The Indian journal of tuberculosis (Indian J Tubercul )


Official Organ of the Tuberculosis Association of India

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    Indian Journal of Tuberculosis website
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    Internet resource
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    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: Background: Liver abscess is fairly common in developing countries and its incidence is ever-rising. Though amoebic and pyogenic liver abscesses form majority of cases in our country, tubercular liver abscess (TLA) should also be considered as differential diagnosis. Aims: To study the clinical and imaging profile of tubercular liver abscess while establishing its increased incidence. Methods: A prospective observational study was carried out on 72 indoor cases of liver abscess, presenting to Department of Medicine, from November 2011 to February 2013. All cases were subjected to abscess tap and tapped abscess was sent for microbiological examination. Results: Though amoebic liver abscess was most common type diagnosed, five cases came out to be tubercular (AFB positive). Mean age ofTLA patients was 28.4 years (all males). All cases were sub-acute in presentation. Splenomegaly and ascites were noted in 60% and 40% cases respectively. ESR was raised in 80% cases with mean value of 52.8 mm at first hour. Haemoglobin was low in 80% cases. Serum Alkaline phosphatise (ALP) was raised in all cases, mean value being 1034.4 U/L. On ultrasonography, all abscesses were < 5 centimetres in size, most commonly involving seventh segment. They were multiple in numbers in 60% cases. All cases responded well to anti-tubercular treatment. Conclusions: Tubercular liver abscess has increased in incidence, and in majority of cases in our study, they were incidentally found with no associated foci of infection in lung or gastrointestinal tract. So, keeping high index of suspicion, TLA should be considered in all patients with subacute presentation and associated anaemia, splenomegaly or ascites. Also, TLA is associated with raised ESR and comparatively higher levels of ALP in serum. They are more commonly multiple in number on ultrasonography.
    The Indian journal of tuberculosis 07/2014; 61(3).
  • The Indian journal of tuberculosis 04/2014; 61(2):148-151.
  • The Indian journal of tuberculosis 01/2014; 61(1):5-8.
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    ABSTRACT: Pulmonary tuberculosis continues to be a significant health problem, especially due to increasing incidence of multi-resistant mycobacteria and patients with immunodeficiency. Pulmonary tuberculoma, like other solitary lung nodules, can often be a diagnostic challenge; moreover no consensus exists on the management strategy. To analyze the results of tuberculoma treatment with thoracoscopic lung resection, followed by anti-tuberculosis treatment (ATT). All patients who underwent thoracoscopic resection of tuberculoma between 1996 and 2008 were retrospectively analyzed. The diagnosis was confirmed morphologically and/or microbiologically. Data were collected from case reports, outpatient medical records, Estonian Tuberculosis Registry and National Population Registry. Forty-three patients (25 men, 18 women) with mean age of 43.3 (range 15-68) years were included. Thoracoscopic approach was converted to thoracotomy in three cases. Median postoperative stay in surgical department was four days. No intra-hospital mortality occurred. Eleven patients received pre-operative ATT for 8 to 288 (median 115) days and 42 patients were treated post-operatively for 40 to 672 (median 185) days. One patient defaulted in ATT. First-line drugs were prescribed in 37 and second-line in five patients. During the median follow-up of 9.0 (range 3.2 to 16.1) years, none of the patients developed relapse. Thoracoscopic pulmonary resection provides a minimally invasive opportunity for morphological and microbiological diagnosis of tuberculoma; and results in an excellent cure rate in combination with ATT.
    The Indian journal of tuberculosis 01/2014; 61(1):51-6.
  • The Indian journal of tuberculosis 01/2014; 61(1):1-4.
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    ABSTRACT: Non-tuberculous mycobacteria (NTM) are widely dispersed in our environment. Pulmonary disease, lymphadenitis, skin and soft tissue infections, bone and joint infections and disseminated infections are common clinical syndromes in immuno-compromised patients. NTM infections are frequently overlooked in developing countries like India withendemic TB due to non-specific clinical manifestations, unfamiliarity of clinicians with mycobacteria, and inadequacy of laboratory services. Here we report a case of multidrug resistant (MDR) pulmonary NTM infection in a non-HIV infected child and her response to therapy.
