Tuberculous pleural effusion – relapse or re-infection? Follow up of a case report and review of the literature

AbstractIntroductionThis is a case report of pleural effusion with acute drug reactions to anti-tubercular drugs.Case presentationA 45year old female patient had the typical signs and symptoms of tuberculosis with continuous coughing, breathlessness and protruded abdomen. The USG abdomen showed fluid in the left pleural space. Thoracocentesis was carried out thrice at an interval of 15days and about 5.15L were aspirated. The symptoms of dyspnea and cough were relieved. There was acute drug reaction after starting the ATT. The blood pressure was very high requiring hospital admission. The patient was monitored during the entire course of treatment. No fluid in the bilateral pleural spaces was observed in USG after 6months of treatment.This patient had spinal tuberculosis 8years ago and had recovered following ATT. Therefore, it is difficult to say whether pleural effusion was due to relapse of a previous infection or a re-infection. It is also not known whether TB patients remain susceptible to yet another infection in some other extra-pulmonary site.ConclusionAbdominal TB should be suspected in patients with fever, abdominal pain and ascites. Sputum induction (in addition to pleural fluid) for acid-fast bacilli and culture is a recommended procedure in all patients with TB pleurisy.This condition carries good prognosis, if promptly diagnosed and treated. A reasonable management strategy for pleural TB would be to initiate a four-drug regimen and perform a therapeutic thoracocentesis in patients with large, symptomatic effusions. Prolonged follow-up is essential in cases of pleural effusion, as in the presented case

HIV infection among pregnant women attending an integrated counseling & testing centre at Agra: comparison with studies in other regions of India

Background: HIV in pregnant women has become an important focus of HIV research because of its role in the spread of HIV infection, particularly, among children. The aim of this seven year (2005-2011) observational study was to determine the prevalence, trend and risk factors associated with HIV infections among pregnant women presenting to ICTC at Agra.Methods: The socio-demographic data like age, marital status, literacy status, profession, locality of residence and index of gravity were analysed in the context of symptoms at the time testing.Results: 433 pregnant women were screened for HIV and VDRL infections. 5.7% were HIV-positive and 14.3% were VDRL-reactive. HIV-positivity ranged between 2-5% whereas that of VDRL ranged from 8-12%. During 2011, there was a surge in HIV-positivity (11%) and VDRL reactivity (24%).Conclusions: There is an urgent need to perform surveys of HIV and other co-infections like HBV, HCV and STD prevalence among pregnant women to assess the true extent of the problem. Cost-effective treatment regimens and HIV prevention programmes for low-risk group clients are urgently needed in most parts of the country. This is the first review of HIV and other co-infections among pregnant women in different regions of the country

Prevalence of pulmonary tuberculosis among the tribal populations in India

IMPORTANCE: There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. OBJECTIVE: To estimate the prevalence of TB among the tribal populations in India. DESIGN, PARTICIPANTS, SETTING: A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. MAIN OUTCOME AND MEASURES: Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. RESULTS: A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m(2), h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. CONCLUSION AND RELEVANCE: The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs

HIV and HBV co-infections among patients with active TB disease attending a primary health care centre in a rural area of north India

This prospective cross-sectional hospital based study was carried out in order to assess the prevalence of HIV and HBV co-infections among patients with active TB disease attending an OPD at the Model Rural Health Research Unit (MRHRU) in Ghatampur, a rural village in Kanpur district of UP. This is a field unit of National JALMA Institute for Leprosy & other Mycobacterial Diseases at Agra. The socio-demographic features and clinical profile of the TB patients were analysed in the context of symptoms at the time of testing. The HIV and HBV status were determined and correlated with clinical features at the time of testing. In our study, seroprevalence of HIV infection among TB patients is 1.48% (18/1215) and that of HBsAg reactivity was found to be 2.96% (36/1215). During 2007–2010, the HIV-positivity varied between 1.5% and 1.45% whereas HBV reactivity ranged between 2.4% and 3.63%. A substantial percentage of the TB patients attending the OPD in Ghatampur harbour HIV and HBV co-infections, which otherwise would remain undiagnosed without serological screening. There is an urgent need to perform population based surveys of HIV and Hepatitis infections among TB patients to assess the true extent of the problem

Nano-technology platforms to increase the antibacterial drug suitability of essential oils: A drug prospective assessment

A huge number of plant-derived essential oils (EOs) are reported to have lots of ethnomedicinal and biological properties with excellent antibacterial activities. Approximately three hundred EOs (ajowan, anise, basil, camphor, chamomile, clove, citronella, coriander, cumin, eucalyptus, lavender, lemon, orange, peppermint, thyme oils, etc.) are documented under economic class based on commercial and pharmaceutical values. However, most active crude EOs and their constituents like carvacrol, eugenol, geraniol, linalool, thymol, 1,8-cineole, etc. are not found in mainstream drug development modules due to their low solubility, poor bioavailability, and rapid volatility profiles, which reduce their potency, half-life, and pharmacokinetics to achieve the ideal drug-ability profiles. To improve the mainstream use of EOs via nanotechnology, we first gathered more information on plant sources, extraction methods, antibacterial potency with mode of action, and the economic importance of EOs. Further, various nanotechnology platforms, such as nanocarriers, nanoemulsions, liposomes, and cyclodextrins with chemical structure conjugation concept with relevant examples were described. Technically, through optimization in particle size and morphology via a nanotechnology platform, EOs enhance the potency without losing any sensitive properties, easily penetrate and cross the bacterial cell membrane, protect from rapid volatility by coating biocompatible materials, improve the aqueous solubility, improve bioavailability, ensure sustainable release, etc. We hope that the detailed analyses of EOs and nanotechnology platforms will encourage academic and pharmaceutical researchers to use antibacterials by overcoming inadequate drug-ability profiles as potent agents in drugs, food, nutrition, beverages, packaging, and coating materials

