Effect of cold vibrator device on pain perception of children aged 6-12 years old undergoing Mantoux Test at Philippine Children's Medical Center out-patient department

@#<p><strong>BACKGROUND:</strong> Painful procedures intensify hospital-related stress and anxiety leading to unpleasant experience that can adversely affect procedure outcomes and health seeking behaviors.</p><p><strong>OBJECTIVE:</strong> To determine the effect of a cold vibrator device on pain perception of children aged 6-12 years old during Mantoux Test at the Out-Patient Department of the Philippine Children's Medical Center.</p><p><strong>METHODOLOGY:</strong> This is a single blinded, randomized control trial where one-hundred four (104) subjects were randomly assigned to experimental (54 subjects) and control group (50 subjects) through fishbowl method. The experimental group received the cold vibrator prior to Mantoux test while the control group received the Mantoux test alone. Pre and post procedural heart rate, respiratory rate and oxygen saturation were obtained. The responses were evaluated using the Wong-Baker Faces Pain Scale.</p><p><strong>RESULTS:</strong> Pain score was higher in the control group. Wilcoxon Rank-Sum Test showed mean rank of 67.5 with aggregated pain rank of 3645.00 compared to experimental group (with cold vibrator) of 36.3 with aggregated pain rank of 1815.00 with a p value 0.0000000046. There was no significant difference between the physiologic parameters (heart rate, respiratory rate, and oxygen saturation) before and after procedure between the two groups.</p><p><strong> CONCLUSION AND RECOMMENDATION:</strong> The use of the cold vibrator was effective in reducing pain perception. It can be used as an adjunct to mitigate pain for needle-related procedures. Demographic data could also be correlated to the pain scores of the subjects. </p>

Clinical study and management of genitourinary tuberculosis

Background: Tuberculosis can affect any organ system of the body, including the genitourinary tract. Genitourinary TB is the most common form of extra pulmonary TB accounting for 27% (14- 41%) worldwide. Aim and objectives: To study distribution of GU TB in relation to age, sex, anatomical site, signs and symptoms and to study various diagnostic modalities, treatment and role of surgery in GU TB. Materials and methods: This study was a cross sectional study done at department of Urology, King George hospital, Visakhapatnam. The study was done over a period of 30 months, which was from September 2014 to February 2017. All the patients reporting to the hospital with proven genitourinary tuberculosis or diagnosed after coming to the hospital were included in the study. Total number of cases was 35. 10 were males and 25 were females. History, physical examination, laboratory and radiological investigations were done on the patients and the primary focus of the disease and organs involved are determined. All the patients received treatment as indicated. Results: Most of the patients (33 out of 35) belonged to low socio-economic status and came from rural settings. Of them 10(28.57%) were males and 25(71.43%) were females. The mean age of patients was 36 years (range 16-60years). 2 patients were <20 years, 11 patients were between 21-30 years, 11 patients were between 31-40 years, 8 patients were between 41-50 years and 3 were above 50 years. In this study, kidney was involved in 19 cases and was the most common organ involved, followed by bladder (14 cases) and ureter(10 cases). Irritative voiding symptoms were the most common symptom seen in 23 cases. Flank pain was noted in 20 cases, sterile pyuria in 22 cases and hematuria in 7 cases. Six(17.14%) out of thirty five patients had renal failure at the time of presentation and diagnosis. Nephrectomy was done in 12 cases. Nephrectomy with augmentation Immadi Chandrasekhar, Pasalapudi Anurag Jose. Clinical study and management of genitourinary tuberculosis. IAIM, 2019; 6(1): 48-57. Page 49 cystoplasty and ureteric reimplantation was done in another 6 cases. Ileal conduit was done in 6 cases. Ureteric reimplantation with psoas hitch was done in 3 cases. Conclusion: Genitourinary tuberculosis is often silent and has nonspecific clinical features. Irritative voiding symptoms are the common presentation. Kidney is the most commonly affected organ in GU TB. GU TB is a disease of young adults, with majority affected in the 3rd and 4th decades. CT scan is replacing IVU as an imaging modality of choice in GU TB. Diagnosis of GU TB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens and the difficulty to isolate or grow TB bacilli. Hence a strong clinical suspicion is necessary for correct diagnosis. Anti-tubercular therapy is the mainstay of treatment. Genitourinary tuberculosis results in sequel which may require major organ removing and reconstructive surgeries

Neumonía como forma de presentación de la tuberculosis pulmonar / Pneumonia as a form of presentation of pulmonary tuberculosis

INTRODUCCIÓN: la tuberculosis pulmonar es un flagelo que continúa afectando a la población en general, y con gran repercusión en la población infantil a nivel mundial y regional. Considerada desde hace varias décadas como una enfermedad en reemergencia, debe ser reconocida -lo más tempranamente posible- por los trabajadores de la salud, y sobre todo, por el personal médico. PRESENTACIÓN DEL CASO: se presenta el caso de un paciente de 14 años de edad, del sexo masculino, que presentaba sintomatología respiratoria de más de dos meses de evolución, e ingresó en un servicio de enfermedades respiratorias con el diagnóstico de neumonía complicada. En el interrogatorio se recogen datos de interés, se supieron las condiciones socioambientales del paciente, y que un familiar conviviente con el niño había evadido el control ambulatorio al haber sido diagnosticado de tuberculosis pulmonar, por lo que no concluyó tratamiento. Se exponen los principales resultados de los complementarios (incluyendo prueba de Mantoux positiva), evolución de las radiografías de tórax y tratamiento antituberculoso aprobado con el servicio de Infectología y el Centro Nacional de Referencia de Tuberculosis Infantil. CONCLUSIONES: es importante una historia clínica epidemiológica detallada en todo paciente con neumonía adquirida en la comunidad.

INTRODUCTION: pulmonary tuberculosis is a scourge that keeps affecting the general population, with a great impact on the infant population in the region and worldwide. Since many years ago, it is considered a re-emergent disease and should be identified -as early as possible- by the health workers, and mainly the medical staff. CASE PRESENTATION: a 14 years-old male patient who presented with respiratory symptoms for more than 2 months and was admitted to a respiratory disease service under diagnosis of complicated pneumonia. During the interview, interesting data were collected about his/her social and environmental conditions and it was found out that a relative, who live in the same house, did evade the outpatient control after he being diagnosed as a pulmonary tuberculosis case, thus he did not finish the treatment. The main results of the supplementary tests (including positive Mantoux test), progress of chest x-rays and the antituberculosis treatment approved by the Infectology service and the National Center of Reference for Child Tuberculosis were all described. CONCLUSIONS: it is essential to have a detailed epidemiological clinical record of every patient with community-acquired pneumonia.

Interpretation of Mantoux test in children

Tuberculosis is the most common infectious cause of death worldwide. Young children especially infants usually are more susceptible to tuberculous infection. Disease usually develops within 1 year of infection. The present study has been conducted upon 41 children in whom Mantoux test was positive (n=41). These children were coming to our outpatient department, in a Teaching Hospital, Nizamabad, Telangana State with mild fever, cough, night sweats, anorexia, and loss of weight. The age group selected for this study was 1 to 12 year, and the period of study was from August, 2013 to December, 2015. Among the 41 children under study 13 children were 1 to 4 year and 28 were 5 to 12 year. Among the total 41 cases of Mantoux positive, 16 (39%) were found to be suffering from tuberculous disease and anti tuberculous drugs were started. In these cases 7 were 1 to 4 year (n=13), and 9 were 5 to 12 year (n=28). After 3 months follow up, all the children who were on ATT became free from their symptoms. It shows association between mantoux positivity and tuberculosis is more in children between 1 and 4 year than children between the age of 5 and 12 year. Most of the other children needed antipyretics, other symptomatic drugs and antibiotics only. But in 3 cases symptoms were not relieved either with antibiotics or with trial ATT. The factors for deciding tuberculosis are history of contact, clinical picture, CBP, ESR, chest- x- ray, Mantoux test, sputum for AFB, antibiotic trial, follow up, trial ATT. All these factors are put together and then only we will decide whether to start ATT or not.

An unusual presentation of lupus vulgaris in pediatric patient: A clinico-histopathological diagnosis.

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 12 years old boy who was diagnosed as lupus vulgaris clinically as well as histopathologically simultaneously. He had well demarcated, irregularly bordered, pink, infiltrated plaques on the nose showing apple-jelly appearance on diascopy with multiple lymphadenopathy on bilateral submandibular and cervical group of lymph nodes. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux test showed positive reaction (20 mm) and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed significant improvement on anti-tuberculosis treatment. The main purpose of this case report was to emphasize that histopathological examination has diagnostic value in clinical suspicion of LV on face, when direct analysis or culture is negative.

Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: A case report and brief review.

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

Profile of serpiginous choroiditis in a tertiary eye care centre in eastern India.

Purpose: To study the clinical profile of serpiginous choroiditis in eastern India. Materials and Methods: Ninety‑one eyes of 54 patients with serpiginous choroiditis presenting to a tertiary care centre in eastern India between January 2006 and December 2010 were included in the study. Clinical presentation, treatment given, and visual outcome of the eyes were studied. Results: Thirty‑five (64.8%) patients were male and 19 (35.2%) were female in the age group of 13‑62 years (mean age: 34.1 ± 18.7 years). Blurring of vision (71; 78%) and floaters (36; 39.5%) were commonest symptoms. In 75 (82.4%) eyes, choroiditis started from optic nerve head and spreading centrifugally. Overall, 38 (41.75%) eyes had macular involvement at first visit. Mantoux test reading was 10 mm or more (Group A) in 12 (22.22%) patients and less than 10 mm (Group B) in 42 (77.77%) patients. Difference between Groups A and B in macular involvement at first visit (10; 50% vs. 28; 39.4%) and rate of recurrence (3; 15% vs. 14; 19.7%) was not statistically significant (P = 0.37 and 0.68). Oral steroid (51; 94.4%) was the commonest mode of treatment. Fifty‑one (56%) eyes had two lines or more improvement in vision. Conclusions: The present study details the clinical presentation, treatment, and visual outcome of serpiginous choroiditis. Mantoux test reading does not affect the clinical presentation or the treatment outcome in these eyes.

Exaggerated mantoux reaction in a case of LTBI.

Summary: A 42-year-old female presented with a history of receiving PPD on right forearm intradermally before two days. Patient started having itching and irritation within a few hours and pain, oedema and vesicles formation by next day at the injection site. On examination, the whole right forearm was oedematous with induration of size 50mm x 50mm around the site of injection. Tubercular infection was suspected and the patient was subjected to further investigation but nothing, including physical examination, hemogram, fundus examination, chest X-ray, USG abdomen and CT thorax, was found suggestive of tuberculosis, leading to a diagnosis of LTBI.

Sarcoidosis in north indian population: A retrospective study.

Background. Sarcoidosis is a systemic granulomatous disease of unknown origin most commonly involving the lungs. Sarcoidosis is frequently misdiagnosed due to its clinico-radiological resemblance to tuberculosis (TB). Hence, the present study was undertaken with the aim of studying the clinico-radiological profile of sarcoidosis in the Indian context. Methods. We retrospectively studied 146 patients diagnosed to have sarcoidosis during the period 2001-2010 at one of the respiratory units at Vallabhbhai Patel Chest Institute. Results. Majority of them (70%) were more than 40 years of age; females comprised 58.2% of the patients. Before coming to our clinic, 30% patients had been misdiagnosed to have TB. Cough (89.7%) was the most common presenting symptom; joint symptoms (28.8%) and end inspiratory crepitations at lung bases (49.3%) were other salient manifestations. Cutaneous involvement and digital clubbing were rarely seen. Pulmonary function testing showed restriction with impaired diffusion in 72.7% patients. The most common radiological feature was bilaterally symmetrical hilar lymphadenopathy. Transbronchial lung biopsy (TBLB) had a very high diagnostic yield (90.8%). Conclusions. Sarcoidosis is often misdiagnosed as TB in India. Transbronchial lung biopsy has high diagnostic yield in sarcoidosis.

Fine needle aspiration cytology in childhood TB lymphadenitis.

Objective. To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features. Methods. This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital. Results. Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis. Conclusion. Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.

Tuberculosis-HIV Coinfection: The Relationship Between Manifestation Of Tuberculosis And The Degree Of Immunosuppression (CD4 Counts)

The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3), patients with CD4 counts ² 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ² 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.

