|Immune response to Mycobacterium Tuberculosis culture filtrate antigen in cured spinal tuberculosis patients and their spouses
Sunil Mathan Kurian,P.Selvaraj,A.M.Reetha,Nirpani Charles,Anila Anna Mathan and P.R.Narayanan
Humoral and cell mediated immune responses were studied in cured spinal tuberculosis patients and their spouses to understand immunity to tuberculosis in cured patients. Antibody titre and immune complex levels were measured and lymphocyte response to Mycobacterium Tuberculosis culture filtrate antigen was observed in cured spinal tuberculosis patients (n=30)and their spouses(n=27). A trend towards increased antibody titre was seen in cured patients as compared to their spouses. Significantly increased circulating immune complex levels ,as measured by PEG OD280(polyethylene glycol optical density 280)were seen in the contacts compared to cured patients. And a trend towards increased lymphocyte response to Mycobacterium Tuberculosis culture filtrate antigen was seen with different antigen concentrations(0.1,1 and 10üg/ml)Moreover the effect of active pulmonary tuberculosis(ATB)plasma taken from HLA-DR2 positive and DR22 negative patients on lymphocyte response of the cured patients showed no dramatic immunomodulatory effect in the lymphocyte response when treated with DR2 positive or DR2 negative plasma. The study suggests that the memory response to Mycobacterium Tuberculosis is well maintained even after 10-15 years of treatment
A comparison of liquid and solid culture media with radiometric system for detection of mycobacteria in clinical specimens
A.Bhargava,A.Jain and S.K.Agarwal
The present study was done on 100 consecutive specimens, received in the tuberculosis laboratory for culture of mycobacteria to determine the sensitivity of and time taken by Lowenstein Jensen(LJ)medium,Middlebrook 7H9(MB7H9)broth and BACTEC 460 radiometric system. Out of 100, a total of 59 specimens tested positive for acid fast bacilli(AFB)by microscopy and 65 were culture positive by one or another culture technique. In all 59 were positive on LJ medium with sensitivity of 90.8% and average detection time of five weeks,60 were positive by BACTEC radiometric system with sensitivity of 92.3% and average detection time of three weeks and MB7H9 broth showed positive growth in 45 specimens with average detection time of six weeks and sensitivity of 62.9%. Two cases were detected by LJ medium,3 by BACTEC and one by MB7H9 broth exclusively.
The results suggest that although LJ and BACTEC are more sensitive culture methods than MB7H9 broth and BACTEC is more rapid and sensitive than other two ,yet none are 100% sensitive. Simultaneous use of all three is suggested for more efficient isolation of mycobacterium species.
Diagnosis of tuberculosis under RNTCP:Examination of two or three sputum specimens
-Rohit Sarin,S.Mukerjee,Neeta Singla and P.P.Sharma
The Revised National Tuberculosis Control Progaramme(RNTCP) recommends examination of 3 sputum smears for diagnosis. This may not be practicable under all conditions specially in difficult areas. It further adds to the cost of diagnossis and causes inconvenience to patients. In order to study the diagnostic yield of examining only two smears and the additional yield by the third smear,a retrospective study of the data from RNTCP area and of the LRS Institute was carried out for the years 1998 and 1999.
In 1998,in all 719 sputum positive patients were diagnosed out of 3738 new chest symptomatics examined(19.2%)and in 1999,there were 1044 sputum positive patients from 4189 new chest symptomatics examined(24.9%). The diagnostic yield of a single sputum specimen examined is insufficient under field conditions, especially were the sputum positivity is low. However sputum positivity of two or more sputum smears examined (spot, early morning, spot), the early morning specimen had the best result.
It is concluded that under field conditions, two sputum smears(one of which is early morning)is as effective as three smears for screening of chest symptomatics. Reduction in the number of smears to two is expected to reduce cost(for patients as well as health care provider)without compromising quality. However before changing national programme policy ,more studies in different situations(rural areas, difficult areas, etc )is recommended.
Integrating Private Health Care in National Tuberculosis Programme: Experience from Ernakulam-Kerala
-Marina Rajan Joseph,Sunny Porathel and C.K.Eapen.
Background: A private institution in Ernakulam took initiative in distributing antituberculosis drugs on behalf of the district tuberculosis programme(DTP) through their Community Medicine Department. A model for integrating private and public health systems in tuberculosis control was thus evolved.
Methods: A critical review of the patients treated for tuberculosis in this project over 3 years was made to evaluate the model. Patient records and feedback from patients received through a postal survey were used for the review.
Results There was 87.7% cure rate, no relapse within 6 months of follow up and 80% had resumed normal life.
Conclusion: A viable model model of how the District Tuberculosis Programme can be integrated into private health care system which is contacted by more than 40% of the patients is presented. Counselling and modified ways of ensuring treatment completion have achieved cure rates comparable to results achieved in DOTS
A comparison of unsupervised treatment along with intensive health education and directly observed treatment in pulmonary tuberculosis
-R.Prasad,D.M.Rizavi,Surya Kant and A.Jain
This study was conducted on newly diagnosed sputum smear positive patients of pulmonary tuberculosis to compare the outcome of treatment given under direct observation and unsupervised treatment along with intensive health education
Out of a total of 89 patients studied,51 were given directly observed intermittent short course treatment as per the recommendations under the Revised National Tuberculosis Programme for Category I patients and 38 were given the same regimen unsupervised along with intensive health education.
The treatment was successful(either cured or treatment completed)in 46(90.20%)of the patients on directly observed treatment and 34(89.47%)of the patients on unsupervised treatment along with intensive health education. Three patients(5.88%)of the directly observed group and 3 (7.89%) of the unsupervised group defaulted during treatment.
It is concluded that the effect of intensive health education on the outcome of treatment is similar to that of direct observation of treatment. Thus it may be possible to replace direct observation of treatment with intensive health education in situations where implementation of directly observed treatment is difficult.
Performance of National Tuberculosis Programme:January to September 1999- A report
-S.J.Savanur and K.M.Vasudeva.
The National tuberculosis Institute is monitoring the national tuberculosis programme.The reports recived from DTC's for the above mentioned period have been analysed.Some salient findings are
Case finding efficiency
Ratio of smear positive to smear negative:1:2.5(Expected 1:1)
- 5%(Expected 8%)
- 12.5%(Expected 18%)
The authors feel that the performance of DTP is far below the expectations in all respects
- Standard regimen
- 30%(Making 10+collections)
- Short course chemotherapy
This summary only is by webmaster
Recurrent Poncet's disease-A rare presentation
-K.B.Gupta and Prem Prakash
A case of active pulmonary tuberculosis presenting as Poncet's disease(tuberculous rheumatism)with recurrence after 10 years is reported because of its unique presentation
Tuberculous osteomyelitis of sternum in a diabetic
-Anupam Prakash and H.S.Hira
A middle aged diabetic woman who presented with a painless swelling of upper middle part of anterior chest was diagnosed to be suffering from the comparatively rare tuberculosis of sternum.Pertinent literature is reviewed along with the case report
The above are only abridged summaries.You may please refer the original articles for details
Besides the above Volume features a brief review of the fifty fifth national conference on tuberculosis and chest diseases by M.M.Singh