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RESPIRATORY DISEASES (103 journals)                     

Showing 1 - 104 of 104 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
Advances in Thoracic Diseases     Open Access   (Followers: 1)
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 259)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 17)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 2)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 1)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 6)
Breathe     Open Access   (Followers: 4)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 1)
Canadian Respiratory Journal     Open Access   (Followers: 3)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 102)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 15)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 1)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 3)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 3)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal  
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 13)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 4)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 4)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 4)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 4)
Journal of Respiratory Research     Open Access   (Followers: 1)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 2)
Lung Cancer     Hybrid Journal   (Followers: 16)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 1)
Open Respiratory Medicine Journal     Open Access   (Followers: 1)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 1)
Pulmonology and Respiratory Research     Open Access   (Followers: 1)
Respiratory Care     Full-text available via subscription   (Followers: 10)
Respiratory Investigation     Full-text available via subscription  
Respiratory Medicine     Hybrid Journal   (Followers: 18)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 17)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 35)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 38)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  


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Journal Cover
Indian Journal of Tuberculosis
Journal Prestige (SJR): 0.221
Number of Followers: 0  
  Full-text available via subscription Subscription journal
ISSN (Print) 0019-5707
Published by Elsevier Homepage  [3204 journals]
  • Intramedullary Tuberculoma of the Spinal Cord,Clinical features & Imaging:
           possibility of early diagnosis with imaging'
    • Abstract: Publication date: Available online 6 April 2019Source: Indian Journal of TuberculosisAuthor(s): Vijay sardana, Prashant shringiAbstractInvolvement of vertebral column is common in tuberculosis(TB) but intramedullary tuberculomas are rare. Spinal intramedullary tuberculoma are extremely rare, seen in only 2 of 100,000 cases of TB and 2 of 1000 cases of CNS TB. Intramedullary tuberculomas normally respond well to conventional antituberculous medications, requiring surgery only occasionally.MRI is optimal diagnostic modality in intramedullary tuberculoma as it can show specific findings. This report describes a case of Intramedullary Tuberculoma of the Spinal Cord with clinical features and specific MRI findings with review of litreture.
  • “Diagnostic dilemma of an isolated Inguinal clinical cold abscess -
           ' Suppurative,' EPTB, ' NTM Infection- A rare and interesting
           case report
    • Abstract: Publication date: Available online 5 April 2019Source: Indian Journal of TuberculosisAuthor(s): S. SumathiAbstractCold abscess is an abscess without local pain and warmth and it usually accompanies Tuberculosis. The site varied depending upon the organ affected and cervical region is the commonly affected one. Cyto-morphology of cold abscess usually showed caseation type of necrosis, lymphocytes and granuloma with degenerated epithelioid cells.Here we presented an inguinal cold abscess in 9 years old girl with unique cyto-morphology of plenty of neutrophils, foam cells and lymphocytes in fine needle aspiration smear without caseation necrosis and epithelioid cells. Presence of Mycobacterium in the aspirated pus was proved by Ziehl-Neelsen as well as Auramine fluorescent staining. This characteristic cyto-morphology of mycobacterium infection mimicking pyogenic abscess emphasizes the importance of Ziehl-Neelsen staining in all abscess for early specific diagnosis and effective treatment.
  • The Risk of Refeeding Syndrome Among Severely Malnourished Tuberculosis
           Patients in Chhattisgarh, India
    • Abstract: Publication date: Available online 4 April 2019Source: Indian Journal of TuberculosisAuthor(s): Puja Chebrolu, Timothy Laux, Shaheen Chowdhury, Bhavna Seth, Prajakta Ranade, Jaya Goswami, Soumya ChatterjeeAbstractBackgroundA secondary care hospital in rural India serving a highly tuberculosis (TB) and malnutrition endemic region.ObjectiveIn this study conducted on patients with chronic protein energy malnutrition (PEM) and TB, we sought to compare nurse-estimated vs. smartphone photograph analytic methods for assessing caloric intake and determine the incidence of refeeding hypophosphatemia (RH) and refeeding syndrome (RFS) in patients with TB.MethodsInpatients were prospectively enrolled. Baseline demographic, comorbidity and preadmission caloric data were collected. Nurse estimated caloric intake was compared with digital “before and after” meal images. Serum phosphorus was measured on days 1, 3 and 7 post admission. Patients with RH underwent further evaluation for RFS-associated findings..Results27 patients were enrolled. 85% were at risk of RFS by National Institute for Health and Care Excellence (NICE) criteria. Significant discrepancy (>700 calories) was noted between nurse-estimated caloric intake compared to digital images. RH was found in 37% (10 / 27). None developed clinical RFS.ConclusionsOur study suggests more standardized methods of caloric intake are needed in resource-limited settings with high co-prevalence of PEM and TB. We noted that despite RH being common in inpatients with PEM+TB given high caloric diets, RFS was not detected.
  • Role of Microbiological tests in diagnosis of genital tuberculosis of
           women with infertility: A view
    • Abstract: Publication date: Available online 30 March 2019Source: Indian Journal of TuberculosisAuthor(s): Monika Agrawal, Partha Roy, Vinay Bhatia, Sarjana Dutt, Ravi Gaur
  • For Drug Resistance (DR) TB is there any strength in the old warriors
    • Abstract: Publication date: Available online 26 March 2019Source: Indian Journal of TuberculosisAuthor(s): Rajeev Soman, TanuSinghal, Anjali Shetty, Camilla Rodrigues
  • Metformin: A Review of its Potential as Enhancer for Anti Tuberculosis
           Efficacy in Diabetes Mellitus-Tuberculosis Coinfection Patients
    • Abstract: Publication date: Available online 8 March 2019Source: Indian Journal of TuberculosisAuthor(s): Bernadette Dian NovitaAbstractMetformin is the most commonly prescribed drug for type 2 diabetes mellitus. Nowadays metformin is also use for efficacy in diabetes mellitus-tuberculosis coinfection patients through several mechanisms, such increasing superoxide production therefore activation isoniazid is increasing; inducing adeno-monophosphate kinase (AMPK) associated autophagy process; and regulating inflammation cytokines. This article will review the mechanism of action of Metformin as enhancer for anti tuberculosis efficacy.
  • Literature review of oral tuberculosis and report of a case with unique
           histological presentation
    • Abstract: Publication date: Available online 7 March 2019Source: Indian Journal of TuberculosisAuthor(s): Shruti Tandon, Vishnudas Bhandari, Arundeep Kaur Lamba, Farrukh Faraz, Kanika Makker, Kamal AggarwalAbstractAs a consequence of the emergence of drug resistant tuberculosis (TB) and various immuno-compromised states, there is a re-emergence of many forgotten extrapulmonary manifestations of TB including oral TB, which must be taken into consideration while diagnosing oral lesions. The present article discusses the geographical burden, temporal evolution, demographic variables, clinical presentation and treatment of oral TB. The occurrence is most commonly secondary to pulmonary TB but oral symptoms may precede systemic symptoms. The most common presentation is ulceration (71%) and histopathological specimens demonstrate the characteristic epithelioid and langhans cells. In a unique case, presented here, an ulcerative tuberculous gingival lesion demonstrated dense plasma cell infiltration histologically and closely mimicked plasma cell gingivitis which made the diagnosis challenging.
  • Regulating E-cigarettes in India: A conundrum for the global giant in
           tobacco production
    • Abstract: Publication date: Available online 6 March 2019Source: Indian Journal of TuberculosisAuthor(s): Rishal Relita Mendonca, V. Anoop Narayanan, D.S. Sandeep, Aysha Ruman, R. Narayana CharyuluAbstractElectronic cigarettes which are termed as e-cigarettes, e-cigs or e-vaporizers are used by the people for creating the inhalable aerosol which carries nicotine in it. Also, commonly referred as vaping. E-cigarettes are used as an alternative to the regular cigarettes and aids in the cessation of smoking. However, there has been tough strife and debate regarding e-cigarettes that are accompanied in the media stories which bring different opinions among consumers, experts as well as regulators who are involved in making decisions from no regulation to regulating e-cigarettes to banning of e-cigarettes which will bring direct impact on public health. In this article, an overview about the controversy of e-cigarettes with respect to the device, its market, regulation norms of e-cigarettes at different platforms and amidst the debate over e-cigarettes banning in India has been portrayed. It is surveyed that India being a hub of around 110 million tobacco smokers and a global giant in tobacco production, where the Indian government is planning to bring a complete ban over e-cigarettes throughout the country propels an elementary question of banning safer alternatives and not regular cigarettes which makes no sense from the point of banning e-cigarettes until or unless regular cigarettes are banned. Varying point of views from experts, scientists, users with respect to e-cigarettes has been addressed which shares a mix opinion with the supporters promoting ban as well as the antagonist with the concept of regulating the e-cigarettes in India.
  • Impact of pharmacist counseling and leaflet on the adherence of pulmonary
           tuberculosis patients in lungs hospital in Indonesia
    • Abstract: Publication date: Available online 6 March 2019Source: Indian Journal of TuberculosisAuthor(s): Hidayah Karuniawati, Okta Nama Putra, Erindyah Retno WikantyasningAbstractBackgroundOne of the goals of counseling in patients with chronic diseases including tuberculosis patients is to improve adherence to taking medication. By patient adherence, therapeutic results are more optimal. Additional counseling alternatives such as leaflets may be needed to make easier for patients to obtain information about their treatment. This study aimed to analyze the effectiveness of counseling with and without leaflets on the adherence on taking tuberculosis (TB) drugs.MethodsThis study was a quantitative research conducted using a quasi-experiment method with a control group for pre-test and post-test design. Data was taken by consecutive sampling. The number of samples in this study was 75 respondents which divided into three groups: counseling, counseling with leaflets, and control that is a usual care in hospital. The inclusion criteria were patients diagnosed with pulmonary tuberculosis with age 25–55 years, who has been taking TB medicines for at least one month and can communicate well. Data was analyzed using Wilcoxon and Kruskal–Wallis with post hoc Mann–Whitney due to abnormality of the distributed data.ResultsBefore the intervention, of 20 respondents (42.6%) out of 75 respondents were obedient to their TB medicines, whereas after the intervention the number of obedient patients was 33 respondents (70.2%). There was a significant increase in adherence between before and after two weeks of counseling intervention with a p-value of 0.029 before and after two weeks of counseling with leaflets with a p-value of 0.003. Counseling and counseling with leaflets improved patients' adherence compare to control group with p-values of 0.028 and 0.001 respectively.ConclusionCounseling and counseling with leaflet impact in patients' adherence to tuberculosis medication.
  • Immune reconstitution inflammatory syndrome in non-HIV patients with
           tuberculosis. A case series
    • Abstract: Publication date: Available online 6 March 2019Source: Indian Journal of TuberculosisAuthor(s): Deepak Aggarwal, Manisha Bhardwaj, Arjun Kumar, Varinder Saini, Nishit SawalAbstractTuberculosis associated Immune reconstitution inflammatory syndrome (IRIS) in a HIV negative patient can present with a multitude of clinic-radiological presentations that are often confused with drug resistance/treatment failure. Being a diagnosis of exclusion, this clinical entity is often prone to under-diagnosis. We present a series of 5 patients who presented with varied but uncommon IRIS manifestations. High index of suspicion coupled with clinical reasoning and judicious use of phenotypic and genotypic culture methods helped in their timely detection and successful treatment.
  • Lessons learnt from an old foe
    • Abstract: Publication date: Available online 18 February 2019Source: Indian Journal of TuberculosisAuthor(s): Sushma Krishna, Ranjini SrinivasanAbstractNeurotuberculosis usually responds well to standard antitubercular therapy. Some; patients have prolonged course A 11 year old boy diagnosed TBM, an immunocompetent patient, had an unusual course of illness in the form of prolonged fever, persistent hyponatremia and CSF; pleocytosis despite adequate treatment. Clinical course in the management of TBM can be; protracted with complications despite adequate therapy.
