ABSTRACT
Background: Sequelae of patients treated for multi-drug resistance tuberculosis (MDR-TB) remain unknown. Objective: To assess the clinical, bacteriological, radiological and functional status of MDR-TB patients after completion of treatment. Methodology: In a cross-sectional study, MDR-TB patients who had initiated standardized, community based therapy from January 2002 to December 2006 at Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases were investigated for their current clinical, bacteriological, radiological and functional status. Results: Between January 2002 to December 2006, 130 patients initiated treatment, of whom 24 died. Among rest 106 patients, 63 (59%) patients could be traced: 51 were currently alive while 12 had died. The 51 alive patients had completed a mean (+S.D.) post treatment period of 24+14.7 months ranging from 6 to 63 months before being enrolled in the study. Among currently alive patients who could be investigated, 78% had persistent respiratory symptoms; 98% had residual radiological sequelae with 40% having far advanced involvement. Abnormal Pulmonary Function Tests were observed in 45 (96%) patients with predominantly mixed type of ventilatory abnormality in 31 (66%) patients, while 9 (19%) had pure restriction and 5 (11%) had pure obstruction. None of the patients was found to be bacteriologically positive. Conclusion: Current study confirms the efficacy of the standardized regimen as none of the patients was bacteriologically positive on follow up. However, after completion of treatment significant number of cured MDR-TB patients are left with residual symptoms, abnormal X-ray chest and impairment of lung functions. These issues need to be addressed as a part of comprehensive management of MDR-TB patients under national programme.
ABSTRACT
OBJECTIVE: To study the influence of initial bacillary load on sputum conversion rates and treatment outcome of new smear positive pulmonary tuberculosis patients. METHODS: A retrospective study was done among 2938 new smear positive pulmonary tuberculosis patients, registered at the peripheral centres, covering a population of 1.6 million in Delhi, India. The patients pre-treatment sputum smears were graded as 1+, 2+ or 3+ based on three samples. Patients were given intermittent short-course chemotherapy under supervision and the treatment outcome was analysed. RESULTS: Sputum conversion rates among patients graded as sputum 3+ and rest of the patients (combined graded sputum 1+ and 2+) at the end of two months were 62.2% and 76.8% respectively (p<0.001), and at the end of three months were 81.3% and 89.5% respectively (p<0.001). Cure rates among same group of patients were 76.6% and 85.1% respectively (p<0.001), and failure rates were 7.7% and 4.5% respectively (p<0.001). CONCLUSIONS: Under field conditions even with directly observed treatment (DOT) new smear positive patients with heavy bacillary load showed statistically significant poor sputum conversion rates at two and three months and higher failure rates as compared to patients with lesser bacillary load. To investigate possible reasons for this poor response and possible solutions further studies are needed.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Directly Observed Therapy , Female , Humans , India , Infant , Infant, Newborn , Male , Middle Aged , National Health Programs , Retrospective Studies , Sputum/microbiology , Treatment Outcome , Tuberculosis, Pulmonary/drug therapyABSTRACT
BACKGROUND: With an increase in life expectancy and the resultant elderly population, there has been an increase in the number of tuberculosis (TB) cases including those in geriatric age as well. However using Directly Observed Treatment-Short Course (DOTS), all categories of TB patients have been sucessfully treated within the country. A need was felt to study the profile of geriatric TB patients under the Revised National Tuberculosis Control Programme (RNTCP). METHODS: A retrospective study of 7439 patients enrolled under DOTS from January 1996 to March 2001 was carried out in a tertiary care referral institute in Delhi and the profile was analysed in terms of the gender, type of TB and ratio of sputum smear-positive to negative patients for both the younger and geriatric age groups. Further, treatment outcomes of the two age groups were analysed and compared for the 2655 new sputum smear patients. RESULTS: The male : female ratio of 315 geriatric TB patients enrolled under DOTS was observed to be 3 : 1 as against the 1.4 : 1 in younger TB patients. The occurrence of pulmonary TB was significantly higher than extra-pulmonary TB in geriatric age group (16:1) as compared to the younger age group (4:1). The ratio of new smear-positive to smear-negative patients was almost similar in the two age groups. Further, the treatment outcomes of new smear-positive geriatric TB patients in comparison to younger TB patients showed significantly lower sputum conversion (75.3% vs 85.7% respectively) and cure rates (69.2% vs 80.7% respectively), significantly higher exclusion rates from DOTS (2.3% vs 0.15% respectively) and relatively higher default and treatment failure rates. CONCLUSIONS: The present study has identified certain issues in the Indian TB patients of geriatric age. These include a lower reported prevalence amongst females, poor sputum conversion as well as cure rates and higher exclusion as well as default rates. Further studies are needed to address the issues under operational conditions of Indian RNTCP.