title: The effect of combination IFN-alpha-2a with usual antituberculosis chemotherapy in non-responding tuberculosis and diabetes mellitus: a case report and review of the literature.
abstract: A limited number of publications indicate that certain interferons (IFNs) may have a role in difficult-to-treat tuberculosis. We present a 48-year-old male diabetic patient who was referred to our department with the presumptive diagnosis of multidrug resistant tuberculosis. During  the previous 8 months, he had been treated initially with a four-drug regimen (rifampicin, isoniazid, pyrazinamide, and ethambutol), which was later modified by the addition of streptomycin and ciprofloxacin, but his clinical condition had not improved and his sputum smear microscopy had remained  positive to acid-fast bacilli. Cultured Mycobacterium tuberculosis from his sputum was sensitive to rifampicin and isoniazid. We administered IFN-alpha-2a at a low dose of 3 million IU intramuscularly weekly, in combination with isoniazid, rifampicin, ethambutol, and pyrazinamide. Two  months after initiation of this therapy, sputum smears became negative, and a dramatic improvement in the patient's clinical and radiological findings occurred. During a 4-year follow-up, all consecutive sputum cultures remain negative. This case provides additional confirmation that  certain IFNs could, potentially, be useful as therapeutic adjuncts for selected cases of non-responding tuberculosis and, therefore, merit further consideration.
authors: Pulmonary Department, G. Papanikolaou General Hospital, Aristotle University of Thessaloniki, Greece. pzarog@hotmail.com
authors: Paul
authors: P
authors: Zarogoulidis
authors: Ioannis
authors: I
authors: Kioumis
authors: Nikolaos
authors: N
authors: Papanas
authors: Katerina
authors: K
authors: Manika
authors: Theodoros
authors: T
authors: Kontakiotis
authors: Antonis
authors: A
authors: Papagianis
authors: Konstantinos
authors: K
authors: Zarogoulidis
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000187:drug effects*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012196:Review Literature as Topic; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000995:Antitubercular Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins