Comparison of CD4 and CD8 counts and ratio in HIV negative pulmonary tuberculosis patients with normal healthy controls

Background: There is an equivocal contention that Tuberculosis may be a cause of non-HIV-associated CD4+ T cell lymphopenia. In HIV negative patients, CD4+ and CD8+ T cell count suppression has been associated with TB infection. Prediction of HIV coinfection in newly diagnosed pulmonary TB patients with negative HIV status by estimation of CD4, CD8 count and CD4:CD8 ratio.Methods: Newly diagnosed pulmonary TB patients comprising of 30 numbers with negative HIV status were subjected for estimation of CD4, CD8 counts and ratio for prediction of HIV coinfection. Equal number of healthy controls was also included in the study for comparison of the values.Results: Significantly lower CD4 and CD8 counts among pulmonary TB infected HIV negative patients as compared with healthy controls was found. The CD4:CD8 ratio was normal when compared with healthy controls.Conclusions: The present study highlights the importance of estimation of CD4+ and CD8+ T cell counts and ratio in newly diagnosed pulmonary TB patients with negative HIV status. Prediction ability in combination with early detection and appropriate management play major role in evading emergence of drug resistance among the HIV-TB coinfected patients

Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital

Background: Sputum microscopy is still used for diagnosis of drug-sensitive pulmonary tuberculosis (TB). Revised National Tuberculosis Control Program (TB programs) aims to rapidly diagnose and treat all cases of TB. The aim of this study is to find the proportion of loss to follow up during diagnosis of pulmonary TB after the patient reached hospital (was handed over sputum cups for sputum collection) from DOTS center after referral from respective outpatient department (OPD) at a tertiary care hospital. Methodology: Record-based data from designated microscopic center at a tertiary care hospital were collected regarding the number of patients who had been given sputum cup container for sputum collection for diagnosis of pulmonary TB referred from different OPDs from January to December 2015. Results: A total of 1518 presumptive patient for pulmonary TB had visited DOTS center after referral from different OPDs in the hospital for sputum examination during the above period. The loss to follow-up during diagnosis among presumptive pulmonary TB patient was 461 (30.04%), which was higher among those below 15 years of age. At this rate of loss to follow up of presumptive TB patient to submit sputum for diagnosis, it was estimated to be about 46 smear-positive pulmonary TB cases per year which will be missed out for diagnosis during the above period (considering sputum positivity rate is 10% in the hospital). The mean gap between sputum referral to submission of two sputum samples was 2.73 days (95% confidence interval 2.52–2.84) among those of submitted sputum for diagnosis. Conclusion: Approximately one-third of presumptive patient for pulmonary TB had loss to follow-up for diagnosis of TB even after consulting a doctor at a tertiary care hospital. There is a need to address this gap in diagnosis of pulmonary TB in this region

Amanita nephrotoxic syndrome: Presumptive first case report on the Indian subcontinent

Mushroom poisoning is a rare cause of acute kidney injury. Here, we present a case with presumed Amanita nephrotoxic syndrome, a first of its kind from the Indian subcontinent