Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
Home | Diagnosis |  Treatment | Control | TB and HIV  | Drug resistance  | Ind J Tub  | About
Vol 52 No 4Oct 2005 ISSN 0019-5707

Original articles

Case reports

Mohanarani Suhadev,Soumya Swaminathan,S.Rajasekaran,Beena E Thomas,N.Arun Kumar,M.Muniyandi and D.Meenalochani

Background: This paper summarises our experience about the role of community DOT providers in the management of TB treatment in HIV infected persons in a mainly rural population of Tamilnadu.
Objectives: To evaluate the feasibility of employing community DOT providers for the treatment of tuberculosis in HIV infected persons ,to study patients ' acceptance of community DOT providers in a closely-knit village communities and to find out the attitude and awareness of DOT providers on TB and DOT
Method: A total of 62 tuberculosis patients (58 males and 4 females)with HIV infection attending the Government Hospital for Thoracic Medicine,Tambaram and Chennai between July 1999 and July 2002 were selected for this study.Patients were given all the doses under supervision(Clinic-based DOT) during the initial intensive phase and through community DOT providers in the continuation phase.Data was collected both from the patients and their Dot providers about their views on DOT,advantages of DOTS,drug intake,treatment adherence,problems faced by the patients and their DOT providers in addition to the level of awareness of community DOT providers on Tuberculosis and DOTS.
Results: Regarding treatment adherence ,95% of 62 patients had taken>75% of their drugs and 39% had taken all% drugs.DOT was appreciated both by the patients and their DOTS providers since it is cost effective and patient friendly : <>BR> Conclusion: Community contribution to TB care even among HIV infected population is feasible,affordable and cost effective.There is a need for greater health education and training on tuberculosis and DOTS for community DOT providers
Indian J Tuberc 2005;52:179-183: 
Background: In an urban area of a North Indian district(Popuation 150000),9 private practitioners of non Allopathic medicine,including 5 with no qualification and 2 private para medical staff,were trained as per programme guidelines before being involved as treatment observers in the DOTS based Revised National TB Control Programme and supervised.They were not given any financial incentive.
Material and methodsDuring 2002 they managed 185 TB patients(85% of the cases in the urban area)and amongst the 63 new smear positive patients,the cure was 84%.Over a 6 month period 6% of the total new smear positive patients detected in the area were referred by these private practitioners,
Results: Results suggest that non allopathic practitioners and para medical staff from the private sector can make a significant contribution to TB control,by increasing case detection and treatment observation
Indian J Tuberc 2005;52:184-187: 
M.Muniandy,Rajeswari Ramachandran and Rani Balasubramanian

Background: The economic burden of TB in India is enormous as TB perpetuates and exacerbates poverty.Revised National Tuberculosis Control Programme(RNTCP)based on DOTS strategy is currently being implemented in India.The purpose of this study is to estimate the costs incurred by tuberculosis patients treated under RNTCP in a district in TamilNadu where services are decentralised for diagnosis and treatment.
Method: In all ,455 patients registered under RNTCP between June and December 2000 in Tiruvallur district were interviewed to collect the following information:Demographic,socio economic characteristics of patients,expenditure incurred due to illness and effect of illness on employment.Based on the data collected,various costs (direct medical,non medical,indirect and total costs incurred on account of tuberculosis before and during treatment)were estimated.In addition standard of living index(SLI) was calculated for patients.
Result: Of 455 patients,62% had low SLI.The median direct,indirect and total costs for 343 patients who successfully completed treatment were as follows:Pre treatment direct costs were Rs 340 during treatment direct costs Rs.100;More than 50 % of patients did not incur any indirect costs.In both pretreatment and during treatment periods and overall total costs were Rs.1398.About 12% of patients lost more than 60 work days and after completing treatment 88% returned to work.
Conclusion: For patients registered under RNTCP in Tiruvallur district in TamilNadu,the findings that the total patient costs were Rs1398/;and also the patients returned to work early establishes the economic benefits to patients treated under DOTS and lend support to rapid expansion of DOTS programme,particularly in low income countries. Indian J Tuberc 2005;52:188-196: 
V.Chandrasekaran,P.G.Gopi,R.Subramani,A.Thomas,K.Jaggarajamma and P.R.Narayanan
Objective To study default and its associated risk factors during the intensive phase of treatment among new sputum smear positive patients registered under a Directly Observed Treatment-Short course(DOTS)programme in Tiruvallur district TamilNadu.
Design Analysis of data collected from the tuberculosis register,treatment cards and interview schedule during May 1999 to December 2002
Results Of the 1463 patients registered drug regularity results were available for 1406 patients.The cure rate was 76% with an overall default rate of 15% of which nearly three fourth occurred during the intensive phase.The potential risk factors were identified by multivariate analysis.A higher likelihood of default was associated with age more than or equal to 45 years(AOR=1.9;95% CI=1.2-3.0).Illiteracy(1.6;1.0-2.4),Alcoholism(2.7;1.8-4.2)DOTS inconvenience(1.9;1.1-3.4) and cases identified and referred by the community survey(1.8-1.1-3.0).Of the 75 defaulters from two cohort periods visited separately,53 defaulted during the intensive phase.Among these only 31 patients were interviewed since 17(32%)migrated,3 died and one was untraceable at the address provided while another had treatment elsewhere.Drug related(84%)work related(32%)problems were the other reasons for default reported by the patients interviewed.
ConclusionThe majority of default occurred during intensive phase of treatment.All efforts should be made to retrieve these patients and return them to treatment to achieve the expected goal of the RNTCP.
[Indian J Tuberc 2005;52:197-202]: 
T.Shanta,P.G.Gopi,R.Rajeswari,N.Selvakumar,R.Subramani,V.Chandrasekharan,B.Rani,A.TThomas and P.R.Narayanan
Background Very little information is available on the drug susceptibility profile among patients who are treated with standardised short course chemotherapy regimens under programme conditions.
Methods Sputum samples were collected new sputum smear positive patients declared 'Failure' after treatment with Category I regimen under tuberculosis control programme using DOTS strategy from a rural area of TamilNadu.
Results: Of 1463 patients started on Category I regimen between May 1999 and December 2002,74 cases were declared as 'Failures'(Smear positive at 5-6 months of treatment)We collected sputum samples from 60(81%)of 74 'Failures' and 27%(16 of 60)of them were culture negative for M.Tuberculosis and 17%(10 of 60)and had organisms resistant to isoniazid and rifampicin(MDR-TB) Conclusions: Based on the drug susceptibility profile at the time of 'failure',treating category I 'failures' with Category II regimen with close monitoring appears to be justified. [Indian J Tuberc 2005;52:203-206]: 
P.Singh,K.V.Shaw,N.T.Shaw J.B.Chauhan,B.Shah,S.Jindal and S.Gami

