Cerebrospinal fluid lysozyme in the diagnosis of tuberculous meningitis

Pretreatment lysozyme levels in cerebrospinal fluid (CSF) were estimated in 37 patients with tuberculous meningitis (TBM), 16 with non-tuberculous meningitis (non-TBM) and 13 with non-inflammatory conditions of the central nervous system (controls) in an attempt to assess the role of CSF lysozyme in the diagnosis of TBM. Lysozyme content in the CSF was found to be elevated in all patients with bacteriologically confirmed TBM and in a large proportion of patients in whom the disease was clinically diagnosed but bacteriologically not confirmed. The enzyme was not detected in all but one of the control subjects and in most (69%) of the non-TBM patients

A controlled study of the effect of domiciliary tuberculosis chemotherapy programme in a rural community in South India

To study thc ellicttq of a domiciliary drug-therapy programme in the control of tuberculosis in a rural community, an investigation was set lip in 1958 under the auspices of the Indian Council of Medlenl I{C!IClln:h ill 12 towns with populations ranging from 6000 to 25000, all within 160 km of Madanapallc (Andhra Pradt'Sh). The prevalences of bacillary and radioloj.(ic~ll cases of pulmonary tuberculosis in adults (llgcd 15 )T or more) were estimated in .. ch town by carrying out a hase-Iine random sample survey iu 1959; also, the prevalences of tuberculous infcl'tion in all schoolchildrt,n aged 5 to 9yr wen' estimated. These thn.'t' in.dices of prevalence were used to rank the 12 towns and tben ndomlyallocate them into two l'omparable groups of 6 towns each, designated as 'Ireatment' and '~:ontmJ' tOWIlS. In treatment tOWIIS, intensi"e case finding ,,-as undertaken hy means of 2 X-ray surveys (suney I during 1960-61 and survey II during 1962-64) l'ovcring alllldults, sputum examinations by microSl'op' Hnd culture when indicated, and eriodic follow lip of all 'suspect' cases with X-ray and SPlltuDl examinations. All bacillary cases were offered domiciliary treatment for onc ~'ear with isoniazid and PAS in the J treatment IOWll~ (selected at random) a.nd with isoniazid alone in the other 3 town.·,. Of 148 2easc~ eligible for trcat-at ment in tJlC 6 treatment towns, 15 per l'en.t refused treatment nd 29 per cent discontin.ued chemotherapy prematurely. In lhe rontrol towns, 0.0 spcdal faeililies for di~gn()sis 01' calment ,vere introduced, and patients w~'re left to the routine treatment facilities aV:lilahk' locally. A tuberculosis prcntlcm:e survey (~ul'l'ey Ill) t'O\'cri~ all adults was 1.1lrried out iD 9.1112 towns during 1965-68, am! lhi:; ~:l." followed hy a random tuberculin sample survey during 1966-69. The overall results of treatment at the end of one year ,,'eJ'e.' (i) among cases initially positive hy micro~opy, 10 per' nt died, 33 per locnt rcmllincd sputum-positive IUld 51 per cent became sputum-negative in INH-PAS towns, the mrl'lsponding percentages fur INH lowns being 15, 48 and 37 per cent respectivel~'; (ii): moug cases initially positive by culture ()nJy, 6 per ent died, 26 J1er cent remained sputum-posithc and 68 per cent became sputum negative in lNH-PAS towns, tbe correspondi percentages for tile INH town~ being 1, 38 an. 55 IJer cent respectively. All the bacillary cases (treated or untrcatt'lf) were followed up and their status at the end of 5 yr was 40.4 per cent dead, 18.2 per cent sputum-positive and 41.4 pCT cent sputum-ne'~ative. Spntum status at one year had considerable prognostic value. Of 532 sputum-negative ea .. at one year, 18 per l'ent were dead, 16 per CCDt sputuDl-posithe and 66 per cent sputum-ncgath'e 5 yr aftenvards, where'd!! the corresponding percentagt'S for (JIC 319 sputum-positive cases at one year were 56, 20 llnd 24 respectively. There was an intennl of about 2l ~'r between sunc)' [ and survey [[ and ahout 4 yr between survey [J and survey 111 in the 6 treatmellt towns. The prevalence of badllary cases in these sUr\'eys was age-standardised, cousidering separately l'UseS found hy microscopy and cases found by culture only. The lJlean prevalence of cases (Wsitive hy microscopy in the 6 treatment towns was 6.81 per thousand in survey I and it decre~sed significanUy (P < 0,01) to 5.01 in survey nand 4.83 in survey Ill. Change of culture technique during the course of the investi~ation complicated the interpretation of prcva· lenl'C:l of culture-positive cases. BetwCCR the 1959 base-line survey and tbe resurvey in 1965·68, the prevalence ()f smear-positive tuberculosis decreas~d from 5.92 per thousand adults to 4.78 in the 6 treatment towns, and similarly from 5.72 to 4.21 in the 6 control towns. The prcvalenl-e of 'culture only-positive' cases was 3.85 and 2.44 per thousand adults in the treatment and control towns respectively at the base-line survey and (with the more sesnsitive culture technique) 4.92 and 4.82 per thousand adults at the resurvey in 1965·68. Lastly, tho tuberculin survey in 1966·69 did not I" .,'ell! any' significant differences between the tr t· ment and the control towns. The inability ofthe domiciliary treatment programme to make an impact on the prevalefl:lc of tuberculosis in the rural community around Madanapalle is a finding that has cOllsidera lie siJ,(nilicance in the context of the tubercUlosis control programme in fndia; the rl'asons for the failure aud its implications are discussed

Acute phase proteins in tuberculous patients

The serum concentrations of some acute phase proteins were determined on admission, during treatment, at the end of treatment and at 12 months after stopping treatment in 20 patients with pulmonary tuberculosis. Measurements were also made, on admission and at the end of treatment, in 19 patients with abdominal tuberculosis, and 11 children with tuberculous meningitis. All 20 patients with pulmonary TB had quiescent disease by the end of treatment and none had a bacteriological relapse during the followup period of 12 months. The response to treatment was considered favorable in 18 of the 19 patients with abdominal TB, and the CSF findings had returned to normal in 9 of 11 patients with TB meningitis. There was a significant decrease with treatment in the concentrations of C-reactive protein, ceruloplasmin, haptoglobin and a1 -acid glycoprotein in all 3 groups of patients. While there was an increase in the concentrations of transferrin in patients with pulmonary and abdominal TB, there was a significant decrease in those with TB meningitis, a2- macroglobulin did not appear to function as an acute phase reactant in any of the 3 groups. Amalgamating the findings in all 3 groups of tuberculous patients, the proportions of patients with abnormal values on admission and at the end of treatment were 62% and 14% for C-reactive protein, 78% and 50% for ceruloplasmin, 86% and 26% for haptoglobin and 92% and 6% for a1- acid glycoprotein, respectively

Evaluation of ELISA as a diagnostic test in pulmonary tuberculosis

The reproducibility and ability of ELISA to discriminate patients with active disease from those infected were investigated.. The results obtained on 60 sputum-positive adult tuberculous patients and 60 adult control subjects showed groupwise discrimination. The anti-PPD antibodies (Ig G class) were significantly elevated in tuberculous patients as compared with control subjects. But because of the large day-to-day variation and considerable overlap in the distribution of antibody levels in tuberculous and control subjects, it is not possible to use ELISA as a diagnostic tool for adult pulmonary tuberculosis

Liver function tests during treatment of tuberculosis with short-course regimens containing isoniazid, rifampicin & pyrazinamide

Serial liver function tests (aspartate amino transferase–AST, alanine amino transferase– ALT and total bilirubin) were undertaken in patients admitted to controlled clinical trials for the treatment of tuberculous meningitis and pulmonary tuberculosis. In patients with tuberculous meningitis, daily treatment with isoniazid 20 mg/kg in addition to rifampicin 12 mg/kg resulted in a significant increase in the activities of both AST and ALT; there was no appreciable change with regimens containing isoniazid 12 mg/kg. In two studies on pulmonary tuberculosis, there was a significant increase in the activities of both enzymes following 2 or 3 months of treatment with daily streptomycin, isoniazid and pyrazinamide with or without rifampicin. No appreciable differences were observed between patients who received rifampicin and those who did not and also between slow and rapid acetylators of isoniazid. Serum total bilirubin showed a significant decrease following treatment for 2 months with a daily regimen containing rifampicin in patients with tuberculous meningitis and also in those with pulmonary tuberculosis. A comparison of patients who developed jaundice during treatment with anti-tuberculosis drugs and others who had jaundice presumably due to infective hepatitis revealed lower mean values for total bilirubin, AST and ALT in the former group (by 48–64%) than in the latter (P < 0.02). There was, however, considerable overlap between the two groups in the distributions of all parameters

