameirão, M. Vanzeller, C. Ribeiro" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alves" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Silva" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Teixeira" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Figueiredo" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Lameirão" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Vanzeller" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Ribeiro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720301367?idApp=UINPBA00004E" "url" => "/25310437/0000002700000001/v1_202012270743/S2531043720301367/v1_202012270743/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "First case report in Latin America: Oral treatment of multidrug-resistant tuberculosis with delamanid and bedaquiline in combination with linezolid, moxifloxacin and clofazimine following a DRESS syndrome in a peruvian patient" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "77" "paginaFinal" => "79" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Pecho-Silva, A.C. Navarro-Solsol" "autores" => array:2 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Pecho-Silva" "email" => array:1 [ 0 => "samuelpechosilva@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A.C." "apellidos" => "Navarro-Solsol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidad Cientifica del Sur Facultad de Ciencias de la Salud, Peru" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Nacional de Ucayali, Universidad Nacional de Ucayali Facultad de Medicina Humana, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1124 "Ancho" => 3167 "Tamanyo" => 420347 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Results of the periodic controls of the QTcF interval in the timeline of this case.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The World Health Organization recommends the use of oral medications for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1–3</span></a> However, few countries have adopted these recommendations, either due to lack of medication or because of outdated local recommendations, as in the case of Peru.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> The combination of some medications for the treatment of MDR TB such as delamanid (Dlm) with bedaquiline (Bdq) has been associated with a potential risk of cardiovascular symptoms such as prolongation of the QT interval corrected by Fridericia interval (QTcF).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Other medications that may enhance the prolongation of this interval are fluroquinolones, especially moxifloxacin (Mfx) and clofazimine (Cfz). We present a case of the simultaneous use of these medications in a patient who provided informed consent. There was no prolongation of the QTcF interval, and no significant cardiac symptoms were observed throughout the entire treatment. (1) This patient was the first Peruvian to receive a completely oral combination of medications for the treatment of MDR tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> (2) This was the first Peruvian case to receive a combination of 4 drugs (Mfx, Bdq, Cfz, and Dlm) considered potentially dangerous because of their sum effects on QTcF.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a single, nulliparous 23-year-old female with no pathological history living in Lima, Peru. At the beginning of August 2018, she presented hemoptysis and malaise and underwent a chest tomography on August 4th, 2018 showing exudative lesions in the right upper pulmonary lobe associated with a cavity of 3<span class="elsevierStyleHsp" style=""></span>cm in diameter. On August 14th, 2018, bronchofibroscopy was performed, obtaining a smear-positive in bronchial lavage. Tuberculosis treatment was initiated on August 15th with isoniazid, rifampicin, ethambutol and pyrazinamide.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> The patient weighed 64 Kg at this time. This treatment was suspended on September 10th, 2018 following results of a Line Probe Assay study (Line ProbeAssay, Genotype® MTBDR Plus Version 2.0) of a sputum sample from August 16th, 2018 showing the presence of primary resistance to rifampicin and isoniazid (Gen KatG). On September 12th, 2018, a new empirical treatment was begun with ethambutol, pyrazinamide, kanamycin, levofloxacin, ethionamide and cycloserine.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> On October 16, 2018, the patient presented cervical lymphadenopathy (>3<span class="elsevierStyleHsp" style=""></span>cm in diameter) and axillary lymphadenopathy, in addition to a temperature of 38.5<span class="elsevierStyleHsp" style=""></span>°C and rash in the following days. On October 23, 2018, eosinophils in peripheral blood were found to be elevated (7%) and proteins were also found in a urine sample. On October 28th, 2018, antituberculosis treatment was suspended. Eosinophils in peripheral blood continued to increase to a maximum of 21% on November 19th and then normalized on January 17th, 2019. Aspartate aminotransferase (AST) values increased to 78<span class="elsevierStyleHsp" style=""></span>IU/L on November 19th and normalized on December 3rd (AST: 26<span class="elsevierStyleHsp" style=""></span>IU/L). Alanine aminotransferase (ALT) values reached a maximum of 152<span class="elsevierStyleHsp" style=""></span>IU/L on November 10th and normalized on December 3rd (ALT: 34<span class="elsevierStyleHsp" style=""></span>IU/L). The patient was diagnosed with Drug Rash and Eosinophilia with Systemic Symptoms (DRESS) syndrome, with a score of 6 points in the Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) secondary to the treatment received.