What is New in Management of Pediatric Tuberculosis ?

Tuberculosis continues to haunt mankind since its discovery more than a century ago. Although commendable advancements have beenmade in the diagnosis as well as treatment, especially in the last couple of decades, the healthcare burden of this disease worldwide isimmense. Continuously evolving medical science has provided recent changes in national guidelines along with discovery of newer anti-tubercular drugs after many decades. In view of WHO declaring tuberculosis as a global health emergency and strong commitment beingreflected by Government of India whereby National Strategic Plan aims to eliminate tuberculosis by 2025, it is high time that we workcollectively on the goal of tuberculosis elimination. This article sums up the updates on newer anti-tubercular drugs as well as the recentchanges adopted in Revised National Tuberculosis Control Program.

Tubercular prevertebral and epidural abscess presenting as stridor and dysphagia in an infant: A rare presentation of tuberculosis in infancy.

Tubercular prevertebral abscess is rare presentation of pott’s spine in infancy. It can lead to life threatening airway obstruction and dysphagia requiring early diagnosis and proper management to prevent consequences. We present a case of 5 month child with tubercular prevertebral and epidural abscess who presented with dysphagia and stridor. Child responded dramatically to anti-tubercular therapy and surgical drainage of abscess. The child is doing well on follow up.

Adjunct therapy of Ayurvedic medicine with anti tubercular drugs on the therapeutic management of pulmonary tuberculosis.

Background: Pulmonary tuberculosis (PTB) is an age old disease described in Vedic Medicine as ‘Yakshma’. Later on, in Ayurveda it earned a prefi x and found way into mythology as ‘Rajayakshma’. After the discovery of streptomycin, the therapeutic management of PTB received a major breakthrough. The treatment module changed remarkably with the formulation of newer anti-tubercular drugs (ATD) with appreciable success. Recent resurgence of PTB in developed countries like United States posed a threat to the medical community due to resistant strains. Consequently, WHO looked toward traditional medicine. Literature reveals that Ayurvedic treatment of PTB was in vogue in India before the introduction of ATD with limited success. Records show that 2766 patients of PTB were treated with Ayurvedic drugs in a tertiary care hospital in Kolkata in the year 1933-1947. Objectives: To evaluate the toxicity reduction and early restoration by adjunct therapy of Ayurvedic drugs by increasing the bio-availability of ATDs. Materials and Methods: In the present study, treatment response of 99 patients treated with ATD as an adjunct with Aswagandha (Withania somnifera) and a multiherbal formulation described in Chikitsa-sthana of Charaka samhita i.e. Chyawanprash were investigated. Hematological profi le, sputum bacterial load count, immunoglobulin IgA and IgM, blood sugar, liver function test, serum creatinine were the assessed parameters besides blood isoniazid and pyrazinamide, repeated after 28 days of treatment. Results: The symptoms abated, body weight showed improvement, ESR values were normal, there was appreciable change in IgA and IgM patterns and signifi cantly increased bioavailability of isoniazid and pyrazinamide were recorded. Conclusion: This innovative clinical study coupled with empowered research may turn out to be promising in fi nding a solution for the treatment of PTB.