Immunological investigations in tuberculous ascites

Cell mediated immunity was assessed in seven patients with bacteriologically and/or histologically confirmed tuberculous ascites. Eight non-tuberculous ascites patients were included as controls. Anti-PPD antibody levels were also estimated by ELISA. Macrophage from tuberculous ascitic fluid showed increased production of H202 when compared with ascitic fluid macrophages from controls. Proliferative response of lymphocytes to PPD antigen was greater in ascitic fluid than in peripheral blood in tuberculous patients, while the responses were reversed in control patients. Tuberculous ascitic fluid had higher levels of anti-PPD antibodies than ascitic fluid from controls, though their levels in peripheral blood were similar in the two groups. It is concluded that the results provide support to the concept of immunologic localization

Susceptibility of south Indian strains of Mycobacterium tuberculosis to tuberactinomycin

A total of 114 strains of Mycobacterium tuberculosis isolated from sputum samples of 114 patients of pulmonary tuberculosis in south India, were coded and tested for their in vitro susceptibility to tuberactinomycin (Tum) incorporated in Lowenstein-Jensen (LJ) medium. Of these strains, 95 (83.3%) and 15 (13.2%) were susceptible to Tum at 25 and 50 mg/l respectively. Only 4 (3.5%) strains were inhibited at 100 mg/l or more. Of the 37 drug sensitive strains, 2 (5.4%) were not susceptible to Tum at 25 mg/l compared to 17 (22.1%) of 77 strains-resistant to one or more of antituberculosis drugs (P <0.02). The drug susceptibility pattern of the strains revealed that there was no significant association of resistance between Tum and streptomycin or rifampicin or ethambutol or ethionamide or isoniazid. However, 15 (53.6%) of 28 kanamycin (K) resistant strains were not susceptible to Tum at 25 mg/l. This cross resistance between Tum and K was further studied in 24 and 15 K sensitive and resistant strains respectively, by correlating their proportion resistance at 16 mg/l and it was found to have a significant positive correlation (r = 0.55; X0.01)

VALUE CHAIN MODEL FOR STEEL MANUFACTURING SECTOR: A CASE STUDY

ABSTRAC

Cell mediated immune response in South India pulmonary tuberculosis patients

Ninety-two untreated pulmonary tuberculosis (TB) patients and sixty two non-tuberculous (non-TB) controls drawn from the same socio-economic strata were studied for their delayed hypersensitivity (DH), cell mediated immunity (CMI) and bacillary-load. There was no correlation between bacillary load and response in parameters of CMI, namely, lymphocyte transformation test (LTT) and leucocyte migration inhibition test (LMI). Migration Index (MI) in LMI did not correlate with DH in TB patients. There was no significant difference in the mean values of MI between TB and non-TB control patients. Response of lymphocytes to mitogens and percentage of T-rosetting cells also did not differ between TB and non-TB control patients. On the contrary, differences were found in the two groups of patients with regard to lymphocyte response to PPD antigen and mean B-cell percentage. While, among non-TB patients. high Mantoux reactors had significantly higher LTT response to PPD compared to low Mantoux reactors: no such difference was observed among TB patients. The mean B-Cell percentage was significantly higher in TB patients than in non-TB controls. The relevance of these differences in relation to tuberculosis in discussed

Arthralgia in South Indian patients with pulmonary tuberculosis during treatment with pyrazinamide and rifampicin

Arthralgia was the major adverse reaction encountered in a clinical trial of the treatment of pulmonary tuberculosis with three short-course regimens containing pyrazinamide in South Indian patients. The first regimen was of rifampicin, streptomycin, isoniazid and pyrazinamide given daily for three months; the second was of the same four drugs daily for three months followed by streptomycin, isoniazid and pyrazinamide twice-weekly for two months, and the third was the same as the second except that rifampicin was not administered. Arthralgia was reported in 36% of 353 rifampicin patients and 66% of 179 non-rifampicin patients, a highly significant difference (p<0.001). The onset of arthralgia was mostly during the first two months of chemotherapy. The knees were affected in about 90% followed by the ankles in about 50% of the patients with arthralgia, and about 60% of these patients had one or more of the signs, swelling, tenderness and limitation of joint movement. Chemotherapy was modified in 10 rifampicin and 15 non-rifampicin patients; the rest of the patients were managed with symptomatic treatment with analgesics. There was a two to three fold increase in serum uric acid concentrations by the end of the first month and the concentrations were more or less stationary throughout the rest of the daily phase of treatment. The mean concentration during the daily phase of treatment in patients with arthralgia (0.482 mmoles/litre) was similar to that in those without arthralgia (0.484 mmoles/litre), while that in the rifampicin patients (0.476 mmoles/litre) was significantly lower (p=0.03) than that in the non-rifampicin patients (0.495 mmoles/litre)