  • Front loading sputum microscopy: Honing the diagnosis of pulmonary
    • Abstract: Publication date: Available online 22 January 2019Source: Indian Journal of TuberculosisAuthor(s): Prabhat Kiran Khatri, Vikrant Negi
  • Byssinosis and tuberculosis amongst “home-based” powerloom workers in
           Madhya Pradesh State, India
    • Abstract: Publication date: Available online 18 January 2019Source: Indian Journal of TuberculosisAuthor(s): Sarabjit Chadha, Debashish Kundu, Karuna Sagili, Anand DasAbstractBackgroundByssinosis is an occupational lung disease observed among workers exposed to cotton, flax, and hemp dust. The severity and extent of Byssinosis are well recognised in the high-income countries and control measures have been implemented to prevent the disease. In India, there are conflicting evidence on burden estimation of the disease, followed by inadequate prevention and control of Byssinosis.Design/methodsWe did a cross-sectional study to assess the prevalence of Byssinosis in “home-based” power-loom workers in Mominpura, an administrative ward of Burhanpur Municipality with 2800 population in the state of Madhya Pradesh, India. 290 adults working from “home-based” power loom units were randomly selected, profiled and screened for Byssinosis like symptoms with the help of a semi-structured questionnaire and simple hand-held peak expiratory flow monitor. For epidemiological purposes the symptoms were classified based on Schilling's classification. Chest x-rays were done for selected subjects. Sputum smear microscopy for detecting TB was done for those who had Byssinosis like symptoms.ResultsPrevalence of Byssinosis among “home based” powerloom workers was found to be 98% [n = 283, 95 CI (95.65–98.96)]. Peak expiratory flow rate (PEFR) was reduced in 44% (n = 124), of which 81 (29%) had more than 50% PEFR reduction, and of these, 69 (29%) were in early stage of Byssinosis (Grade 0.5). 11% of study participants who had Byssinosis like symptoms, also had TB.ConclusionsByssinosis is highly prevalent in “home-based” power loom units in Madhya Pradesh. Adequate advocacy on awareness and prevention; prompt diagnosis and linkages to treatment services in “home-based” power loom units are urgently required to address Byssinosis at an early disease stage.
  • Limitations of CBNAAT for diagnosis of mycobacterium tuberculosis in
           gastric aspirate and pleural fluid
    • Abstract: Publication date: Available online 16 January 2019Source: Indian Journal of TuberculosisAuthor(s): Vivek Chauhan, Suman Thakur, Rajesh Kumar Sood, Kamlesh Thakur
  • Endo-bronchial application of glue in the management of hemoptysis
    • Abstract: Publication date: Available online 16 January 2019Source: Indian Journal of TuberculosisAuthor(s): Rakesh K. Chawla, Arun Madan, Aditya ChawlaAbstractBackgroundHemoptysis from varied etiologies, often fails to respond to conservative therapy. The conventional managements of such a situation are Bronchial Artery Embolization (BAE) or thoracic surgery which is often not possible. Endoscopic application of glue may stand as a method of therapy in these circumstances.Methods202 patients of hemoptysis were treated by video-bronchoscopy assisted endobronchial application of glue (n-butyl cyanoacrylate) with the help of polyethylene catheter being placed through the working channel. The details of the procedure and their 6 month follow up are presented.ResultsImmediate control of hemoptysis was achieved in 183 i.e. 90.59% of patients. 19 patients had a partial response, i.e., hemoptysis stopped and then recurred, endobronchial application of glue was repeated in them out of which 14 (6.9%) responded to the second procedure whereas 5 (2.47%) failed to show any response in spite of the repeated procedure. The complication rate was 0.49% in the form of glue migrating into the trachea. There was no mortality.ConclusionEndobronchial application of glue for hemoptysis can be an effective, economic and alternative therapy for mild to moderate hemoptysis.
  • A rare case of coexistence of allergic bronchopulmonary aspergillosis
           (ABPA) and active pulmonary tuberculosis- Role of CBNAAT in ABPA
    • Abstract: Publication date: Available online 12 January 2019Source: Indian Journal of TuberculosisAuthor(s): Swetabh Purohit, Varsha Joshee
  • Peritoneal tuberculosis with benign ovarian tumor
    • Abstract: Publication date: Available online 4 January 2019Source: Indian Journal of TuberculosisAuthor(s): Manju Lata Verma, Vartika Tripathi, Uma Singh, Preeti Agarwal, Rekha Sachan, Pushp Lata Sankwar
  • Pharmacokinetics of rifabutin during atazanavir/ritonavir
           co-administration in HIV-infected TB patients
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Geetha Ramachandran, A.K. Hemanth Kumar, T. Kannan, R. Sridhar, S.K. Guha, Deelip Kadam, N. Poorana Gangadevi, T. RajapandianAbstractBackground & objectiveRifabutin (RBT) is the rifamycin that is recommended to treat tuberculosis (TB) in HIV-infected individuals during combination antiretroviral therapy (ART) containing HIV protease inhibitors (PIs). We studied the pharmacokinetics of rifabutin at doses of 300 mg thrice weekly and 150 mg daily during concomitant atazanavir/ritonavir (ATZ/r) administration in adult HIV-infected TB patients treated in the Revised National TB Control Programme (RNTCP) in India.MethodsThis was a multi-centric study conducted in 45 adult HIV-infected TB patients, who were being treated for TB with a RBT-containing regimen and an antiretroviral treatment regimen with ATZ/r, at doses of 300 mg thrice-weekly (n = 36) or 150 mg daily (n = 9). Serial blood draws at pre-dosing and at 1, 2, 4, 6, 8, 12 and 24 hours after drug administration were done. Plasma RBT was estimated by high pressure liquid chromatography (HPLC).ResultsThe peak concentration (Cmax) of both doses were within the therapeutic range (0.45–0.90 μg/ml) of RBT. Proportion of patients having Cmax above or below the therapeutic range and trough concentration (Cmin) below the minimum inhibitory concentration of RBT did not significantly differ between the two doses. TB treatment outcomes were also similar at both doses.ConclusionsThis is the first and only study from India reporting on the pharmacokinetics of RBT at 300 mg thrice weekly and 150 mg daily doses. Both doses yielded similar plasma RBT concentrations, outcomes and were well tolerated. RBT can be administered at either doses during ATZ/r co-administration in HIV-infected patients with TB.
  • A prospective study on quality of life in patients with pulmonary
           tuberculosis at a tertiary care hospital in Kashmir, Northern India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Shabir Ahmad Dar, Naveed Nazir Shah, Zaid Ahmad Wani, Deeba NazirAbstractBackgroundPulmonary Tuberculosis (PTB) is a contagious, airborne infection that destroys when M. tuberculosis primarily attacks the lungs. PTB is curable with an early diagnosis and antibiotic treatment. Stigmatization and negative emotions resulting from the illness could result in long term impairment of patients psychological well being which may result in work absenteeism resulting in loss of productivity and reduced monthly income.MethodsThis was a prospective study which was conducted over a period of one and half year. A total of 198 patients were recruited for the study. Quality Of Life (QOL) was assessed at baseline and at the end of intensive phase. For QOL WHO based QOLBREF was used.ResultsIn the present study patients scored lowest in the baseline physical (8.36 ± 1.60) followed by the psychological domain (10.40 ± 1.72) however at the end of intensive phase both physical (11.98 ± 1.70) and psychological (12.75 ± 1.) domains improved very much and the difference was statistically significant.ConclusionWe conclude that HRQOL is significantly reduced in patients with PTB, and that it improves rapidly and significantly with DOTS-based intensive phase of treatment. Special focus on reduction of stigmatization should be given in the management of TB to reduce the psychological distress.
  • Efficacy and safety of cholecalciferol-augmented anti-tuberculosis therapy
           for treatment of naïve patients with pulmonary tuberculosis: A
           randomized, controlled, clinical study
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Ahmad Farooq Alsayed Hasanain, Ali Abdel-Azeem Hasan Zayed, Rasha Bakheet Abd-ellatief, Amany Mohamed Adawi NafeeAbstractBackground/objectiveVitamin D deficiency may contribute to the therapeutic failure of antituberculosis therapy (ATT). The aim of this study is to explore the role of adding cholecalciferol to the standard ATT in improving the therapeutic outcome among the naïve patients with pulmonary tuberculosis (TB).MethodsA randomized, controlled, clinical study, which included 496 naïve patients with pulmonary TB, was carried out. The patients were randomly allocated to two groups. Group-A included 247 patients who received ATT, while group-B included 249 patients who received ATT with cholecalciferol.ResultsThe rate of therapeutic failure among the study population was 29.4%; it was significantly lower among patients of group-B compared to those of group-A (22.1% (95% CI 14.7–26.2) vs 38.1% (95% CI 31.5–46.1), p 0.036). In addition, the rate of early therapeutic response was significantly higher among patients of group-B compared to those of group-A (35.3% (95% CI 29.6–42.3) vs 19.4% (95% CI 15.1–24.6), p 0.041). Incidence rate of adverse effects was 19.3%; it was higher (although not statistically significant) among patients of group-A compared to those of group-B (21.9% vs 16.9%).ConclusionsIn conclusion, cholecalciferol-augmented ATT can be more efficacious in treating naïve patients with pulmonary TB compared to the standard ATT. In addition, adding vitamin D3 to ATT provides extra protection against the hepatic and muscular adverse effects of ATT.
  • Impact of integrated psycho-socio-economic support on treatment outcome in
           drug resistant tuberculosis – A retrospective cohort study
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Rama Bhatt, Kamal Chopra, Rohit VashishtAbstractObjectiveTo assess the impact of providing integrated psycho-socio-economic support to drug resistant tuberculosis (DRTB) patients on the treatment outcome under programmatic conditions.Study designRetrospective cohort study.SettingAn urban district TB centre in India under the Revised National Tuberculosis Control Programme.ParticipantsA cohort of 123 patients who started DRTB treatment between June 2010 and May 2013.MethodsPatients started on treatment for DRTB between June 2010 and May 2013 who were provided with the integrated support package for at least 3 months formed the supported group while the other patients of the cohort formed the non-supported group. The treatment outcomes and sputum culture conversion rates were compared between the two groups.ResultsThe supported group consisted of 60 patients and the non-supported group of 63 patients. The treatment success rate was found to be significantly higher in the supported group (65% vs 46.03%; p = 0.0349). Support duration was significantly associated with lower incidence of death [HR 0.876, 95% CI 0.811–0.947; p = 0.0009] and loss to follow up [OR: 0.752, 95% CI 0.597–0.873; p = 0.0023]. The treatment failure rate was higher in the supported group (16.66% vs 4.76%) with 60% of the failures in the supported group occurring after 24 months of compliant treatment. There was no significant association found between support duration and treatment failure or sputum culture conversion.ConclusionIntegrated support seems to significantly increase the treatment success rate and improve survival and treatment adherence of DRTB patients. However, early diagnosis and effective pharmacotherapy are crucial for reducing treatment failures.
  • Sensitivity and specificity of screening tools and smear microscopy in
           active tuberculosis case finding
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): V.K. Chadha, S.M. Anjinappa, Kiran Rade, D. Baskaran, P. Narang, C. Kolappan, J. Ahmed, P. PraseejaAbstractSettingCommunity based five pulmonary tuberculosis (PTB) surveys among adults.ObjectivesEstimate sensitivity and specificity of screening tools for PTB and sputum microscopy.MethodsFor each survey site, we estimated sensitivity and specificity of different screening criteria and microscopy against culture; pooled estimates were obtained using Random Effects Model.ResultsSensitivity of cough alone, screening for any symptom (persistent cough ≥2 weeks, fever or chest pain ≥1 month, hemoptysis), any symptom or history of anti-TB treatment (h/o ATT) were 56.2%, 66% and 71.2% respectively; specificities were 95.3%, 93.8% and 92.7% respectively.X-ray when used alone for primary screening had sensitivity and specificity of 76.6% and 97.3% respectively. When used along with screening for cough, these figures were 94.3% and 93.1%, and 100% and 97.3% when used with any symptom and h/o ATT. When used for secondary screening, sensitivity and specificity of X-ray was 66.8% and 87.8% respectively after primary screening for cough, 65.0% and 89.8% after screening for any symptom, and 67.1% and 86.7% when used after screening for any symptom or h/o ATT.Pooled sensitivity and specificity of smear was 46.2% and 99.3% respectively.ConclusionProgram managers may use these estimates while evaluating algorithms for active case finding.
  • Catastrophic costs of treating drug resistant TB patients in a tertiary
           care hospital in India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Jai B. Mullerpattan, Zal Z. Udwadia, Radhika A. Banka, Shashank R. Ganatra, Zarir F. UdwadiaSummaryBackgroundPrivate healthcare is choice of point of care for 70% of Indians. Multidrug resistant tuberculosis (MDR-TB) treatment is costly and involves duration as long as 2 years.AimTo estimate costs to patients undergoing treatment for MDR-TB.MethodsA health-economics questionnaire was administered to 50 consecutive patients who successfully completed ambulatory private treatment for MDR-TB. Direct costs included drug costs, investigations, consultation fees, travel costs, hospitalisation and invasive procedures and cost prior to presentation to us. Indirect costs included loss of income.ResultsOf our cohort of 50 patients, 36 had pulmonary TB while 14 had extra-pulmonary TB (EPTB). 40 had MDR-TB and 10 had XDR-TB. There were 15 males and 35 females. Mean age was 30 years (range 16–61 years). Treatment cost for pulmonary MDR-TB averaged $5723 while it averaged $8401 for pulmonary XDR-TB and $5609 for EPTB. The major expense was due to drug costs (37%) while consultation fees were only 5%. Annual individual income for the cohort ranged from $0 to $63,000 (mean $11,430). On average, the cost of treatment ranged from 2.56% to 180.34% of the annual family income. 34/50 (68%) had total costs greater than 20% of annual family income and 39/50 (78%) had total costs greater than 10% of annual family income. The number of patients with total costs>40% of total family income was 22.ConclusionMDR-TB in the private sector results in “catastrophic health costs”. Financial and social support is essential for patients undergoing treatment for MDR-TB.
  • Clinical study of spinal tuberculosis presenting with neuro-deficits in
           Western India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Bhumika Vaishnav, Nilay Suthar, Sameer Shaikh, Rahul TambileAbstractBackground/objectivesSpinal tuberculosis (TB) is a destructive extra-pulmonary disease manifestation of Mycobacterium tuberculosis infection. It is responsible for many cases of paraparesis and quadriparesis in developing countries where patients seek treatment late. The aim of this study was to understand and analyze the clinical and radiological profile of patients with spinal TB and correlate it with the anatomical site affected by it.MethodsA retrospective, observational study of 100 cases of spinal TB admitted over a period of three years. Data on demography, clinical signs and symptoms and investigations were analyzed.ResultsIncidence of spinal TB was found to be the highest in the third and fourth decade of life (45%). Incidence among males was 64% and females was 36%. Low socioeconomic class (72%) and past history of pulmonary TB (34%) were found to be risk factors for spinal TB. Average duration between onset of symptoms and time of presentation to the hospital was 154 ± 15.5 days. Patients with bone involvement presented later than those without bone involvement. Paraplegia (91%) and backache (62%) were the most common clinical presentation. Thoracic spine involvement (36%) and vertebral wedging and destruction (58%) were the commonest X-ray findings. 69% patients had compressive lesion with vertebral body destruction being the commonest cause of compression.ConclusionsSpinal TB with neurological deficits affected the thoracic spine. Compressive spinal cord lesions were the common form of presentation of spinal TB. Paraplegia with backache and neurological bladder-bowel involvement were the most prevalent neuro-deficits. Magnetic resonance imaging of the spine proved to be the most useful investigation to differentiate and localize the site of tubercular lesions.
  • Characteristics and sputum conversion of tuberculosis (TB) patients in
           Kalutara, Sri Lanka
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Sumal Nandasena, Chaminda Senavirathna, Champa Munasinghe, Chapa Wijesena, Ridmi SucharitharathnaAbstractBackgroundTuberculosis (TB) is an infectious bacterial disease; remains as one of the important public health problem affecting every part of the world. Substantial number of TB cases are reported from Sri Lanka every year irrespective of its strong preventive health system. The aim of this analysis is to describe the characteristics of TB patients and to assess the factors associated with sputum conversion. This analysis was based on the data from the District Chest Clinic of Kalutara district, Sri Lanka.MethodsInformation of all newly diagnosed and registered patients in the District Chest Clinic, Kalutara in year 2013 were ascertained. Out of 687 newly reported TB patients, 669 records were included in final analysis.ResultsMajority of patients were males (n = 451, 67.4%), in the age group of 36–60 years (n = 306, 45.7%) and underweight (n = 359, 61.7%). Substantial proportion of normal weight or overweight adult patients (92.1%) had sputum conversion at 2–3 months as compared to underweight adult patients (82.5%) (p = 0.034). Those who smoke tobacco is less likely to have sputum conversion at 2–3 months as compared to non-smokers (90.2% vs. 82.1%, p = 0.045).ConclusionProvision of good nutrition, maintaining of appropriate body mass index (i.e., BMI), and abstinence from smoking and alcohol consumption are important for sputum conversion among smear-positive pulmonary TB patients.
  • Association between vitamin D receptor gene polymorphisms and pulmonary
           tuberculosis in a Mexican population
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Beatriz Silva-Ramírez, Cyntia A. Saenz-Saenz, Leonardo A. Bracho-Vela, Katia Peñuelas-Urquides, Viviana Mata-Tijerina, Brenda L. Escobedo-Guajardo, Nelly R. González-Ríos, Ofelia Vázquez-Monsiváis, Mario Bermúdez de LeónAbstractBackground and aimsThe impact of host genetic variation in susceptibility of tuberculosis is well documented. The vitamin D receptor gene (VDR) is a transacting transcription factor which mediates innate immune response by enhancing the expression of several antimicrobial peptides, including cathelicidin. An association between VDR polymorphisms with tuberculosis (TB) has been investigated in different ethnic groups; however there are contradictions and inconsistencies in the results. The aim of this study was to evaluate the association between polymorphisms of functional VDR with the susceptibility to pulmonary tuberculosis in a Mexican population.MethodsA case–control study was performed in, 257 patients with pulmonary tuberculosis and 457 healthy controls recruited from: family medicine clinics of the Mexican Social Security Institute. The VDR gene polymorphisms Fok I (rs 2228570), BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236) were genotyped by TaqMan assays. Statistical analysis was performed using: Epi Info V-7 and SNP Stats software.ResultsNo statistically significant associations were observed in genotype and haplotype distribution between BsmI, ApaI and TaqI polymorphisms and disease susceptibility. The CC genotype for the VDR gene FokI was significantly more frequent in patients than in controls (29.6% versus 17.5%, OR = 1.97; 95% CI = 1.37–2.8, PC = 0.0004). Moreover, TT genotype was decreased in patients as compared to the control group (24.1% versus 34.8%, OR = 0.59; 95% CI = 0.42–0.84, PC = 0.004).ConclusionTo our best knowledge, this is the first case-control study that finds an association between CC genotype of FokI SNP in the VDR gene with pulmonary tuberculosis in Mexican patients. However more validation studies should be performed to prove our conclusions.
  • Metformin induced autophagy in diabetes mellitus – Tuberculosis
           co-infection patients: A case study
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Bernadette Dian Novita, Mulyohadi Ali, Agung Pranoto, Endang Isbandiati Soediono, Ni Made MertaniasihAbstractMetformin (MET) is a potential combination drug to elevate anti-TB efficacy. However, the clinical effect, especially smear reversion, during metformin applied with anti-tuberculosis and insulin in patients with type 2 DM newly TB co-infection were remain unknown.An observational clinical study was done in DM newly TB co-infection outpatients at Surabaya Paru Hospital. This study evaluated MET therapy, at least 2 months, accompanying with insulin and anti-TB regimens and compared to comparison group. The smear, microtubule-associated Protein1 Light Chain 3B (MAP1LC3B) level, as the presentation of autophagy, Superoxide Dismutase (SOD) level, Interferon (IFN)-γ and Interleukin (IL)-10 levels were evaluated twice.From 42 participants in this study, 22 participants of observation group that received additional MET therapy, 100% had sputum smear reversion after 2-months intensive phase of anti-TB therapy. Whereas 25% of 20 participants of comparison group did not undergo reversion inserts sputum smear.As conclusion, MET has the potential of being an additive combination therapy to enhance the bactericidal effect of anti-TB on DM-TB coinfection patients. Metformin enhances the effects of anti-TB and insulin therapy in increasing the smear reversion by increasing autophagy.
  • Feasibility of a mobile based Continuing Medical Education (CME) program
           for recent updates in the medical colleges of Himachal Pradesh, India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Dinesh Kumar, Ashok Kumar BhardwajAbstractBackgroundMobile based messaging system provides a platform to communicate to health care professionals of medical colleges for an updated knowledge in Revised National Tuberculosis Control Program (RNTCP) in the state of Himachal Pradesh.Material and methodsPragmatic trial under routine programmatic conditions was planned in which an automated messaging system was developed along with development of message banks tailored for medical faculty (total 335) with respect to their discipline.ResultsMessage banks were developed by the research team by referencing the relevant training modules and guidelines under RNTCP. Two message banks consisted of relevant message lines were developed; one was for case notification, revised presumptive definition, and revised diagnostic methods and general information and another one was for INDEX-TB guidelines. Different combinations –input system – of message lines were decided and designed for both message banks. Input system was kept for one-month cycle with delivery of messages on fixed day and at fixed time (usually at 19:00 h on a selected day) to ensure sustained interest and effective reading time for messages.ConclusionMobile based medical education program to the medical faculties proved to be feasible and useful to keep them updated about recent changes in the RNTCP.
  • Spectrum of central nervous system tuberculosis: An experience from a
           large tertiary care institution of India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Rajan Ingole, Ravindra Kumar Garg, Hardeep Singh Malhotra, Amita Jain, Neeraj Kumar, Imran Rizvi, Rajiv GargAbstractObjectivesCentral nervous system (CNS) is an important site for extrapulmonary tuberculosis. The present study evaluated the spectrum of CNS tuberculosis in a high tuberculosis endemic region.MethodsThe study included 306 cases of CNS tuberculosis. All cases were assessed for clinical evaluation and neuroimaging. All cases were followed up for 3 months. Modified Barthel index was used to assess the outcome.ResultsOut of 306 cases of CNS tuberculosis, 174 (56.86%) had intracranial tuberculosis, 55 (17.97%) had spinal tuberculosis, 15 (4.91%) had both intracranial and spinal pathology. Sixty-two (20.26%) patients had disseminated tuberculosis. Two-hundred and fourteen (69.9%) cases had tuberculous meningitis. Disseminated tuberculosis patients had significantly poor modified Barthel index and 3-month outcome. Culture positivity was significantly higher in the disseminated group. Ten (27.02%) out of 37 culture positive tuberculous meningitis cases had multi-drug-resistant tuberculosis. On multivariate analysis disseminated tuberculosis, baseline modified Barthel index ≤12, and stage 3 predicted poor outcome. Fifty-five patients had spinal tuberculosis. Thirty-four (75.56%) patients with Pott's spine improved with antituberculosis treatment and only 11 (24.44%) patients had modified Barthel index ≤12, after 3 months.ConclusionsIn tuberculosis-endemic areas a varied form of CNS tuberculosis is frequent. CNS tuberculosis is often part of disseminated tuberculosis.
  • Cough of more than two weeks – Time to think beyond pulmonary TB
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Manu Chopra, D. Bhattacharyya, M.S. Barthwal, G.D.S. Madan, B. Chakrabarthy, I.M. Pandey, Meenakshi ChopraAbstractBackgroundCough of more than two weeks has become sine quo non with pulmonary tuberculosis (PTB) in a developing country like India. The causes may be different in patients reporting to respiratory OPD vis a vis general OPD.Aims and objectivesTo study the prevalence of PTB and causes of cough other than PTB among respiratory OPD attendees with cough of more than two weeks duration.MethodsA cross sectional study was carried out over two years in respiratory OPD of a tertiary care chest center of Indian armed forces. Of the 13,004 patients, 505 non HIV PTB suspects were included. Patients with definitive diagnosis of chronic cough were excluded. Efforts were made to establish diagnosis of pulmonary TB using clinical, microbiological and radiological features. However, patients were also subjected to further evaluation (spirometry, bronchoscopy, CECT) based on clinical features, radiological and lab profile to establish definitive diagnosis.ResultsOut of the 505 patients, 10.5% patients had smear positive pulmonary TB, 13.5% smear negative PTB, bronchial asthma (24%), COPD (9.3%), diffuse parenchymal lung diseases (DPLD's) (12.5%), bronchiectasis (6.3%), lung cancer (5.3%) and congestive cardiac failure (4.2%).ConclusionThough prevalence of PTB in the study correlated well with the national statistics, but a significant number of patients had other causes of chronic cough, especially, obstructive airway diseases and DPLDs. Thus, there is a need to spread awareness regarding other causes of chronic cough and all efforts should be made to establish alternate diagnosis especially in patients who do not conclusively have PTB.
  • Identifying and mapping TB hot spots in an urban slum by
           integratingGeographic positioning system and the local postman – A pilot
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Chitra C. Iravatham, Venkata Sanjeev Kumar Neela, Vijaya Lakshmi ValluriAbstractSettingMahavir DOT Centre, Hyderabad, Telangana, IndiaIntroductionUrban slums are characterized by crowding, poverty. In such setting due to lack of infection control the transmission of tuberculosis is known to rise, thereby creating a “Hot” spot. Distribution of residences in such areas does not necessarily follow postal codes, making it difficult for health workers to locate TB patients unless accompanied by the STLS.ObjectiveTo investigate the utility of integrating the help of local postman and geographic positioning system (GPS) to identify and create map of hot spots in an area under a regional DOT centre.Materials & methodsRetrospective and prospective demographic data of TB patients enrolled during 12 years (1999–2011) was analysed from the TB register at a ward where number of cases continued to increase despite active implementation of DOTS strategy. Non-Spatial data was generated with the local postman identifying individual house addresses. The corresponding co-ordinates were recorded with GPS and uploaded in Google Earth to identify the locations.Area map was created by software (AutoCAD, Map R3, MapInfo Pro 7.5 Trial Version and MS office Tools). Residences of Index patients were marked in different colours year wise on the map.ResultsMaps displayed in the DOT centre area helped in identifying HOT SPOT and visualization of the clustering of TB cases in the area. Time interval between subsequent infections (3 months–5 years) could be calculated in the locality, within household, neighbourhood and random contacts. Average distances (
  • Achieving TB elimination in India: The role of latent TB management
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Nandini Sharma, Saurav Basu, Kamal K. ChopraAbstractThe elimination of Tuberculosis (TB) in settings with a high dual burden of active and latent TB is one of the most important public health challenges of the 21st century. India has the highest TB burden in the world and nearly 40% of the population being infected with TB. There also exist large often overlapping socially and medically vulnerable populations like the PLHIV, pediatric TB contacts, children with protein-energy malnutrition, homeless people, workers in silica industry and adults with low BMI. A significantly higher risk of progression into active tubercular disease exists in those with compromised immune or nutritional status. It is uncertain if global TB elimination targets can be achieved in the absence of aggressive LTBI treatment strategies for interrupting the chain of transmission of the disease. India hence needs to accelerate and prioritize capacity building in latent TB research. A research agenda is outlined for generating evidence towards the evolution of critical evidence-based policy for LTBI management under Indian health settings.
  • Tuberculosis control in India: Refocus on nutrition
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Bhagya Shaji, E.T. Arun Thomas, P.K. SasidharanAbstractMany western societies have eliminated tuberculosis years before the advent of potent anti-tuberculous drugs, as a result of the improved standards of living and good nutrition. But even with the availability of powerful anti-tuberculous drugs, India still has a long road ahead to reach the “End TB by 2025” goal. One of the major reason is that tuberculosis control program in India till now have focused primarily on case detection and medical treatment of active tuberculosis. Drug treatment alone does not completely prevent the occurrence of new infections in the community and also contributes to development of drug resistant strains if used improperly or incompletely. Although the treatment of active cases can reduce the period of transmission of disease, a significant amount of transmission to contacts occurs even before they have been diagnosed and treated. Additionally, this approach cannot prevent re-activation to active TB in the vast pool of persons with latent TB infection. Tuberculosis occurs in those with suppressed cell mediated immunity mainly due to poor nutritional status. Improving the nutritional status of the society by several social interventions hand-in-hand with utilizing the available anti-tuberculous drugs is possibly the only effective strategy. Promising programmatic guidance for nutritional support in TB patients have been formulated by the Central TB division of India but it needs a refocusing of TB control strategies towards nutrition at all levels and strong public health actions for effective implementation.
  • Development of new drug-regimens against multidrug-resistant tuberculosis
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Mahesh S. Vasava, Sneha G. Nair, Sanjay K. Rathwa, Dhaval B. Patel, Hitesh D. PatelTuberculosis (TB) being the leading infectious killer in the domain wherein globally, almost 20% of all TB strains are resistant to at least 1 major TB drug and there's a growing incidence of multi-drug resistance tuberculosis (MDR-TB). Looking at the current scenario and challenges the existing strategies fall back in terms of treatment of TB. So, to overcome this new, stronger, improved TB drug pipeline and a new standard for the development of novel anti-TB drugs are required in order to make more drug-resistant and efficient drug which also lower the duration period of the treatment of the TB. This review article aims to highlight the recent developments in the anti-tuberculosis agents, those are currently in the clinical development stage.Graphical abstractImage 1
  • Breast tuberculosis
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Richa Sinha, RahulAbstractTuberculosis (TB) of breast is an uncommon entity even in endemic regions. Moreover, it is seldom reported. It often presents in young lactating females as a painless breast lump and confused with breast malignancy or pyogenic abscess. A high index of suspicion is required. Fine needle aspiration cytology is important to direct the patient to further tests pertaining to TB. New diagnostic modalities based on detection of nucleic acids have improved the accuracy and cut down the time to diagnosis. Anti-tubercular chemotherapy remains the standard of care. Surgical intervention is seldom required.The fact that the disease being rare, having symptom overlap with commonly prevalent breast malignancy and potentially curable, it becomes important to analyze the presentation, available investigative modalities for early goal directed treatment.
  • Occupational tuberculosis in sewage workers: A neglected domain
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): V.K. Arora, Kalpana Chandra, Mina Chandra
  • Effect of transport temperature on the viability of Mycobacterium
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Prabha Desikan, Nikita Panwalkar, Protiti Bose, Kudsia Ansari
  • Initial experience of bedaquiline implementation under the National TB
           Programme at NITRD, Delhi, India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Rohit Sarin, Neeta Singla, Vikram Vohra, Rupak Singla, M.M. Puri, Sushil Munjal, U.K. Khalid, V.P. Myneedu, Ajoy Kumar Verma, K.K. MathuriaAbstractBackgroundBedaquiline (BDQ) was approved for treatment of drug resistant TB (DR-TB) under Conditional Access Programme (CAP) of Revised National Tuberculosis Control Programme (RNTCP) and was also implemented in the National Institute of TB and Respiratory Diseases (NITRD). We present early efficacy and safety of BDQ containing regimens for DR-TB.ObjectiveTo ascertain the early efficacy and safety of Bedaquline containing regimens in treatment of DR-TB.MethodsBDQ containing regimens along with other drugs were designed as per WHO recommendations for DR-TB patients. They were followed up for sputum smear and culture conversion, adverse events during the treatment.ResultsA cohort of 290 DR-TB patients (Median age-29.77) were initiated on BDQ containing regimens. Of the available Sputum results, smear conversion was seen in 51% and 91% patients at the end of 1st week and 3rd month respectively. Similarly, 93% and 98% patients had culture conversion at the end of 3rd and 6th month respectively. 201 adverse events (AE) including 47 deaths were reported among 109 patients. QTc prolongation was seen in 29% patients but only 4 required discontinuation of BDQ. Lost to follow up of treatment was about 6%.ConclusionBedaquiline along with an optimized background regimen has shown early sputum conversion in larger number of difficult to treat patients having additional resistance of second line drugs along with INH and Rifampicin. The regimen is feasible in programmatic conditions and is relatively safe.
  • N-TB: A mobile-based application to simplify nutritional assessment,
           counseling and care of patients with tuberculosis in India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Anurag Bhargava, Madhavi Bhargava, Tripti Pande, Raghuram Rao, Malik ParmarAbstractUndernutrition is the most prevalent comorbidity in patients with tuberculosis (TB) in India. Undernutrition is often severe and results in higher risk of death, drug toxicity during treatment, poor functional status at end of treatment and a higher risk of relapse after successful treatment. A World Health Organization guideline has recommended nutritional assessment, counseling, and care as integral parts of TB care. The Revised National Tuberculosis Control Programme has recognized undernutrition as a significant comorbidity, released a guidance document for improving nutritional care and support, and launched a scheme for direct bank transfer of monthly cash benefit to TB patients. However, there are gaps at the provider level on nutritional assessment, due to challenges in calculation and interpretation of body mass index (BMI). A mobile based application has been developed for use in the programme, which makes estimation of BMI possible, classifies the severity of undernutrition, suggests triage and clinical actions based on the BMI, indicates desirable body weight corresponding to a BMI of 21 kg/m2, and the daily caloric and protein intake for underweight patients with active TB. The app also provides tips for dietary counseling for TB patients, information on the major food groups, emphasizes an adequate and balanced diet from locally available foods for nutritional recovery of TB patients.
  • Burden of pulmonary tuberculosis in modern prison: A cross sectional
           prevalence survey from south India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Chandra Kumar Dolla, Baskaran Dhanraj, Muniyandi Malaisamy, C. Padma Priyadarshini, S. Syeed Hissar, Mohan Natrajan, Rajendran Krishnan, Srikanth Prasad TripathyAbstractBackgroundThe risk of spread of Pulmonary Tuberculosis (PTB) disease depends on several factors. One important factor is the situational and environmental vulnerabilities of the prison setting. Study was conducted in central prison in Chennai, south state, India to estimate the prevalence of PTB disease in 2013.MethodsAll inmates aged 15 years and above were available during survey period screened for symptoms suggestive of PTB and X-ray taken chest PA view. Two sputum specimens were collected for smear and culture examination. All culture positive samples were used for drug sensitivity testing for first line anti-TB drugs. Information on demographic, life style characteristics, past history of PTB treatment were collected through pre-coded interview schedule.ResultsOf 1854 jail inmates were screened, prevalence of symptoms suggestive of PTB was 35% and it was dominated by males. Out of all screened 16 PTB cases are diagnosed and the estimated overall prevalence of PTB among prison inmates was 16/1854 (863/100,000 population).ConclusionsPrevalence PTB was 2.5 times higher as compared to prevalence of PTB in general population in the same areas, and 3.4 times higher as compared to national average.
  • Early efficacy and safety of Bedaquiline and Delamanid given together in a
           “Salvage Regimen” for treatment of drug-resistant tuberculosis
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Rohit Sarin, Vikram Vohra, Neeta Singla, Rupak Singla, M.M. Puri, S.K. Munjal, U.K. Khalid, V.P. Myneedu, Ajoy Verma, K.K. MathuriaAbstractBackgroundDrug-Resistant Tuberculosis (DR-TB) patients for whom a WHO recommended regimen along with Bedaquiline (BDQ) cannot be prescribed, Delamanid (DLM) was added along with other drugs to provide a “Salvage Regimen”. The experience of the Institute in respect of early efficacy and safety of both drugs given together is presented.ObjectiveTo ascertain the early efficacy, safety and tolerability of Bedaquline and Delamanid given together as a part of salvage regimen.MethodsBDQ and DLM were used together to make regimens along with other drugs where four effective anti TB drugs could not be prescribed as per WHO recommendations. Patients were followed up for sputum smear and culture conversion and adverse events during the treatment.ResultsIn this cohort study, 53 DR-TB patients (Median age-24) were initiated on regimens containing both BDQ and DLM. Sputum smear conversion was seen in 35% and 94% patients at the end of 1st week and 3rd month respectively. 84% patients had culture conversion at the end of 4th month. 29 adverse events (AE) were reported among 17 patients and there were 11 deaths. QTc prolongation more than 500 MS was seen in only 1 patient.ConclusionBDQ and DLM given together in a salvage regimen is efficacious with low rate of adverse events. The combination provides hope to DR-TB patients with limited treatment options and should be provided as a life saving option.
  • Journey of tuberculosis control in India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): V.K. Arora, K.K. ChopraAbstractNTP was pilot tested in Anantapur district of Andhra Pradesh during 1961 and thereafter the programme was launched throughout the country.In 1992, the Government of India together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA) reviewed the National TB Programme and concluded that it suffered from managerial weakness, inadequate funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion and lack of systematic information on treatment outcomes. Programme review showed that only 30% of patients were diagnosed and only 30% of those treated successfully. Based on the findings and recommendations of the review in 1992, the GOI evolved a revised strategy and launched the Revised National TB Control Programme (RNTCP).