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was hospitalized on January 25th, 2019 with the aim of designing a new tuberculosis treatment schedule. She was stable with normal vital signs and with a weight of 65<span class="elsevierStyleHsp" style=""></span>kg. Laboratory tests showed a normal blood count, mild anemia, normal renal, hepatic and cardiac function (normal echocardiogram, electrocardiogram, QTcF, and cardiac enzymes), normal glycosylated hemoglobin, and negative viral hepatitis studies (HAV, HBV, HCV). Antibiotic susceptibility testing showed sensitivity to: ethambutol, pyrazinamide, streptomycin, kanamycin, capreomycin, ethionamide, cycloserine, ethionamide, para-aminosalicylic acid (PAS), levofloxacin and Mfx. The MDR TB unit decided to use new tuberculosis drugs that had not previously been combined in Peru, and the new antituberculosis treatment was begun on March 13th, 2019. This treatment consisted of linezolid (Lzd) at a dose of 600<span class="elsevierStyleHsp" style=""></span>mg/day, Mfx 400<span class="elsevierStyleHsp" style=""></span>mg/day, Cfz 200<span class="elsevierStyleHsp" style=""></span>mg/day, Bdq at a dose of 400<span class="elsevierStyleHsp" style=""></span>mg/day for the first 14 days and then 200<span class="elsevierStyleHsp" style=""></span>mg 3 times/week for 22 weeks for a total of 24 weeks, and Dlm at 100<span class="elsevierStyleHsp" style=""></span>mg bid for 24 weeks. After 24 weeks of treatment, Bdq and Dlm<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,7</span></a> were suspended. The patient continued to receive Lzd at the dose described. Cfz was decreased to 100<span class="elsevierStyleHsp" style=""></span>mg daily from the fourth month due to changes in skin color. The dose of Mfx was increased from 400<span class="elsevierStyleHsp" style=""></span>mg to 800<span class="elsevierStyleHsp" style=""></span>mg daily from week 24. Throughout this period laboratory tests were normal. There was no prolongation of the QTcF interval, and no significant cardiac symptoms were observed during the entire treatment. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the results of the periodic controls of the QTcF Interval in the timeline of this case. Direct sputum smear and cultures taken monthly were negative from the first month of treatment and throughout the treatment. The 2 tomographic controls taken at months 4 and 8 of treatment showed no lung lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Several aspects are of note in the present case: (1) This patient was the first Peruvian and the first Latin American patient to receive a completely oral combination of medications for the treatment of MDR tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> (2) This was the first Peruvian and the first Latin American case to receive a combination of 4 drugs (Mfx, Bdq, Cfz, and Dlm) considered potentially dangerous because of their sum effects on QTcF.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> (3) According to the study of Borisov et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> only 39 out of a total of 658 cases (6.1%) have received Bdq and Dlm consecutively or in combination, none being from Peru. In addition, of the 9 cases presenting severe cardiological events, none had received the same combination as our patient. (4) In Latin America, only Chile and Mexico together have reported 4 cases treated with the combination of Bdq and Dlm, with apparently none using Cfz and Mfx simultaneously.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> The treatment was well tolerated by our patient, with no adverse cardiovascular events like those reported in other series of patients using this combination.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,10</span></a> Cfz produced slight pigmentation of the skin that did not bother the patient. Lastly, clinical response was excellent with notable radiological improvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This drug combination was demonstrated to be safe and effective and well tolerated. None of the frequent adverse reactions that occur with the use of kanamycin injectable medications that are still used in Peru for the treatment of MDR tuberculosis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> were observed. Moreover, this treatment is highly effective since the sensitivity of bacteria to Bdq, Dlm and Lzd is high.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> The patient will be followed every 3 months for 2 years to record possible development of relapse. The results of this case are important for demonstrating that oral treatment of MDR tuberculosis is possible and can be carried out safely with suitable monthly clinical controls and periodic QTcF controls.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Statement of ethics</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no ethical conflicts to disclose.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have not received any funding specifically for this correspondence.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Author contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">All authors contributed equally to this correspondence.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Statement of ethics" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Author contributions" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:2 [ "identificador" => "xack503230" "titulo" => "Acknowledgements" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Hospital Nacional Edgardo Rebagliati Martins, Peru</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1124 "Ancho" => 3167 "Tamanyo" => 420347 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Results of the periodic controls of the QTcF interval in the timeline of this case.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Whatis new in the WHO consolidatedguidelinesondrug-resistant tuberculosis treatment?