Interpretación de la prueba tuberculínica en adultos vacunados con BCG / Tuberculin skin test interpretation in adults vaccinated with BCG

La prueba de tuberculina o de Mantoux, es el único método probado en nuestro medio para la identificación de las personas infectadas por M. tuberculosis que no presentan la enfermedad. La prueba de tuberculina dirigida es un componente estratégico para el control de la tuberculosis (TB), ya que permite identificar a los sujetos de alto riesgo para el desarrollo de la enfermedad. Se incluyeron 80 estudiantes de la Escuela de Enfermería, para detectar los casos de tuberculosis latente y los sujetos PPD negativos. Se realizó historia clínica y administración de PPD siguiendo la metodología estándar. De los sujetos estudiados, el 85% eran del género femenino y 15% masculino. El grupo etario predominante (71%) estuvo entre 15 y 24 años. Los resultados de lectura fueron los siguientes: 36% de estudiantes presentó induración entre 0 y 4 mm; el 34% entre 5 y 9 mm, el 16% entre 10 y 14 mm y el 14% entre 15 y 20 mm. La prueba de tuberculina es el mejor método diagnóstico para la tuberculosis latente y la vacunación BCG no resta valor a esta prueba diagnóstica.

The Mantoux test is the only proven diagnostic method for latent tuberculosis in our country. The targeted tuberculin test is an strategic component for TB control, as it permits identifying high risk subjects for developing the disease and once detected can be treated. We included 80 students from our Nursing School. Clinical examination and case history was performed and the Mantoux test was applied following the standard techniques. From the subjects included 85% were females and 15% males. The age group predominant was between 15 and 24 years old. The Mantoux results were as follows: induration values between 0 and 4 mm 36%; 5 to 9 mm 34%; 10 to 14 mm 16% and 15 to 20 mm 14%. The Mantoux test is the best method for diagnosing latent TB and previous vaccination with BCG does not invalidate the test for this purpose.

The Significance of Mantoux Test and Antitubercular Therapy in the Patients with Inflammatory Nodules on the Legs / 대한피부과학회지

BACKGROUND: The inflammatory nodules on the legs are often difficult to distinguish because of clinical variations and similarity of histopathologic features. Both erythema nodosum and erythema induratum are known to be associated with various conditions, especially tuberculosis. In Korea where tuberculosis is still a major health problem, it may be a cause for the inflammatory nodules on the legs. OBJECTIVE: The purpose of this study was to establish the correlation with Mantoux test and inflammatory nodule and evaluate the efficacy of antitubercular therapy in Korea. METHODS: We performed the prospective study of 26 patients with inflammatory nodules on the legs. All patients preformed Mantoux test and skin biopsy. The patients who had strongly positive Mantoux reaction were treated with antitubercular therapy. RESULTS: The ages of the 26 patients (Male 4:Female 22) ranged from 12 to 76 years. All patients had recurrent painful, tender subcutaneous nodules on the legs. Fourteen patients of total 26 patients had a strongly postive Mantoux reaction (induration > or = 20 mm). They were treated with combination antitubercular therapy. After antitubercular therapy, skin lesions subsided in 12 patients within 2 months and in the remaining 2 patients, subsided within 4 months. The therapy was well tolerated except for flu-like symptom in one patient and drug induced hepatitis in the other patient. CONCLUSION: We suggest that antitubercular therapy is effective in the management of patients with a strongly positive Mantoux reaction with chronic recurrent inflammatory nodules on the legs in Korea.

Mass screening of tuberculosis among Filipinos by the Heaf test and its comparison with the Mantoux test

1. In 1962 and 1963 a study was conducted by the authors to determine the usefulness and practicality of the Heaf test for mass screening of tuberculosis2. The study group consisted of children and adults attending 7 public and 2 private schools and institutions in Manila and Quezon City as well as in towns and barrios in the provinces of Cavite, Laguna, Marinduque, Rizal and Bulacan. A total of 7,920 individuals were tested3. The Heaf test was positive in 24.2% of 7,920 children and adults tested4. Reactors to the Heaf test vary in different localities thus: in cities these reached, 22% in towns 27% and in barrios 21%5. The reactor group was found to increase proportionately with icreasing age, which is the usual finding in almost any tuberculin survey by any test used6. In this study, we observed the equivalent of reactions for Heaf and Mantoux tests. Thus, a reaction of 1 to 6 papules to Heaf test is the equivalent of a "soft","erythema" or an induration of less than 10 millimeters by Mantoux which is the accepted positive reaction in the Philippines, has a corresponding 10 mm. induration by Heaf7. The two tests have a high percentage of agreement being 71.6% to 92% in 10 TU and 5 TU, (96%) in which the precentage of disagreement was 4%8, Taking into account the case and convenience of testing, a reasonable overall cost, and the finding of a high percentage of agreement with the standard Mantoux test, this study gives basis for recommending the Heaf test as a mass screening test for tuberculosis. (Summary)