  • Active tuberculosis case finding in India – The way forward
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): V.K. Chadha, P. PraseejaAbstractCommunity based active case finding (ACF) for tuberculosis (TB) has seen resurrection in the current armamentarium of many TB managers in their fight toward eliminating TB. This article explores the accuracy and approximate cost of various ACF algorithms currently in vogue in India or those which could be useful, while inputting the sensitivity and specificity of screening and diagnostic tools as estimated from recently conducted community based surveys. This analysis informs that ACF may be prioritized to higher prevalence settings and the diagnostic algorithm for specific setting may be chosen taking into account the expected prevalence, estimated accuracy of the algorithm and resource availability. Further, chest X-ray cannot be used alone as a diagnostic tool and can be relied upon for this purpose when at least one of the three sputum specimen is smear positive. Accuracy of Xpert MTB/RIF as a diagnostic tool in community situations needs to be investigated further.The review brings out significant proportions of initial default and default during treatment among cases detected through ACF thus emphasizing the need for heightened efforts toward preventing the same. The article rounds off emphasizing priority to addressing barriers to speedy scale up of more sensitive diagnostic tools for health center based case finding including in private sector and ACF in high risk clinical groups for early and efficient case detection. It concludes by putting forth certain research areas that would strengthen future efforts.
  • Reflections on the end TB strategy
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Hans L. Rieder
  • End TB – Strategy – A dream to achieve
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): K.K. Chopra, V.K. Arora
  • Identifying costs contributing to catastrophic expenditure among TB
           patients registered under RNTCP in Delhi metro city in India
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Rohit Sarin, Vikram Vohra, Neeta Singla, Beena Thomas, Rajendran Krishnan, Malaisamy MuniyandiAbstractBackgroundTuberculosis (TB) patients often incur large costs related to illness, as well as for seeking and receiving health care. Despite TB treatment being free under RNCTP, out of pocket expenditure incurred (OOP) by patients for TB diagnosis and treatment impoverishes the households. This expenditure may turn catastrophic (more than 20% of their family income) impacting adherence and leading to poor treatment outcomes.ObjectiveTo estimate the proportion of households experiencing catastrophic expenditure due to TB and also to find out the various costs contributing to catastrophic expenditure.MethodsIn this cohort study, 450 TB patients (including 96 children) registered under Revised National Tuberculosis Control Programme (RNTCP) in Delhi were interviewed at three different time points (in the beginning of treatment, end of intensive phase, end of treatment). Interview schedule was used to collect information on direct medical and non-medical, and indirect costs. The TB-specific indicator of “catastrophic total costs” incorporates both, direct medical and non-medical payments for treatment such as transportation, lodging charges and indirect costs such as wage loss.ResultsA total of 450 patients were enrolled in this study, out of which 425 were followed up to the end of treatment. It was observed that 7% of TB patients registered under RNTCP in Delhi experienced catastrophic expenditure due to TB. The total mean cost to patients with TB was Rs. 12165 (Rs. 1406 during diagnosis and Rs. 10759 during treatment). The indirect cost was higher compared to direct cost i.e.Rs. 7564 and Rs. 4601 respectively).ConclusionThis information will be useful for policy makers to design an intervention to provide financial protection to TB patients. In addition, findings of this study will aid in providing baseline evidence to periodically measure the OOP which is the one of the End TB strategy target.
  • Tuberculosis and other chronic morbidity profile of sewage workers of
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Kalpana Chandra, Vijay Kumar AroraAbstractBackgroundSewage management is hazardous due to chronic exposure to chemical gases, bioaerosols and micro-organisms through inhalation; accidental oral intake and penetration through skin or mucous membranes through injuries or breech in personal protective equipment. While there has been some research on isolated infections and multisystem symptom profiling of sewage workers, there is little research on the burden of chronic illnesses like Tuberculosis and Non Communicable Diseases (NCDs).MethodsA cross sectional observational study was conducted on chronic comorbidity profile of sewage workers with more than five years of occupational experience and employed in three contiguous districts of NCT of Delhi.ResultsThe study sample consisted of 104 sewage workers with mean age of 50.71 (±8.43) years, an average of 7.35 (±3.75) years of formal education and an average occupational exposure to sewage work of 21.28 (±10.54) years.21.15% sewage workers had Tuberculosis and 92.31% had at least one of the chronic respiratory diseases (COPD, Asthma or ACOS). 85.6% of participants were smokers. The most common NCD was Hypertension (67.3%) followed by Dyslipidaemia (50%) and Diabetes Mellitus (43.3%). There was clustering of NCDs with 53.85% subjects having three or more chronic disorders. Less than 5% of study participants were free from all the investigated chronic diseases.ConclusionThe sewage workers have an adverse chronic morbidity profile for both Tuberculosis and NCDs. There is an urgent need for epidemiological research and targeted screening and public health intervention for Tuberculosis and other NCDs in sewage workers as an occupational group.
  • Changes of CRP serum levels in pulmonary TB patients with AFB
           smear-positive sputum before and two months after receiving
           anti-tuberculosis drug treatment
    • Abstract: Publication date: January 2019Source: Indian Journal of Tuberculosis, Volume 66, Issue 1Author(s): Soedarsono Soedarsono, Mochamad Cahyo SubiantoroAbstractBackgroundPulmonary tuberculosis (TB) produces an inflammatory process of the lung parenchyma. While effective treatment of pulmonary TB and disease resolution processes have an impact on decreasing inflammatory conditions of the pulmonary parenchyma. This stimulates researchers to investigate changes in lung parenchymal inflammatory conditions detected from changes of C-reactive protein (CRP) serum levels pre and post two months of anti-tuberculosis drug treatment.ObjectivesTo know the changes of CRP serum levels in pulmonary TB patients with Acid Fast Bacillus (AFB) smear-positive sputum before and 2 months after receiving anti-tuberculosis drug treatment.MethodThis study used prospective cohort study design, conducted in pulmonary outpatient unit at Dr. Soetomo General Hospital Surabaya from March to June 2013. Sample size was 30 pulmonary TB patients with AFB smear-positive sputum. AFB sputum grading and CRP serum level was measured before and 2 months after receiving anti-tuberculosis drug treatment. International Union Against Tuberculosis and Lung Disease (IUATLD) scale was used for AFB sputum grading. CRP serum was measured using immunoturbidimetric method.ResultThe average CRP serum levels of pre anti-tuberculosis drug treatment were 6.48 ± 4.27 mg/dL in males and 6.28 ± 5.26 mg/dL in females. After two months of anti-tuberculosis drug treatment, the average CRP serum levels were 1.21 ± 1.94 mg/dL in males and 1.21 ± 1.22 mg/dL in females. Sputum conversion occurred in 27 out of 30 samples after two months of anti-tuberculosis drug treatment.ConclusionThe CRP serum levels was not significantly different in patients with pulmonary TB who experienced sputum conversion compared to patients without sputum conversion after two months of anti-tuberculosis drug treatment.
  • Oxidative stress, antioxidant status and lipid profile in pulmonary
           tuberculosis patients before and after anti-tubercular therapy
    • Abstract: Publication date: Available online 4 December 2018Source: Indian Journal of TuberculosisAuthor(s): Ramachandran Vidhya, Krishnamoorthy Rathnakumar, Vaithialingam Balu, Kodukkur Viswanathan PugalendiAbstractBackgroundPulmonary tuberculosis (PTB) is a highly infectious dreadful disease caused by mycobacterium tuberculosis (MTB). Numerous studies reported free radicals activity, antioxidant status and lipid profile in PTB patients, but previous studies have lacunae in comparing the biochemical variables between before and after anti-tubercular therapy (ATT) supplementation to PTB patients. Hence, the present study was carried out to investigate oxidative stress markers, antioxidant status, lipid profile, liver function markers, and glycoprotein components in pulmonary tuberculosis patients (PTB) patients before and after 60 days of ATT.MethodsThis is a case-control study carried out with 100 healthy subjects and 110 PTB patients. All the patients diagnosed with sputum test and were positive for acid fast bacilli (AFB) were included for the study. An informed consent was obtained from all the patients.ResultsOur study found increased levels of oxidative stress markers, decreased enzymatic and non-enzymatic antioxidants, altered lipid profile in PTB patients as compared to healthy subjects before treatment and these levels were restored after clinical improvement with ATT. We also found increased concentrations of liver function parameters and components of glycoprotein in PTB patients. ATT refurbished lipid levels, antioxidant status and oxidative stress markers with decrease in liver function enzymes and glycoproteins in PTB patients.ConclusionCo-supplementation of antioxidants, along with ATT and inclusion of nutritious diet could be useful to reduce the pathogenesis of PTB and is warranted as a future study for the management of PTB.
  • Brainstem tuberculoma: A delayed IRIS
    • Abstract: Publication date: Available online 3 December 2018Source: Indian Journal of TuberculosisAuthor(s): Arunmozhimaran Elavarasi, Vinay GoyalAbstractWe describe a twenty six years old lady with tuberculous meningitis who developed new onset left ptosis and binocular diplopia with features of left fascicular 3rd nerve palsy after 9 months of anti tubercular therapy (ATT) and imaging revealed new onset tuberculoma in the mid-brain. Tuberculoma responded to steroids while continuing ATT. Formation of new tuberculoma as a part of immune reconstitution inflammatory syndrome (IRIS) is possible even after prolonged therapy of 9 months, which responded well to only steroids without altering ATT.
  • Mycobacterium avium-intracellulare septic arthritis of the
    • Abstract: Publication date: Available online 19 November 2018Source: Indian Journal of TuberculosisAuthor(s): Apostolos Vrettos, Maria Prasinou, Ehtasham Ahmad, Dionyssios Malamis, Abdul KhanAbstractA 34 year-old lady was referred for rheumatology review by the orthopaedic team for further investigation of chronic left sternoclavicular joint pain. No preceding event such as trauma, injury or infection had occurred. A rheumatology workup turned out to be negative for an inflammatory arthropathy. After extensive investigations including blood tests, an MRI scan, a CT scan, and a bone scan, and in consultation with the orthopaedic team, the affected joint was biopsied and tested for mycobacterium avium-intracellulare infection. The results came back as positive and the patient was started on anti-mycobacterial treatment. We report the diagnosis, management and 3-year follow-up of this unique case. This highlights an uncommon and often misdiagnosed cause of septic arthritis caused by mycobacterium avium-intracellulare infection. To our knowledge this is the first confirmed sternoclavicular mycobacterium avium-intracellulare infection in an immunocompetent host reported in the literature.
  • Gastric tuberculosis
    • Abstract: Publication date: Available online 10 November 2018Source: Indian Journal of TuberculosisAuthor(s): Poras Chaudhary, Abdul Qayoom Khan, Romesh Lal, Utsav BhadanaAbstractTuberculosis of the stomach is an extremely rare manifestation of Mycobacterium tuberculosis infection and mimics gastric carcinoma in its presentation. Most of our knowledge about this rare disease comes from case reports and there are only a few case series published on this disease and thus the majority of the part remains uncovered. Diagnosis is made commonly only after a major surgery. Endoscopy and guided biopsy are the diagnostic modality of choice. Surgery is indicated in cases which present with complications. Patients respond well to antituberculous therapy. The authors encountered 4 cases of gastric tuberculosis over 5 years. This study summarises the available literature and gives comprehensive update on this rare disease.
  • Gastric tuberculosis presenting as non healing ulcer: A case report
    • Abstract: Publication date: Available online 5 November 2018Source: Indian Journal of TuberculosisAuthor(s): Piyush Manoria, Hanni V. GulwaniAbstractTuberculosis is a major health problem in India. Gastrointestinal tuberculosis is the sixth most common causes of extrapulmonary tuberculosis and it mostly involves the ileocaecal region. Primary gastric tuberculosis in immunocompetent person is very rare. Stomach as its site is rare and is the sixth most common site of gastrointestinal tuberculosis. It mostly presents as a cases of non healing ulcer or gastric outlet obstruction. Yield of endoscopic biopsies for granuloma is low due to submucosal location of these lesions and mostly they are diagnosed after surgical intervention. We report a case of isolated gastric tuberculosis in a middle age immunocompetent female who present as a cases of non healing ulcer and responded well to standard antitubercular treatment. A high index of its suspicion should be kept in mind in any chronic infiltrative lesions of stomach like non healing ulcers and gastric outlet obstruction for its early diagnosis and treatment.
