The Bandim TBscore – reliability, further development, and evaluation of potential uses

Background: The tuberculosis (TB) case detection rate has stagnated at 60% due to disorganized case finding and insensitivity of sputum smear microscopy. Of the identified TB cases, 4% die while being treated, monitored with tools that insufficiently predict failure/mortality. Objective: To explore the TBscore, a recently proposed clinical severity measure for pulmonary TB (PTB) patients, and to refine, validate, and investigate its place in case finding. Design: The TBscore's inter-observer agreement was assessed and compared to the Karnofsky Performance Score (KPS) (paper I). The TBscore's variables underlying constructs were assessed, sorting out unrelated items, proposing a more easily assessable TBscoreII, which was validated internally and externally (paper II). Finally, TBscore and TBscoreII's place in PTB-screening was examined in paper III. Results: The inter-observer variability when grading PTB patients into severity classes was moderate for both TBscore (κ W=0.52, 95% CI 0.46–0.56) and KPS (κ W=0.49, 95% CI 0.33–0.65). KPS was influenced by HIV status, whereas TBscore was unaffected by it. In paper II, proposed TBscoreII was validated internally, in Guinea-Bissau, and externally, in Ethiopia. In both settings, a failure to bring down the score by ≥25% from baseline to 2 months of treatment predicted subsequent failure (p=0.007). Finally, in paper III, TBscore and TBscoreII were assessed in health-care-seeking adults and found to be higher in PTB-diagnosed patients, 4.9 (95% CI 4.6–5.2) and 3.9 (95% CI 3.8–4.0), respectively, versus patients not diagnosed with PTB, 3.0 (95% CI 2.7–3.2) and 2.4 (95% CI 2.3–2.5), respectively. Had we referred only patients with cough >2 weeks to sputum smear, we would have missed 32.1% of the smear confirmed cases in our cohort. A TBscoreII>=2 missed 8.6%. Conclusions: TBscore and TBscoreII are useful monitoring tools for PTB patients on treatment, as they could fill the void which currently exists in risk grading of patients. They may also have a role in PTB screening; however, this requires our findings to be repeated elsewhere

Topical Treatment Modalities for Old World Cutaneous Leishmaniasis: A Review

Diagnosis and therapy of cutaneous leishmaniasis (CL) can be difficult due to the variability of the clinical pictures and resistance to therapy. There is no vaccine currently available for CL. The aim of the present review is to describe different topical treatment modalities for old world CL. The mainstays of treatment for old world CL are pentavalent antimony compounds which are administered parenterally or intralesionally. New topical treatment alternatives have been available within the past few years. Amongst several treatments used topically, physical therapies including cryotherapy, heat therapy and CO2 laser are promising for the treatment of old world CL. Along with that, other randomized placebo controlled trials should be designed to find new effective therapeutic regimens

Cystic Tuberculous Pericarditis A Rare Form

Tuberculous pericariditis is the most common cause of chronic pericarditis, especially in developing countries. Cystic tuberculous pericarditis is an exceedingly rare type of tuberculosis. Authors discuss clinical manifestations and radiological findings in a patient with cystic tuberculous pericarditis in whom diagnosis was confirmed by pericardial biopsy.
 Key words: Cystic Pericarditis, Tuberculosis, Ira

Diagnostic risk factors to differentiate tuberculous and acute bacterial meningitis

The objective of this study was to identify independent predictor factors for diagnosis of tuberculous meningitis and develop a clinical prediction tool based upon a set of simple clinical and laboratory parameters in our local population. Clinical and laboratory features were compared in 68 patients with tuberculous meningitis and 123 cases of acute bacterial meningitis in 3 referral centres for tuberculosis in south-eastern Iran. Twenty-two clinical and laboratory features were analysed. Based on the best-fitted model a receiver operating characteristic curve with the highest surface under the curve was constructed. Disease duration before diagnosis (5 d) had the highest odds ratio of 21.9. Age over 30 y, CSF leukocyte count 1000103 cells/ml and CSF lymphocytosis 70% were placed after disease duration with odds ratios of 5.1, 3.7 and 2.6, respectively. Sensitivity, specificity and likelihood ratio for a positive test in this model were 84%, 88% and 7.4, respectively. The area under the ROC curve was 0.92. It appears that a single model can not predict TBM diagnosis in different populations. Using clinical and laboratory parameters may facilitate empirical diagnosis of TBM in endemically low income countries with limited microbiological diagnostic facilities