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| Home |IJT | Links | Contact | FAQ | Forum | About | Vol 48  No 3July 2001 ISSN 0019-5707 |
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ORIGINAL ARICLES
CASE REPORTSSHORT COMMUNICATION
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Clinico-radiological spectrum of tuberculosis among HIV seropositives-A Tambaram study C.N.Deivanayagam,S.Rajasekaran,V.Senthilnatahan,O.R.Krishnarajasekar,S.Palanisamy,A.Samuel Dinesh,G.Jothivel and V.Elango Background: Tuberculosis infection is the most common co infection among HIV seropositives in high tuberculosis prevalence countries. Varied clinico radiological manifestations have been observed according to the time of occurrence of tuberculosis infection and the immune status of the HIV positives. Objectives:=:At the Govt Hospital of Thoracic medicine ,Tambaram Sanatorium, which is the largest AIDS care centre in India ,varying patterns of tuberculosis are being observed since 1992.The present study aims to relate the clinico radiological manifestations of tuberculosis and other opportunistic features found in confirmed HIV seropositive patients. Methods: Confirmed ELISA and Western Blot/Line ImmunoAssay positives were subjected to detailed clinical examination. Pleural fluid and CSF analysis were done as wand when necessary. Results: In all 1600 patients with HIV and tuberculosis co infection were studied. Pulmonary tuberculosis was found in 1342 patients(83.9%) with both typical and atypical radiological manifestations-upper and or lower lung field lesions,and cavitary or non cavitary disease. Enlarged hilar glands with or without mediastinal glands were observed in 63% of patients.Extrathoracic lymph nodal involvement (7%),pleural effusion(6%),pericardial disease(6%),pneumothorax (6%)meningitis(6%) and bone and joint tuberculosis (2%)were the other manifestations encountered. Opportunistic infections like Pneumocystis carinii pneumonia(63%),fungal manifestation(60%),bacterial infections followed by sepsis (25%) and progressive AIDS Related Diseases Syndrome coexisted with pulmonary tuberculosis, as seen in chest skiagrams . Conclusion: Tuberculin test and sputum smear microscopy do not contribute much to the diagnosis of tuberculosis in many HIV positive patients. Adequate knowledge of the clinico radiological spectrum of tuberculosis in HIV patients at different levels of immunosuppression is absolutely necessary. The increasing presence of overlapping opportunistic infections in advanced HIV stages makes the clinico radiological spectrum both hazy and atypical.
Comparison between rapid colorimetric Mycobacterial isolation and susceptibility testing method and conventional method using LJ medium.B.Mahadev,N.Srikanataramu,P.James,P.G.Mathew and R.Bhagirathi The objective of the study was to evaluate mycobacterial isolation rates. Mean Detection Time(M.D.T),and reliability of susceptibility as well as identification procedures in regard to clinical specimens by colorimetric and conventional methods. A total of 205 clinical specimens were processed by modified Petroff's method and then inoculated into MB /BacT-240 system bottles and on LJ medium slopes. A total of 101 isolates were detected by both the methods.: The recovery rate was 57.1%.(117/205) by the colorimetric method and 55.1 %(113/205)by the conventional method. Contamination rates were 1% &6.8% respectively. The MDT including susceptibility testing time was 28 and 52 days respectively. Highly significant difference was observed between the two sample means in the colorimetric and conventional methods. Colorimetric method enables rapid detection and drug susceptibility testing, making it possible to get the results four weeks earlier compared to the conventional method. But the Para-nitro Benzoic Acid(PNB)test by the colorimetric test needs standardization. Clinical utility of polymerase chain reaction in patients of pulmonary tuberculosis-R.Prasad,S.K.Lath,P.K.Mukerji,S.K.Agarwal and R.Srivastava The utility of PCR test system for examining sputum was determined in 255 sputum specimens of which 65 were from clinically diagnosed cases and 190 from controls. The positivity rate of PCR was found to be higher (83%)than that of culture (70%),and substantially greater than that of smear microscopy(61.5%)All smear positive cases were positive by both culture and PCR.In respect of smear negative cases,positivity rates of PCR and culture were, 54% and 24% respectively.Sensitivity of PCR,culture and smear microscopy was 83.0% 70.7% and 61.5% respectively, while specificity of these tests was 100%.Positive predictive values of PCR,culture and smear microscopy were 100% by all the three methods while negative predictive values were 94.5%,90.9% and 88.3% respectively. Post tuberculosis bronchial asthma-S.Rajasekaran,S.Savithri and D.Jeyaganesh Background: Asthma is a chronic inflammatory disorder of airways. The Th 2 lymphocytes ,responsible for immediate type hypersensitivity in asthma do not co-exist with Th1 lymphocytes produced as a part of cell mediated enhanced effects of immunological response(CMI)in active tuberculosis. Hence co-occurrence of asthma and active tuberculosis is uncommon. Objectives: To assess the time of occurrence and severity of post