4 research outputs found
Rifampicin-induced acute thrombocytopenia.
Rifampicin is an essential component of the treatment regimen
for tuberculosis. Extensive clinical experience has shown that the
drug is well tolerated, but on rare occasions it can cause life threatening
adverse reactions like acute renal failure and thrombocytopenia. At
the Tuberculosis Research Centre, we have treated more than 8000
patients with pulmonary and extra-pulmonary tuberculosis with
rifampicin-containing regimens over the past 30 years and we are
reporting a case of acute thrombocytopenia probably rifampicin
induced, in a patient who was retreated for tuberculosis. The physician
treating tuberculosis patients must be aware of this rare life threatening
complication, which if detected early, is completely reversible
Interferon gamma (IFN -gamma) and interleukin -4 (IL-4) gene variants and cytokine levels in pulmonary tuberculosis. Indian Journal of Medical Research
Background & objectives: Cytokine gene polymorphisms may alter Th1/Th2 balance with major
implications in tuberculosis. The aim of our study was to find out whether Interferon � +874A and
IL-4 -590T polymorphisms were associated with susceptibility to pulmonary tuberculosis as well
as the level of IFN� and IL-4 in south Indian population.
Methods: Interferon � +874A and IL-4 -590T promoter polymorphisms were studied in 129
pulmonary tuberculosis (PTB) patients and 127 normal healthy subjects (NHS) and were associated
with culture filtrate and live Mycobacterium tuberculosis induced IFN� and IL-4 production in
peripheral blood mononuclear cells (PBMCs). IL-4 gene variants were also associated with IgG
antibody levels against M. tuberculosis culture filtrate antigen.
Results: The variant IFN� genotypes and IFN� levels between genotypes did not differ significantly
in patients and controls. Significantly increased frequency of variant IL-4 ‘CT’ genotype in PTB
patients (P<0.05) and ‘CC’ genotype in control group (P<0.01) was observed. IL-4 levels were
detectable in very few subjects and the IgG levels did not differ between the three IL-4 genotypes.
Interpretation & conclusion: The study suggests a lack of functional association of Interferon �
+874A polymorphism in tuberculosis in south Indian population. The higher frequency of IL-4
‘CT’ genotype in PTB suggests a possible association of IL-4 -590T promoter polymorphism with
susceptibility to tuberculosis, and the ‘CC’ genotype may be associated with protection
Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: An analysis of risk factors
Background & objectives: New smear-positive pulmonary tuberculosis (PTB) patients in the Revised
National Tuberculosis Control Programme (RNTCP) are treated with a 6-month short-course
chemotherapy (SCC) regimen irrespective of co-morbid conditions. We undertook this retrospective
analysis to compare sputum conversion rates (smear, culture) at the end of intensive phase (IP) of
Category-1 regimen among patients admitted to concurrent controlled clinical trials: pulmonary
tuberculosis alone (PTB) or with type 2 diabetes mellitus (DM-TB) or HIV infection (HIV-TB), and
to identify the risk factors influencing sputum conversion.
Methods: In this retrospective analysis sputum conversion rates at the end of intensive phase (IP) in
three concurrent studies undertaken among PTB, DM-TB and HIV-TB patients, during 1998 –
2002 at the Tuberculosis Research Centre (TRC), Chennai, were compared. Sputum smears were
examined by fluorescent microscopy. HIV infected patients did not receive anti-retroviral treatment
(ART). Patients with DM were treated with oral hypoglycaemic drugs or insulin (sc).
Results: The study population included 98, 92 and 88 patients in the PTB, DM-TB and HIV-TB
studies. At the end of IP the smear conversion (58, 61, and 62%) and culture conversion (86, 88 and
92%) rates were similar in the three groups respectively. The variables associated with lack of
sputum smear or culture conversion were age >45 yr, higher pre-treatment smear and culture grading,
and extent of the radiographic involvement.
Interpretation & conclusions: Our findings confirm that the current policy of the control programme
to treat all pulmonary TB patients with or with out co-morbid conditions with Category-I regimen
appears to be appropriate
Assessment of long term status of sputum positive pulmonary TB patients successfully treated with short course chemotherapy
Background: Long term status of pulmonary tuberculosis (PTB) patients treated with short course chemotherapy (SCC) regimens remains unknown.
Objective: To assess the clinical, bacteriological, radiological status and health related quality of life (HRQoL) of PTB
patients 14 -18 years after successful treatment with SCC.
Methodology: In a cross-sectional study, cured PTB patients treated during 1986 – 1990 at the Tuberculosis Research Centre
(TRC) were investigated for their current health status including pulmonary function tests (PFT). The St Georges respiratory
questionnaire (SGRQ) was used to assess the HRQoL
Results: The mean period after treatment completion for the 363 eligible participants was 16.5yrs (range 14-18 yrs, 84%
coverage) ; 25 (7 %) had been re-treated and 52 (14%) died. Among the investigated, 58 (29%) had persistent respiratory
symptoms; 170(86%) had radiological sequelae but none had active disease. Abnormal PFT was observed in 96 (65%) with
predominantly restrictive type of disease in 66(45%). The SGRQ scores for activity and impact were high implying
impairment in HRQoL.
Conclusion: Assessment of long term status of cured PTB patients showed an impairment of lung functions and HRQoL
highlighting the need to address these issues in the management of TB that may provide added value to patient care