Drug lymphocyte stimulation test in the diagnosis of adverse reactions to antituberculosis drugs.
BACKGROUND
Tuberculosis (TB) is a worldwide infectious disease. Recently, standard therapy has become very effective for treating patients with TB; however, as a result of this powerful regimen, serious side effects have become an important problem. The aim of this prospective study was to evaluate the usefulness of the drug lymphocyte stimulation test (DLST) to determine anti-TB drugs causing side effects.


METHODS
Four hundred thirty-six patients with TB were admitted to our hospital for treatment between January 2002 and August 2007. DLST was performed in patients who had certain adverse drug reactions during TB treatment. The causative drug was identified by the drug provocation test (DPT). The tested drugs were mainly isoniazid (INH), rifampin (RIF), ethambutol (EMB) and pyrazinamide (PZA).


RESULTS
Of 436 patients, 69 patients (15.8%) had certain adverse drug reactions to anti-TB drugs. Of the 261 agents that underwent the DLST and DPT, 28 agents (10.7%) in 20 patients (28.9%) were positive by DLST, and 67 agents (25.7%) in 46 patients (66.6%) were identified as causative drugs by DPT. The sensitivity of DLST was only 14.9% for all drugs (INH, 14.3%; RIF, 13.6%; EMB, 14.3%; PZA, 0%).


CONCLUSIONS
DLST offers little contribution to the detection of causative agents in patients with adverse anti-TB drug reactions.
Suzuki
Yuzo
Y
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Miwa
Seiichi
S
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan. Electronic address: hirosei@za.tnc.ne.jp.
Shirai
Masahiro
M
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan.
Ohba
Hisano
H
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan.
Murakami
Miho
M
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan.
Fujita
Kaoru
K
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan.
Suda
Takafumi
T
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Nakamura
Hirotoshi
H
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Hayakawa
Hiroshi
H
Department of Respiratory Medicine, Tenryu Hospital, National Hospital Organization, Hamamatsu, Japan.
Chida
Kingo
K
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004977:Ethambutol / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use; D008213:Lymphocyte Activation / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011718:Pyrazinamide / Q000009:adverse effects / Q000627:therapeutic use; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin