title: Drug-induced hepatotoxicity and tuberculosis in a hospital from the Argentinian northeast: cross-sectional study.
abstract: BACKGROUND
  Hepatotoxicity is a serious adverse effect of tuberculosis treatment.
  
  
  OBJECTIVE
  The aim of this study was to estimate the prevalence, forms of presentation and clinical course of patients with hepatotoxicity secondary to antituberculosis drugs.
  
  
  METHODS
  We performed a descriptive and observational study using medical records from patients older than 16 years between Jaunary 1, 2011 and June 30, 2014 in the Medical Clinic of the Hospital Angela I. de Llano, Corrientes, Argentina.
  
  
  RESULTS
  During the study period 118 patients were diagnosed with tuberculosis; 7.6% (nine patients: six men and three women) developed hepatotoxicity. Six had hepatocellular characteristics and three had cholestatic characteristics. The mean age was 34.6 ± 14.3 years. All patients received triple-association medication plus ethambutol on a daily basis. They were hospitalized for an average of 16 days (range: 4-37). Four were asymptomatic, three had anorexia, nausea and vomiting, and two were jaundiced. The interval between the beginning of treatment and the appearance of clinical manifestations was on average 9.6 days (range 2-23). The interval between the onset and cessation of treatment was on average 15.2 days (range 3-48). No patients required liver transplantation and no deaths were recorded.
  
  
  CONCLUSIONS
  Hepatotoxicity of antituberculosis drugs has been associated with factors such as age over 35 years, female gender, pregnancy, malnutrition, alcoholism, human immunodeficiency virus, preexisting liver disease, daily treatment, diabetes, renal failure, and combined treatment. Since we lack a regional registry, this casuistry could be the kickoff for the creation of regional and/or national records of anti-tuberculosis drugs adverse effects and pharmacologic vigilance. Also, there is a need for programs to actively seek this complication, and the development of guidelines for unifying concepts and treatment protocols.
authors.affiliation: Residencia de Clínica Médica, Hospital Ángela I. de Llano, Corrientes, Argentina. Address: Avenida Centenario #3288, Ciudad de Corrientes, Argentina. Email: golembabmx@hotmail.com.
authors.forename: Alfredo Sebastián
authors.initials: AS
authors.lastname: Golemba
authors.affiliation: Residencia de Clínica Médica, Hospital Ángela I. de Llano, Corrientes, Argentina.
authors.forename: Francisco Gastón Emmanuel
authors.initials: FG
authors.lastname: Ferreyra
authors.affiliation: Residencia de Clínica Médica, Hospital Ángela I. de Llano, Corrientes, Argentina.
authors.forename: Ricardo Enrique
authors.initials: RE
authors.lastname: Martearena
authors.affiliation: Servicio de Infectología, Hospital Ángela I. de Llano, Corrientes, Argentina.
authors.forename: Fernando Ramón
authors.initials: FR
authors.lastname: Achinelli
authors.affiliation: Residencia de Clínica Médica, Hospital Ángela I. de Llano, Corrientes, Argentina.
authors.forename: Gloria Beatriz
authors.initials: GB
authors.lastname: Rovai
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001118:Argentina / Q000453:epidemiology; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol
keywords: drug-induced liver injury; tuberculosis