Indian Journal of Tuberculosis

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A 35-year old man with a non-resolving pleural effusion.
(2004-01) Panjabi, Chandramani; Khanna, Puneet; Jain, Sudhir; Shah, Ashok
A thirty-five-year old male, a nonsmoker, was referred to us for evaluation of progressive pulmonary disease. His clinical course during the past 2 years was characterized by paroxysmal attacks of cough with scanty mucoid sputum. This was accompanied by intermittent fever and malaise. There was no history of wheezing, nasal symptoms or loss of weight. Eighteen months prior to referral, based on his symptomatic and roentgenologic profile, he was clinically diagnosed as a case of tuberculous mediastinal lymphadenitis. He was initiated on antituberculous therapy (ATT) comprising rifampicin 450 mg, isoniazid 300 mg, pyrazinamide 1500 mg and ethambutol 800 mg once daily. Prednisolone (10 mg thrice daily) was added after 2 months when the patient did not experience any relief. He was however irregular with the oral steroids and stopped it after 1 month. One year prior to referral, while on ATT for 6 months, he had few episodes of blood-streaked sputum, episodic exertional dyspnoea, and rightsided chest pain that increased on coughing and deep breathing. This was diagnosed as right-sided pleural effusion, and the patient was initiated on second line ATT in the form of kanamycin 1gm intramuscularly, sparfloxacin 400 mg, prothionamide 750 mg, clofazamine 200 mg, clarithromycin 500 mg, thiacetazone 150 mg and isoniazid 300 mg once daily. Kanamycin was stopped after 6 months but the other drugs were continued for a period of 1 year. In spite of regular second line ATT for 1 year, the patient remained symptomatic and as the effusion persisted, he was referred to us for evaluation. Physical examination revealed a middle-aged male in no acute distress. There was no clubbing or cyanosis. Chest examination suggested a right-sided pleural effusion. Examination of other systems, including an ophthalmologic referral, did not detect any abnormality.
Abstracts from the 61st National Conference on Tuberculosis and Chest Diseases. February 23-25, 2007. Udaipur, India.
(2007-10-02)
Accidental isoniazid poisoning--a report.
(2008-04-04) Agrawal, R L; Dwivedi, N C; Agrawal, Manju; Jain, Sachin; Agrawal, Anand
Eight patients who had taken accidental overdose of Isoniazid were followed in relation to its clinical manifestations, EEG changes and management. All cases survived without any residual effect.
Acute Respiratory Distress Syndrome as a paradoxical response to anti-tuberculosis and anti-retroviral therapy.
(2006-07) Subhash, H S; Supriya, S; Prakash, B; Thomas, K
Paradoxical response or immune reconstitution inflammatory syndrome (IRIS) during the course of antituberculous therapy is being increasingly recognised among patients with and without HIV co-infection. A 40-year-old HIV infected male on anti-retroviral therapy (ART) presented with persistent fever and weight loss. He was diagnosed to have miliary tuberculosis and HIV co-infection. Following initiation of anti-tuberculous chemotherapy, the clinical course was characterised by development of acute respiratory failure (ARDS) as a paradoxical response/IRIS to treatment. This uncommon manifestation of paradoxical response (ARDS) in HIV and tuberculous co-infection following initiation of ART and anti-TB treatment is very scarcely reported in the past. With the increasing incidence of HIV/AIDS and TB co-infection along with liberal access to ART in the developing world, it is likely that paradoxical reactions will be encountered more frequently.
Acute suppurative presentation of Osteoarticular Tuberculosis in children.
(2011-04) Agarwal, Anil
Introduction: Osteoarticular tuberculosis is known for its atypical presentations. The acute presentation of osteoarticular tuberculosis although mentioned by many observers is seldom seen in practice. We report the varied presentations of acute suppurative presentation of osteoarticular tuberculosis in pediatric age group. Methods: Our study retrospectively assessed 10 children with osteoarticular tuberculosis who had acute presentation with short history of a few days and signs of acute inflammation. Results: The age range varied from 3-12 years. The duration of symptoms averaged 14.7 days (range, 4-28 days). Three patients were afebrile at the time of presentation. The diagnosis of tubercular aetiology was made only retrospectively in all the cases. All, except one, were subjected to Fine Needle Aspiration Cytology (FNAC)/ trochar bone biopsy. Diagnosis was based on smear positive for acid fast bacilli (n=3), histopathology (n=5), and on clinicoradiological findings in two cases. The acute exudative pattern was seen in seven and gravity assisted tracking and accumulation of abscess (dependent) in three patients. In eight patients, the FNAC/ trochar biopsy decompressed the lesion initially. Incision and drainage were performed on one case of osteoarticular tuberculosis with clinical presentation of acute pyogenic infection. Another patient of acute exudative pattern was subjected to drainage and debridement in view of impending burst. Both exudative and dependent forms of suppurative presentations of osteoarticular tuberculosis responded well to standard antitubercular chemotherapy. The abscesses resolved within a period of 6-12 weeks. Conclusion: The acute suppurative presentation is a rare and atypical form of osteoarticular tuberculosis. It has close resemblance to acute pyogenic infections or septic arthritis and pose significant diagnostic dilemma for the unwary. A vigilant and methodical approach is the key for managing acute suppurative tubercular presentations.
