Pulmonary Tuberculosis

BACKGROUND Tuberculosis is a global pandemic which affects millions of people every year. The treatment of tuberculosis consists of simultaneous use of a number of drugs for a prolonged period of time, therefore anti-tuberculosis treatment induced toxicity is a real problem. Many risk factors which make a tuberculosis patient prone to the development of hepatotoxicity associated with the anti-tuberculosis treatment have been identified. The aim of this study was to determine common risk factors responsible for precipitation of hepatotoxicity following treatment with anti-tuberculosis drugs. METHODS This cross-sectional study was conducted in the Department of Pulmonary Medicine, Ayub Teaching Hospital, Abbottabad from 20th April 2013 to 19th March 2014. Patients -' , who were newly diagnosed cases of tuberculosis in whom treatment of tuberculosis with first line anti-tuberculosis drugs was initiated and were 20 years or older, were included. The precipitation of drug induced hep...

To study the impact of fused (18)F-fluoro-deoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on conformal radiation therapy (CRT) planning for patients with esophageal carcinoma. Thirty-four patients with esophageal carcinoma were referred for concomitant radiotherapy and chemotherapy with radical intent. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. PET-images were coregistered using five fiducial markers. Target delineation was initially performed on CT images and the corresponding PET data were subsequently used as an overlay to CT data to define the target volume. FDG-PET identified previously undetected distant metastatic disease in 2 patients, making them ineligible for curative CRT. The Gross Tumor Volume (GTV) was decreased by CT and FDG image fusion in 12 patients (35%) and was increased in 7 patients (20.5%). The GTV reduction was >or=25% in 4 patients due ...

The mycobacterial antigens and the factors related to protection for the development of active tuberculosis are not known. In a natural model of tuberculosis, we studied 10 patients with active pulmonary tuberculosis (non-protective immune response) and 38 healthy household contacts (protective immune response). We tested the lymphocyte proliferative response by T cell Western blotting to eight different antigen fractions and lo two purified mycobacterial antigens of 30 and 64 kD. Patients with active tuberculosis recognized fractions with molecular weights of 80–114, 60–80, 28–41 and 14–19kD. Household contacts recognized the same fractions except the 14–19 kD. The response lo the 64-kD antigen was not significantly different between groups. In contrast, 10% of the patients with active tuberculosis and 73% of the household contacts responded to the 30-kD antigen. The humoral response against the 30-kD antigen by ELISA showed a significantly higher production of antibodies in tuberculosis patients compared with household contacts. We conclude that patients with active pulmonary tuberculosis develop an immune response characterized by poor proliferative response to the 30-kD antigen with a strong humoral response, whereas the opposite occurs in healthy subjects infected by Mycobacterium tuberculoses.

Isoniazid (INH) is an effective first-line antituberculosis drug. KatG, a catalase-peroxidase, converts INH to an active form in Mycobacterium tuberculosis, and katG mutations are major causes of INH resistance. In the present study, we sequenced katG of 108 INH-resistant M. tuberculosis clinical isolates. Consequently, 9 novel KatG mutants with a single-amino-acid substitution were found. All of these mutants had significantly lower INH oxidase activities than the wild type, and each mutant showed various levels of activity. Isolates having mutations with relatively low activities showed high-level INH resistance. On the basis of our results and known mutations associated with INH resistance, we developed a new hybridization-based line probe assay for rapid detection of INH-resistant M. tuberculosis isolates.

Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and ...

