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Abstract of articles from |
| Indian Journal of Tuberculosis | |
| reproduced with kind permission |
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Vol 51 
No 1January 2004
ISSN 0019-5705 |
Review article
Original articles
Radiology forum
- Multi drug resistant extra pulmonary tuberculosis in a HIV negative patient
- Tubercular osteomyelitis of nasal bones: A rare entity
Human immunodeficiency virus (HIV)infection and acquired immunodeficiency syndrome(AIDS)have resulted in resurgence of tuberculosis the world over.Given that the South East Asia region of the World Health Organization accounts for nearly 40 percent of all tuberculosis(TB)cases globally and 18% of the world's HIV infected also live in this region ,the twin challenge of this "cursed duet" seems to be daunting.Treatment of patients co infected with HIV and TB in India is very difficult especially because there is very little coordination between the Revised national Tuberculosis control Programme and HIV control.Clinical presentation of TB in early HIV infection resembles that observed in immuno-competent persons.In late HIV infection the clinical presentation of TB can be atypical.Diagnosis of TB in HIV infected persons may be delayed because of atypical clinical presentation and involvement of inaccessible sites and low sputum smear positivity.Rational management of patients co infected with HIB and TB in severely resource limited settings involves detailed history taking,thorough physical examination,clinical staging.,assessment of CD4+ T-lymphocyte count or total lymphocyte count and institution of antiretroviral drugs and anti tuberculosis treatment using the directly observed treatment short course (DOTS)strategy.HIV infected patients respond well to the standard anti tuberculosis drug treatment regimen using the DOTS strategy.Thorough knowledge and familiarity regarding the adverse drug reactions and drug interactions between anti retroviral and anti-tuberculosis drugs is essential for ensuring compliance and successful outcome.
Sophia Vijay,V.H.Balasangameshwara,P.S.Jagannatha and P.Kumar
Background and objectivesThe level of initial drug resistance(IDR)and its trend is a sensitive indicator of the programme efficiency and provides indirect reflection of the quality of tuberculosis services in the area.Studies from some parts of India have reported an increase in the level of IDR to INH and Rifampicin.There is paucity of information on age specific pattern on IDR from India.Frequency of drug resistance in the younger age group provides a precise evaluation of the current situation.The published data from Bangalore(1985-86)pertaining to patients under the national TB programme reported an IDR of 20.6% to any drug.Subsequently,the RNTCP with DOTS strategy to achieve high cure rate was implemented in the area in late 1998.The present study was undertaken in a cohort of 324 new smear positive patients initiated on Cat-1 regimen under RNTCP in Bangalore Mahanagar Palike from April to December 1990 to study the pattern of IDR among them,soon after RNTCP implementation in the area.This information would serve as a useful baseline data for the area to assess the impact of DOTS strategy on the levels of IDR subsequently.
Material and methodsTwo pre-treatment sputum samples were collected from these patients and subjected to microscopy,culture and susceptibility testing at the National Tuberculosis Institute.The susceptibility testing was done by economic version of proportion method,as per IUATLD guidelines. Information regarding the previous treatment was elicited using a pre-tested semi-structured schedule based on the WHO questionnaire for IDR surveillance and scrutiny of available records.
ResultsAmong the 271 correctly categorized new patients ,27.7% were resistant to one or more drugs.The resistance to streptomycin was the highest(22.5%)followed by INH(13.7%),and MDR was 2.2%.The age specific resistance was highest in <25 years and declined significantly in the higher age groups,being lowest (17.7%)in 45 years and more.Effective RNTCP implementation is expected to show declining trends in the IDR,particularly in the younger age groups during the subsequent surveys
Objective: Paraffin slide culture method (PSC)was used to isolate Non-tuberculous mycobacteria (NTM)from stool and sputum samples of HIV seropositive and negative patients
Material&Methods: Eighty stool and forty two sputum samples from both symptomatic or asymptomatic HIV seropositive patients;and 40 stool and 128 sputum samples from symptomatic but HIV seronegative patients were cultured by PSC to assess its utility in isolating NTM from the clinical specimens.The samples were simultaneously processed by culture on Lowensten Jensen (LLJ)medium for comparison with regard to isolation rate,isolation time and contamination rate.
Results: The PSC proved to be as good as LJ in isolating NTM from clinical specimen a nd ,in addition had the advantage of in situ staining for acid fast bacilli and lower contamination rate.The PS was also used for typing NTM by biochemical tests.
Dheeraj Gupta,Kshaunish Das,Balamurugesh T,Asutosh N.Agarwal and Surinder K Jindal
Background There is a need to re assess the role of generally identifiable risk factors for development of tuberculosis(e.g old age,poverty and poor socio economic status)The present study was designed to look into the socio-economic and demographic characteristics of patients of tuberculosis(TB)vis-a-vis those with other respiratory diseases in the area in and around Chandigarh.