  • Quantitative estimation of isoniazid content in the commercially available
           and government-supplied formulations
    • Abstract: Publication date: Available online 2 November 2018Source: Indian Journal of TuberculosisAuthor(s): S.S. Niranjan Prabhu, Jeana Dibu, Premila Wilfred, Devashish K. Chaudhary, Chriset Jeyaraj, Margaret Shanthi, Aniket KumarAbstractBackgroundMulti-drug resistant tuberculosis is on the rise, resulting in treatment failure. One potential reason for drug resistance is the substandard quality of manufactured antituberculous drugs. This study aims at finding out the difference in the quantity of isoniazid between government-supplied tablets and commercially available tablets.MethodTablets from the single most commonly used brand of isoniazid manufactured by a pharmaceutical company and from RNTCP DOTS providing centre were obtained for the estimation of concentration using a spectrophotometer. The results were analysed using Un-paired Student's t-test.ResultsOf the 98 isoniazid tablets from each arm studied, none had the strength that deviated from the WHO limit of 90–110%, i.e. 270–330 mg. The mean strength ±SD of the commercial preparation of isoniazid tablets was found to be 295.16 ± 12.14. The mean strength ± SD of DOTS isoniazid tablets was found to be 298.69 ± 9.55. The difference observed in the strengths of isoniazid tablets between DOTS and commercial preparation was statistically insignificant (p = 0.1704).ConclusionThis method to estimate the strength of isoniazid tablets is inexpensive, relatively easy, and considerably accurate to perform, and hence can be employed in primary or secondary care centres to ensure the standard strengths of tablets dispensed from such centres.
  • Tuberculosis diagnostic and treatment practices in private sector:
           Implementation study in an Indian city
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): V.K. Chadha, Bhoomika Bajaj Bhalla, Sowmya B. Ramesh, J. Gupta, N. Nagendra, R. Padmesh, J. Ahmed, R.K. Srivastava, R.K. Jaiswal, P. PraseejaAbstractSettingImplementation study in private health facilities in an Indian metropolis.ObjectivesImprove Tuberculosis (TB) care by private practitioners (PPs).MethodsPPs from a defined city area were imparted short training in TB care and linkages made with public facilities; subsequent practices were recorded.ResultsOf 364 presumptive TB patient records, 70 (19.3%) did not conform to its definition. Of the conforming, 174 (59.2%) had presumptive pulmonary TB (PTB), 53 (18%) presumptive extra-pulmonary (EPTB) and 67 (24%) had both. Of conforming presumptive PTB, most underwent Chest X-ray and sputum examination in private laboratories. Tissue based diagnostics were not advised for most presumptive EPTB patients. Of 101 cases diagnosed with TB, 82% were new, 23% known diabetic and 4.7% human immune deficiency virus (HIV) reactive out of 64 tested. Most were notified and initiated treatment within 15 days of diagnosis. One-fourth was prescribed standard treatment regimen and treatment was not directly observed for most. One third was initial defaulters or lost during treatment; 62% of PTB and 46% EPTB cases initiated on treatment in private were successfully treated. Of successfully treated PTB cases, 61% had undergone follow-up sputum examination.ConclusionMuch intensified support mechanisms are needed to improve TB care in private sector.
  • Delineating the factors associated with recurrence of tuberculosis in
           programmatic settings of rural health block, Himachal Pradesh, India
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Dinesh Kumar, Chirag Goel, Avi Kumar Bansal, Ashok Kumar BhardwajAbstractBackgroundTuberculosis (TB) recurrence observed to be an important event in its treatment and has future implications under national TB control efforts. The present study was carried out to assess the recurrence rate along with its risk factors among patients undergoing treatment for TB under Revised National TB Control Program (RNTCP).Material and methodsTotal 204 patients in health block of district Una, Himachal Pradesh were studied using pretested structured interviewer-administered questionnaire. Along with univariate a non-hierarchal multi-way frequency analysis (MFA) was done to study the one and multi-way effects between the discrete variables included in a hypothesized model. The variables were under-nutrition, pulmonary TB, injecting drug use (IDU), multi-drug resistant (MDR) TB, and past TB (recurrent cases).ResultsTotal 29 cases (14.2%) had recurrence (17.7/100,000 population) with significantly high fraction for alternate residence (Recurrent: 50.0%, Non-recurrent: 47.4%; p = 0.001), Multi-drug resistance (MDR) TB (Recurrent: 13.8%, Non-recurrent: 2.3%; p = 0.003), and sputum negative patients (Recurrent: 51.7%, Non-recurrent: 14.5%; p = 0.000). Non-recurrent cases had significantly high fraction for sputum positive cases (Recurrent: 48.3%, Non-recurrent: 72.1%; p = 0.011), and extra-pulmonary TB (Recurrent: 00.0%, Non-recurrent: 13.4%; p = 0.036). MFA observed all significant one-way effects. Significant two-way effects were IDU and pulmonary TB (p = 0.001), MDR and past TB (p = 0.004), IDU and past TB (p = 0.019), and IDU and MDR-TB (p = 0.039).ConclusionProportion of TB recurrence was expected with a significant difference between the history of change of residence, MDR-TB, pulmonary and extra-pulmonary nature of the disease. Hypothesized model observed with a significant association of IDU, pulmonary TB, MDR-TB and past TB.
  • The clinical utility of cycle of threshold value of GeneXpert MTB/RIF
           (CBNAAT) and its diagnostic accuracy in pulmonary and extra-pulmonary
           samples at a tertiary care center in India
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Ashish K. Prakash, B. Datta, J.P. Tripathy, N. Kumar, P. Chatterjee, A. JaiswalAbstractBackgroundThere are knowledge gaps in the in-depth analysis of the most promising and robust diagnostic tool, GeneXpert MTB/RIF (CBNAAT). The cycle of threshold (CT) value of the CBNAAT test and its clinical implications has not been explored much.Aims and objectivesThe study aimed at (a) estimating the diagnostic accuracy and incremental yield of Xpert MTB/RIF in various specimens (b) establishing the association between CT value category (high, medium, low, very low) and culture time-to-positivity (TTP).MethodsA total of 1000 samples, both pulmonary and extra-pulmonary were collected from presumptive TB cases in a large tertiary care hospital. Sensitivity and specificity of CBNAAT was calculated with culture as the gold standard. The association of CT value with culture TTP was also studied.ResultsThe overall sensitivity of CBNAAT was 88.5%, with bronchial washing specimen being the most sensitive (92.3%) and pleural fluid being the least (66.7%). In smear negative individuals, the sensitivity of CBNAAT was 80.9%. The additional yield of CBNAAT over smear microscopy was 10.9%. It was observed that as we move from high to very low CT category, culture positivity decreases significantly (p 
  • A cross sectional study to assess the Tuberculosis Treatment Providers in
           the mid hills of India
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): S.K. Ajay, C. Sumit, B.K. Dimple, C. BhartiAbstractBackgroundA high level of knowledge about Tuberculosis amongst the Multi-Purpose Workers (MPWs) is the cornerstone for the successful implementation of Directly Observed Treatment Short-course (DOTS) strategy under the Revised National Tuberculosis control Programme of India. In this regard, the evaluation of MPWs, the major workforce of the Health Department of Solan district, has never been done in the past. Hence the present study was undertaken.MethodsObjective: To evaluate the knowledge about Tuberculosis among the MPW DOT and non DOT Providers.DesignA cross sectional study amongst 174 MPWs of the five Tubercular Units was conducted.Informed written consent was obtained. A pretested self-administered questionnaire was used.Data was analyzed in Microsoft Excel 2010 and IBM SPSS statistics version 21 software.Results85.6 per cent of the study participants were or had been DOT Providers. Only 9.2 per cent of the workers had received RNTCP Modular training whereas, 87.4 per cent had received just the ‘On the Spot training’ about DOTS. The difference in knowledge by Gender distribution across the five TUs was found significant.ConclusionThere is inadequate knowledge of tuberculosis amongst the MPW DOT and Non DOT Providers. Hence regular Modular and refresher trainings are recommended.
  • Prevalence of allergic bronchopulmonary aspergillosis in asthmatic
           patients: A prospective institutional study
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Kalaiyarasan, Anil Kumar Jain, Manmohan Puri, Devika Tayal, Ritu Singhal, Rohit SarinAbstractBackgroundAllergic bronchopulmonary aspergillosis (ABPA) is characterized by an allergic inflammatory response to colonization by Aspergillus species, most commonly Aspergillus fumigatus.AimTo study the prevalence of ABPA in asthmatic patients presenting to our institute.Materials and methodsAll consecutive asthma patients attending our allergy clinic Out Patient Department (OPD) over a period of 20 months were tested with skin prick test (SPT) for Aspergillus antigens and those who were found positive were further evaluated for ABPA using Greenberger's criteria.ResultsSeventy consecutive asthmatic patients were screened by SPT using Aspergillus antigens. Thirteen patients (18.57%) were found to be SPT positive, out of which nine patients (12.9%) were diagnosed as having ABPA using Greenberger's criteria. ABPA was common among 25–35 age group with no gender predilection. ABPA patients had longer duration of illness, predominantly mixed pattern in PFT, higher mean absolute eosinophil count (AEC) and serum total IgE compared to non-ABPA asthmatic patients. Specific IgE for A. fumigatus was positive in all ABPA patients and serum precipitins were positive in seven patients (77.58%). Chest X-ray abnormalities were seen in five patients (55.6%) and HRCT showed central bronchiectasis in eight patients (88.9%) with varying other radiological features. None were sputum fungal culture positive and five patients (55.6%) have been misdiagnosed as pulmonary tuberculosis in the past.ConclusionThe prevalence of ABPA is significantly higher in bronchial asthma patients presenting to tertiary care centers and hence awareness is required among physicians for early diagnosis and management of ABPA to achieve better asthma control and to avoid permanent lung damage.
  • Tuberculosis and HIV co-infection; the deadly duos in vulva
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Vikash Paudel, Deepa Chudal, Dinesh Binod PokhrelAbstractHuman Immunodeficiency Virus induced immune suppression leads the way for various infections with tuberculosis being the most common. Tuberculosis of the vulva is an extremely rare entity and is seen in only 1–2% of genital TB with increased risk in HIV co-infection. The co-infection places an immense burden on health care systems and poses particular diagnostic & therapeutic challenges with high mortality and morbidity. We present, here, a rare case of a 47 years postmenopausal female, who presented with itchy ulcerating lesions in the vulva with diagnostic dilemma turned to be vulval tuberculosis and during investigations, was found to be co-infected with HIV. The early diagnosis of TB and HIV in atypical looking lesions of vulva with high index of suspicion could lead to improved outcome.
  • Can sputum microscopy be replaced'
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): K.K. Chopra, M. Hanif.K.M, V.K. Arora, Himanshu Vashistha
  • What is the role of “T reg Cells” in tuberculosis
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Masoud Keikha, Mehdi Shabani, Sepehr Navid, Bahar Sadegh Ehdaei, Mohsen Karbalaei Zadeh Babaki
  • Two unusual reports of urogenital tuberculosis: One ‘putty’ kidney and
           another in association with benign prostatic hyperplasia
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Krishnendu Mondal, Rupali MandalAbstractIn India urogenital tuberculosis is the second commonest form of extra-pulmonary tuberculosis. Kidney is the highest and prostate is the least affected urogenital organ. But the extreme stage of renal tuberculosis named as ‘putty’ kidney is a rare manifestation. In general most cases of urogenital tuberculosis are quasi-symptomatic, and therefore an uttermost apprehension is needed from physicians to intercept such cases at the earliest. In this presentation we describe a case of ‘putty’ kidney, and another incidental association of prostate tuberculosis with benign prostatic hyperplasia.
  • Concomitant methicillin-resistant Staphylococcus aureus infection in
           tubercular sacroiliitis masquerading as anti-tubercular drug resistance:
           Role for molecular diagnosis
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Narendran Pushpasekaran, Deepak Gupta, Abhishek Kashyap, Sumit Arora, Ajay Kumar GuptaAbstractA 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right sided gluteal and thigh abscess. Suspecting treatment failure, surgical evacuation of purulent material was done. The bacteriological isolation showed positivity for methicillin-resistant Staphylococcus aureus. Although the microbiological and histopathology examination of the specimen were negative for tubercular isolates, the cartridge based –nucleic acid amplification tests revealed positive genes for Mycobacterium tuberculosis and additional primers showed sensitivity for rifampicin and isoniazid. She was adequately treated with vancomycin for six weeks and anti-tubercular drugs for eight months and followed till the bony ankyloses at 18 months. This is a rare case based scenario wherein concomitant staphylococcal infection in tubercular sacroiliitis masqueraded as anti-tubercular drug resistance. The cartridge-based nucleic acid amplification test for tuberculosis is a rapid and sensitive modality in identifying mycobacteria even mixed infections and also determine drug resistance. There are fewer consensuses in the literature regarding the drugs and duration of anti-tubercular regime for tuberculous sacroiliitis with most regimes using four drugs between six to eighteen months.
