Pattern of drug resistance in tuberculosis

To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. This work was done at the TB Research center of Pakistan Medical Research Centre at Mayo hospital Lahore from 2000 to 2003. The center receives specimens from all the leading hospitals of Lahore. Five first line anti tuberculosis drugs were tested on LJ medium using proportion method. A total of 894 confirmed isolates of Mycobacterium tuberculosis [759 pulmonary and 135 extra pulmonary] from 894 patients, with and without history of previous treatment, were subjected to drug susceptibility testing about 50% of the patients had some resistance. Multiple drug resistance [MDR] was found in 12% and 23% without and with history of previous treatment respectively. Overall resistance to rifampicin was 28.6%, isoniazid 25.6%, streptomycin 23.8%, ethambutol 14.5%, and pyrazinamide 29.3%. Statistically significant difference was seen between primary and acquired resistances. Results when compared with the previous studies from the same area showed a gradual increase in drug resistance. Resistance to anti tuberculosis drugs in Lahore is high and needs to be addressed in the national tuberculosis control program and in the implementation of DOTS program in the country

Lower lung field tuberculosis

This study was conducted to define the frequency of lower lung field tubercuiosis.The patients who were AFB smear positive and had infiltrate in the lower lung field on X-ray chest P.A. view were analyzed in detailed for age group, sex proportion, clinical presentations and for their outcome. They were also analyzed for associated diseases and the findings were compared with other reported studies. A retrospective review of 25 cases of lower lung field tuberculosis treated at the institute of tuberculosis and Chest diseases, King Edward Medical College/Mayo Hospital, Lahore during on year period was undertaken. The 25 patients comprise 16 males [64%] and 9 females [36%]. The clinical features of the patients were similar to those of previous reported studies. In one year period 54.45% admission were due to pulmonary tuberculosis. Among them 3.98% had lower lung field tuberculosis. 60% were between 15-55 years, 32% had diabetes mellitus 4% renal failure 8% cirrhosis of liver and 4% were having kyphoscoliosis. We conclude that this atypical presentation i.e. lower lung field tuberculosis should be kept in mind because the clinical features of the disease may be nonspecific. Lower lung field tuberculosis produces much confusion in the diagnosis. The atypical presentation is more common in advance age, patients on steroids treatment, renal or hepatic disease. An early diagnosis of lower lung field tuberculosis is necessary to prevent complications. A high index of suspicion is essential for the early diagnosis in order to avoid delay in therapy and poor out come