Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 51 No 2April 2004 ISSN 0019-5707

Original articles

Case reports

B.N.Panda

Fungal infection of the lungs are important infective processes which are being encountered more and more often in today's practice .fortunately ,we only encounter a few of these pathogenic fungi.With more and more of people undergoing organ transplantation and cytotoxic therapy,chances of encountering these diseases are steadily increasing.Though treatment is difficult nevertheless ,the results are encouraging.Hence it is all the more important today to know these diseases well so that we are able to manage them scientifically.Diseases like Allergic Broncho pulmonary Aspergillosis(ABPA) ,if diagnosed early can be treated effectively so as to prevent progression to fibrotic stage and reduce the number of respiratory cripples.Invasive systemic mycosis is also amenable to multi modal therapy.With advent of newer imidazoles and newer modalities of drug delivery like liposomal Amphotericin B ,the so called complicated treatment modalities can be further simplified .Prophylaxis is today available for preventing PCP in immuno compromised patients and they need to adhere to prophylaxis.
Sunil Mathan Kurian,P.Selvaraj,A.M.Reetha,N.Charles and P.R.Narayanan
Background Our earlier studies on Human Leukocyte antigen (HLA)in pulmonary tuberculosis patients revealed the association of HLA-DR2 antigen with susceptibility to pulmonary TB and DR2 antigen has been shown to influence the immunity to tuberculosis.
Objectives The present study was carried out to find out whether HLA-DR antigens are associated with susceptibility to spinal tuberculosis .Moreover the role HLA-DR antigens on lymphoproliferative response to Mycobacterium tuberculosis culture filtrate antigens was studied using Lymphocyte Transformation Test.(LTT) Materials and Methods HLA-DR genotyping and lymphoproliferative response was carried out in 63 cured spinal TB patients and 63 control subjects(spouse of pulmonary and spinal TB patients)
Results A trend towards an increased frequency of HLA-DR9 antigen was observed in spinal TB patients compared to controls.A significantly decreased lymphocyte response to Mycobacterium tuberculosis antigens was observed in HLA-DR( antigen positive control subjects compared to HLA-DR9 antigen negative subjects(p=0.0009)whereas increased response was observed with DR9 positive cured spinal TB patients compared to HLA-DR9 antigen negative patients.Further HLA -DR3 antigen positive patients showed a decreased lymphocyte response compared to HLA-DR3 antigen negative patients(P<0.05)
Conclusion The study suggests that HLA-DR9 antigen either alone or in combination with other HLA antigen as haplotype and non-HLA genes may be associated with susceptibility to spinal TB and play a regulatory role on the immune response to M.Tuberculosisin spinal tuberculosis patients
Desiree T.B.D'Souza,Tannaz.J.Birdi,Yatin Dholakia,Subhash Hira and Noshir H.Antia

Background: Diagnosis of tuberculosis is difficult in HIV positive patients since they often present with atypical symptoms and are susceptible to pulmonary infections that mimic tuberculosis.Sputum collection may not be possible even in patients with pulmonary involvement since a productive cough is not always present.In such patients ,blood smear and culture for AFB apart from serving as a diagnostic tool can be used for testing drug sensitivity.
Objectives: This study was undertaken to explore the value of blood culture for diagnosis in patients with suspected TB .In addition ,a comparison of drug sensitivity patterns of blood and sputum isolates in 10 of these patients was also carried out . Methods: Blood and sputum samples were processed,cultured and isolates tested for their drug susceptibiity and for niacin production,nitrate reduction as well as catalase activity at 680 C
Results: All 214 blood samples were culture positive although only 6 were smear positive .On the basis of the biochemical investigations ,22 strains were identified as Mycobaterium tuberculosis All the 10 sputum samples were culture positive despite 4 being smear negative.Comparison of drug sensitivity profiles from blood and sputum revealed concordance to five first or second line drugs in 5 of 10 patients.Additionally ,2 patients demonstrated discordance for only one first or second line drug.
Conclusion: The study demonstrates the importance of blood culture in confirming diagnosis of blood culture in confirming diagnosis of tuberculosis and testing for drug sensitivity in HIV positive patients without productive cough .The level of discordance in drug sensitivity profiles between blood and sputum in the same individual is suggestive of infection with multiple strains.Testing for the occurrence of multistrain infections through individual colony examination of single isolate is necessary since such infections would affect treatment of non responder patients having HIV-TB dual infections
S.N.Gaur,V.K.Dhingra,S.Rajpal,J.K.Aggarwal and Meghna
A retrospective study of the profile and treatment outcome in the elderly TB patients taking DOTS was carried out in an urban TB clinic of Delhi.Out of 2118 tuberculous patients reaated between 1999-2001,a total of 238(11.4%) patients were over 50 years of age and of these 45(2.2%) were over 65 years of age .A total of 78.6% of the 283 patients of all categories include in the study had a successful outcome (Cure/completion)The overall case fatality ,default,failure rates among TB patents over 50 years were found to be 7.1%,8.8%and 4.6% respectively ,despite directly observed treatment being given under RNTCP.The fatality was significantly higher (15.6%)in the age group>65 years as compared to patients between 50-65 years(5.2%)The failure rate was significantly higher(13.3%)in the age group>65 years than among patients in the 50-65 years age group(2.6%).This emphasizes the need for intensive motivation and stringent monitoring among tuberculosis patients over 65 years of age.
K.Vishak Acharya,Ramachandra Saahoo,R.Anand and Ashwini Kumar
A 56 year old man presenting with complaints of pain chest with radiation to the right arm and haemoptysis was found to have a right upper zone mass lesion with rib erosion on the Xray chest ,fine needle aspiration cytology of which revealed squamous cell carcinoma.Subsequently sputum smear was found to be positive for acid fast bacilli by Ziehl-Nielson stain.Synchronous presence of Pancoast tumour of the lung with active pulmonary tuberculosis in the same lobe is a very association.To our knowledge,there has been no previous report of any similar case in literature.
Prem Prakash Gupta,K.B.Gupta,Rohtash Yadav,Dipti Agarwal and S.Sood
The most frequent cause of diaphragmatic paralysis and hoarseness of voice is involvement of phrenic nerve and recurrent laryngeal nerve by a thoracic malignancy.Here we describe a patient who developed diaphragmatic paralysis and hoarseness of voice due to mediastinal tuberculous lymphadenopathy,which is not a common etiological factor leading to it.

Created on ... April 30, 2004