Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 53 No 2April 2006 ISSN 0019-5707

Original articles

Case reports

Miscellaneous

  • Sixtieth national conference on tuberculosis and chest diseases A brief review
  • Forum
  • Book review
G.R.Khatri

Background: Accessibility to the entire TB family in the country for 24 hours for all 365 days of each year from 1996-2002,hands on monitoring meetings with all levels of workers,random visits to peripheral centres and patients in their houses,balance between expressing displeasure and appreciation and lending shoulder to fellow workers were some of the pillars of success.At the same time,initial slow expansion,delayed formulation of national IEC strategy,temporary suspension of disbursement by World Bank were some of the weak areas.
Indian J Tuberc 2006;53:64-68: 
Kavita Modi-Parekh,Vika Inamdar,Anaga Jog and Anita Kar

Background: The sensitivity of Polymerase Chain Reaction(PCR)makes it a potential diagnostic test for detection of M.Tuberculosis in samples with low bacillary load
Aim: To assess the efficiency of PCR as compared to routine diagnostics in detection of M.Tuberculosis from sputum samples of suspects referred to a tuberculosis clinic and those identified during a morbidity survey.
Methods: Respiratory samples (sputum with or without saliva)from 144 individuals were examined by PCR using MPB64 primers,culture and microscopy.97 samples were from suspects referred to a tuberculosis clinic,26 were from suspects identified during a morbidity survey and 211 from patients with diseases other than tuberculosis.Study was conducted blind. Results: Total cases considered to be positive for tuberculosis by all criteria was 71.PCR detected 98% of 'culture positive',97% of 'smear positive culture positive' and 100% of 'smear negative culture positive' samples.from tuberculosis suspects diagnosed on the basis of other routine diagnostics and supporting clinical evidence,Seventeen samples were positive only by PCR but based on clinical parameters only 7 were considered true positives.
The sensitivity of PCR was 91.5% compared to 51% for smear microscopy and 68% for sputum culture.This was due o the fact that PCR could pick up bacterial DNA even from saliva mixed sputum specimens,which are generally not considered appropriate for microbiology.The specificity of PCR(86%)was found to be lower than other than diagnostic tests mainly due to lack of a suitable gold standard to assess its efficiency.This is an important limitation in evaluation of the test.
Conclusion: PCR using MPB64 primers has potential and can be a useful adjunct to diagnose clinical tuberculosis particularly in smear negative paucibacillary cases.However,the major limitation of PCR results from the absence of a suitable gold standard by which to evaluate the results.
Indian J Tuberc 2006;53:69-76: 
Background and Objective: Extra-pulmonary tuberculosis((EPTB)cases have been treated with a daily short course chemotherapy(SCC)regimens in the past.Following the success of Directly Observed Treatment-Short Course(DOTS)programme over recent years,a study was carried out to determine prevalence of EPTB,to draw comparison between annual case detection of pulmonary TB(PTB)and extra-pulmonary TB and to assess outcome of DOTS in EPTB in a patient population in Delhi.

Methods: All consecutive EPTB cases of Delhi,diagnosed within LRS Institute of TB and Respiratory Diseases between january 1996 to March 2003 and subsequently given DOTS at the area DOTS centres,constituted the study group.
Results: Of overall 14185 cases,2849(20%)had EPTB.A significantly higher prevalence was observed in females(57%) and in young age (mean±standard deviation of 23.4±12.8 years)commonest involved site was lymph node (54%).Whereas number of PTB and EPTB cases have increased over successive years,percentage of former declined significantly though 84 in 1996 to 78 in 2002 and that of latter rose significantly through 16 to 22 correspondingly.EPTB to PTB ratio changed significantly from 1:5 at start to about 1:3.5 at study-conclusion.Treatment completion was observed in 94%(1775/1885)of EPTB cases.
Conclusions: Under Revised National TB Control Programme (RNTCP)employing a DOTS strategy ,annual case detection has improved for both pulmonary and extra-pulmonary TB.CUre of infectious diseases is likely to have resulted in a relative rise of the annual EPTB case detection.DOTS effected an acceptable treatment outcome in EPTB case management. Indian J Tuberc 2006;53:77-83: 
Sugawara,T.Udagawa and Y.Kazumi