The Comparison of the Conversion Rate and Duration after Multipuncture BCG vaccination / 소아알레르기및호흡기학회지

PURPOSE: During the childhood, Mantoux test is very popular for detecting tuberculous infection and also useful for evaluating the immunity against tuberculosis after BCG vaccination. But the response and conversion rate is affected by the age of vaccination, the quality of vaccine, the duration after vaccination and the frequency of the test. Recently percutaneous multipuncture technique of BCG vaccination was introduced and used because of local side effect and technical problem of intradermal BCG vaccination, however there is only a study of conversion rate and side effect at 3month after multipuncture BCG vaccination. We performed this study to evaluate of the difference of the Mantoux reaction and conversion rate according to duration (3month, 9month and 15month) after vaccination, gestational age, sex, and feeding type. METHODS: 174 neonates (155 of full term infants, 19 of preterm infants) who were born Kangnam St. Mary's Hospital were given multipuncture BCG vaccination within 4weeks after birth between July, 1995 and June 1997. All subjects was performed Mantoux test using 5TU PPD (NIH, Korea) at 3month, 9month and 15month. Injecting BCG and interpretating the result of the Mantoux test was done by the same person. RESULTS: 1) The positive rates of Mantoux test which was done 3month , 9month and 15month after vaccination were 38.7%, 58.1%, 71.6% in the full term infant group and 31.6%, 31.6%, 47.4% in the preterm infant group. 2) The size of induration in Mantoux test, which was done 3month, 9month and 15month after vaccination were 7.3 mm, 9.4 mm, and 10.6 mm in the full term infant group and 5.6 mm, 7.7 mm, 9.2 mm in the preterm infant group. The size of induration was significantly lower in the preterm infant group as compared with that of the full term infant group 9month after vaccination. 3) The positive conversion rate, less than 5 mm to more than 10 mm, was 6.3% (3 infants of 48 infants who were negative Mantoux test 3month became positive 9month) and 26.3% (5 infants of 19 infants who were negative 9month became positive 15month) in the full term infant group, and 33.3% (one infant of 5 infants who were negative 9month became positive 15month). 4) There is no difference in conversion rate of Mantoux test according to the sex, feeding type in both groups5) Complication rate for multipuncture is 3.2%, which is leaded by local ulceration and fever in the full term infant group, and 5.3%, which is only fever in the preterm infant group. CONCLUSION: In those result the size of induration and conversion rate is increased as the duration after vaccination, then their smaller size in the preterm group 9month after vaccination maybe due to immunological immaturity of preterm group.

The Response of Mantoux Test after BCG Vaccination According to the Clinical Factors / 소아알레르기및호흡기학회지

PURPOSE: During the childhood, Mantoux test is very popular for detecting tuberculous infection and also useful for evaluating the immunity against tuberculosis after BCG vaccination. But the response and conversion rate is affected by the age of vaccination, the quality of vaccine, the duration after vaccination and the frequency of the test. This study was performed to investigate the difference of the response and conversion rate, according to duration after vaccination, gestational age, sex and feeding type. METHODS: The subject was included 85 of infants (71 of full term infants, 14 of preterm infants) and was followed up 3 months, 9 months, 15 months after vaccination, from July, 1992 to June, 1994 in Kangnam St. Mary's Hospital. We injected intradermally the BCG vaccine (0.05ml) which was produced by National Institute of Health and PPD (5TU) was used as a testing material of Mantoux test. Injecting BCG and interpreting the result of the Mantoux test was done by the same person. RESULTS: 1) The positive conversion rates of Mantoux test which was done 3 month, 9 month and 15 month after vaccination were 26.8%, 53.5% and 60.6% in the full-term infant group, and 14.3%, 28.6%, and 50% in the preterm infant group. The conversion rate was significantly lower in preterm infant group as compared with that of the full-term infant group 3 months after vaccination. 2) The sizes of induration in Mantoux test, which was done 3 month, 9 month and 15 month after vaccination, are 7.2mm, 8.5mm, 9.4mm in the full-term infant group and 5.0mm, 6.6mm, 8.2mm in the preterm infant group. The size of induration was significantly lower in the preterm infant group as compared with that of the full-term infant group. 3) There is no difference in conversion rate of Mantoux test according to the sex, feeding type in both groups. 4) Complication rate for BCG vaccine is 9.9%, which is leaded by lymphadenitis, persistent ulcer, and febrile abscess as the order, in the full-term infant group and there are no complications in the preterm infant group. CONCLUSIONS: In those results, the size of induration and conversion rate is increased as the duration after vaccination, then lower conversion rate in the preterm infant group 3 months after vaccination may be due to immunological immaturity of preterm infant.

