Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 55 No 1jan 2008 ISSN 0019-5705

Editorial

Limitations of conducting community surveys to assess the epidemiological impact of TB control programme on the incidence of TB

Original articles

Continuing medical education

Case report

Sudha Ganapathy,Beena E Thomas,M.S.Jawahar,K.Josephine Arockia Selvi,Sivasubramaniamand Mitchell wwiss

Background: The Revised nationa Tuberculosi Control Programme in India advocating directly observed treatment short course(DOTS) detects nearly 3 times more male than female TB patients.The reasons for this difference are unclear.An understanding of the community's health beliefs,perceptions on the diseaase and behaviour towards TB patients may throw some light on this issue
Material and methods: A qualitative study using focussed group discussions was conducted among men and women of younger and older age groups from lower income neighbourhoods.The information otained was grouped into themes which included,understanding of TB, vulnerability,access to health care and social responses.Gender differences in community perception of TB seem to be critical in issues related to marriage
Results: The stigma of TB is more visible in women than in men when it comes to marriage.Men and children were perceived to get preferenttial attention by their families during illness.While the younger age age groups,irrespective of their gender,accessed care from private providers.The older group preferred a government facility.Awaareness of TB was acceptable but it seemed more associated as a respiratory disease and the common symptom assocaited with TB was cough.
Conclusion This study highlights the need for gender specific intervention strategies to enhance better access of TB services..
Indian J Tuberc 2008;55,9-14
V.K.Dhingra,S.Rajpal,Anshu Mittal and M.Hanif
Aim To determine the clinical,radiological and drug resistance profile,as well as the factors asociated with treatment outcome of multi drug resisstant tuberculosis(MDR TB)
ResultsOut of total 27 bacteriologically proven cases of MDR-TB included in this study,19 were males (mean age and weight 38.5 years and 52.6 Kgs,respectively)and eighr females (mean age and weight34.3 years and 40.7Kgs respectively.A majority(18 were residents of Delhi and the rest hailed from different parts of North India. All of them had a history of previous treatment ranging from 6 to 34 monthsCavity on chest Xray was seen in 81% while 44% showed extensive involvement.The patients received at least 4 "second line drugs" during their treatment with a mean of 6.2 antitubercular drugs during their intensive phase.Of the 27 patients 13 were cured 10 defaulted one died one is still on treatment and 2 were referred for surgery.Radiological improvement was observed in two third of cases and chest Xray of 2 patients showed a complete resolution.6 predictors were identified for successful outcome of MDR-TB.They include weight gain at 6 months,culture conversion,radiological improvement during treatment,disease with M.tuberculosis strains exhibiting resistance to less than or upto these multi tubercular drugs,use of less than or upto 3 second line drugs in treatment and no change of regimen during treatment
Conclusion Default from treatment was observed to be a major challenge in the treatment of MDR-TB due to long duration and expense of ATT..
Indian J Tuberc 2008;55:15-21
P.G.Gopi,R.Subramani,V.Chandrasekkaran,T.Santa and P.R Narayanan
Objective To study the impact of improved treatment outcome of a cohort of patients treated under DOTS strategy on the prevalence of pulmonary tuberculosis(TB)in the community.
Design The data from TB register of one tuberculosis unit(TU)in Tiruvallur district of Tamilnadu, and two disease surveys.conducted in the same area during 1999-2003 were analysed.The successful treatment outcome was compared to the prevalence of TB in the subsequent cohort.
Results: The proprtion of patients who completed treatment successfully was 75.3% in the first cohort period. This higher proportion of treatment success among patients treated under DOTS in the first cohort period(1999-2001) Compared to the 51.55% reported during SCC reesulted in a lower prevalence of smear positive cases,irrespective of culture results observed in the survey conducted during 2001-2003 compared to that in the survey conducted during 1999-2001(252 versua 323 per 100000;Annual decline of 9%).Similarly,a decline in culture positive cases,irrespective of smeaar results,was also observed(434 vs 605;Annual decline 11%)
Conclusion The higher proportion of successful completion of treatment after DOTS implementation was associated with a substantial decline in the prevalence of TB.These findings showed that we are in the direction towards achieving millennium development goals(MDGs
Indian J Tuberc 2008,55,22-27