    The Indian journal of tuberculosis 01/2014; 61(1):72-4.
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    ABSTRACT: In India, Tuberculosis (TB) continues to be a public health problem. One of the key reasons for it is the stigma associated with the disease which affects the treatment seeking behaviour and hence the outcome. To assess the perceived and enacted stigma among TB patients and perceptions of other patients related to TB in Central Delhi. A cross-sectional study conducted in urban field practice area of a medical college of Delhi, using a pre-designed questionnaire containing items for assessment of stigma being faced by a TB patient in family, social life and workplace. It also contained questions pertaining to reaction of patients from general OPD to a family member who develops TB. A total of 100 patients on DOTS and 200 patients from general OPD were interviewed. There were 21 patients who reported to have delayed treatment seeking due to stigma. Nearly one third patients (n=34; 34%) noted negative changes in the behaviour of their family members towards them while 40% were isolated on being diagnosed with the disease. Out of the 36 employed TB patients, 65.5% (n=23) experienced negative change in the behaviour of their colleagues. In general OPD patients, significantly higher proportion of female patients said that they would not disclose the disease status of a family member suffering from TB to their neighbours (p<0.001). Perception of stigmatizing effect of Tuberculosis was high both amongst TB and other patients. Behaviour Change Communication (BCC) strategies are needed to address the effects of stigma like delayed treatment seeking.
    The Indian journal of tuberculosis 01/2014; 61(1):35-42.
  • The Indian journal of tuberculosis 01/2014; 61(1):89.
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    ABSTRACT: Tuberculosis may involve any organ in the body and extra-pulmonary tuberculosis is commonly seen in immuno-compromised patients mostly in developing countries. Here we report an unusual case of tuberculosis of space of retzius (pre-peritoneal space) forming a lump, this lump caused weakness of anterior abdominal wall which later developed ventral hernia, corrected by surgery in a 62-year immuno-competent person. This type of presentation of extra-pulmonary tuberculosis at space of Retzius has been rarely reported.
    The Indian journal of tuberculosis 01/2014; 61(1):75-8.
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    ABSTRACT: In India, the quality of care that tuberculosis (TB) patients receive varies considerably and is often not in accordance with the national and international standards. In this article, we provide an overview of the third (latest) edition of the International Standards of Tuberculosis Care (ISTC). These standards are supported by the existing World Health Organization guidelines and policy statements pertaining to TB care and have been endorsed by a number of international organizations. We call upon all health care providers in the country to practice TB care that is consistent with these standards, as well as the upcoming Standards for TB Care in India (STCI).
    The Indian journal of tuberculosis 01/2014; 61(1):12-8.
  • The Indian journal of tuberculosis 01/2014; 61(1):9-11.
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    ABSTRACT: A conceptual framework to study the epidemiologic basis of tuberculosis control is provided. The basic model to discuss the epidemiology of tuberculosis is based on a classification of tuberculosis based on its pathogenesis with exposure, latent infection, tuberculosis, and death from tuberculosis, showing the conditional probabilities leading from one to the next step in the chain of events. Historical data are utilized to demonstrate how the dynamics of tuberculosis over multiple decades have contributed to shape the present. It is shown that the key concept to understand the dynamics is related to current and past incidence and prevalence of latent infection with M. tuberculosis. The dynamics of the epidemic are shaped both by the behaviour of the causative organism of tuberculosis as well as the population structure and changes that take place in parallel in which M. tuberculosis thrives. Both the present and the future shape of the epidemic, as well as the principles applied to its control lie very much in the past of a society. While new risk factors such as HIV or diabetes have been or are emerging more strongly, it is noted that the majority of all new cases emerging cannot be pinned to one or the other such factor. It is the historical experience of a population that offers the most valuable key to understanding the present and the future.
