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Abstract of articles from |
| Indian Journal of Tuberculosis | |
| reproduced with kind permission |
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Vol 52 
No 4Jan 2005
ISSN 0019-5707 |
Original articles
- Surveillance of drug resistance to antituberculosis drugs in districts of Hoogli in West Bengal and Mayurbhanj in Orissa
- Proficiency to read sputum AFB smears by senior tuberculosis laboratory supervisors under training at a reference laboratory in India
- Effectiveness of community -based anga-wari workers in the directly observed treatment of tuberculosis patients in Haryana
- Isolation of mycobacterium avium complex and M.Simiae from blood of AIDS patients from Sevagram,Maharshtra
- Post BCG vaccination check based on serum IgG to culture filtrate antigens
- Mycobacterial antigen in tissues in diagnosis of cutaneous tuberculosis
- Transbronchial needle aspiration in undiagnosed radiographic shadows
Case reports
Background:: The central TB division(CTD)Government of India,initiated a systematic drug resistance surveillancee(DRS)as per the global guidelines,among new TB patients reporting to health facilities under RNTCP.The data obtained from two districts of the eastern part of the country,conducted by National TB Institute(NTI)are presented in this study
Objective:: To measure the levels and pattern of resistance to anti-tuberculosis drugs among "newly diagnosed" sputum smear positive pulmonary tuberculosis cases in two identified districts
Results:: Of the total 693 smear positive specimens subjected for culture from both the districts ,545(78.6%)were positive for M.tuberculosis62(8.9%)were culture negative and 86 (12.4%)were contaminated.Culture negativity and contamination rates were 7.9%&9.9% from Mayurbhanj district and 16.7% in Hoogli district.
The resistance to any drug was 5.4% in Mayurbhanj and 16.7% in Hoogli district.The resistance level to all the four primary drugs ranged from 0.4% to 3.9% in Mayurbhanj and 1.9% to 13.7% in Hoogli district.MDR was 0.7%(95% CI:0.0%-1.7%)and 3.0%(95% CI:1%-5.1%)in Mayurbhanj and Hoogli districts respectively.
Conclusions:: The study demonstrates that the levels of H,R and MDR in these two districts are within the exepected levels,when compared with other studies conducted in India as per global DRS guidelines.However in order to document success of RNTCP in reducing the level of MDR-TB,particularly in younger population,it is now necessary to conduct DRS in much larger population
Indian J Tuberc 2005;52:5-10:
Proficiency to read sputum AFB smears by senior tuberculosis laboratory supervisors under training at a reference laboratory in India
N.Selvakumar,Vanaja Kumar,P.G.Gopi,S.Sivagamasundari,E.Prabhakaran,Samuel Vasanthan and P.R.Narayanan
Background:: A national reference laboratory imparting training on sputum AFB smear microscopy to fresh Senior Tuberculosis Laboraory supervisors(STLS)
N.Selvakumar,Vanaja Kumar,P.G.Gopi,S.Sivagamasundari,E.Prabhakaran,Samuel Vasanthan and P.R.Narayanan
Aim:To assess the proficiency of STLS under training to read sputum AFB smears. Methods: Each of 342 trainees read the same set of 15 to 20 Ziehl Neelson stained smears in a blinded fashion on day-1 and day-15 of the training programme.The smear results were 75%,88%,93%,63% and 94%,99%,99%,89% respectively on day-1 and day-15
Conclusion:: The sensitivity to read sputum AFB smears by fresh STLSs with little or no experience increased from 75% to 94% during the carefully planned training programme;the specificity increased from 88% to 99%.The study highlights the importance of training in improving the microscopy results.
Indian J Tuberc 2005;52:11-14:
Setting:: A tuberculosis unit(TU)with a population of 600000 in Gurgaon district Haryana
Objective:: To compare the treatmenr success rate among TB patients taking DOT from community-based Angan-wari workers(AWWs)with that of TB patients with other DOT providers
Design AWWs were given a two day modular training ,included in the local DOT directory and were directly supervised by the TB programme staff.From the TB register held at the TU ,treatment outcomes of all new sputum positive(NSP)patients registered in Gurgaon TU from 1st January to 31 stDecember 2002 were evaluated
Results During 2002,AWWs obseerved the treatment of 115 (11%)patients in the TU.The cure rate amongst the 41 NSP patients ,who had AWWs as DOT providers,was significantly better than for those who had other DOT providers(95% vs 78%)respectively(p=0.02)
Conclusion:: Community based Angan-wari workers with adequate training and regular supervision, can contribute effectively to TB programme as DOT providers
Indian J Tuberc 2005;52:15-20:
Pratiba Narang,Rahul Narang,Deepak Kumar Mendiratta,Devashis Roy,Vijayshree Deotale,M.A.Yakrus,Tony Sean,and Kale Varsha
Background and methodology: Mycobacterium avium complex(MAC)has not been reported as an opportunistic pathogen among patients with AIDS in the Indian subcontinent.Blood samples were cultured for mycobacteria using BACTEC460TB system from 71 HIV seropositive and 33 seronegative patients ,tested at Mahatma Gandhi Institute of Medical Scineces,Sevagram between August 2001 and December 2002
Results: MAC and M.simiae were isolated from three patients each.All the six patients with mycobacteremia were AIDS cases.Clinically none of them was diagnosed as a cases of mycobacteremia.However laboratory results confirmed the dissemination of MAC and M.simiae among these patients
Conclusion: These results confirm that disseminated MAC and M.simiae disease exist among AIDS patients in India also.
[Indian J Tuberc 2005;52:21-26]:
Surekha H.Rani,V.Vijayalakshmi,Suman G.Latha and K.J.R.Murthy
Background: Since there are no reliable methods to demostrate the effect of BCG vaccination in children,culture filtrates of BCG were evaluated for their specificity and sensitivity.BCG culture filtrate(BCG-CF),BCG sonicate and tuberculin were used as antigen and tested against serum for the presence of IgG class of antibodies by ELISA and Western Blot.
Methodology: Children in the age group of 1 to 10 years were categorized as :(a)normal,and vaccinated n=35;(b)normal without a scar and with no evident history of vaccination,n=15 and (c)children with tuberculosis(meningitis,miliary and lymphadenitis)n=15
Resuls:: The mean values of optical density (OD)in group (a),4.0±0.08,were significantly high (P< 0.001)to BCG-CF compared to that of groups (b)(1.0±0.02) and (c)(1.4±0.03.The Western Blot results revealed that a greater number of children(71%)in the vaccinated group reacted to low molecular weight proteins(10-30kDa)compared to other groups(unvaccinated:17% and TB:20%).The ovrerall specificty,sensitivity ,positive predictive value and negative predictive value of BCG-CF were higher in the vaccinated group.
Conclusions. The results of the study suggest that the secreted antigens of BCG induce antibody formation,which are specific and are directed mostly towards the low molecular weight proteins.The presence of these antibodies could probably be expoited in an assay to distinguish children immunized by BCG from the unvaccinated and those having tuberculosis [Indian J Tuberc 2005;52:27-30]:
L.Padmavathy,L.Lakshmana Rao,Ramanadhan and Shakila
Background: Cutaneous tuberculosis presents a diagnostic challenge,as it is difficult to demonstrate the causative organism by histopathology and also culture of organisms from skin lesions is a less rewarding and time consuming process
Aim:Present study was undertaken to evaluate the utility of immnuo-histochemical staining to demonstrate Mycobacterium tuberculosis antigen in tissue sections.This is based on the finding that the mycobacterial antigen is the last to disappear from the tissues and thus can be used as a marker of mycobacterial infections.
Material and methods: Fifty randomly selected skin biopsy specimens were subjected to routine histopathological examination to corroborate the clinical diagnosis.Immuno histochemical study was undertaken to demonstrate mycobacterial antigen,
Observations: All the tissue sections were negative for AFB both by Z-N stain and culture.Mycobacterial antigen was demonstrable in 68% of cases of cutaneous tuberculosis.The highest positivity was recorded in scrofuloderma(89%)followed by lupus vulgaris(69%)and Tuberculosis verrucosa cutis(47%)
Conclusion: Mycobacterial antigen was demonstrable in majority of cases of cutaneous tuberculosis using polyclonal antiserum.However,since cross reactivity was reported in cases of leprosy and also in some fungal infections,this test by iteslf cannot be considered as diagnostic.The results should be considered along with other findings. [Indian J Tuberc 2005;52:31-35]:
Rana Sherwani,Kafil Akther,Rakesh Bhargava,Sharad Goel and Vivek Nangia
Background Transbronchial needle aspiration(TBNA)is diagnostic in benign and malignant pulmonary lesions.The technique of TBNA has made mediastinal and hilar nodes accessible.In addition to its usefulness in central airway lesions,TBNA has been found to increase the diagnostic yield in peripheral lesions also.
Aim To evaluate the role of transbronchial needle aspiration(TBNA)in cases of unconfirmed radiographic shadows.
Material and methods A detailed clinical history was recorded in all the 54 patients,who presented with an unconfirmed radiographic shadow.Therafter,fibreoptic specimens of bronchial aspirate and TBNA were collected and subjected to Ziehl-Neelson staining,Gram's staining,fungal smear,culture for pyogenic organisms and acid fast bacilli and cytological examination by H&E stain and Papanicolau staining.Brochial biopsy was collected in cases wherever feasible and specimens were paraffin embedded cut into 3-mm thickness and stained with H&E stain.
Results Out of 54,48,1% were diagnosed to be having bronchogenic carcinoma,20.4% each Pneumonia and tuberculosis while one patient had primary fungal infection(Candiada albicans)The overall diagnostic yield was highest with TBNA(85.2%)followed by transbronchial biopsy(48.2%)and bronchial aspiration(42.7%)cases.
Conclusion TBNA offers an unique opportunity to make a pathological diagnosis at the time of bronchoscopy.It is equally effective in diagnosing various infective conditions like pneumonia and tuberculosis
[Indian J Tuberc 2005;52:37-44]:
Ashwani Sethi ,Ramanuj bansal,Deepika Sareen,and A.K.Agarwal
Tuberculosis of pinna is a rare presentation.We present a case of a 25 year old woman who presented with a chronic-non healing ulceration of pinna.On histopathological evaluation of the incisional biopsy from the lesion,she was found to have tuberculosis of pinna.She responded to 4 drug anti-tubercular treatment.To our knowledge,there has been no previous report of any similar case in the past[Indian J Tuberc 2005;52:239-240]:
- In this quarter the new sputum positive case detection rate is 75% with 1,04590 placed ontreatment
- Success rate of 86% of the new smear positive in the 3rd quarter of 2003
- Sputum conversion rate and cure among the new sputum positives --89% and 85% respectively
- About 900000 patients have already been placed under treatment during the year.
Created on ... january 18, 2005