A 22 year male patient presented as bilateral chylous pleural effusion.There was no evidence of intra-abdominal or pulmonary pathology.Further investigation proved constrictive pericarditis as the most likely aetiology.Patient underwent pericardectomy by a cardiothoracic surgeon.The diagnosis was of tuberculous pericarditis.Patient responded to antitubercular treatment.Constrictive pericarditis as a cause of chylothorax is rare but should be considered in the differential diagnosis of chylothorax. [Indian J Tuberc 2005;52:207-210]: 
M.F.Hoda,R.Prasad,V.P.Singh,P.Maurya,K.Singh and V.Sharma
Spinal intramedullary tubercular abscess is an extremely rare entity.Only few cases are reported in literature.A 9 year old girl presented with pain in gluteal region and progressive para paresis.Her chest Xray revealed a primary focus suggesting pulmonary Koch and MRI lumbosacral spine showed a ring enhancing hypo intense lesion in T1w and hyper intense in T2w at L2 to L3 suggestive of epidermoid or tubercular abscess,which was confirmed at operation and subsequently by AFB staining and culture.Mycobacterium tuberculosis was seen in both staining culture of pus.Patient improved after 2 months of ATT.
[Indian J Tuberc 2005;52:211-214]: 
Faiz Uddin Ahmed,P.Sarat Chandra,Sujoy Sanyal,Ajay Garg and Vir Singh Mehta Tuberculomas are common intracranial lesions in our country.However,tubercular infection of pituitary gland is very unusual.We present a case of intrasellar tuberculoma mimicking pituitary adenoma,and suggest the radiological features and management.A 22 year old woman had presented with generalised dull aching mild to moderate headache for 8 months and decreased vision in both eyes for 6 months.Visual acuity was 6/9 in both eyes but visual fields and fundus examination were normal.There were no significant findings.CT scan and MRI(brain)showed a sellar-supra sellar lesion.The pituitary stalk was thickened,as was the mucosa of sphenoid sinus,which raised the suspicion of an infectious pathology other than pituitary macroadenoma.Surgery was performed through sub labial transsphenoid route.A firm,rubbery,yellowish,non suckable and relatively avascularr lesion was found in the sella.Only sub total decompression was done.Frozen section biopsy was suggestive of inflammatory pathology.Histopathology revealed features compatible with tuberculosis.We suggest that tuberculosis should be considered in the differential diagnosis of sellar lesions,especially if associated with contrast enhancement and thickening of sphenoid sinus mucosa or pituitary stalk,particularly in patients from tuberculosis endemic areas.Most of these patients are negative for work up for systemic tuberculosis.Intra operatively,a frozen section should be sent and if it shows inflammatory pathology, only a decompression for biopsy should be done.We do not advise radical decompression of the lesions as antitubercular treatment is sufficient for cure. [Indian J Tuberc 2005;52:215-217]: 
Samir Singhal,A.Arbart,A.Lanjewar and Rahul Ranjan
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and manifested by formation of tubercles and caseous necrosis in tissues.In the musculo skeletal system,tuberculous spondylitis is the most typical form of the disease;However joint changes in extra spinal sites, such as the hip.knee,wrist and elbow,also may occur.Other abnormalities commonly encountered are tuberculous dactylitis and involvement of the tendon sheath.Characteristically the tissues respond to the Mycobacterial infection by forming tubercles.Clusters of epithelial cells surrounded a central zone of caseating necrosis,with the central part of the tubercle being composed of multi nucleated giant cells and the periphery consisting of a mantle of lymphocytes.Special types of tuberculous osteomyelitis include cystic tuberculosis and tuberculous dactylitis.The radiographic characteristic of cystic tuberculosis resemble those of eosinophilic granuloma,sarcoidosis,cystic angiomatosis,plasma cell myeloma,fungal infections,metastasis and other conditions.Tuberculous dactylitis involving the short tubulat bones of the hands and feet occurs especially frequently in children.In addition to soft tissue swelling,periostitis of phalanges,metacarpals or metatarsals may be evident.Expansion of the bone with cystic quality is termed spina ventosa.Tubercuosis of the metacarpals metatarsals and phalanges is uncommon after the age of five years.
[Indian J Tuberc 2005;52:218-219]: 
  • For the second quarter of 2005 the case detection rate was 74%
  • Patients put on treatment 346264
  • Success rate of 86% of the new smear positive in the 2nd quarter of 2004
  • Sputum conversion rate and cure among the new sputum positives --89% and 84% respectively
By the end of 2nd quarter of 2005 93%(1030 million)of the India's population has access to DOTS services. [Indian J Tuberc 2005;52:221-223]: 

Created on ... October 18, 2004