Agreement between skin testing and QuantiFERON®d-TB Gold In-Tube assay (QFT-TB) in detecting latent tuberculosis infection among household contacts in India.
(2012-10) Pattnaik, Satyajit; John, K R; Shalini, E; Michael, J S
Aims: The present study was designed to find the agreement between Tuberculin Skin Test and interferon gamma assay test in detecting latent tuberculosis infection in household contacts of sputum culture positive tuberculosis cases. Setting: Department of Community Medicine, Christian Medical College, Vellore. Methods: One hundred and fifty household contacts of sputum culture positive tuberculosis cases were tested with both the methods simultaneously and actual as well as kappa agreement was determined. Results: The overall actual agreement between both the tests was found to be 82% with a kappa agreement of 0.57. Conclusion: The agreement was very high (both percentage agreement and Kappa) in pediatric contacts but it was poor in adult contacts.
Annual risk of tuberculosis infection in a rural population of South India and its relationship with prevalence of smear positive pulmonary tuberculosis.
(2013-10) Chadha, V K; Anjinappa, Sharada M; Gowda, Umadevi; Srivastava, Ramesh; Ahmed, J; Kumar, Prahlad
Background: We conducted a tuberculin survey to estimate the annual risk of tuberculous infection (ARTI) among children in a sub-division of rural Bangalore district. A TB disease survey was conducted in the same area around the same time and has already been published. DOTS strategy is being implemented in the study area since 2002. Methods: The tuberculin survey was conducted during 2010-2011 among 3838, 5-9-year-old children attending 147 schools selected by simple random sampling. Children were tuberculin tested with 2TU PPD RT23 with Tween 80 and maximum diameter of induration was measured between 48-96 hours. ARTI was computed from prevalence of infection estimated by mirror-image technique. Prevalence of smear positive pulmonary TB estimated during the disease prevalence survey in 2008-10 was used to find out its relationship with ARTI. Results: Using the observed mode of tuberculin reaction sizes at 19 mm, among surveyed children, prevalence of infection was estimated at 7.3% (CI: 6.5-8.1); ARTI was computed at 1.05%. Considering the mean age of children, estimated ARTI most closely approximated to the year 2008. Every one per cent ARTI was found to correspond to a prevalence of 103 sputum smear positive patients of PTB, which was similar to the ratio of 106 found in the same study area during 1960s. Conclusion: There has been no change in the relationship between ARTI and prevalence of smear positive pulmonary TB from the pre-DOTS era and thus in the number of children infected by each adult point prevalent case of smear positive pulmonary TB each year suggesting the need for early case detection and treatment.
Annual risk of tuberculosis infection in Chennai city.
(2008-07-24) Gopi, P G; Prasad, V Venkatesh; Vasantha, M; Subramani, R; Tholkappian, A S; Sargunan, D; Narayanan, P R
AIM: To study the proportion of children infected with Mycobacterium Tuberculosis in Chennai city. METHODOLOGY: A cluster sampling methodology was adopted to select an estimated sample size of 7000 children from five corporation zones selected systematically from ten zones of the city. A total of 7098 children aged 1-9 years were subjected to Mantoux and test read; 1897 (27%) from slum area and 5201 (73%) from non-slum area. RESULTS: The prevalence of infection among children without BCG scar was estimated to be 10.5 % (ARTI of 2.0%) and was similar to that among children irrespective of scar status. The prevalence of infection was higher among children in slum areas (11.1%; ARTI 2.1%) compared to non-slum areas (8.9%; ARTI 1.7%); but the difference was not statistically different. CONCLUSION: The tuberculosis situation in Chennai as measured by risk of infection was higher in urban city area than rural areas and comparable to that found in other cities as reported from earlier studies. This information can be used as baseline information for monitoring the epidemiological trends in Chennai city in future.
Annual risk of tuberculous infection in Andhra Pradesh, India.