Sonia Khatter,Urvashi B.Singh,J.Arora,T.Rana and P.Seth
Background: There is high prevalence of tuberculosis in patients with HIV infection;Hence the role of non tuberculosis mycobacteria(NTM)in HIV patients has always been undermined.NTM may be responsible for clinical disease in a substantial number of immunocompromiseed HIV seropositive individuals even in a country endemic for Mycobacterium tiberculosis(M.tuberculosis)The study was designed to look for the the contribution of NTM to morbidity in HIV seropositive patients.
Material and methods: In a prospective study of ninet four HV seropositive individuals presenting with pulmonary or extra-pulmonary symptoms suggestive of mycobacterial infection,appropriate samples were collected and processed. Detailed clinical history was utilsed to differentiate colonisation or contamination by NTM from true lung disease.
Results: Forteen samples grew mycobacterial species,8 (57.2%)being NTM.The distribution of NNTM was 3 M avium complex,2 M.Fortuitum 2 M vacci ,1 M phlei ,6 isolates were M.Tuberculosis
Conclusion NTM may be responsible for a significant proportin of mycobacterial infections in HIV seropositive individuals.Despite the high endemicity of tuberculosis in developing countries like India the presence of NTM should be ruled out;especiaally in immunocomromised HIV seropositive individuals before instituting anti-tubercular therapy empirically.In addition,non response of NTM to ATT may wrongly attributed to multi-drug resistant tuberculosis Indian J Tuberc 2008,55,28-33
 S.Radhakrishna
Methodological considerations in clinical trials apply to prophylaxis studies also.In addtion there are certain aspects that need special attention.These are the identification of a valid group of controls,the choice of the unit of randomisation and its impact on subsequent analysis,the specificity and the senstivity of case diagnosis and their imapct on estimated efficacy and its reliability.The ethical aspects of the trial also need special consideration,bearing in mind that the intervention is on healthy individuals,and not patients with disease. These are discussed in the context of community.Pdhulaxix trials of tuberculosis and leprosy undertaken in South India Indian J Tuberc 2008,55,34-41
During the third quarter 2007
  • 222,108 sputum positve cases were diagnosed
  • 374,254 TB cases were registered for treatment
  • Of which 149242 new smear negative cases ,100429 extra pulmonary cases,72268 retreatment cases
  • The annualysed total case detection rate is 132 per lakh population The success rate amongst the new smear positive PTB cases registered in the third quarter 2006 was 86%,for new smear negative cases 87%,new extra pulmonary cases 90% and for smear posiive re-treatment cases it is 69%

A.Chakravarthy,Swathilika Pai,J.K.Sahani
Pharyngeal tuberculosis is rare and usually occurs in association with primary pulmonary disease.Primary tuberculosis involving the palatine tonsils and the posterior oropharyngeal wall is still a rare clinical entity.We report one such case of primary tuberculosis involving both the palatine tonsils and posterior oropharyngeal wall in a 22year old male. The patient responded to anti-tubercular treatment with complete disappearance of lesion and no sign of recurrence on one year follow up.The final diagnosis was based upon histopathological report.
Indian J Tuberc 2008,55,48-50

Ramakant Dixit,Sidharth Sharma,and Paras Nuwual

Tuberculosis involvement of oral cavity is very rare.A 34 year old male presented with non healing ulcer at upper lip mucosa Biopsy from ulcer revealed tuberculosis lesion.He also had asymptomatic pulmonary tuberculosis diagnosed during work up for prrimary site of disease..
[Indian J Tuberc 2008;55:51-53

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