    The Indian journal of tuberculosis 01/2014; 61(1):19-29.
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    ABSTRACT: Tuberculosis is five to six times more common among diabetics than among non-diabetics and causes greater morbidity, according to reports. The effective control of each affects the control of the other. Diabetes increases the risk of developing tuberculosis, especially in developing countries with a high incidence of tuberculosis. DOTS strategy has been an effective tool on a mass basis. However, patients under DOTS are not screened for diabetes before the therapy. To study the prevalence of diabetes mellitus in patients with tuberculosis under DOTS strategy. A cross-sectional study was conducted in Santosh Medical College & Hospital, Ghaziabad, with the patients taken from different DOTS centres of NCR-Delhi, India. The present study was undertaken to evaluate the presence of undiagnosed diabetes under DOTS strategy. Fasting capillary blood glucose levels of patients diagnosed with tuberculosis were analyzed and were managed as per DOTS guidelines at multiple centres in the northwest region of India. We studied 700 patients. The prevalence of diabetes was 12.6% (n=88), which is quite high. When category-wise analysis of diabetic subjects was done, it was found that patients under Category-I were 11.7% (n=47), patients under Cat-II were 15.5% (n=39) and those under Cat-III were 3.9% (n=2). The higher percentage of patients in Cat-II indicates the poor outcome of Cat-I patients, probably due to diabetes as a co-morbid disease. The higher prevalence of diabetes mellitus in DOTS patients raises immediate concerns in preventing the morbidity due to both the diseases. Therefore, it is recommended that some strategy on the lines of HIV disease should be formed under DOTS for the concomitant treatment of TB and diabetes for better outcome and care.
    The Indian journal of tuberculosis 01/2014; 61(1):65-71.
  • The Indian journal of tuberculosis 01/2014; 61(1):88.
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    ABSTRACT: Tuberculosis of thyroid gland is extremely rare. It spreads to thyroid by lymphogenous or heamatogenous route or from adjacent focus, either from larynx or cervical and mediastinal adenitis. We report an unusual case of a 33-year-old male with thyroid swelling. Fine needle aspiration (FNA) smears showed epithelioid cells without necrosis and acid fast bacilli (AFB). Subsequent investigation revealed mediastinal tuberculous lymphadenitis on Computerized Tomography (CT) scan. FNA confirmed the diagnosis of mediastinal tuberculous lymphadenitis. We conclude, when epithelioid cells are seen on FNA thyroid, tuberculosis must be ruled out especially in regions where there is high prevalence of tuberculosis.
    The Indian journal of tuberculosis 01/2014; 61(1):84-7.
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    ABSTRACT: The treatment for MDR TB is quite prolonged and associated with adverse effects and hence costly. The aim of study was to study the side-effects of reserve line drugs developing in initial seven days of starting therapy, so as to weigh the need for admission for initiation of treatment against heavy economic burden by admission of huge number of MDR TB patients, and to identify the factors which may have an effect on the number of patients developing side-effects All MDR TB patients (930) admitted during study period, who were initiated on Cat IV treatment for MDR TB under RNTCP were questioned daily for any side-effects throughout the day, during initial seven days of treatment. On day one, 342 (36.8%) patients developed side-effects, on 2nd day 456 (49%), on day 3 356 (38.3 %), on fourth day 257 (27.6%), then on fifth day only 172 (18.5 %) patients respectively had reported side-effects. Further decline of side-effects was reported on sixth day 94(10.1%) and seventh day 39(4.2%). Number of events also decreased from 669 on dayl and 965 on day 2, to only 61 on day 7 of treatment. Most of the patients had nausea, vomiting, pain abdomen, restlessness, dizziness, insomnia and headache. Patients with low Hemoglobin had more side-effects from day 2 onwards (p<0.05).Age, BMI, gender and co-morbidities had no significant effect on side-effects in these patients. Many patients report side-effects initially on treatment, which gradually decrease from day 4 onwards , so hospitalization for atleast seven days during initiation of Cat IV may not be required in all the patients.