(2007-10-13) Chadha, V K; Kumar, P; Satyanarayana, A V V; Chauhan, L S; Gupta, J; Singh, S; Magesh, V; Lakshminarayana,; Ahmed, J; Srivastava, R; Suganthi, P; Devi, G Uma
BACKGROUND: There is paucity of information on epidemiological situation of Tuberculosis (TB) in Andhra Pradesh. The DOTS strategy under the Revised National Tuberculosis Control Programme (RNTCP) was introduced in the year 2000 to cover the entire State by 2005. OBJECTIVES: To estimate the prevalence of tuberculous infection among children 5-9 years of age and to compute the average Annual Risk of Tuberculosis Infection (ARTI) from the estimated prevalence. METHODS: A cluster-sample house-based tuberculin survey was carried out in a representative sample of children between 5-9 years of age. The clusters were selected by a two-stage sampling procedure. At first stage, five districts were selected by probability proportional to population size (PPS) method. Depending upon child population ratio, 32 clusters allocated to each district were further sub-divided into rural and urban clusters selected by simple random sampling. A total of 3636 children, irrespective of their BCG scar status, were tuberculin tested using one TU PPD RT23 with Tween 80 and the maximum transverse diameter of induration was measured about 72 hours later. RESULTS: The prevalence of infection estimated by mirror-image technique using observed mode of reactions attributable to infection with tubercle bacilli at 20mm was 9.6% (95% CI: 8.0-11.2). The ARTI was computed at 1.4% (95% CI: 1.1-1.6). CONCLUSION: Survey findings indicate a fairly high rate of transmission of tubercle bacilli.
Annual risk of tuberculous infection in rural areasof Kota district.
(2004-07) Vaidyanathan, Preetish; Chadha, V K; Kumar, P; Jaganatha, P S; Devi, G Uma
Background: A nation wide tuberculin study was undertaken to estimate the Annual Risk of Tuberculous Infection (ARTI) in different parts of India. The study in the rural areas of Kota, one of the districts selected for the survey, is described in this article. Material & Methods: A total of 6264 children 1-9 years of age, residing in 64 clusters were registered into the study. The children were subjected to the standard tuberculin test using 1 TU PPD RT23 with Tween 80 procured from BCG Laboratory, Guindy and the maximum transverse diameter of the induration was measured at about 72 hours. Results: A total of 3157 children without BCG scar and 1520 with BCG scar was successfully test read. The prevalence of infection among children without BCG scar using the mirror image technique was estimated as 13.6% and the ARTI was computed at 2.6%. Using similar technique, the prevalence of infection among the entire study group-irrespective of BCG scar was estimated as 14.9% and the ARTI was computed at 2.8%. Conclusion: The findings indicate a high rate of transmission of tuberculous infection in rural areas of Kota and emphasise the need for further strengthening of tuberculosis control measures.
Assessment of long term status of sputum positive pulmonary TB patients successfully treated with short course chemotherapy.
(2009-07) Rekha, V V Banu; Ramachandran, Rajeswari; Rao, K V Kuppu; Rahman, Fathima; Adhilakshmi, A R; Kalaiselvi, D; Murugesan, P; Sundaram, V; Narayanan, P R
Background: Long term status of pulmonary tuberculosis (PTB) patients treated with short course chemotherapy (SCC) regimens remains unknown. Objective: To assess the clinical, bacteriological, radiological status and health related quality of life (HRQoL) of PTB patients 14 -18 years after successful treatment with SCC. Methodology: In a cross-sectional study, cured PTB patients treated during 1986 – 1990 at the Tuberculosis Research Centre (TRC) were investigated for their current health status including pulmonary function tests (PFT). The St Georges respiratory questionnaire (SGRQ) was used to assess the HRQoL Results: The mean period after treatment completion for the 363 eligible participants was 16.5yrs (range 14-18 yrs, 84% coverage) ; 25 (7 %) had been re-treated and 52 (14%) died. Among the investigated, 58 (29%) had persistent respiratory symptoms; 170(86%) had radiological sequelae but none had active disease. Abnormal PFT was observed in 96 (65%) with predominantly restrictive type of disease in 66(45%). The SGRQ scores for activity and impact were high implying impairment in HRQoL. Conclusion: Assessment of long term status of cured PTB patients showed an impairment of lung functions and HRQoL highlighting the need to address these issues in the management of TB that may provide added value to patient care.
Association of 22 cytokine gene polymorphisms with tuberculosis in Macedonians.
