Combined drug medium with isoniazid and rifampicin for identification of multi-drug resistant Mycobacterium tuberculosis.

A low-cost method of detecting multi-drug resistant Mycobacterium tuberculosis (MDR-TB) with the possibility of quick adoption in a resource limited setting is urgently required. We conducted a study combining isoniazid and rifampicin in a single LJ medium, to detect MDR-TB strains. Combined and individual drug media showed 100% concordance for the detection of MDR-TB and susceptible strains by proportion method. Considering the results, combined isoniazid and rifampicin containing medium could be considered for use in settings where the sole detection of MDR-TB strains is justified.

Socio-economic dimensions of tuberculosis control: review of studies over two decades from Tuberculosis Research Center.

Tuberculosis (TB) affects the most productive age group and the resultant economic cost for society is high. Even though diagnostic and treatment services under TB control are offered free of cost, TB patients do incur out of pocket expenditure. Tuberculosis Research Centre under took a series of studies on economic aspects of TB. We interviewed TB patients enrolled under TB control programme in south India, and assessed the following: socio-economic status of patients (SLI - standard of living index) and economic impact on patients, families both before and after Revised TB Control Programme (RNTCP) and the impact of parental TB on children. In addition patient's perceptions of physical, mental, social well being during and after completion of treatment were also elicited. A TB patient incurs out of pocket expenditure of Rs 5986 amounting to about 13,000 crores a year for the country; 11% of children dropped out of school on account of parental illness and 20% of the children had to take up employment in order to supplement income especially if the father had TB. About 64% of TB patients registered under RNTCP were poor (low SLI). The provider cost to treat a TB patient under RNTCP was Rs 1587/- for Category I, Rs 1924/- for Category II and Rs 1417/- Category III. At the end of treatment even though 47% of patients continued to have respiratory symptoms, 54% of patients perceived 'happy mental status'. Majority of the patients registered under RNTCP were poor. Patients' and provider costs and the impact on patients including families on account of TB were enormous. About half of TB patients, despite completing treatment successfully had persistent respiratory ill health resulting in frequenting health facilities. This information is vital for programme planners indicating that the existing control programs have been ineffective. To achieve success in control programs, the existing ones should be amended as there is evolution of resistance in the parasite as well as the vector. Public health education, to make the people aware about preventive aspects of the disease is important. The possibility of the existence of animal reservoirs should also be considered and checked out for better control measures.

Seroprevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients in Tamil Nadu.

BACKGROUND & OBJECTIVES: The dual epidemic of HIV and tuberculosis is a cause for concern in those countries where these two infections are prevalent in epidemic proportions. We undertook a survey at two sites in North Arcot district of Tamil Nadu in 1992-1993, to know the seroprevalence of HIV infection among tuberculosis patients. The objective of this study was to re-examine the prevalence of HIV infection among tuberculosis patients in a repeat survey. METHODS: The study was undertaken in four centres: District Tuberculosis Centre (DTC), Vellore, Tuberculosis Sanatorium, Pennathur (Vellore), District TB Centre (DTC), Kancheepuram and the Government Thiruvotteswarar Tuberculosis Hospital (GTTH), Chennai in the northern part of Tamil Nadu during 1997-1998. A total of 2361 newly diagnosed TB patients were registered in this study. HIV serology after pre-test counseling was done along with sputum examination for acid-fast bacillus by smear and culture for mycobacteria for all patients. RESULTS: The overall HIV seroprevalence among TB patients was 4.7 per cent. The highest HIV seropositivity rate was found among patients aged 30-39 yr (10.6%). HIV seroprevalence showed a wide variation among the different centres ranging from 0.6. per cent in DTC, Kancheepuram to 9.4 per cent in Pennathur Sanatorium, Vellore. Sputum smear positivity was 88 per cent among the HIV-negative and 83 per cent among HIV-positive tuberculosis patients. INTERPRETATION & CONCLUSION: HIV infection is on the rise among TB patients in Tamil Nadu. Acid-fast smear microscopy is adequate for the diagnosis of pulmonary tuberculosis, and drug resistance among HIV positive patients is not a major problem at this point of time; hence antituberculosis regimens recommended by the Revised National Tuberculosis Control Program (RNTCP) can be used to treat HIV positive patients with tuberculosis.

Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis.

A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.

Management of non-pulmonary forms of tuberculosis: review of TRC studies over two decades.

Tuberculosis Research Centre, Chennai has been conducting randomized controlled clinical trials in both adults and children (n = 1015) in various non-pulmonary forms of tuberculosis, for the last two decades. This communication discusses the salient findings of these studies. The important finding is that short course chemotherapeutic regimens have been proven to be highly effective in tuberculosis of spine, superficial tuberculous lymphadenitis, abdominal tuberculosis, brain tuberculoma and Pott's paraplegia. However, in tuberculous meningitis, the outcome appears to be directly related to the stage of the disease on admission. The intermittent regimens have been found to be as effective as daily regimens. The other important aspects highlighted are the need to obtain bacteriological/histo-pathological confirmation by resorting to relevant diagnostic procedures, value of Mantoux as a diagnostic tool and role of surgery.

The association of t (13q, 14q) with Down's syndrome and its inheritance.

Cytogenetic analysis of the first child of an older couple afflicted with Down's syndrome revealed a Robertsonian translocation between the chromosomes 13, 14 in addition to trisomy 21. His mother was found to be a carrier of this translocation with no history of abortion.