  • Metformin associated inflammation levels regulation in type 2 diabetes
           mellitus-tuberculosis coinfection patients – A case report
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Bernadette Dian Novita, Endang Isbandiati Soediono, Jusak NugrahaAbstractIFN-γ elevation is one of the indicators of successful treatment in active tuberculosis (TB) infection due to macrophage and Th-1 activation in inducing autophagy process. However, IL-10 also inhibits interferon-mediated mycobactericid activities by blocking IFN-γ; signaling pathways in autophagy. Therefore, ratio IFN-γ/IL-10 has to be greater than 1 (>1) then IFN-γ remains has anti-mycobacterium. Metformin (MET) is a potent combination drug to elevate anti-TB efficacy and able to regulate inflammation.In this study, an observational clinical study was done in diabetes mellitus (DM)-TB co-infection outpatients at Surabaya Paru Hospital. This study evaluated how MET therapy; affected inflammation. MET was used at least 2 months, accompanying with insulin and; anti-TB and as comparison to non MET group.The result in this study MET increased both pro-inflammatory and anti-inflammatory cytokines, thus MET may consider as adjunct therapy in DM-TB coinfection patients due; to its ability in Th-1 and Th-2 immuno-regulating response, especially to enhance IFN-γ; and to reduce insulin associated IL-10 upregulation.
  • Potential of adjunctive Mycobacterium w (MIP) immunotherapy in reducing
           the duration of standard chemotherapy against tuberculosis
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): Mamta Chahar, Krishan Dutta Rawat, P.V.J. Reddy, Umesh Dutt Gupta, Mohan Natrajan, Devendra Singh Chauhan, Kiran Katoch, Godavarthi B.K.S. Prasad, Vishwa Mohan KatochAbstractIntroductionThe need to shorten the treatment duration in tuberculosis has always been felt. Immunotherapy in combination with chemotherapy has been considered a promising approach for this purpose into tuberculosis. We studied the adjuvant immunotherapeutic activity of Mycobacterium indicus pranii (MIP or Mw) in combination with conventional chemotherapy using guinea pig of pulmonary tuberculosis infected with Mycobacterium tuberculosis H37Rv via aerosol.MethodsExperimental animals treated with standard chemotherapy and immunotherapy (MIP) separately and in combination of both. Guinea pig lungs evaluated following infection and subsequent therapy at predefine time point. Various cytokine mRNA expressions levels were quantified by quantitative reverse transcriptase PCR at the 4th, 8th and 12th week post-infection of M. tuberculosis.ResultsWe determined the time required for bacterial clearance from guinea pig lungs. Standard chemotherapy (RvCh) compared to the animals where chemotherapy plus Mw immunotherpay (RvChMwT) was given. It took 12 weeks to achieve bacterial clearance in the RvCh group while this was achieved in 8 weeks in RvChMwT group. Pro-inflammatory cytokines (IFN-γ, IL-2, IL-12p35 and TNF-α) level were higher in RvCh, RvChMwT and RvMwT group, while the IL-10 and TGF-β were suppressed.ConclusionCytokine expression level showed that Mw in conjunction with chemotherapy enhances the effect of pro-inflammatory cytokines (such as, IFN-γ, IL-2, IL-12 and TNF-α) and reduces the production and effect of anti-inflammatory cytokines (like IL-10 and TGF-β) thereby restoring the pro-inflammatory / anti-inflammatory cytokines balance. Thus, the present study indicates that subject to rigorous testing by other parameters, Mw (MIP) as adjunct immunotherapy has potential for reducing treatment duration.
  • “Identification of Non-Tuberculous Mycobacterium by LPA (CM/AS) assay,
           HPLC and biochemical test: which is feasible for RNTCP'”
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): George Sebastian, Sharath Burugina Nagaraja, Telagi Vishwanatha, Krishna Hemalatha, Narayana Vijayalakshmi, Prahlad KumarAbstractIntroductionNon-tuberculous mycobacteria (NTM) causing clinical disease have become increasingly common and more diverse. The development of fast, inexpensive, and reliable tests to identify nontuberculous mycobacteria is need of the hour especially under the Revised National TB Control Programme (RNTCP). The Aim of the study was to check the Diagnostic efficacy of the GenoType Mycobacterium CM/AS assay compared with HPLC and Biochemical Test for Identification of Non-Tuberculous Mycobacteria under the Revised Tuberculosis Control Programme.Methods and resultIt is a cross-sectional study, the suspected NTM culture isolates from the RNTCP accredited laboratories were sent to NRL for speciation and Identification. The culture positive isolates were subjected to Biochemical Identification Test, HPLC and LPA CM/AS. The LPA had 98.23% sensitivity, 50% specificity, 99.56% positive predictive value (PPV) and 20% Negative predictive value (NPV) when compared to HPLC considering Biochemical test as Gold reference standard. The comparison of HPLC and LPA for identification of each species using Mc Nemers Chi square test shown no significant difference between these tests.ConclusionConsidering Cost, Time and ease of performing the techniques, we recommend first do the basic biochemical test to rule out MTBC from NTM. Then do HPLC and further if results are unclear do LPA CM/AS kit for species confirmation.Significance and impact of studyNTM are emerging as important causative agents of pulmonary and extra pulmonary disease, the ability to recognize disease caused by NTM and subsequently treat such disease has become increasingly important. The identification of NTM up to its species level using HPLC and LPA CM/AS should gain importance in all TB reference Laboratories.
  • Time to sputum culture conversion and treatment outcome among the first
           cohort of multidrug resistant tuberculosis patients in a high burden
    • Abstract: Publication date: October 2018Source: Indian Journal of Tuberculosis, Volume 65, Issue 4Author(s): O.M. Ige, Regina E. OladokunAbstractBackgroundSputum conversion considered the most important interim indicator of the efficacy of anti-tuberculosis treatment was assessed at varying time points among the first cohort of multidrug resistant tuberculosis (MDR-TB) patients in a National TB Control Programme.MethodsA retrospective study was conducted for the period between 2010 and 2013, at the premiere MDR-TB treatment center in Nigeria. Genexpert, culture and drug susceptibility tests were carried out. Total duration of treatment was 20 months.ResultsA total of 115 patients were studied consisting of 76 (66.1%) males and 39 (33.9%) females with ages ranging between 15 and 65 years. Median time to sputum conversion was 2.06 months (95% confident interval [CI] = 1.82, 2.30). At the end of the first month, 43 (37.4%) patients sputum converted, increasing to 104 (90.4%) at the end of three months. There was no significant interaction with Human Immunodeficiency Virus (HIV) status. Overall treatment success was 69.4%. The default rate was 8.7% (10/115) and 25 (21.7%) deaths were recorded.ConclusionThe treatment success rate in the study was high with most of cases with or without HIV infection, achieving sputum culture conversion within 2 months of commencing treatment. Expansion of MDR-TB treatment services is necessary to reduce the death rate.
  • Panhypopituitarism- An unusual presenation of tuberculous meningitis
    • Abstract: Publication date: Available online 2 August 2018Source: Indian Journal of TuberculosisAuthor(s): Satyendra Kumar Sonkar, Satish Kumar, Neeraj Kumar SinghAbstractPituitary gland involvement is a very rare entity of central nervous system tuberculosis. Tubercular meningitis (TBM) is a chronic meningitis on hypothalamic-pituitary axis which causes high morbidity and mortality hence it is the most dreaded form of extra pulmonary tuberculosis. Here we report a case of 24 year old female presenting with three months history of fever and headache along with altered sensorium since four days. There was also complain of secondary amenorrhea and generalised apathy. Neuroimaging revealed subependymal tuberculomas with meningitis and obstructive hydrocephalus. Cerebrospinal fluid (CSF) examination was also suggestive of tubercular meningitis. Endocrinological investigations showed multiple hormonal deficiencies manifesting as pituitary hypothyroidism, hypocortisolism, hypogonadotropic hypogonadism, and hypoprolactinemia. Anti-tuberculosis treatment was started, and it led to significant improvement in the general condition of the patient.
  • Epidemiological and behavioural correlates of drug-resistant tuberculosis
           in a Tertiary Care Centre, Delhi, India
    • Abstract: Publication date: Available online 10 July 2018Source: Indian Journal of TuberculosisAuthor(s): Kevisetuo A. Dzeyie, Saurav Basu, Tanzin Dikid, Anuj K. Bhatnagar, L.S. Chauhan, J.P. NarainAbstractBackgroundMultidrug-resistant tuberculosis (MDR-TB) is a major public health challenge in India. It is associated with poor treatment outcomes, multiple adverse effects to treatment and involves enormous social and economic losses. The objective of the study was to ascertain the epidemiological and behavioural correlates contributing to drug resistance among patients admitted in a tertiary hospital in Delhi with drug-resistant TB (DR-TB).MethodologyA descriptive cross-sectional study was carried out during the period of July–November 2013 at the Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), Delhi. All patients admitted with DR-TB for treatment were interviewed regarding social, demographic, and treatment aspects, using a semi-structured questionnaire. Their medical records were also reviewed.ResultsA total of 250 patients were included in the study; 198 (79.2%) with multidrug-resistant (MDR-TB) and 52 (20.8%) with extensively drug-resistant TB (XDR-TB). Of these, 66% patients were male and 46% came from poor socioeconomic background. All the patients had history of receiving anti-tubercular treatment (a mean of 2.3 times, range 1–6 times) before the current diagnosis of DR-TB. While 81 (32%) took treatment from private practitioner during the first episode of TB, 146 (58%) received treatment exclusively at government health facilities. Almost 87% of DR-TB patients were previously treated with category-II under RNTCP. Irregularity of treatment was reported by 88 (35%) patients.ConclusionThe study explores the epidemiological and behavioural correlates among the patients with drug-resistant TB. History of previous treatments for TB was a common feature among all the enrolled patients. The fact that more than half of DR-TB patients received anti-tubercular treatment exclusively in government facilities is a matter of concern. There is an urgent need to ensure treatment adherence through improved quality in service delivery in public sector and strong linkage with the private sector. Health education and patient counseling is needed to address personal level risk factors and to ensure treatment adherence.
  • Study of IL-6 and vitamin D3 in patients of pulmonary tuberculosis
    • Abstract: Publication date: Available online 28 June 2018Source: Indian Journal of TuberculosisAuthor(s): Shubhangi M. Dalvi, Nagsen N. Ramraje, Vinayak W. Patil, Rohit Hegde, Neelam YeramAbstractBackgroundMycobacterium tuberculosis can grow in hostile intracellular environment of macrophages by actively evading macrophage-associated antibacterial activities. The stress response factor contributes this process by releasing inflammatory cytokine Interleukin 6 (IL-6). IL-6 screening of patients with TB may be useful to monitor the progress of infection and to infer the risk of progression to active disease. Vitamin D has a critical role in the innate immune system, in the circulating metabolite and supports induction of pleiotropic antimicrobial responses, through the production of antimicrobial peptides, particularly cathelicidin and its active metabolite. 1,25-dihydoxyvitamin D, has long been known to enhance immune response to mycobacteria. In this study, we have studied the role of IL-6 and Vitamin D3 in M. tuberculosis.Materials and methodsThree groups involved in this study are Control, Category I (newly diagnosed TB) and MDR TB patients. The serum levels of IL-6 and vitamin D3 were measured using chemiluminescence and fully-automated enzyme-linked immunosorbent assay respectively.ResultsThe serum levels of IL-6 were significantly increased, whereas vitamin D3 decreased in TB multidrug-resistant group of patients compared to the newly diagnosed TB patients.ConclusionIL-6 appears to be the major cytokine elaborated by mycobacteria infection as well as play a role in the clinical manifestations and pathological events and hence may function as a potent biomarker of tuberculosis. Since, Vitamin D increases activity of cell-mediated immunity; it can be used as a supplementation during tuberculosis therapy.