HIV-TB Co-Infection among Clients Attending an Integrated Counselling & Testing Centre at Agra: Comparison with Studies in other Regions of India

Settings: This prospective cross-sectional hospital based study was carried out in order to determine the prevalence of HIV-TB co-infection among patients attending an ICTC of this Institute at Agra.Methods: The socio-demographic characteristics and clinical profile of 5391 clients attending the ICTC were analyzed at the time of testing in the context of symptoms. All clients were screened for the presence of the signs and symptoms of TB disease. TB patients were referred to DOTS centre and HIV-positive patients were referred to ART centre, S.N.Medical College, Agra for further care and management.Results: In this study, HIV prevalence among clients was found to be 24% and HIV-TB co-infection was 12%. Major symptoms among these clients, at the time of testing, were weight loss, fever, cough and chronic diarrhea. Both HIV-positivity and HIV-TB co-infection were found to be higher among males, in the age group of 21-35 years, married, illiterate and working as daily laborers.Conclusion: Our study emphasizes the need for routine screening of clients for HIV and TB patients which, in turn, would guide the clinicians in deciding the appropriate treatment regimens in the management of HIV- TB co-infected patients

Prevalence, risk factors and health seeking behaviour of pulmonary tuberculosis in four tribal dominated districts of Odisha: Comparison with studies in other regions of India.

AIM:To determine the prevalence of pulmonary tuberculosis, socio-cultural practices and health seeking behaviour of tribal people in four districts of Odisha. METHODOLOGY:This was an action research study with qualitative and quantitative design following a sequential approach implemented in a 4-phased manner. It was carried out in the 6 selected villages from July,2015 to June,2017. The screening for active TB among chest symptomatics is followed as per the guidelines of the (RNTCP) Revised National Tuberculosis Control Program in India. RESULTS:In all, 1455 households were surveyed in the 6 tribal dominated villages of 4 districts, namely Balangir, Dhenkanal, Kandhamal and Mayurbhanj. Total population of the villages was 6681. Based on the eligibility, 5144 (97.7%) individuals were screened. About 139 (2.3%) could not be screened due to non-availability in their households during day time. Out of the screened individuals (5144), 126 chest symptomatics were identified. Sputum samples were collected from them and sent to the National Reference Laboratory, RMRC, Bhubaneswar using public transport and maintaining cold chain. Out of 126 chest symptomatics, 35 patients were found to be having active TB disease and 18 were culture positive. The prevalence of pulmonary TB is 0.68%. The risk factors seemed to be ignorance about TB symptoms, addiction to alcoholic drinks, difficulty reaching the health facilities owing to the long distances, lack of communication and transport. In addition, other morbidities like Malaria, diabetes, hypertension, malnutrition, etc. were observed in the tribes of the study sites. CONCLUSION:TB control programs need further strengthening in the tribal dominated regions. This study is the first of its kind in this State

Seroprevalence of HIV infection among tuberculosis patients in Agra, India-a hospital-based study

In this study which was carried over a period of 4 years, from 2001 to 2004, 600 adult patients with active TB disease attending the OPD of TBDTC, Agra, were screened for HIV-1/2 antibodies. Of these, 26 were found to be HIV-positive. Seroprevalence of HIV infection among adult TB patients in Agra is 4.3% (26/600). The HIV infection was found to be more in females, i.e. 7.95% (7/88) than in males, 3.71% (19/512). HIV-positivity of 5% was observed in the age groups, 15-24 and 25-34 years, i.e. 3/60 and 13/260, respectively. Among HIV-positive TB patients, 4.2% (22/524) were of pulmonary and 5.3% (4/76) were of extra-pulmonary type. A total of 3.04% (6/197) of HIV-positive TB patients were PPD positive and 4.96% (20/403) were PPD negative and bacillary positivity was 4.4% (15/340) and bacillary negativity was 4.2% (11/260). A total of 3.5% (18/515) of TB patients had a history of positive contact, i.e. spouse or one of the family members was HIV-infected. The difference in signs and symptoms among the HIV positive and HIV negative TB patients was found to be statistically significant

Seroprevalence of HIV infection among paediatric tuberculosis patients in Agra, India: a hospital-based study

In this study which was carried over a period of 2 years, from 2003 to 2004, 270 paediatric patients with active Tuberculosis (TB) disease attending the OPD of S.N. Medical College, Agra were screened for Human Immunodeficiency Virus (HIV)-1/2 antibodies. Of these, 23 were found to be HIV-positive. Seroprevalence of HIV infection among paediatric TB patients in Agra is 8.51% (23/270). The HIV infection was found to be significantly higher, i.e. 82.61% in male children than in female children, i.e. 17.39%. Among the age groups, which were divided into &lt; or=1, 2-5, 6-10 and 11-15 years, maximum cases of HIV-positivity, i.e. 65.22% was observed in the age group, 2-5 years of age. Among the HIV-positive children with TB, 86.75% were of pulmonary and 13.04% were of extra-pulmonary type. Among the vaccinated children, 65.22% were found to be HIV-positive, while 34.78% of the HIV-positive children were not BCG vaccinated. HIV-positive children are more likely to suffer from prolonged fever, weight loss, failure to thrive, developmental delay, stunted growth, cough, anorexia, lethargy, lower respiratory tract infections (LRTI) and hepatosplenomegaly while HIV negative are more likely to suffer from fever, diarrhoea, lymphadenitis, pallor and LRTI. 82.60% (19/23) of these TB patients had a history of positive contact with HIV, i.e. one of the parents was HIV-infected. The mode of transmission of HIV infection among paediatric TB patients was perinatal as revealed during the counselling sessions (pre-test and post-test) of both the parents