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In Indian subcontinent where tuberculosis is endemic, the spinal infection was thought to be due to mycobacterium tuberculosis in most of the cases. Hence there is a practice of treating these patients with empirical antitubercular treatment. However, recent guidelines advice biopsy and tissue diagnosis before starting antibiotics.
Our retrospective study analyses the role of biopsy in establishing the microbiological diagnosis and thus identifying the incidence of pyogenic and tubercular spondylodiscitis presented to a tertiary care centre.
All patients who were diagnosed as spondylodiscitis by clinical and radiological criteria and who underwent biopsy were included in the study and data was retrieved from medical records and PACS. Criteria for tubercular spondylodiscitis included presence of mycobacterium tuberculosis either in smear/gene Xpert, or histopathological evidence of tuberculosis. Organism isolation other than MTB or absence of tubercular granuloma and response to antibiotics were considered as non-tubercular aetiology.
Our study achieved 84% (n-63) accuracy for first biopsy and 34 patients (53.96%) were diagnosed as pyogenic spondylodiscitis. Organisms were isolated in 11 cases (32%) of pyogenic spondylodiscitis and tubercular bacilli in 17 cases (65%) of tubercular spondylodiscitis. Aspiration of pus yielded better isolation of organisms (P<0.001) in pyogenic spondylodiscitis. 11% of cases showed drug resistant tuberculosis.
We conclude that there is an increasing trend of pyogenous spondylodiscitis compared to tubercular spondylodiscitis in patients presenting to tertiary care centre, hence biopsy is essential to start antimicrobials.
We conclude that there is an increasing trend of pyogenous spondylodiscitis compared to tubercular spondylodiscitis in patients presenting to tertiary care centre, hence biopsy is essential to start antimicrobials.
The delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP).
to identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB.
We recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25.
The mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p<0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n=49), reported a significant delay in the initiation of ATT-DOTS (p<0.001).
Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.
Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.
The spectrum of morphological pattern in tubercular lymphandenopathies was observed to study the various cytomorphological patterns and their correlation with acid fast bacilli.
FNAC smears of 210 cases of granulomatous lymphadenitis stained with Giemsa, Pap and haematoxylin and eosin were used to analyze cytomorphological pattern and Zeihl Neelsen stained smears for acid fast bacilli (AFB) detection.
193 cases with necrotising granulomatous inflammation or positive acid fast bacilli were included. Age group 21-30 years was most common (38.3%) followed by age group 11-20 years (30.05%). Females constituted 66.3% of patients and 33.7% were male. Overall the most common pattern in present study was pattern A (Epitheloid granuloma with caseous necrosis 33.7% followed by pattern B (caseous necrosis with few scattered epitheloid histiocytes and lymphocytes) 31.1% and pattern C (caseous necrosis with suppurative inflammation) 30.6%, followed by pattern D (Caseous necrosis only) (3.6%) and pattern E (non necrotising epitheloid granuloma with positive acid fast bacilli) (1.03%). Acid fast bacilli were demonstrable in 175 cases (90.7%). Amongst the acid fast bacilli positive cases highest bacillary load 3+ grade was seen in pattern C in 6/59 (10.16%) cases.
FNAC is a simple useful tool and should be attempted in all cases of lymphandenopathies. It helps in establishing a diagnosis of tubercular etiology based on its morphological patterns however demonstration of acid fast bacilli on aspirated material confirms the diagnosis.
FNAC is a simple useful tool and should be attempted in all cases of lymphandenopathies. It helps in establishing a diagnosis of tubercular etiology based on its morphological patterns however demonstration of acid fast bacilli on aspirated material confirms the diagnosis.
Tuberculosis (TB) is a major public health problem in India, particularly with very limited information on TB among the tribes. This cross sectional descriptive study aims to estimate the prevalence of TB among tribal groups; understand the socio cultural determinants as risk factors for TB, and understand the knowledge attitude and practices regarding TB among Tribal population.
A multistage cluster sampling design was adopted. Tribal population >70% formed the sampling frame for selection of villages. Probability Proportional to Size (PPS) sampling method was used to select villages within the districts Villupuram, Namakkal, Nilgiris. The required sample size was estimated to be 2400 adults aged ≥15 years with an assumed prevalence of 387/100,000 bacteriological positive cases with a precision of 15% at 95% confidence level and design effect of 1.3.