  • The comparison of pleural fluid TNF-α levels in tuberculous and
           nontuberculous pleural effusion
    • Abstract: Publication date: Available online 8 June 2018Source: Indian Journal of TuberculosisAuthor(s): Nurlela Damayanti, Resti YudhawatiAbstractBackgroundTuberculous pleural effusion is the manifestation of Mycobacterium tuberculosis infection in pleura. With existing means, it is difficult to establish the diagnosis of tuberculosis (TB) and non-TB pleural effusions; thus, establishing the diagnosis of TB pleural effusion and non-TB pleural effusion is still a clinical problem. Tumour necrosis factor alpha (TNFα) is a potent inflammatory cytokine that plays an important role in immunity to Mycobacterium tuberculosis infections, this level of cytokine increases in pleural effusion due to tuberculosis.ObjectiveTo compare the TNF-α level of pleural fluid in TB and non-TB pleural effusion.MethodsThe samples in this study that fulfilled the inclusion criteria were patients with non-TB pleural tuberculosis effusion in the inpatient ward in Pulmonology Unit Dr. Soetomo General Hospital Surabaya, male and female, aged between 15 and 60 years. The data is divided into two: primary data and secondary data of patients who fulfilled inclusion and exclusion criteria. The data with normal distribution was analyzed using independent t2 test and if the data distribution is abnormal, it was analyzed using Fisher's exact test.ResultsThere were 22 subjects divided into 2 groups that were 11 patients with TB pleural effusion and 11 patients with non-TB pleural effusion. The TNF-α level of pleural fluid in TB pleural effusion was 25.43 ± 13.55 pg/mL. The TNF-α level of pleural fluid in non-TB was 5.98 ± 1.89 pg/mL. The serum TNF-α level in TB pleural effusion was 83.22 ± 88.15 pg/mL. The serum TNF-α level in non-TB was 68.54 ± 57.88 pg/mL. There was higher level of TNF-α pleural fluid in TB pleural effusion than in non-TB pleural effusion (25.43 ± 13.55 pg/mL vs 5.98 ± 1.89 pg/mL, p value 0.05).ConclusionThe TNF-α level of pleural fluid in TB pleural effusion was higher than non-TB pleural effusions and there was no significant difference between serum TNF-α levels in the TB pleural effusion group and in the non-TB pleural effusion group.
  • Role of percutaneous transpedicular biopsy in diagnosis of spinal
           tuberculosis and its correlation with the clinico-radiological features
    • Abstract: Publication date: Available online 8 June 2018Source: Indian Journal of TuberculosisAuthor(s): Madan Mohan Sahoo, Sudhir Kumar Mahapatra, Gopal Chandra Sethi, Anshuman Sahoo, Bikram Keshari KarIntroductionTuberculosis (TB) has long been an important cause of destructive lesions of spine in India. However the scenario is fast changing with atypical presentations and increasing reports of non-tubercular conditions. This poses a great diagnostic dilemma.AimThe present study is aimed at evaluating the diagnostic efficacy of percutaneous transpedicular needle biopsy and the correlation of the histology with clinico-radiological features.MethodsForty-one patients diagnosed of TB spine by magnetic resonance imaging (MRI) were revaluated of their clinical presentations, radiological and MRI features and underwent transpedicular needle biopsy under fluoroscopic guidance. Quality of the sample and radiological/MRI features between the tubercular and non-tubercular lesions were studied.ResultsA good sample obtained in 92.7% patients. Of these 28 patients had TB, 3 non-specific inflammatory lesion and 7 with other non-tubercular conditions (3 pyogenic, 3 metastasis, 1 multiple myeloma). Statistically there is no significant difference among the TB and non-TB groups in terms of vertebral involvement and MRI features. However risk of presentation with cord compression, cord changes and neurodeficit are higher with TB spine.ConclusionIt is very difficult to differentiate between tubercular and non-tubercular pathology of spine on the basis of most of the clinical and MRI features. It is more difficult in early cases without any neurodeficit. Thus histopathological confirmation is must for further management and percutaneous needle biopsy is the best option considering the simplicity and minimally invasive nature of the procedure.Graphical abstractGraphical abstract for this article
  • Cartridge based nucleic acid amplification test is superior in diagnosing
           lymphnode tuberculosis
    • Abstract: Publication date: Available online 17 May 2018Source: Indian Journal of TuberculosisAuthor(s): Nandish Chandrappa, Ankita Rastogi, Anuj K. BhatnagarAbstractBackgroundThe role of Cartridge based Nucleic Acid Amplification test (CBNAAT) in the diagnosis of lymphnode TB which helps in reducing the mortality and morbidity by early identification and initiating treatment at the earliest. Also helps in identify the drug resistance among tubercular lymphnodes cases.Patients and methodsA prospective clinical study was performed in 101 suspected lymph node tuberculosis patients. The results of FNAC and/or excision biopsy of lymphnode samples obtained by CBNAAT were compared with direct smear microscopy for AFB bacilli, cytology and their combination considering AFB culture as gold standard.ResultsA total of 101 patients were evaluated of which 74 subjects (73.3%) were CBNAAT positive for TB. Among the CBNAAT positive cases, 57 were aged above 16 years, 38 were females, equal number (37) had single and multiple lymphnodes, 46 had less than 1 cm size lymphnodes, 69 had lymphnode in neck region, 65 had chest X-ray normal. Among CBNAAT positive 74 subjects, 53 subjects (71.6%) were positive for AFB direct smear, 64 subjects (86.48%) were cytology consistent with TB and their combination were positive for TB in 71 subjects (95.94%) and 71 subjects (95.94%) were positive by AFB culture and 3 cases (0.04%) showed Rifampicin resistance.ConclusionCBNAAT is a rapid diagnostic tool having sensitivity of 93.42% with specificity of 86.96% and positive predictive value of 95.95% and having comparable results with AFB culture and more sensitive than other investigation procedures. Thus it can be a rule in test for lymphnode TB.
  • Pulmonary tuberculosis: An analysis of isolation practices and clinical
           risk factors in a tertiary hospital
    • Abstract: Publication date: Available online 7 May 2018Source: Indian Journal of TuberculosisAuthor(s): Srivathsan Thiruvengadam, Lauren Giudicatti, Siaavash Maghami, Hussein Farah, Justin Waring, Grant Waterer, Kumaraweerage Ruad Herman PereraAbstractBackgroundInadequate isolation of patients with active pulmonary tuberculosis causes exposure whereas over-cautious isolation generates time and cost inefficiencies. This study aims to ascertain the delays involved in isolating subjects and the importance of risk factors.Methods and materialBetween December 2010 and January 2013, a retrospective analysis of 271 subjects was performed. Information was obtained from discharge letters, radiological and microbiological results.ResultsThe median time taken to isolate subjects was 0 days, and 71.7% were isolated within 1 day. Most subjects (75.3%) had sputum samples obtained after isolation, of which 14.7% were positive. The median time from admission to first sputum sample was 1 day. Smear was negative in 174 subjects (85.3%). Country of birth (high or low risk) did not significantly affect sputum positivity (25.5% vs 19.4%, p = 0.52). Suspicious radiological findings were noted in 38.6% subjects, and 32.8% had a suspicious clinical history. Subjects with both clinical and radiological probability had more sputum positivity (46.2%), compared to subjects who had neither (2.7%).ConclusionThere are delays with isolation and diagnosis of subjects with a high probability of tuberculosis. Clinical and radiological probability were more significant in predicting sputum positivity than country of birth.
  • Performance of Xpert MTB/RIF for detection of Mycobacterium tuberculosis
           and rifampicin resistance in pus aspirates
    • Abstract: Publication date: Available online 22 April 2018Source: Indian Journal of TuberculosisAuthor(s): Reena Set, Sheetal Bankar, Disha Sharma, Daksha Shah, Jayanthi ShastriAbstractIntroductionWHO endorsed Xpert MTB/RIF assay has proven to be rapid with results obtained within 2 h. The evidence base regarding the use of Xpert MTB/RIF in pulmonary TB is strong. Relatively few performance data have been published to date on detection of Mycobacterium tuberculosis in aspirated pus specimens from abscesses.ObjectivesThe aim of the study was to determine the sensitivity and specificity of Xpert MTB/RIF assay for the detection of M. tuberculosis and rifampicin resistance in aspirated pus specimens using culture on Lowenstein Jensen (LJ) medium and economic variant of proportion method (PM) for drug susceptibility testing (DST) as the reference standard.ResultsXpert MTB/RIF assay in comparison to conventional reference method showed sensitivity and specificity of 76.19% and 68.75% for detection of M. tuberculosis and 71.4% and 100% for detection of rifampicin resistance respectively.ConclusionThe simplicity, sensitivity, speed and automation makes this assay a very promising diagnostic test for detection of M. tuberculosis and rifampicin resistance in aspirated pus specimens.
  • A study on procedural delay in diagnosis and start of treatment in drug
           resistant tuberculosis under RNTCP
    • Abstract: Publication date: Available online 19 April 2018Source: Indian Journal of TuberculosisAuthor(s): Amit Kumar Sharma, Neeraj Gupta, Satyadeep Verma, Arjun Chandran, Ramakant DixitBackgroundMulti-drug-resistant TB (MDR-TB) has become a significant public health problem and an obstacle to effective TB control. Rapid diagnostic tests for anti tubercular drugs sensitivity have significantly reduced total time in initiation of treatment. Still there is a significant gap between MDR diagnosis and start of category IV treatment. Delay in establishing the diagnosis may cause disease progression, transmission, lost to follow up and death. This study was planned to assess the actual delay from day one of sputum examination to the day of initiation of category IV in operational settings.MethodologyMDR-TB suspected patients attending the Respiratory medicine department, JLNMC, Ajmer from June-15 to July-16 were followed from sputum examination to sample deposition for drug sensitivity testing (LPA/CBNAAT) to MDR detection to category IV initiation, for assessment of procedural delay at various steps.ResultsLPA group (371 patients): Sputum smear to LPA deposition mean duration was 8.02 days, LPA deposition to LPA result upload mean duration was 3.78 days, LPA deposition to patients received LPA reports mean duration was 21.73 days and reports received to PMDT site admission (if drug resistant) mean duration was 3.61 days. Total time duration in category IV initiation was 32.63 days.CBNAAT group (50 patients): Sputum smear to CBNAAT deposition mean duration was 6.70 days, CBNAAT deposition to CBNAAT result upload mean duration was 1.13 days, CBNAAT deposition to patients received CBNAAT reports mean duration was 6.53 days and reports received to PMDT site admission (if R-resistant) mean duration was 3.8 days. Total time duration in category IV initiation was 12.4 days.ConclusionMajor delay seen on part of receiving sensitivity reports indicates the need to stress upon field staff motivation, appropriate training, sensitisation and expert counselling.
  • CBNAAT is suboptimal in diagnosing tubercular pleural effusion but can be
           a rule in test for tubercular empyema
    • Abstract: Publication date: Available online 27 February 2018Source: Indian Journal of TuberculosisAuthor(s): Ankita Rastogi
  • Concomitant presentation of sarcoidosis and pulmonary tuberculosis with
           ARDS: A diagnostic dilemma and therapeutic challenge
    • Abstract: Publication date: Available online 9 January 2018Source: Indian Journal of TuberculosisAuthor(s): Rohit Vadala, Manohar N.M. Bhat, Ebenezer Rabindrarajan, Nagarajan RamakrishnanAbstractTuberculosis and sarcoidosis are chronic multisystem granulomatous conditions which have different aetiology and management but may mimic each other clinically, radiologically and pathologically. Both these diseases usually have a sub acute or chronic presentation and it is rather uncommon for them to coexist or present with acute respiratory failure.We report a case of a 57-year-old male who presented with pyrexia of unknown origin with chronic cough. He was initially diagnosed to have sarcoidosis based on clinico-radiological and histologic evidence and was started on corticosteroids. However, he presented within two weeks with acute respiratory distress and on further investigation was diagnosed with co-existing pulmonary tuberculosis.
  • Primary hepatic tuberculosis masquerading as intrahepatic
    • Abstract: Publication date: Available online 8 January 2018Source: Indian Journal of TuberculosisAuthor(s): Rahul Prabhudesai, Durga Lawande, Gautam Gondal, Sanjivani KenyAbstractAbdominal tuberculosis is a common clinical entity in Indian subcontinent; however, hepatic tuberculosis in the absence of miliary abdominal tuberculosis is restricted to the case reports and small case series in English literature. It mimics common liver diseases like liver abscess and tumours. We report a case of 38 years old male presenting with abdominal pain, loss of appetite and weight initially misdiagnosed as intrahepatic cholangiocarcinoma on magnetic resonance imaging and FNAC of the lesion but later diagnosed as a case of hepatic tuberculosis on post operative histopathology specimen. It is important to consider tuberculosis in the differential diagnosis when suspecting lymphoproliferative or metastatic diseases in a patient with vague symptoms.
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Heriot-Watt University
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