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.K. Sharma" 1 => "K. Dheda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/ijmr.IJMR_579_19" "Revista" => array:6 [ "tituloSerie" => "Indian J Med Res" "fecha" => "2019" "volumen" => "149" "paginaInicial" => "309" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31249191" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Rapid communication: key changes to the treatment of drug-resistant tuberculosis" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2019" "editorial" => "World Health Organization" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequently asked questions on the WHO rapid communication: key changes to the treatment of multidrug-and rifampicin-resistant TB prepared by the WHO Task Force to support country transition towards new recommendations for the treatment of MDR-TB" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Dravniece" 1 => "A. Gebhard" 2 => "A. Mhazo" 3 => "F. Wares" 4 => "A.U. Nyaruhirira" 5 => "A. Zagorski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2018" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modificatoria de la NTS° 104 - Minsa/DGSP V.01 norma técnica de salud para la atención integral de las personas afectadas por tuberculosis; aprobada por R.M. N° 752-2018 - Minsa [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Ministerio del Perú" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2018" "paginaInicial" => "38" "editorial" => "Minsa" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Compassionate use of delamanid in combination with bedaquiline for the treatment of multidrug-resistant tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Hafkin" 1 => "N. Hittel" 2 => "A. Martin" 3 => "R. Gupta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01154-2018" "Revista" => array:4 [ "tituloSerie" => "Eur Respir J" "fecha" => "2019" "volumen" => "53" "paginaInicial" => "180154" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic criteria for drug rash and eosinophilia with systemic symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.K. Pannu" 1 => "A. Saroch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Fam Med Prim Care" "fecha" => "2017" "volumen" => "6" "paginaInicial" => "693" "paginaFinal" => "694" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "WHO best-practice statement on the off-label use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "editorial" => "World Health Organization" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "(Re)moving the needle: prospects for all-oral treatment for multidrug-resistant tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Milstein" 1 => "A. Brzezinski" 2 => "F. Varaine" 3 => "C.D. Mitnick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Tuberc Lung Dis" "fecha" => "2016" "volumen" => "20" "paginaInicial" => "S18" "paginaFinal" => "S23" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surveillanceof adverse events in thetreatmentofdrug-resistant tuberculosis: first global report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Borisov" 1 => "E. Danila" 2 => "A. Maryandyshev" 3 => "M. Dalcolmo" 4 => "S. Miliauskas" 5 => "L. Kuksa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01522-2019" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2019" "volumen" => "54" "paginaInicial" => "1901522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31601711" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined treatment of drug-resistant tuberculosis with bedaquiline and delamanid: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Pontali" 1 => "G. Sotgiu" 2 => "S. Tiberi" 3 => "M. Tadolini" 4 => "D. Visca" 5 => "L. D’Ambrosio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00934-2018" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2018" "volumen" => "52" "paginaInicial" => "1800934" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29903862" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro drug susceptibility of bedaquiline, delamanid, linezolid, clofazimine, moxifloxacin, and gatifloxacin against extensively drug-resistant tuberculosis in Beijing, China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Pang" 1 => "Z. Zong" 2 => "F. Huo" 3 => "W. Jing" 4 => "Y. Ma" 5 => "L. Dong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/AAC.00900-17" "Revista" => array:5 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "2017" "volumen" => "61" "paginaInicial" => "1" "paginaFinal" => "8" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack503230" "titulo" => "Acknowledgements" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The authors would like to thank Delia Loayza Tamayo, Félix Alcántara Virú, and Javier Torres Valencia for their generous assistance during the treatment of the patient. The authors would like to thank Partners In Health – Perú for the donation of medicines: delamanid, clofazimine, bedaquiline.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002700000001/v1_202012270743/S2531043720300441/v1_202012270743/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002700000001/v1_202012270743/S2531043720300441/v1_202012270743/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720300441?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 23 | 26 | 49 |
| 2024 September | 39 | 25 | 64 |
| 2024 August | 47 | 28 | 75 |
| 2024 July | 43 | 41 | 84 |
| 2024 June | 41 | 22 | 63 |
| 2024 May | 55 | 27 | 82 |
| 2024 April | 37 | 37 | 74 |
| 2024 March | 40 | 20 | 60 |
| 2024 February | 41 | 18 | 59 |
| 2024 January | 36 | 22 | 58 |
| 2023 December | 29 | 41 | 70 |
| 2023 November | 48 | 48 | 96 |
| 2023 October | 41 | 30 | 71 |
| 2023 September | 50 | 35 | 85 |
| 2023 August | 46 | 25 | 71 |
| 2023 July | 45 | 27 | 72 |
| 2023 June | 51 | 19 | 70 |
| 2023 May | 51 | 34 | 85 |
| 2023 April | 49 | 18 | 67 |
| 2023 March | 69 | 31 | 100 |
| 2023 February | 34 | 21 | 55 |
| 2023 January | 30 | 24 | 54 |
| 2022 December | 50 | 20 | 70 |
| 2022 November | 42 | 34 | 76 |
| 2022 October | 60 | 35 | 95 |
| 2022 September | 35 | 34 | 69 |
| 2022 August | 38 | 40 | 78 |
| 2022 July | 48 | 47 | 95 |
| 2022 June | 41 | 38 | 79 |
| 2022 May | 52 | 35 | 87 |
| 2022 April | 41 | 34 | 75 |
| 2022 March | 50 | 51 | 101 |
| 2022 February | 40 | 48 | 88 |
| 2022 January | 46 | 56 | 102 |
| 2021 December | 34 | 37 | 71 |
| 2021 November | 31 | 35 | 66 |
| 2021 October | 47 | 62 | 109 |
| 2021 September | 36 | 42 | 78 |
| 2021 August | 38 | 31 | 69 |
| 2021 July | 31 | 9 | 40 |
| 2021 June | 47 | 48 | 95 |
| 2021 May | 43 | 55 | 98 |
| 2021 April | 115 | 110 | 225 |
| 2021 March | 57 | 54 | 111 |
| 2021 February | 70 | 37 | 107 |
| 2021 January | 96 | 54 | 150 |
| 2020 December | 43 | 44 | 87 |
| 2020 November | 13 | 20 | 33 |
| 2020 October | 26 | 23 | 49 |
| 2020 September | 29 | 39 | 68 |
| 2020 August | 39 | 35 | 74 |
| 2020 July | 34 | 22 | 56 |
| 2020 June | 31 | 28 | 59 |
| 2020 May | 32 | 21 | 53 |
Show all