tuberculosis bronchial asthma To evaluate the response to anti asthma management and implications of long term corticosteroid administration in such cases. To follow up these patients for occurrence of airways obstruction and respiratory disability. Methodology: Fifty-five adult wheezers ,who were attending Govt Raja Mirasudar Hospital ,Thanjavur as confirmed tuberculosis patients for which they had complete courses of antituberculosis treatment and proven post tuberculosis bronchial asthma were assessed for pulmonary functions ,before and after broncho dilator therapy, on each visit. Results: Bronchial asthma had emerged within 3 years of stopping antituberculosis treatment in 42 (76.3%)patients .Two thirds had no familial history of asthma. Patients with moderate and far advanced residual lung lesions had more persistent symptoms and low PEFR levels requiring prolonged corticosteroid administration. None of the 55 patients studied had relapsed in the 2 year follow up despite most of them being on prolonged corticosteroid therapy. Conclusion Post tuberculosis bronchial asthma patients ,with moderate or far advanced lesions had more persistent symptoms needing continued corticosteroid therapy. Tubercular etiology in cases of retinal vasculitis-S.P.Rai,B.N.Panda,V.S.Gurunath and P.K.Sahoo Isolated tuberculosis of retina is very rare .In a given case of retinal vasculitis ,after excluding other etiologies, any evidence of tuberculosis elsewhere in the body suggests the diagnosis of ocular tuberculosis, and otherwise of Eale's disease.the present study was conducted to assess the frequency of tubercular etiology of retinal vasculitis. A total of 44 cases of retinal vasculitis admitted in the tertiary care centre of the Armed Forces ,between January 98 and June 2000 ,were evaluated prospectively for evidence of healed or active tuberculosis in the body. Retinal vasculitis was bilateral in 28 and unilateral in 16 patients.: all were males :the average age was 31.7 years(range 16 to 53 years):only 2 patients had constitutional symptoms and no patient had past history of tuberculosis.ESR was marginally raised in only 5 patients. Tuberculin test with 5 TU PPD was found positive in 27 patients(61%).ELISA test for tuberculosis A60)was positive in 14 patients(43.7%)X-Ray chest showed abnormality in 13 patients(29.5%)CT chest showed mediastinal lymphadenopathy in 6 and minimal parenchymal fibrosis in 6 patients, picking up abnormality in additional 6 patients in whom chest X-ray was normal. In all 29 patients(66%)had evidence of tuberculosis but only 5 showed features of active tuberculosis. None had HIV infection.CT chest was found to be the most sensitive diagnostic tool. Tuberculin test and ELISA provided supportive evidence in diagnosis. Prolonged fever occurring during treatment of pulmonary tuberculosis-An investigation of 40 cases :Deepak Rosha A study that investigated the causes of prolonged fever or onset of fever during antituberculosis treatment(ATT)in sputum smear positive, HIV negative patients admitted in a TB sanatorium is reported. A total of 40 patients were studied .All were males with ages ranging between 22 and 55 years(mean 43 years)There were 28(70%)patients who had evidence of extra pulmonary disease. It was found that fever occurred because of direct complications of tuberculosis in 22.5% ,tuberculous cold abscess in 12.5%,drug resistance in 10% and drug reaction 22.5%.Other diseases were the cause of fever in 32.5%.These included superadded lung infection ,malaria,filariasis and amoebic liver abscess. Tuberculosis of gallbladder-Problem of diagnosis-S.Mukherjee,A.K.Ghosh and U.Bhattacharya Tuberculosis of gallbladder is extremely rare and seldom reported. The case of a 35 year old multipara lady who presented with features of calculous cholecystitis,but after cholecystectomy,on histopathology was proved to be tuberculous gallbladder,is reported .The problems due to making a post operative diagnosis are discussed. HIV seropositivity in pulmonary tuberculosis patients in Indore,Madhya Pradeh -K.C.Khare In order to assess the extent of HIV seropositivity in patients of pulmonary tuberculosis in Indore Madhya Pradesh,a study was undertaken on 100 consecutive smear patients diagnosed in Medicine and Tuberculosis OPDs at the M.Y and the associated M.R.TB hospitals.4 were tested HIV positive,3 were male and one female. The clinical profile of HIV positive and negative are tabulated. (Webmaster's summary) Evaluation of Mycobacteria growth indicator tube (MGIT)for primary isolation of mycobacteria from clinical specimens -C.Chitra and C.E.Prasad This short communication describes the experience with Mycobacteria growth indicator tube for primary isolation of 65 clinical specimens. Of these 24 specimens were positive for AFB by direct smear. The mean time for detection of positive cultures in MGIT was 21.2 days(range 4 to 53 days whereas in LJ medium it was 40.4 days(range 30 to 56 days).The authors conclude that the MGIT system is a simple and easy to use non radiometric system and could prove to be a cost effective alternative for more rapid isolation ,compared with highly expensive BACTEC 460 system. (Webmaster's summary) The above are only abridged summaries. You may please refer the original articles for details |