Incidence Of Tuberculosis In Otorhinolaryngology - Our Experience From A Tertiary Care Centre In Western India

Background:Tuberculosis (TB) is a worldwide leading public health problem even today. It affects all tissues of the body, but pulmonary tuberculosis is the most common type of tuberculosis (80% total tuberculosis cases). Extrapulmonary TB (EPTB) has major challenge for its clinical detection, definitive diagnosis and treatment. Out of all extrapulmonary cases, TB occurring in head and neck region is uncommon.Material And Methods:A prospective analytical studyof 50 patients who presented toENT OPD setupof ourtertiary carehospital with extra pulmonary TB. We look at the various clinical and laboratory aspects of tuberculosis of theotorhinolaryngeal region that would help to diagnose this uncommon but important form of extra pulmonary tuberculosis.Result:Male: Female ratio was 1.8:1 exhibiting male preponderance. Majority of the patients belonged to the age group of 20-40 years. Our study included patients with tuberculous cervical lymphadenopathy (84%), laryngeal TB (2%), tuberculous otitis media (12%), and retropharyngeal abscess (2%). FNAC seems to be de finitive and easier mode to diagnose TB of cervical nodes and Excision Biopsy can be done when FNAC is inconclusive.Conclusion:Extra pulmonary TB is significant health problem worldwide. It presents as a challenging task for diagnosis and overall surveillance of the treatment. The ear, nose, PNS, pharynx, larynx and cervical nodes are very important anatomical sites of extra pulmonary affliction. Its early diagnosis and definitive management will seize its sequence and further complications. The practical implications of an awareness of ENT tuberculosis are a benefit of anti-tubercular therapy and hence conservative management usually suffices.

Multidrug-resistant pulmonary & extrapulmonary tuberculosis: A 13 years retrospective hospital-based analysis.

Background & objectives: Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of great significance in India. In the present study an attempt was made to analyse the progression of MDR-TB pattern during a course of 13 years (2000-2012) among the patient population at a tertiary care centre in New Delhi, India. Methods: Mycobacterial isolates obtained on Lowenstein-Jensen (L-J) medium/BacT/ALERT 3D were identified using AccuProbe molecular identification system, routine biochemical tests or GenoType Mycobacteria CM. Antimycobacterial susceptibility testing was performed using resistance ratio method on L-J medium (2000-2004) and one per cent proportion method on BacT/ALERT 3D system (2005-2012). Results: Of the total 14,849 samples subjected to mycobacterial culture, 6569 pulmonary and 8280 extrapulmonary, 2364 were detected positive for mycobacteria. The average percentage positivity rate was 15.9 per cent (18.9 and 13.6% in case of pulmonary and extrapulmonary samples, respectively). Our study revealed a significant increase (P<0.001) in multidrug resistance by 12 per cent (4.7% in 2000 to 19.8% in 2012). MDR-TB was more in case of pulmonary (28.2%) than extrapulmonary (11.6%) TB (P<0.001). Only 6.5 per cent (154) of mycobacterial isolates were non-tuberculous mycobacteria and rapid growers represented by Mycobacterium fortuitum and M. abscessus were the most commonly isolated species. Interpretation & conclusions: Increase in prevalence of MDR-TB by 12 per cent in the past 13 years is alarming. Policy modifications may have to be done to strengthen the existing TB control programmes to encourage contact tracing and culture and drug susceptibility testing for all smear positive pulmonary cases to ensure early and appropriate therapy.

Tubercular ileal perforation - atypical, acute presentation in a renal transplant recipient - a case report.

Summary: Extrapulmonary tuberculosis (TB) is more common than pulmonary TB in immuno-suppressed renal transplant recipients. Atypical presentation of TB and disseminated TB is known in transplant recipients. Usually intestinal TB presents with pain abdomen, intermittent subacute intestinal obstruction, diarrhoea and/or constitutional symptoms like fever and weight loss. Here we report a case of renal allograft recipient on regular hospital follow up, presented with acute abdomen with no previous symptoms of fever, weight loss or abdominal symptoms and was diagnosed to have tubercular ileal perforation on exploratory laporatomy and confirmed by histopathological examination. This patient succumbed to the illness due to sepsis despite timely surgery, broad spectrum antibiotics and antitubercular therapy.

Atypical Presentation of Mycobacterium Tuberculosis in an Infant.

Tuberculosis of the skeletal muscle is very rare which is often missed in the early stages. This leads to delay in treatment resulting in irreversible limb deformity and loss of function. The authors describe a case of healthy child with an intramuscular cystic swelling above the elbow joint. The pus showing acid fast bacilli morphologically resembling Mycobacterium tuberculosis was also isolated in culture. Following the diagnosis and confirmation, the child was treated successfully with anti tubercular drugs.