    The Indian journal of tuberculosis 01/2014; 61(1):57-64.
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    ABSTRACT: The management of tuberculosis re-treatment in HIV-infected individuals is complex. The clinical and radiological manifestations in this group and response to Category II treatment is not well described. We performed a prospective cohort study of HIV-infected patients retreated for TB due to failure, relapse or default after treatment, at Tuberculosis Research Centre, Chennai, between February 2001 to September 2005. The Category II regimen followed in the TB programme in India (RNTCP) was administered (2 months of Streptomycin (S), Ethambutol (E), INH (H), Rifampicin (R), Pyrazinamide (Z)/1 month of EHRZ/5 months of HRE all given thrice weekly). Antiretroviral treatment was not routinely available at that time. Of the 42 patients enrolled, 35 (83%) were males. The mean age was 33.2 (SD-6.3) years. Cough was the commonest (67%) presenting symptom and opacities were the commonest (48%) radiographic occurrence. 31 patients were culture-positive at baseline, drug susceptibility results showed that 21 (68%) were fully susceptible to all first line drugs, four patients (13%) had MDR TB and four had resistance to INH alone. Among the 31 culture-positive patients, 15 patients (48.4%) completed treatment and were declared cured, of whom two subsequently relapsed. All four MDR patients died. Six patients who received ART, survived. Only 50% of HIV-infected, ART-naive patients who were retreated for tuberculosis using an intermittent Category II regimen had a favourable response to treatment. Early detection of MDRTB and concurrent antiretroviral therapy could contribute to improved outcomes.
    The Indian journal of tuberculosis 01/2014; 61(1):43-50.
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    ABSTRACT: In recent years, there has been a substantial increase in number of reports involving uncommon sites involving in tuberculosis. Rise in number of HIV positive patients has made the scenario worse. Calvarial tuberculosis has beenreported very rarely in world literature till now. We are reporting a case of primary tuberculous osteomyelitis of frontal bone in a 15-year-old female. With prompt as well as careful diagnostic workup and treatment, we were able to halt the disease progression and excellent response to treatment was observed in follow up.
    The Indian journal of tuberculosis 01/2014; 61(1):79-83.
  • The Indian journal of tuberculosis 01/2014; 61(1):30-4.
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    ABSTRACT: Tiruvallur district In Tamil Nadu where DOTS was implemented by the State Government as the tuberculosis control measure in 1999, and monitored by the National Institute for Research in Tuberculosis for over five years. To estimate trends in TB prevalence in a rural community with DOTS. Surveys of pulmonary tuberculosis were undertaken in representative samples of subjects aged > or =15 years (N = 83,000 - 92,000), initially and after two and half, five and seven and half years of implementation of DOTS. Sputa were collected from those with abnormal radiograph and/or presence of chest symptoms, and examined by direct smear and culture. The prevalence of culture-positive tuberculosis was 607, 454, 309 and 388 per 100,000 in the four surveys, and that of smear-positive tuberculosis was 326, 259, 168 and 180. In the first five years; annual decrease was 12.4% (95% CI 10.4 - 14.4%) for culture-positive tuberculosis, and 12.2% (95% CI 8.0-16.2) for smear-positive tuberculosis. This was, however, followed by a significant increase in the next two and half years. The average new smear-positive case-notification rate was 75 per 100,000 during first four years but declined to 49 in subsequent years. There were no methodological differences during this period and information on changes in socio-economic indicators and nutritional standards was unavailable. Despite the average annual success rate (78%) in this tuberculosis unit being lower than the expected rate of 85%, the implementation of DOTS was followed by a substantial decrease in the prevalence of pulmonary tuberculosis over the seven and half year period. Our findings suggest that sustaining the high effectiveness of DOTS programme needs vigilant supervision.
    The Indian journal of tuberculosis 07/2013; 60(3):168-76.

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