Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 54 No 3Jul 2007 ISSN 0019-5707

Editorial

MDR-TB-Interventional strategy(Oration-Summary not available

Original articles

Case reports

Short communication

Management of Multi-Drug Resistant tuberculosis in the field-Tuberculosis Research centre experience
Aleyamma Thomas,Rajeswari Ramachandran,Fathima Rehaman,K.Jaggarajamma,T.Santha,N.Selvakumar,Nalini Krishnan,Nalini Sunder Mohan,V.Sundaram,Fraser Wares and P.R.Narayanan
Setting: Multi-Drug TB resistant(isoniazid and Rifampicin)patients identified from a rural and urban area.
Objective: To study the feasibility of managing MDR-TB patients under field conditions where DOTS programme has been implemented.
Methods: MDR-TB patients identified among patients treated under DOTS in the ruralarea and from cases referred by the NGO when MDr-TB was suspected from the study population.Culture and drug susceptibility testing were done at Tuberculosis Research centre(TRC)Treatment regimen was decided on individual basis.After a period of initial hospitalization,treatment was continued in the respective peripheral health facility or with the NGO after identifying a DOT provider in the field.Patients attened TRC at monthly intervals for clinical,sociolgical and baceriological evaluations.Drugs for the month were pre packed and handed over to the respecive centre.
Results: A total of 66 MDR-TB patients(46 from the rural and 20 from the NGO)started treatment from the study started on treatment from the study population and among them 20(30%)were resistant to 1 or more second line drugs(Etho,Ofx, Km)including a case of XDR-TB .Less than half the patients stayed in the hospital for more than 10 days.The treatment was provided partially under supervison.Providing injection was identifed to be a major problem.Response to treatment could be correctlu predicted based on the six month smear results in 40 of 42 regular patients.Successfuls treatment outcome was observed only in 37% of cases with a high default of 24%.Adverse reactions necessitating modification of treatment was required only for 3 patients. Implications: Despite having reliable DST and drug logistics,the main challenge was to maintain patients on such prolonged treatment by identifying a provider close to the patient who can also give injection,have social akills and manage minor adverse reactions. [Indian J Tuberc 2007;54:117-124]: 
Isolation and analysis of circulating tuberculous antigens in Mycobabacterium Tuberculosis
Neeraj Shinde,Sonica Gupta,Vijay,Upadhye,Satish Kumar and Baska.C.Harinath

