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Vol 47  No 4 October 2000 ISSN 0019-5707 |
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| Chemotherapy of drug resistant tuberculosis: The Tuberculosis Research Centre experience of 40 years Tuberculosis Research Centre(ICMR) A retrospective review was undertaken of randomised controlled clinical trials done at the Tuberculosis Research Centre,Chennai during the past 4 decades to assess the response to primary and retreatment regimens in patients found resistant to Streptomycin,Isoniazid and Rifampicin. SCC regimens were found to be effective in patients with S resistance. For patients who had SH resistance ,in the pre-Rifampicin era ,the retreatment regimens (containing Ethionamide,Pyrazinamide,Cycloserine)available then were less effective ,toxic and unacceptable to most patients. In post-Rifampicin era, SCC regimens containing R and Z in addition to E or S gave excellent results. Besides 91% of H or SH resistant patients became culture negative when treated with 12RE plus 3 months of Kannamycin. The number of drugs in the regimen, the rhythm of administration of Rifampicin and also other companion drugs influenced the treatment outcome in patients with SH resistance. Patients with Rifampicin resistance failed to respond to primary SCC regimens. Even with initially tailored regimens, containing drugs like Ofloaxacin ,PAS thiacetazone and Amikacin the success rate was only 50% and the mortality rate was high(34%) Retreatment of MDR-TB cases .is therefore ,unsatisfactory at present. The best approach remains to cure patients during primary treatment with standardized SCC regimens and supervised chemotherapy (DOTS)in order to prevent the development of resistance ,especially to RH. Annual risk of Tuberculosis infection : An estimate from ten year old children in Trivandrum district KS Kumari Indira,S.Sivaraman,M.Joshi and Sivanandan Pillai Annual rate of tuberculosis is considered as the best indicator for assessing the trend of tuberculosis in the community. Age specific data on prevalence of infection can be used to estimate the annual risk of infection(ARI) as well as annual decline in ARI Objectives: Primary objective was to estimate ARI among 10 year old non vaccinated children in Trivandrum district. Secondary objective was to determine the impact of BCG vaccination on eliciting tuberculin reactions Study design Cross sectional tuberculin survey. Population and setting:& The 10 year old in Trivandrun district schools were tuberculin tested between June 1991 and February 1992. Method: Proportionate cluster sampling was done from urban and rural schools. Children of one class formed the cluster unit. Approximately an equal number of children with and without BCG scar were registered from each school (184 cluster pairs from 158 schools). Tuberculin testing was done using 1 TU PPD RT23 Tween 80 Results Tuberculin reactions of 7657 children with BCG scar and 7250 children without BCG scar were analyzed. Distribution of tuberculin reactions was similar for both groups, but a relative preponderance of 10 to 19mm indurations was noted for BCG scar group. In no scar group, estimated prevalence of tuberculous infection and ARI(at>=12 mm cut off point)were 7.2%(95% CI6.5-8.0)and 0.75%(95% CI 0.67-0.83)respectively)At cut off points of>=10mm ,>=12mm,and >=14mm ,the estimated prevalence rates for children with BCG scar(12.(%,10.9% and 9.3% respectively)were significantly higher(P less than 0.0001 at all the levels)compared with no scar group(8.5%,7.2% and 6.5% respectively) Conclusion The estimated ARI in Trivandrum district(0.75% is lower than that reported from other centres in India(0.9% to 3%) Paraffin slide culture technique for "baiting" non tuberculous mycobateria -P.Narang,Sangeeta Dey and D.K.Mendiratta The ability of nocardia to utilize paraffin as the sole source of carbon has been used for its isolation from clinical specimens. Some mycobacterium also possess this property, which is not so well known. The paraffinophilic nature of non tuberculous mycobacteria as well as M.Tuberculosis using commercially prepared Infectech Identity kitTM(USA)was investigated. Fifteen known species of non tuberculous mycobacteria(NTM)and one strain each of H37Rvand Nocardia asteroides were inoculated into tubes containing paraffin coated slides . Visible growth was seen for all NTM within 7-14 days(and compared with Nocardia asteroides which acted as growth control.)While M.tuberculosis strain did not grow even after 8 weeks of incubation. Thus the paraffin slide culture(PSC)technique proved to be useful in distinguishing between NTM and M.tuberculosis. Further tests like nitrate ,urease,Tween 80 hydrolysis and tellurite reduction could also be performed in PSC system to distinguish species such as M.Kansasii,M.avium intracellulare and M.fortuitum. The colonies could also be sub cultured on fresh Lowenstein Jensen medium for further characterisation. The kit can also be modified for drug susceptibility tests by incorporating drugs in Czapek broth. Trend of HIV infection in patients with tuberculosis in rural south India" -S.Rajasekaran. A.Uma,S.Kamakshi,D.Jeyaganesh,A.Sentamizchelvan,S.Savithri and Gopinatahn. Setting:- Rural pockets of south Indian population, hitherto considered "low"-prevalence zones". objectives:- To find out the trend of HIV infection in pulmonary tuberculosis patients in the rural areas and to evaluate the clinical profile of tuberculosis patients with HIV infection. Design:- HIV seropositivity was assessed among 510 bacteriologically,radiologically and/or histologically confirmed tuberculosis patients attending the Department of Thoracic medicine,Govt Raja Mirasdar Hospital ,Thanjavur in 1996. The findings of 1996 sentinel surveillance were compared with a similar repeat surveillance survey done in 1999 among 405 confirmed tuberculosis patients. Results:- HIV seropositivity rate among 520 tuberculosis patients in 1996 