A total of 2945 respondents were included in the analysis wherein approximately 87% were tribes and around 13% were non tribes. The point prevalence ofote knowledge about TB among tribes. This study provides important information on the burden of TB and would help design an innovative model for policy makers and health managers to address TB in the tribal population of Tamilnadu.
Although, Tuberculosis (TB) is curable if the treatment is adhered to and completed it is still a major cause of death globally including South Africa. The success rate for TB treatment was 77.2% in 2014, of which more than 37000 lives were lost because of it in South Africa. Several studies have been carried out on this subject, but the difference between the present study and the previous work done is the methodology proposed to establish the determinants of anti-TB medication compliance. Understanding the determinant of anti-TB medication compliance will help the policymakers on the appropriate decision to reduce the menace of the disease.
In this study, we proposed logistic regression to a sample of individuals taken from the National Income Dynamics Survey data that self-reported to have been TB diagnosed. A comparison of the classical logistic regression and parametric bootstrap estimation methods was done for this data to determine the model that best describes the data.
The results obtained from the two methods were similar and identified gender, language, alcohol, English literacy, belief in religion and household SES as the determinants of TB patients on medication. The standard errors for the bootstrap logistic model were bigger than the standard errors of the classical model.
We conclude that the classical model is better and for this scenario, there was no need to resample. The outcome of this study supports the existing findings that controlling the social and economic determinants of health will help eradicate TB.
We conclude that the classical model is better and for this scenario, there was no need to resample. The outcome of this study supports the existing findings that controlling the social and economic determinants of health will help eradicate TB.
The present study was conceived to evaluate multi-targeted loop mediated amplification (MLAMP) for the rapid diagnosis of extrapulmonary tuberculosis (EPTB).
A total of 700 patients were included who were classified into 2 groups Group 1 (n=400) included a 100 culture confirmed EPTB patients and 300 culture negative, suspected EPTB patients. Group 2 (n=300) included negative controls from non-tubercular patients. All samples were subjected to Ziehl-Neelsen microscopy, solid culture on Lowenstein Jensen media, Polymerase chain reaction (PCR) targeting IS6110 gene and LAMP targeting both IS6110 and MPB64 individually and as MLAMP. The overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the MLAMP assay were 12%, 25%, 72.5%, 80% and 86.6% respectively and the specificity of all the tests was 100%.
MLAMP is a rapid robust tool for the diagnosis of EPTB and utilizing two targets for M. tuberculosis can improve the overall sensitivity and increase the yield of detection from extrapulmonary samples. The rapidity, ease of performance and low cost make MLAMP an excellent alternative in low-income, resource limited settings.
MLAMP is a rapid robust tool for the diagnosis of EPTB and utilizing two targets for M. GW3965 mw tuberculosis can improve the overall sensitivity and increase the yield of detection from extrapulmonary samples. The rapidity, ease of performance and low cost make MLAMP an excellent alternative in low-income, resource limited settings.
Burden of tuberculosis (TB) is still high in Bangladesh. Pre-treatment delay is a hindrance in reducing this burden by early diagnosis and prompt treatment of TB. The study was conducted to identify the patient factors related to pre-treatment delay of pulmonary TB.
This retrospective cohort study was performed during January to June 2018 in a cohort of 240 consecutively enrolled; newly detected adult pulmonary TB (PTB) patients initiated anti-TB therapy during the study period. Two DOTS were selected randomly using cluster sampling and all the PTB patients enrolled in the DOTS centres formed the study population. Informed written consent was obtained from the patients, prior to data collection. Data were collected by face-to-face interview and reviewing medical records using a semi-structured questionnaire and checklist respectively.
Age of the patients was associated with pre-treatment delay of TB (p<0.05) with predominance in elderly (75.0%). Delay in care seeking was associated with inability to lly to pre-treatment delay of PTB. Considerable reduction in pre-treatment delay may be achieved through changes in awareness of patients and ensuring early diagnosis and prompt treatment of PTB under DOTS programme.