Background: Infection with Mycobaterium Tuberculosis is thought to be induced by a single strain ,and the presence of two strains within the same tuberculosis(TB) patient can rarely be considered.
Aims : The present experimental study was done to investigate the phenomenon of mixed infection with the H37Rv and Kurono strains ofMycobaterium Tuberculosis,
which can be distinguished genetically from each other by IS6110 restriction fragment length polymorphism(RFLP)
Methods: The guinea pigs were infected with the two strains simultaneously,or initially with H37Rv or Kurono followed by the other strain seven days later or 30 days later,via the air borne route.
ResultsTwo strains were recognised in the individual guinea pigs only when the guinea pigs were infected initially with H37Rv and later infected with Kurono strain.The coinfecting strains were unequally distributed in the lung,liver,spleen and lymph nodes depending upon the colony forming unit(CFU)and order of infection.Although pulmonary lesions were diminished significantly (incomplete protection against Mycobacterium Tuberculosis) 7 weeks after guinea pigs were infected with H37Rv initially and with Kurono strain 30 days later,Kurono strain was recognised in the lungs and H37Rv was recognised in the liver,spleen and pulmonary lymph nodes. Conclusion: These results suggest that prior exposure with a particular strain may lead to partial protection or altered immunity which affects the subsequent exposure and that multiple infections may not be so rare clinically and occur in high incidence regions of tuberculosis. Indian J Tuberc 2006;53:84-91: 
P.C.Mathur,K.K.Tiwary,Sushma Trikha and Dharmendra Tiwary
Background Adenosine deaminase has been proposed to be a useful surrogate marker for tuberculosis in pleural pericardial and peritoneal fluids.Studies have confirmed high sensitivity and specificity of adenosine deaminase for early diagnosis of extra-pulmonary tuberculosis.
Aim To assess the diagnostic level of ADA in tubercular serosal effusion and to determine its sensitivity and specificity.
Methods: The study was carried out on 120 patients suffering from seroal effusion(50 pleural,50 peritoneal,and 20 cases of pericardial effusion).Detailed history,physical examination and routine and relevant investigation of all patients including ADA estimation by GALANTI AND GUSTI method was done. Results ADA level in tuberculous pleural effusion ranged from 45-160U/L with a mean level of 100U?L and sensitivity and specificity of 100%(p<0.001,highly significant.ADA level in tuberculous peritoneal effusion ranged from 35-135U?L with a mean level of 92U/L and sensitivity and specificity of 100% and 95% respectively(P<0.001,highly significant).ADA level in tubercular pericardial effusion ranged from 63-117U/L with a mean level of 90U/L and sensitivity and specificity of 100% and 83.3% respectively(P<0.005,Very significant). In toto serosal fluid ADA level estimation offers high degree of sensitivity and specificity of about 100% and 94.6% respectively.
Conclusion ADA was found positive with a mean value of 100U/L,92U/L and 90U/L in tubercular pleural,peritoneal and pericardial effusion respectively with overall 100% sensitivity and 94.6% specificity and cut off value of 40U/L [Indian J Tuberc 2006;53:92-95: 
Pratima Gupta,Jagdish Rawat,Girish Sindhwani,Ramji Prasad and Manju Talekar
Setting: Patients of tuberculosis attending the out patient department of Himalayan Institute of Medical Sciences(HIMS), a post graduate institute and a large tertiary care centre in Dehra Dun
Objective: To study the trend of HIV seropositivity in patients of tuberculosis along with demographic profile,clinical features and associated complication,in patients of HIV-TB co-morbidity
Design: HIV seropositivity was assessed among all tuberculosis patients(Pulmonary and extra-pulmonary),diagnosed between January 1999 and August 2005 attending the outpatient department of HIMS.
Result:HIV seropositivity in tuberculosis patients rose from 1.19% in 1999 to 4.19% in 2005.Out of total 42 HIV seropositive patients,71.42% were males,88.09% were married,and 69.4% belonged to rural population.Most common route of HIV transmission was heterosexual(66.67%)followed by blood transfusion(16.67%).64.28% of the patients had pulmonary tuberculosis and 35.71% had extra-pulmonary tuberculosis.Sputum was positive for Acid Fast Bacilli in 40.74%.Fever was the most common (83.33%)symptom and oral candidiasis(40%)was the most commonly associated complication
[Indian J Tuberc 2006;53:96-100]: 
  • For the fourth quarter of 2005 the case detection rate was 59% with a total of 305251 patients placed on treatment
  • The success rate amongst new smear positive PTB cases registered in the 4th quarter of 2004 was 86%
  • The sputum conversion rate and cure rate among the new sputum positive cases were 89% and 84% respectively
  • The case detection rates have declined considerably as compared to the previous year for which intensive monitoring is done
    • [Indian J Tuberc 2005;52:221-223]: 

    [Indian J Tuberc 2006;53:30-32]: 
    Prem Prakash Gupta,K.B.Gupta and Dipti Agarwal
    The term right middle lobe syndrome(RMLS)is often used in clinical practice though it has no consistent definition.Inflammatory lesion,malignant tumours followed by brochiectasis are considered as the most common aetiological factors for RMLS.Here we describe 12 cases of RMLS due to tuberculosis etiology diagnosed over a period of 6.5 years at our institute.They were diagnosed using conventional methods and responded to antitubercular treatment with favourable outcome.The cases are being presented here to highlight the fact that tuberculosis,though not frequently reported in published literature,is an important etiological factor and must be considered for differential diagnosis when RMLS is evaluated particularly in regions where the prevalence of tuberculosis is high as it responds to anti-tubercular chemotherapy remarkably
    [Indian J Tuberc 2006;53:104-108]: 

    Created on ... Feb 17, 2006