was 0.59%.Of the 404 patients screened in 1999,36 patients(8.89%)were HIV seropositive. Disseminated tuberculosis (30.6%)and variable/mixed radiological patterns were observed in the 1999 survey. Conclusion:- This prospective study suggests that HIV infection is rising sharply in pockets of rural south Indian population. Plasma glutathione-S-transferase activity in lung malignancy -K.B.Gupta,Sanjeev Tandon ,Vani Garg and Harbans Lal Plasma gluatathione-S-transferase (GST)level was estimated in cases of lung malignancy and compared with that in cases of chronic bronchitis and normal healthy volunteers. Mean GST values were found to be significantly raised in cases of lung malignancy(19.94±5.14 IU/l)compared to chronic bronchitis(5.08±1.67 IU/l)and healthy volunteers(3.64±1.19 IU/l) Significance of serum-effusion albumin gradient in the differential diagnosis of pleural effusion -M.C.Dhar,S.Chaudhuri,K.Basu,T.J.Sau.D.Pal and K.Mitra The aim of the study carried out in the department of medicine ,R.G.Kar Medical college ,Calcutta from May 1998 to April 2000 was to compare serum effusion albumin gradient (serum albumin level-pleural effusion albumin level)with Light's traditional criteria (pleural effusion fluid/serum total protein ratio >0.5;pleural fluid /serum LDH ratio>0.6 and pleural fluid LDH>200IU/l)for differentiating between exudative and transudative pleural effusions. Fifty consecutive patients of pleural effusion -33 male and 17 female ,in the age group range of 15-75 years-were studied. For clinical diagnosis of the patients, biochemical tests on serum and pleural effusion fluid were done. The serum effusion albumin gradient and Light' criteria were compared. Light's criteria correctly identified all the exudates but misdiagnosed 2 of 5 transudates(cases of heart failure). By using albumin gradient of 1.2g/dl or less to indicate exudate and greater values to indicate transudate,all the patients(35 exudates and 15 transudates)were correctly diagnosed. Light's criteria are accurate for identifying exudates but not so much in the case of transudates. The serum -effusion albumin gradient is accurate equally for exudates and transudates. Relapse following directly observed chemotherapy short course(DOTS-A follow up study -Yatin Dholakia,Usha Danani and Chhaya Desai DOTS strategy was introduced in the RNTCP in 1993 because of its high efficiency. However follow up reports on the patients completing treatment under DOTS ,and considered cured ,to assess relapse rate are very few. We have followed up a cohort of 2,136 patients put under DOTS from 1996 to 1998 in a Municipal Ward in Mumbai,of whom 75.55% were new patients and 24.45% were retreatment cases. The cohort had shown cure treatment completion of 83.59%(1936/2316),deaths 4.66 %(108/2316) treatment failures 1.08%(25/2316)defaulters 9.45%(219/2136) and transferred out.2%(28/2316) All the cohort patients were followed up in their homes during August-October 1999 after lapse of varying periods of observation. Of the 2068 (89.29%)cases traced out,3.83%(79/2068) had relapsed, 1.98%(41/2068)had died and 82.68%(1710/2068) had no complaints at the time of follow up. The rest were either on treatment or were without treatment. Among the 41 additional deaths, there 8 who had relapsed prior to follow up.Therfore relapse occurred in 4.5% (87/1936)of the 1936 cases who had cured/completed treatment and overall mortality was 6.43%(149/2316) Allergic bronchopulmonary aspergillosis-review of 29 cases -Raj Kumar Twenty nine cases of allergic bronchopulmonary aspergillosis (ABPA) seen over a period of two years were reviewd.The major symptoms were breathlessness ,cough fever and haemoptyisis. All patients showed peripheral eosinophilia and an immediate skin reaction to A.fumigatus antigen. delayed positive cutaneous reactivity was seen in 45% of cases. Serum precipitins against A.fumigatus antigen were detected in 79% of cases and sputum was positive in 55%. Total IgE and specific IgE against A.fumigatus were raised in all the cases. Twenty seven per cent of the cases had shown fleeting shadows on radiological examination and were treated for pulmonary tuberculosis in the past. Eighty per cent had central bronchiectasis on CT scan Isolated appendicular tuberculosis-A case report -Paras Nuwal,Ramakant-Dixit,Sudha Jain and Vandana Porwal Isolated appendicular tuberculosis is a comparative rarity. We are reporting a patient with provisional clinical diagnosis of acute on chronic appendicitis who was finally diagnosed as tuberculous appendicitis Tuberculosis of middle ear-Report of two cases -R.K.Gopal,B.K.Padmavathy,S.Vasanthi and G.K.Ponnuthai Two cases of tuberculous otitis media, one associated with HIV infection and the other in an immuno competent individual are reported because of their comparatively rare occurrence Extra pulmonary lesions among HIV positive tuberculous individuals and response to chemotherapy -B.K.Dash and S.R.Panigrahi This is a short communication on 15 extrapulmonary cases seen in SCB Medical College Hospital Cuttack.The authors conclude that theirs was a highly selected group.Only those who belonged to high risk group were tested for HIV positivity. Extra pulmonary manifestations of tuberculosis were seen earlier and more often among the HIV positive individuals. The response to antituberculosis therapy was satisfactory. The above are only abridged summaries. You may please refer the original articles for detailsBesides the above Volume features an appeal by R.P Bhagi(Delhi) inviting opinion regarding BCG test so that its role could be defined and evaluated by studies conducted under the guidance of Tuberculosis Association of India. There are two case reports(vulval tuberculosis,and another on epitrochlear lymphadenitis in the Forum section |
ContentsChemotherapy of drug resistant tuberculosis: The Tuberculosis Research Centre experience of 40 yearsOriginal articles
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