Assessing Pulmonary Tuberculosis Using Bandim Tuberculosis and Karnofsky Performance Scale Scores with Serum Adenosine Deaminase Levels / 가정의학회지

Background@#Elevated pulmonary serum adenosine deaminase (ADA) levels signify lung tissue damage and severe tuberculosis (TB). Serum ADA assays can be used as an additional criterion for assessing TB treatment response and as a prognostic marker in patients with pulmonary TB. The Bandim TB and Karnofsky Performance Scale (KPS) scores were developed based on available clinical data and investigations to allow physicians to evaluate disease treatment and response. This study examined the use of a clinical scoring system (Bandim TB and KPS scores) in the context of serum ADA activity. @*Methods@#Forty adults (aged >18 years) diagnosed with pulmonary TB by Ziehl-Neelsen staining for acid-fast bacilli and/or cartridge-based nucleic acid amplification test were recruited. Standardized questionnaires were used to record Bandim TB and KPS scores. Serum ADA levels were estimated using a commercial kit. @*Results@#The Bandim TB score was positively associated (ρ=0.74, P≤0.001) and the KPS score was negatively associated (ρ=-0.69, P≤0.001) with serum ADA levels. @*Conclusion@#Subjective and objective clinical scores of pulmonary TB were strongly correlated with serum ADA levels. Knowledge of clinical scores corresponding to serum ADA levels could help physicians understand stage and progression of the disease which may aid in early detection and better management, and reduce disease transmission in a TB-endemic country.

Diagnostic dilemma in female genital tuberculosis- staining techniques revisited

Tuberculosis [TB] is an increasing public health concern worldwide. On a global scale it has a devastating impact in developing nations. Genital TB, an extrapulmonary form, is not uncommon particularly in areas where pulmonary TB is prevalent. Genital TB may be asymptomatic or may even masquerade as other gynaecological conditions; hence, diagnosis requires a high degree of suspicion and the use of appropriate investigations. This study attempted to identify endometrial TB in endometrial biopsies taken from women evaluated for infertility by comparison of various staining techniques. A comparative cross sectional study was conducted from February 2011 to April 2011 in Guru Teg Bahadur Hospital, New Delhi. Endometrial biopsy specimens from 55 endometrial TB suspects were stained for acid fast bacilli by Ziehl Neelson staining and Gabbet staining. The biopsy samples were also subjected to Auramine Phenol fluroscent staining and H and E staining. Culture on Lowenstein Jensen medium was taken as the gold standard. Three samples were culture positive giving positivity rate of 5.4%. Considering culture as the gold standard the senstivities of ZN, Gabbet, fluorescent and H and E staining were 33, 33, 66, and 66% respectively while their specificities were 100, 100, 98, and100% respectively. Combination of fluorescent staining techniques along with one of the acid fast staining techniques or histopathology achieves sufficient sensitivity and specificity for the diagnosis of female genital tuberculosis. There is an urgent need for developing definitive diagnostic methods to make a conclusive diagnosis of genital TB

Dengue fever presenting as acute liver failure--a case report

Dengue fever (DF) and dengue haemorrhagic fever (DHF) are important mosquito-borne viral diseases of humans and recognized as important emerging infectious diseases in the tropics and subtropics. Compared to nine reporting countries in the 1950s, today the geographic distribution includes more than 100 countries worldwide. Dengue viral infections are known to present a diverse clinical spectrum, ranging from asymptomatic illness to fatal dengue shock syndrome. Mild hepatic dysfunction in dengue haemorrhagic fever is usual. However, its presentation as acute liver failure (ALF) is unusual. We report a patient with dengue shock syndrome who presented with acute liver failure and hepatic encephalopathy in a recent outbreak of dengue fever in Delhi, India.

Respiratory syncytial virus in lower respiratory tract infections

Acute lower respiratory infections lead to high morbidity and mortality rates in children from developing countries. The aim of this study was to look into the extent of respiratory syncytial virus infections in children with special reference to the role of specific immunoglobulins in protection against infection as well as the association with bacterial pathogens. Nasopharyngeal aspirates were tested for respiratory syncytial virus antigen by enzyme immunoassay and IgA antibodies by single radio immunodiffusion test. Viral culture on HEP-2 cell system and bacterial culture was done. Sera were tested for detection of antibodies to respiratory syncytial virus by indirect fluorescent antibody test. Antigens of streptococcus pneumoniae and haemophilus influenzae were detected in serum and urine by latex agglutination assay. Incidence rates of acute lower respiratory infections were highest in infants; bronchiolitis and bronchopneumonia being the main contributors. Respiratory syncytial virus infection was found in 27.08% of the cases. Secretory IgA antibodies level was found to be a good indicator of respiratory syncytial virus infection as seen by the significantly higher levels in cases as compared to both non respiratory syncytial virus cases and controls

Relationship of IgG avidity index and IgM levels for the differential diagnosis of primary from recurrent cytomegalovirus infections

Since the incidence of symptomatic congenital cytomegalovirus infection is low [0.05%] and risk factors are not well defined, it is difficult to develop strategies for prevention. The aim of this study was to recognise the utility of specific Immunoglobulin G avidity analysis for distinguishing primary infection from past/recurrent infection. Sera from 50 women with cytomegalovirus specific Immunoglobulin M antibodies without proven seroconversion and infants born to these women were tested for presence of Immunoglobulin M antibodies by commercial enzyme immunoassay. For cytomegalovirus specific immunoglobulin G avidity, sera were measured by commercial kit according to manufacturer's recommendations. Among 50 sera form mothers, 26 showed the presence of Immunoglobulin M antibodies out of which 15 had low avidity antibodies. Out of 50 sera from children, 18 showed the presence of Immunoglobulin M antibodies. Out of these 18 sera from children, 12 were symptomatic, which all showed the presence of low avidity antibodies. The results showed that an avidity index<40% and presence of Immunoglobulin M antibodies is highly suggestive of a recent primary infection