Molecular tests show low sensitivity for smear-negative pulmonary tuberculosis (SNPT). We propose a screening and risk assessment system for SNPT using Artificial Neural Networks (ANNs) based on patient́s signals and symptoms. Prognostic and risk assessment models exploit a multilayer perceptron (MLP) and an inspired adaptive resonance theory (iART) network. Model's development considered data from 136 SNPT suspects from a general hospital. MLP showed higher sensitivity (100%, CI 78-100), as compared to other techniques, such as SVM linear (86%; CI 60-96), MLR (79%; CI 95% 53-93) and CART (71%; CI 95% 45-88). MLR also showed slight higher specificities (85%; CI 95% 59-96), as compared to MLP (80%; CI 95% 54-93), SVM linear (75%,CI 95% 49-90) and CART (65%; CI 95% 39-84). In terms of area under receiver operation curve (AUC), the MLP model exhibited a higher value (0.918, CI 95% 0.824-1.000) than SVM linear (0.796, CI 95% 0.651-0.970) and MLR (0.782, CI 95% 0.663-0.960). Remarkab...

To explore the feelings and experiences of TB patients, and to highlight how TB stigma may affect case finding and compliance with treatment. Qualitative research approach using focus groups and individual interviews. Sekondi-Takoradi Metropolitan district, Ghana. Purposeful selection of TB patients receiving TB at four government hospitals in the district. None. Because of TB stigma, majority of the patients failed to recognise their symptoms as due to TB, and attributed it to malaria and ordinary cough. They reported to the hospital only after prolonged period of self-medication in the community, with some indicating multiple visits before a diagnosis was made. When diagnosed, some were worried and cried, questioned how they got the disease, contemplated committing suicide, and others doubted it was TB. Most of them hid the diagnosis from others, and were isolated within the family and community. Most TB patients failed to recognize their symptoms as due to TB, because of the stig...

OBJETIVO: Avaliar o impacto do treinamento da equipe do Programa Saúde da Família (PSF) e da busca ativa domiciliar na detecção de casos de TB em uma comunidade de baixa renda de Fortaleza. MÉTODOS: Intervenção realizada na área de abrangência de um centro de saúde de Fortaleza, Ceará, com cinco equipes do PSF, responsáveis por cerca de 25.000 pessoas. Treinaram-se todas as equipes de saúde do centro de saúde e implantou-se a busca ativa domiciliar apenas na área de abrangência da Equipe 5. Comparou-se o número de casos detectados em cada uma das cinco áreas antes e depois da intervenção, bem como os casos na área 5 com os das outras áreas e com os casos notificados no município de Fortaleza durante o mesmo período. RESULTADOS: Observou-se um aumento no número de casos de TB detectados na área do estudo: de 1 caso em 2002 para 22 em 2004 (p < 0,005), sem diferença entre a área em que foi feita a busca domiciliar e as outras quatro (p > 0,05). Houve um aumento significativo no número de casos detectados na área do estudo em comparação com aquele no município como um todo (p < 0,05). CONCLUSÕES: O treinamento e a sensibilização da equipe de saúde da família foram capazes de promover um aumento na detecção de casos de TB em uma comunidade de baixa renda.

The regulatory role of vitamin D receptor (VDR) gene variants of BsmI, ApaI, TaqI, and FokI polymorphisms on vitamin D3-modulated macrophage phagocytosis with live Mycobacterium tuberculosis and lymphoproliferative response to M. tuberculosis culture filtrate antigen (CFA) was studied in patients with pulmonary tuberculosis (n = 46) and in normal healthy subjects (NHS) (n = 64). Vitamin D3 at a concentration of 1 × 10−7 M enhanced the phagocytic potential of normal subjects who had a phagocytic index of less than 20%. This increase was seen in subjects with the genotypes BB (p = 0.017), AA (p = 0.016), tt (p = 0.034), and FF (p = 0.013) and the extended genotype BBAAtt (p = 0.034). Normal subjects with BBAAtt performed better phagocytosis than individuals with bbaaTT genotype (p = 0.034). Vitamin D3 at 10−9, 10−8, and 10−7 M concentrations suppressed the lymphoproliferative response to CFA antigen in normal subjects. This decreased lymphocyte response was observed in normal individuals with the genotypes BB (p = 0.0009), tt (p = 0.016), and FF (p = 0.008) and the extended genotype BBAAtt (p = 0.02). Addition of vitamin D3 had no significant effect on macrophage phagocytosis and lymphoproliferative response to CFA in pulmonary TB patients. This may be due to the unresponsive nature of the cells to the action of vitamin D3 or the downregulated VDR expression by virtue of the disease, which renders them inactive. The genotypes BB, tt, and the extended genotype BBAAtt may be associated with increased expression of VDR which in turn regulate the action of vitamin D3 and modulate the immune functions to M. tuberculosis in NHS.