(2009-07) Trajkov, Dejan; Trajchevska, Mirjana; Arsov, Todor; Petlichkovski, Aleksandar; Strezova, Ana; Efinska-Mladenovska, Olivija; Sandevski, Aleksandar; Spiroski, Mirko
Objective: To examine the possible role of 22 cytokine gene polymorphisms in host susceptibility to or protection against tuberculosis (TB) in Macedonians. Method: 301 healthy unrelated individuals and 75 patients with pulmonary TB were studied. Cytokine genotyping was performed by PCR with sequence-specific priming (PCR-SSP) (Heidelberg kit). Results: TNF-Ü -238/G, IL-1R psti1970/C, IL-1â +3962/T:T, IL-4 -1098/ T:T, IFNã utr5644/A:A, IL-10 -1082/G:G, IL- 4 -590/C:C, IL-10/ATC, IL-4/TCT, IL-4/TCC, IL-10/ATC:GCC, IL-4/TCT:TTT, IL-4/TCC:TTC, IL-10/GCC:GCC and IL-4/TCC:TCC were positively associated with TB, while protective association was identified for IL-4 -1098/G, IL-1â +3962/C, IFNã utr5644/T, IL-1â +3962/C:T, IL-4 -1098/G:T, IL-4 -590/C:T, IFNã utr5644/A:T, IL-4/GCC, IL-4/TTC and IL-4/GCC:TTC. Conclusion: These results suggest that some cytokine polymorphisms are significantly associated and affect host susceptibility/resistance to TB in Macedonians.
Atypical presentation of Tuberculosis.
(2006-10) Sarda, Dinesh K; Kothari, Paras; Adivarekar, Prashani; Kumar, Ravi; Dipali, Raghunath; Kulkarni, Bharati
Incidence of tuberculosis is increasing with emergence of many cases of multi-drug resistance and extrapulmonary manifestation. We report three cases of tuberculosis presenting in very atypical ways.
Awareness, attitude and treatmnt seeking behaviour regarding tuberculosis in a rural area of Tamil Nadu.
(2010-10) Kar, Malini; Logaraj, M
A population based cross-sectional study was carried out to assess the awareness, attitude, and treatment seeking behaviour regarding TB in rural Tamil Nadu. Out of 1985 people interviewed, 56% had heard of TB, but 80% were not aware of the cause and mode of spread of TB. Television was reported to be the main source of information (45%). Only 34% people were aware that treatment for TB was available free of cost. Less than 10% people felt the need to maintain confidentiality, if contracted TB. More than 80% people preferred to visit Government hospital, if developed TB, whereas 54% actually sought treatment from government hospital for cough of more than three weeks.
BCG induced mycobacterial spindle cell pseudotumor in an infant.
(2009-04) Suchitha, S; Sheeladevi, C S; Manjunath, G V; Sunila, R
Mycobacterial Spindle cell Pseudotumor (MSP) is a rare complication of mycobacterial infection, especially the atypical variety. It is characterized by an exuberant spindle cell proliferation. This has been reported in the lymph nodes, skin, spleen, lungs, brain, etc. The incidence is higher in immuno-compromised patients, especially those with acquired immunodeficiency syndrome. It is rare to encounter this lesion in infants. We report a case of MSP in the axillary lymph node of a 7-month-old infant, following Bacillus Calmette Guerin (BCG) vaccination due to Mycobacterium tuberculosis complex, which was proved by PCR.
Benefits of early anti-retroviral therapy in patients with HIV-TB co-infection.
(2009-07) Rajasekaran, S
Bilateral lower zone shadows on chest radiograph - A clinicopathological profile.
(2005-07) Sherwani, Rana; Akhtar, Kafil; Siddiqui, Talat; Bhargava, R; Zaheer, Sufian
Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can be compared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examination and transbronchial biopsy. Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initial clinical diagnosis to the final diagnosis. Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination along with PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after a detailed clinical history and thorough physical examination. Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in 10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatid disease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%, malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in 3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lung in 1.7% case each respectively. Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph. However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmation of the diagnosis and provides a significant yield.
Bilateral spontaneous Pneumothorax in Miliary Tuberculosis.
(2010-07) Arya, Manoj; George, Jacob; Dixit, Ramakant; Gupta, Rakesh C; Gupta, Neeraj
Pneumothorax is a common complication in pulmonary tuberculosis that is usually seen with underlying cavitary lesion. However, it is uncommonly seen in patients with miliary tuberculosis. This communication describes bilateral spontaneous pneumothorax in an 18 years’ old female patient having miliary tuberculosis.
Bio-safety precautions in tuberculosis laboratory.
(2013-07) Singh, Sarman
Blastoschizomyces Capitatus Pneumonia in an immunocompetent female.
(2011-04) Gill, Parmjeet Kaur; Gill, Jaspal Singh
Pulmonary infection due to Blastoschizomyces capitatus is less common. It is an emerging fungal pathogen. We describe a case of Blastoschizomyces capitatus pneumonia in an otherwise healthy female and review the clinical presentation, microbiological characteristics, and treatment for B .capitatus infection.

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