Setting Chest clinic of a tertiary care hospital Design Case control study Material and methods Two hundred and fifty consecutive cases of TB and an equal number of patients with pulmonary diseases other than tuberculosis as controls were interviewed as per a pre-designed structured questionnaire that inquired into several socio economic and demographic variables besides the clinical details,Univariate and multiple logistic regression analyses were carried out to obtain odds ratios separately for each variable
Results The mean age of patients suffering from tuberculosis was 35.6 years(SD 13.69)There were 168 men(67.2%)and 82(32.8%)women among the cases.Persons suffering from tuberculosis were more frequently found to have the worst of the socio economic conditions for all the variables.Odds ratio(OR)increased by 3.14 (95% CI 2.48-3.98 p<0.001) for every decrease of Rs 500/- in the income level per person per month below Rs2000/- Similarly the OR increased by 3.66 (CI 2.9-4.61,p<0.001) with increasing number of persons per room.The ORs for poorer housing ,toilet facilities ,water supply and consumer articles were also significant.In multi variate logistic regression analysis the age,level of education,crowding type of housing,water supply and number of consumer articles in the household was found to be independently and significantly associated with a higher risk of TB
Conclusion There is a significant SES health gradient in TB prevalence;tuberculosis risk increases with lowering of socio economic status
Background Multi drug resistant tuberculosis(MDR-TB) is emerging as an increasingly important cause of morbidity and death.The patients continue to spree disease for a prolonged period and may pose a threat to the success of DOTS.
Aim To evaluate response to chemotherapy with second line drugs given on domiciliary basis in cases of MDR-TB.
Methods Retrospective case records of 36 proven MDR-TB patients from April 1998 -to April 2001 were analyzed. The patients were defined as cured when they had continued to be smear and culture negative for more than one year in addition to clinical and radiological improvement.All patients were followed up for one year.
Results Out of 36 patients 27 had far advanced lesions and 8 had moderately advanced lesions.All patients had at least resistance to Isoniazid and Rifampicin. Additional resistance was observed to Streptomycin in 19,Pyrazinamide-8,Ethambutol-8,Ethionamide-6,Cycloserine-5,Thioacetazone-4,Ciprofloxacin-3 and 3 and PAS in one patient.Average duration of pre-treatment chemotherapy was 14 months.Twenty patients were cases of relapse.Ten patients had concomitant disease(NIDDM-3,COPD-4,Bronchial asthma -2,IHD-1)Average time for sputum conversion was 5 months.Twenty three patients had sputum conversion in less than 4 months after revised chemotherapy.Out of 35 patients ,28 patients were declared cured at the end of 24 months of therapy,7 patients defaulted and one patient died due to massive haemoptysis.Adverse reactions to chemotherapy included photo sensitivity to Sparfloxacin-4 patients,ototoxicity to Kannamycin -2 patients and hyperuricemia-one patient.
Conclusion Problem of MDR-TB can be managed to some extent by ambulatory treatment with other logistic supports like drugs,laboratory services and sympathetic motivated staff.
Chandramani Panjabi,Puneet Khanna,Sudhir Jain and Ashok Shah
A 35 year old male,non smoker with persistent pleural effusion despite one year of ATT is described
S.K.Sharma and A.Mohan
A 25 year old ,HIV seronegative male presented with bilateral cervical adenopathy with cold abscesses and sinus formation,peripancreatic lymphadenopathy and hypodense lesions in the spleen.Culture of pus aspirated from the cold abscess in the neck grew M.tuberculosis resistant to Rifampicin ,Isoniazid,Ciprofloxacin and Para amino salicylic acid.In a resource limited setting ,he was treated with Ethambutol(E),Pyrazinamide(Z),Ethionamide(Eth),Cycloserine(Cyc),and Ofloxacin(Ofl)While on treatment he developed drug induced drug induced heaptotoxicity:Z and Eth were stopped and Clofazimine was added to the regimen.Subsequently he developed splenic abscess and Clofazimine induced generalized pigmentation of the body including tongue.After eighteen moth of treatment,lymphadenopathy and splenic lesions regressed significantly.Thus present case highlights several important basic principles of management of MDR-TB such as procuring tissue for microbiological testing,judicious use of imaging modalities,careful monitoring for adverse drug reactions,inter current infections and the need for pre-treatment counselling for ensuring compliance and completion of treatment.
Roman Wadhera,Avinash Kumar,S.P.Gulati and Sanjeev Arora
A case of tubercular osteomyelitis of nasal bones in a 10 year old child is being reported because of its extremely rare occurrence
Created on ... January 28, 2004