ABSTRACT
The emergence of drug-resistant strains of Mycobacterium tuberculosis has become a significant public health problem and has led to a setback in efforts to end tuberculosis (TB) worldwide. The longer duration, heavier pill load, and higher toxicity profile of DR-TB regimens compared to those for drug-susceptible TB (DS-TB) lead to reduced adherence and worse treatment results, including mortality. This study was conducted to estimate treatment outcomes and adverse effects in patients with drug-resistant TB patients on bedaquiline-containing regimen. Patients after the pre-treatment evaluation were enrolled for bedaquiline-containing regimen. These patients were followed up for 18 months and the final outcome was assessed along with the adverse effects. It was found that 49 (84.4%) patients achieved culture conversion by three months and 54 (93.1%) achieved culture conversion by six months, 52 (83.81%) patients had favourable outcomes (cured, treatment completed) and 10 patients had unfavourable outcomes (died, lost to follow-up, failed). Coupled with gradually increasing trends of success rates from 2012, lesser failure rates and lesser concerns regarding grave adverse effects are a silver lining along the cloud of increasing burden and widening resistance patterns. More funding has to be directed towards ensuring adherence and finding high-risk individuals in order to expedite the achievement of sustainable development (SDG) goals.
ABSTRACT
BACKGROUND: Since time immemorial tuberculosis (TB) has been and continues to be one of the most significant infections causing human disease. In tropical countries, TB remains a leading cause of death. Human immunodeficiency virus (HIV) epidemic continues to fuel this global TB epidemic. The rapid growth of the HIV epidemic in many countries has resulted in an equally dramatic rise in the estimated number of new TB cases, which present therefore the integration of HIV and TB testing at the primary level is need of the hour. METHODS: A prospective study was conducted on newly diagnosed, untreated TB patients aged 15-45 year and patients were screened for HIV infection. Clinico-radiological spectrum of TB among HIV seropositive and seronegative patients was evaluated. RESULTS: Out of a total of 307 patients screened, 17 (5.54%) were found to be HIV seropositive. Seroprevalence was found significantly (P < 0.01, χ2 9.301) more common in 26-35 year age group and higher in Extrapulmonary TB (EPTB) patients than that in pulmonary TB (PTB) patients (9.90% vs 3.4%). Fever was the most common presenting symptom for TB in HIV seropositive patients. On examination pallor (58.82% vs. 15.86%), oral ulcer (35.3% vs. 0.35%) was found more common and on chest X-ray mid-lower zone involvement and mediastinal lymphadenopathy were more common in HIV seropositive patients. CONCLUSION: HIV seropositivity rates among newly diagnosed TB patients aged 15-45 year was 5.54 percent. The presentation of TB was more often atypical among these patients. Thus, an integrated model of TB and HIV at primary healthcare service delivery is an efficient use of resources that would address the two very important co-epidemics and thereby result in better management.
ABSTRACT
We report a 63-year-old patient with black-colored pus (pyopneumothorax) resulting from an infected pleural effusion associated with metastatic malignant melanoma of the skin. The patient was also positive for Pseudomonas, so the color was unexpected. Although rare, malignant melanoma can present as a black pleural effusion due to the presence of melanocytes in the pleural fluid. Black pleural fluid should raise the suspicion of malignant melanoma. SIMILAR CASES PUBLISHED: Nine cases of black pleural effusion due to different causes have been reported.1,2 Three cases of black pleural effusion due to metastatic malignant melanoma are published.2,6,7.