Conversion Rates of Tuberculin Test according to BCG Vaccination Methods

PURPOSE: Tuberculosis, a major public health problem, is an important cause of childhood morbidity and mortality in developing countries. To decline the tuberculosis morbidity rate, active BCG vaccination is performed worldwide. Recently percutaneous multiple puncture technique of BCG vaccination was introduced and used because of side effects of intradermal BCG vaccination such as scar, local ulceration, regional suppurative lymphadenitis. We studied the difference of positive conversion rates and side effect after intradermal BCG vaccination and percutaneous multiple puncture technique BCG vaccination. METHODS: Three hundred seventy one infants, who were vaccinated at well baby clinic of Soonchunhyang University Hospital and performed tuberculin skin test using 5TU PPD (NIH, Korea) at 4month, were divided two groups; group I of 257 infants immunized percutaneous multiple puncture technique BCG (Japan BCG Laboratory, Japan) and group II of 174 infants immunized intradermal BCG (Institute Meri ux, France). RESULTS: 1) Sixtysix point five percent of male infants and 72.4% of female infants were vaccinated percutaneous multiple puncture technique BCG (Group I) 2) The positive conversion rate was 97.7% in group I and 76.3% in group II (p<0.05). 3) The positive conversion rate vaccinated within 2 weeks after birth were 97.9%, 2-4weeks 97.8%, 5-6weeks 95.2% in group I, and within 2 weeks 73.5%, 2-4weeks 75.8%, 5-6weeks 83.3% in group II. 4) The mean induration of positive conversions were 10.6+/-2.8mm in group I and 9.3+/-2.7mm in group II, that of Group I was significantly higher than that of groupII (p<0.05). 5) The complications of BCG vaccination were fever, generalized rash, and local ulceration in group I, fever, severe irritability in groupII. But there was no significant difference in two groups. CONCLUSIONS: The infants of vaccinated with percutaneous multiple puncture technique showed larger size of mean induration and higher positive conversion rate after PPD and less scar after vaccination compared with intradermal method. Further studies is necessary to find out the optimum time for BCG vaccination by percutaneous multiple puncture technique to provide the better immunity.

Clinical Observation and Antituberculous Treatment of Erythema Induratum ( Bazin' s disease ) / 대한피부과학회지

BACKGROUND: Erythema induratum was first described by Bazin in association with tuberculosis. However, the tuberculous cause of this entity has been questioned by several authors and gradually, the concept of nontiiberculous nodular vasculitis has been accepted OBJECTIVE: The purpose of this study is to document the clinicopathologic features of erythema induratum. METHODS: We investigated clinical and histopathological findings of 31 patient with erythema induratum who showed positive tuberculin hypersensitivity reaction or had active associated tuberculosis. RESULTS: The ages of the 31 patients(M7: F24) ranged from 13 to 66 years(mean 37.1 years). All patients displayed recurrent crops of tender, painful, violaceous noudules or plaques. Most lesions were present on the legs, but they also occurred on the thighs, feet, buttocks, and forearms. The skin lesions evolved for several weeks and healed with scarring and residual pigmentation. Histological examination revealed lobular or septolobular panniculitis with varying cornbinations of granulomatous inflammaticn, primary vasculitis and necrosis in most biopsies. Twenty two patients were treated with isoniazid alone and the remaining 9 patients received combination anti tuberculous treatment. Relapses were encountered in 4 patients who received isoniazid alone or stopped the medicationrgainst medical advice. CONCLUSION: A diagncisis of erythema induratum should be rendered in the presence of relevant clinicopathologic features, strong positive Mantoux test reaction, and good therapeutic response to antituberculous treatme,it. A full course of combination antituberculous therapy is indicated to achieve a cure of the skin lesions of erythema induratum.