Errors in the diagnosis and treatment of pulmonary tuberculosis

The objective of this study was to evaluate the causes of treatment failures in patients diagnosed as pulmonary tuberculosis and started on ATT by general practitioners and general physicians. This was a descriptive observational study conducted at CMH Multan from 1st August 2004 till 31st July 2006. It included patients of all ages and both sexes. All of these patients received ATT for more than 2 months but failed to respond. All relevant investigations including sputum microscopy/culture sensitivity, bronchoscopy and CT scan chest were carried out. Total numbers of patients registered were 48. There were 27 males and 21 females and the mean age of patients was 42.75 years. Of these, 58.33% [n=28] were wrongly diagnosed. 25.02% [n=12] did not show proper compliance. 10.41% [n=5] were prescribed inadequate dosage. While 6.25 [3] were suffering from MDR-tuberculosis. Chronic bronchitis/ COPD, bronchiestasis and bronchogenic carcinoma were the commonest disease found in this series. All TB suspects should have a sputum microscopy done at the earlier stage. AFB culture/ sensitivity should be carried out whenever considered necessary. In Sputum smear negative patients high index of suspicion for non tubercular pulmonary diseases should be maintained. DOTS needs to be employed in all patients with active pulmonary tuberculosis

Efficacy of rifampicin in eradication of carrier state of staphylococcus aureus in anterior nares with recurrent furunculosis

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. Quasi-experimental study. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. Patients and The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily [depending on the body weight] for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 [57.5%], while in group II the carrier state was found in 8 [20%] individuals [p <0.001]. Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive [p<0.001]. These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection