Role of isoniazid prophylaxis for prevention of tuberculosis in haemopoietic stem cell transplant recipients.

OBJECTIVE: To evaluate the role of isoniazid prophylaxis in prevention of tuberculosis among allogeneic stem cell transplant recipients. METHODS: This study was conducted at Armed Forces Bone Marrow Transplant Center Rawalpindi, Pakistan from July 2001 to October 2003. Patients suffering from various haematological disorders undergoing allogeneic stem cell transplantation were included in the study. The demographic information, primary diagnoses and relevant investigations were recorded. Patients had negative tuberculin skin tests and chest X-Ray at pre-transplant assessment. First 25 patients (group I) did not receive isoniazid prophylaxis while the next 25 (group II) were given isoniazid in a dose of 5-10 mg/kg (maximum 300 mg/day). Isoniazid prophylaxis was started on day-1 and continued for 6 months post transplant. The patients developing tuberculosis were treated with rifampicin, ethambutol, isoniazid, and pyrazinamide during first 3 months followed by 2 drugs for a total duration of 12 months. Minimum follow up in group I and II was 783 and 403 days respectively. RESULTS: There was significant difference (p < 0.001) in frequency of tuberculosis between two groups. In group I, four patients developed Tuberculosis (frequency 16%) whereas none of the patients in group II had the disease. Out of these four cases 3 had extrapulmonary disease. One patient died two weeks after the start of anti tuberculosis treatment while others successfully completed the treatment. CONCLUSION: Tuberculosis in stem cell transplant recipients is an important opportunistic infection especially in areas of high disease prevalence like Pakistan. Isoniazid prophylaxis for 6 months is effective in preventing tuberculosis among this class of patients.

Childhood visceral leishmaniasis in Muzaffarabad, Azad Jammu and Kashmir: frequency and response to treatment in 61 cases.

OBJECTIVE: To study the epidemiology and status of resistance to antimonial compounds of paediatric hospital population with visceral leishmaniasis in Muzaffarabad, Azad Jammu and Kashmir, Pakistan. METHODS: Children admitted between January to December 1999 in Azad Kashmir Combined Military Hospital Muzaffarabad and diagnosed as Visceral Leishmaniasis by demonstration of Leishmania parasites in bone marrow aspirate were included in the study. Patients received meglumine antimoniate for 21 days. The demographic information and time taken for resolution of fever after initiation of treatment were recorded. RESULTS: During study period out of 3520 paediatric admissions, 61 patients had visceral leishmaniasis. The frequency of disease was 1.73%. Median age of the patients was 18 months. Eighty two percent cases reported during non-winter seasons. Fifty nine (96.7%) patients responded to treatment with antimonial compounds. Median time taken for resolution of fever was 5.7 days. Two of the patients died during the study period. CONCLUSION: Childhood visceral leishmaniasis is common in Muzaffarabad and there is no resistance to antimonial compounds.

Clinicopathological features of childhood visceral leishmaniasis in Azad Jammu & Kashmir Pakistan.

BACKGROUND: In Pakistan visceral leishmaniasis (VL) is endemic in Azad Jammu & Kashmir. Northern Areas and Northwest Frontier Province; the areas which lack adequate diagnostic facilities. This study describes the clinical and laboratory features in 61 cases of childhood VL. METHODS: All the children below 12 years of age who were managed as indoor cases from 1st Jan 1999 to 31st Dec 1999 were included in this study. The diagnosis of VL was established by demonstration of leishmania parasites in bone marrow aspiration. The demographic information, physical signs at presentations and results of complete blood picture and formol gel test were recorded. RESULTS: Median age of the patients was 18 months. Eighty four percent children were malnourished. Mean duration of fever before diagnosis was 45 days. Hepatosplenomegaly was present in all cases with mean enlargement of spleen and liver 6.8 and 3.2 cm respectively. Mean haemoglobin level. WBC and platelet counts were 6.7 g/dl, 4.8 x 109 /l and 70 x 109 /l respectively. Absolute neutrophil count was <1.5 x 109 /l in 61% cases. Mean reticulocyte count was 6.2%. There was significant negative correlation (p= 0.014) between haemoglobin level and spleen size. Formol gel test was positive in all cases. Mean hospital stay to established diagnosis was 8.6 days. CONCLUSION: The clinical and laboratory features of childhood VL in Azad Jammu and Kashmir are similar to Mediterranean type of disease caused by leishmania infantum. Cytopenia with high or normal reticulocyte count provides a useful clue to diagnosis in a febrile patient with hepatosplenomegally in an endemic area.