Performance of ICT-TB test in the detection of pulmonary and extra-pulmonary tuberculosis

Tuberculosis is a major public health problem of the developing nations including Pakistan. We need a simple, economical and non invasive test to make an early diagnosis of T.B. in order to avoid the complications. A study was conducted at the Dept. of Pulmonology, PGMI LRH Peshawar and Ayub Teaching Hospital Abbottabad with the collaboration of Deptt of Pathology KMC Peshawar from Jan 1998 to Dec 2002. A total of 129 patients were included in the study. Out of these 129 patients 52 were pulmonary TB [PTB] smear positive, 30 were PTB smear negative, 30 pleural effusion and 17 were TB lymphadenitis. The control group consisted of 25 non TB patients and healthy subjects. Antibody was detected in 23 of 52 [44%] sputum positive patients, 11 of 30 [36%] sputum negative PTB patients, 10 of 30 [20%] patients of TB pleural effusion and 6 of 17 [35%] patients of TB lymphadenitis. Antibody was detected in none of the control subjects. The overall sensitivity for Pul-T.B. Sputum positive patients was 44%, 36% for sputum Negative Pulmonary TB, 20% for TB pleural effusion and 35% for TB lymphadenitis. The specificity was 100%. ICTTB is a highly specific, but less sensitive aid in the diagnosis of Pulmonology and extra Pulmonology TB

Efficacy, safety and tolerability of streptokinase in multiloculated empyema

Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety of intra-pleural Streptokinase in loculated empyemas. A total of 15 patients admitted in Pulmonology unit with multiloculated empyemas whose drainage via drainage tube was less than 100 ml during the last 24 hours were included in the study. Aliquots of 250,000 units of Streptokinase in 100 ml of normal saline were instilled into the pleural cavity and the tube clamped for 3 hours. Response was assessed by clinical outcome, measurement of drain output after unclamping and subsequent chest radiography and serial chest ultrasounds. Streptokinase enhanced drainage in all patients with complete resolution of Empyema in 13 patients. Two patients with thickened visceral pleura following empyema drainage were referred to thoracic surgeon for decortication. The number of instillations of Streptokinase per patient ranged from 1 to 3 and the volume of drained empyema fluid ranged from 60 ml to 600 ml per patient. Streptokinase was well tolerated in all patients. Intrapleural Streptokinase is a safe and effective means of increasing the tube drainage in multiloculated Empyema without causing systemic fibrinolysis