Immune Responses of CD4 [+] T-cells of MDR-TB patients to M. tuberculosis total lipid antigens

CD4 [+]T-cell have a central role in protective immune responses to Mycobacterium tuberculosis [M. tuberculosis] protein antigens, but function of these cells in response to M. tuberculosis total lipid antigens has remained unclear. The present study was undertaken to determine role of CD4[+] T cells in the MDR-TB patients against M. tuberculosis total lipid antigens. CD4[+]T- cells were isolated from MDR-TB patients and stimulated with M. tuberculosis total lipid antigens. Proliferative responses and cytokine secretion were assessed by MTT and ELISA, respectively. Our study results showed that proliferative responses of stimulated CD4[+]T- cells to M. tuberculosis total lipid antigens and IFN-gamma production in MDR-TB patients were significantly lower than those of the PPD-positive subjects [P < 0.05] whereas, IL-4 production in the MDR-TB patients was elevated[P < 0.05]. Responses of CD4[+]T -cells of MDR-TB patients to total lipid antigens was significantly lower than that of PPDpositive healthy subjects. Therefore, it seems that M. tuberculosis lipid antigens, as protein antigens, have an important role in specific immune response

Evaluation of pseudoadrenal insufficiency in tuberculosis patients

Adrenal insufficiency following initial treatment of active tuberculosis [TB] is a rare phenomenon. It is also one of the most important causes of mortality within the first few days of TB treatment. The present study evaluated this adverse effect of anti-tuberculous treatment. A prospective study was performed on TB patients hospitalized in Masih Daneshvari Hospital between 2004 and 2005. All patients had received standard anti-TB drug regimen. We evaluated pseudo-adrenal insufficiency in these patients. The study group included 429 patients out of which 6[1.4%] developed adrenal insufficiency following anti-TB treatment. In all 6 patients, basal serum cortisol levels were measured which were below the normal range after treatment. No patient had clinical findings of adrenal insufficiency before initiation of anti-TB therapy. After treatment with dexamethasone, the general condition of patients improved. [The average response to treatment was 3.1 +/- 1.7 days]. No mortality was reported during the treatment course or follow-up period. In TB patients, the adrenal reserve/ serum cortisol reserve level is low. Standard anti-TB drug regimen including rifampicin causes rapid catabolism of cortisol in tissues specially in the liver and lungs; therefore, serum cortisol level will be more decreased and consequently the patient develops adrenal insufficiency. As a whole, despite of the low incidence rate of this adverse effect, early diagnosis and treatment is essential to save the patient's life

Vitamin A supplementary effect on immunologic profiles in tuberculosis patients

The effects of vitamins on human immune system have been well studied. Vitamin A deficiency and its effects on immune system in pulmonary tuberculosis [TB] patients have been established. This study was carried out to evaluate vitamin A supplementary effect on immunologic profile of tuberculosis patients. In a double-blind clinical trial, thirty-five patients with confirmed pulmonary tuberculosis were included. The case group received vitamin A injection, 50000 lU, every 10 days for two months along with standard treatment of TB; the control group received only anti-TB drugs. Immunologic profiles including CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, HLA-DR, CD16+56+, and plasma vitamin A as well as nutritional status were assessed in both groups primarily and two months after above-mentioned treatments. Data were analysed using SPSS software version 10. The study showed that there were not significant differences in mean[ +/- SD] of age, body weight, height, body mass index [BMI], fat thickness and vitamin A plasma level between the vit A-receiving and control groups. The mean of peripheral blood CD3+ showed significant increase in patient-control group [71.8 +/- 7.9% lymphocytes [after supplementation] compared with 68.3 +/- 10.7% [before supplementation]; p= 0.014.]. This was also true about CD4+ [p= 0.001]. CD4+ to CD8+ ratio and the mean of CD19+ showed significant decrease in the patient control group and the vit A-receiving group, respectively [p= 0.002 and p= 0.04, respectively]. In contrast, there was an increased significant difference for CD+16+56+ mean in the above-mentioned groups which was more prominent in the vit A- receiving group [p=0.038]. The means of HLA-DR and CD8+ did not show significant differences in both groups before and after supplementation. It seems that vitamin A supplementary effects on the quality of lymphocytic markers are remarkable. However, further studies should be performed regarding immunologic response quality

Evaluation of patients with infective endocarditis in a pulmonary referral centre

Despite the decreased incidence of rheumatic fever and use of prophylactic antibiotic the incidence rate of infective endocarditis has not declined. In this research, we have studied the clinical feature and therapeutic response of patients with infective endocarditis presenting with pulmonary manifestations to a pulmonary referral center. All patients with diagnosis of endocarditis that had pulmonary manifestations [based on Duke Criteria] as their primary clinical presentation were entered in this study. Data in regard to individual information, clinical features, laboratory finding and therapeutic responses were noted. All data were analysed using SPSS software [version 11.5]. A total number of twenty patients here entered the study. Mean age was 34.8 +/- 11.6 yr. The commonest clinical features included: fever [95%], cough [65%] and dyspnea [65%]. Also the commonest signs were cardiac murmurs [65%], hepatomegaly [35%] and splenomegaly [35%]. Clubbing was seen in 10%. Sixty percent of the cases were intravenous drug users and 25% were infected with HIV. Also 50% of the patients did not have any background of valvular diseases. However, there was vegetations on one valve in 75% and multiple valves were involved in 25%. The commonest valves affected were trocuspid [50%], mitral [30%] and pulmonic valve [10%]. Staphylococcus aureus [47.3%] and Streptococcus viridans [27.3%] were the commonest microorganisms detected. Pericardial effusion was present in 30% which was higher in IV drug users [p. value=0.042]. Total mortality rate in hospital was 5%. Infective endocarditis should be considered in the list of differential diagnosis in patients suffering from pulmonary symptoms especially in IV drug users

Clinical and radiological presentation of adult tuberculous spondylitis

Tuberculous spondylitis is an uncommon form of extra-pulmonary TB. Delay in establishing diagnosis and management causes spinal cord compression and spinal deformity. We studied to determine clinical and radiological presentations of this dangerous form of TB diseases. During 2002-3 years, all patients over 14 years old who hospitalized with a probable diagnosis of TB spondylitis were evaluated. Everybody with mycobacteriologic or pathologic confirmation was enrolled in study. fourteen patients met our inclusion criteria. The mean age [SD] was 39[16] year. 57% were male. Treatment delay was 8.3 months. Fever reported in 7[50%] patients. Local tenderness was reported in 92.6% of cases. PPD was positive in half of the patients. The most regions involved were T8-T12 [43%] and L1-L3 [36%] respectively. Sputum smear was surprisingly positive in 50% of cases. Most of the patients had received anti-TB drugs for 9-12 months. CT guided aspiration and biopsy of spine lead to correct diagnosis in 93% of patients. Simultaneous pulmonary involvement is evident in half of them