Background: Serological techniques like enzyme linked immunosorbent assay(ELISA)and immunoblotting are useful for detection of mycobacterial antigens of diagnostic imporatance in tuberculosis
Aim: To isolate and identify circulating tuberculous antigens reactive with sputum positive and sputum negative pulmonary tuberculosis(PTB)Sera
Methods: Circulating tuberculous antigen was isolated by ammonium sulphate fractonation from the sera of sputum positive and sputum negative(clinically and radiologically diagnosed)PTB cases.The circulating antigen fractions and individual patients 'serum samples were resolved by sodium dodecyl sulphate polyacrylamide gel electrophoresis(SDS-page)and immunoblotting was performed using anti M.tb sonicate IgG as a probe to detect antigens.
Result: Anti M.tb sonicate IgG was found to be reactive with mycobacterial proteins 170 kDa 140 kDa,85kDa,55kDa,43kDa,20kDa and 16kDa int he antigen fraction isolated from sputum positive tuberculosis sera by immunoblotting.However only 85kDa,55kDa,43kDa and 20kDa antigenic proteins were found to be recognised by antisonicate IgG in the antigen isolted from sputum negative sera.these observations were further confirmed by analysis of individual S+and S- Ptb serum by immunoblotting Conclusion: Seroreactive studies of circulating tuberculosis and antigens showed the presence of 170kDa,140kDa,85kDa, 55kDa,43 kDa,20kDa and 16kDa protein antigens in sputum positive sera while 85 kDa,55kDa,43kDa and 20kDa antigens were found to be present in sputm negative Ptb which need further evaluation for their use in serological diagnosis of tuberculosis [Indian J Tuberc 2007;54125-129]
Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme(RNTCP) K.Jaggarajajamma,G.Sudha,V.Chandrasekaran,C.Nirupa,A.Thomas,T.Santha,M.M.Muniandy and P.R.Narayanan
Objectives To elicit reasons for treatment default from a cohort of TB patients under RNTCP and their DOT providere. Methods: A total of 186 defaulters among the 938 patients registered during 3rd and 4th quarters of 1999 and 2001 in one tuberculosis unit (TU)of Tiruvallur district,Tamilnadu and their DOT provider were included in the study.They were interviewed using a semi-structured interview schedule
Results: Sixteen (9%%)had completed treatment.Twenty five(13%)died after defaulting and four (2%) could not be traced. Main reasons given by the remaining 141 patients and their DOT providers were:Drug related problems(42%,34%)migration(29%,31%),relief from symptoms(20%,16%) work related(15%,10%)alcohol consumption(51%,21%)treatment from other centres(13% ,4%)respectively.Risk factors for default were alcoholism(p<0.001)Catgory of treatment(p<0.001)smear status(p<0.001)type of disease (p<0.001) and inconvenience for DOT(p<0.001)
Conclusion: This tudy has identified group of patients vulnerable to default such as males,alcoholics,smear positive cases, and DOT being inconvenient.Intensifying motivation and counselling of this group of cases are likely to improve patient complance and reduce default.
<[Indian J Tuberc 2007;54:130-135]
Status Report on RNTCP
During the first quarter of 2007 1,570,000 suspects were examine and 211,340 sputum positive cases were diagnosed.The toal annualised case detection rate was 124 per 100,000 population..The new smear positive PTB case detection for the first quarter of 2007 was 66% with a total 140,601 new smear positive cases being registered for treatment.In addition 96,857 new smear negative cases ,48,964 extra pulmonary cases,45,602smear positive retreatment cases and 18,398others were also initiated.on treatment.The treatment success rate amongst the new smear positive PTB cases registered in the fourth quarter 2006 was 86%.The sputum conversion rate and cure rate among the new sputum positive cases was 89% and 84% respectively.
Tuberculosis Verrucosa cutis(TBVC)-foot with miliary tuberculosis
LPadmavathy,L.Lakhmana Rao,N.Ethirajan,M.Ramakrishna Rao,E.N.Subramanian and U.Manohar
Tuberculosis Verrucosa cutis or Warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity (CMI)to Mycobacterium tuberculosis while miliary tuberculosis is associated with with very poor CMI.Two widely different clinical presntations inthe same patient are very rare and being reported
[Indian J Tuberc 2007;54:145-148]: 
Pinanaki,R.Debnath,Rakesh Tripaty,Deepak Kandapall,Banth Kumar,Ekta Malik and Shyam.B.Sharma<>BR> Isolated tubercular liver abscess is mainly reported in adult patients.We report two cases of isolated tubercular liver abscess in paediatric patients.Diagnosis was made by clinican and ultrsound guidedd aspiration of pus showing acid fast bacilli in one case.In second case,biopsy of abscess wall was confirmatory.In both cases percutaneous drainage of pus and trans catheter infusion of isoniazid was given.Afte two weeks of infusion no acid fast bacilli was detected and cavity size decreased.Direct infusion of antitubercullar drugs is more effficient than systemic therapy alone.This first of its kind in treating isolated tuberculous abscess in pediatric patients.So,percutaneous infusion of ant-tuberclar agents can be considered in the treatment of tubercular liver abscess. [Indian J Tuberc 2007;54:149-151]
Comparison of tuberculin reaction sizes at 48 and 72 hours among children in Tiruvallur district,South India
P.G.Gopi,M.Vasantha,C.Kolappan and P.R.Narayanan
Setting: A rural population in Tiuvallur district South India
Objective: To study the variability of skin test reaction sizes between 48 and 72 hours
Method: A tuberculin test survey was conducted among children aged less than 10years.The reaction sizes were red by the same reader at 48 hours and 72 hours independently.The results of the tuberculin tests were compared
Of 597 children aged below 10years were included in the study,the male and female ratio was 1:1.1.There were no significant differences between th readings of reaction size at 48 and 72 hours.
Conclusion : The tuberculin test results can be read either at 48hours or 72 hours without compromising the validity
[Indian J Tuberc 2007;54:152-156]

Created on ... July 6, 2008

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