Limited data exists to inform contact tracing guidelines in children and HIV-affected populations. We evaluated the yield and additionality of household contact and source case investigations in Swaziland, a TB/HIV high-burden setting, while prioritizing identification of childhood TB. In partnership with 7 local TB clinics, we implemented standardized contact tracing of index cases (IC) receiving TB treatment. Prioritizing child contacts and HIV-affected households, screening officers screened contacts for TB symptoms and to identify risk factors associated with TB. We ascertained factors moderating the yield of contact tracing and measured the impact of our program by additional notifications. From March 2013 to November 2015, 3,258 ICs (54% bacteriologically confirmed; 70% HIV-infected; 85% adults) were enrolled leading to evaluation of 12,175 contacts (median age 18 years, IQR 24-42; 45% children; 9% HIV-infected). Among contacts, 196 TB cases (56% bacteriologically confirmed) w...

Aspergillus infections are among the most feared opportunistic infections in humans because they are capable of causing several distinct pulmonary diseases. The aim of this study was to determine the prevalence of Aspergillus species in patients with pulmonary pneumonia and susceptibility testing to the most commonly used antifungal agents.
A total of 311 specimens were collected from patients presented with the pulmonary complaint. Out of which, 139 (44.6%) yielded Aspergillus growth. Aspergillus isolates were obtained from Bronchoalveolar lavage and sputum. Ten species of Aspergillus were identified, A. flavus, A. niger, and A. terreus were the most frequently isolated species. Antifungal susceptibility of 10 different Aspergillus spp. isolates were performed using E-test. Voriconazole and caspofungin were having full inhibitory activity (100%) against tested Aspergillus spp., while some resistance was observed against itraconazole and posaconazole (50% and 75% respectively). Aspergillus was found to be the predominant fungal pathogen isolated from patients with pulmonary diseases, notably from patients with COPD and pulmonary TB.

This paper explores the architecture of the Mount Sinai Sanatorium in Sainte-Agathe-des-Monts (Qc) to disentangle the role of religion in the treatment of tuberculosis. In particular, we analyze the design of Mount Sinai, the jewel in the crown of Jewish philanthropy in Montreal, in relation to that of the nearby Laurentian Sanatorium. While Mount Sinai offered free treatment to the poor in a stunning, Art Deco building of 1930, the Protestant hospital had by then served paying patients for more than two decades in a purposefully home-like, Tudor-revival setting. Using architectural historian Bernard Herman's concept of embedded landscapes, we show how the two hospitals differed in terms of their relationship to site, access, and, most importantly, to city, knowledge, and community. Architects Scopes & Feustmann, who designed the Laurentian hospital, operated an office at Saranac Lake, New York, America's premier destination for consumptives. The qualifications of Mount Sinai architects Spence & Goodman, however, derived from their experience with Jewish institutions in Montreal. Following Herman's approach to architecture through movement and context, how did notions of medical therapy and Judaism intersect in the plans of Mount Sinai?

The present investigation was carried out to determine the possible bioactive components of tuber of Ruellia tuberosa L. (Acanthaceae) using GC-MS analysis. Twenty five compounds were identified. The prevailing compounds in the ethanol extract of tuber of R. tuberosa were Lupeol (68.14%), Stigmasterol (8.89%), á-Sitosterol (3.99%), Sucrose (2.24%), Cholest-5-ene, 3-bromo-, (3á- (2.24%), Octadecane, 2-methyl- (2.10%), Nonadecane, 2-methyl- (1.93%), Eicosane, 2-methyl- (1.79%) Heptacosane (1.43%) and Heptacosane (1.29%).