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PubMed2000

Private pharmacies and tuberculosis control: a survey of case detection skills and reported anti-tuberculosis drug dispensing in private pharmacies in Ho Chi Minh City, Vietnam.

SETTING: Ho Chi Minh City (HCMC), Vietnam. OBJECTIVES: To assess knowledge about tuberculosis, to describe self-reported dispensing practices and to estimate the magnitude of anti-tuberculosis drug dispensing in private pharmacies. DESIGN: Survey of a random sample of 147 private pharmacies out of a total of 1814 registered pharmacies. Interviews were carried out based on a structured questionnaire. RESULTS: Eighteen per cent of interviewees identified TB as a possible diagnosis for a fictitious case with fever and cough for 4 weeks. Fifty-eight per cent reported selling anti-tuberculosis drugs often or sometimes. Interviewees estimated that 1.3 persons on average (95%CI 0.6-1.9) had bought anti-tuberculosis drugs during the last 4-week period, and that 24% of them had bought anti-tuberculosis drugs without a prescription. CONCLUSION: We have estimated that between 1100 and 3400 persons buy anti-tuberculosis drugs each month in the 1814 registered private pharmacies in HCMC, that about a quarter of them do so without a prescription, and that at least 40% of all anti-tuberculosis drug dispensing in HCMC occurs in the private sector. Regulations need to be put in place urgently and collaboration strengthened between the strong National Tuberculosis Programme and the unorganised private sector in HCMC.

Adult↗

PubMed2003

Secular trends in the occurrence of tuberculosis in an urban community in north west England, 1918-2001: implications for a local tuberculosis control programme.

In recent years enhanced surveillance of tuberculosis has been undertaken for England and Wales to monitor national epidemiological trends. The Chief Medical Officer's strategy for communicable diseases has identified the development of a national strategy for the control of tuberculosis as a priority. Regional and sub-regional variations in the occurrence of tuberculosis require further exploration to inform local implementation of the national strategy. Secular epidemiological trends in tuberculosis for the period 1918-2001 are described for a deprived urban area in the north west of England, and implications for local enhanced surveillance and control measures are discussed. A substantial decline in mortality and morbidity from tuberculosis is shown due to interruption of transmission following improvements to the housing stock and the introduction of chemotherapy and BCG vaccination. The proportion of incident cases of tuberculosis in non-white groups has markedly increased over the period observed. The local tuberculosis control programme now specifically targets recent non-white immigrants. Other urban areas may need to adopt similar measures to improve local control of tuberculosis.

Adolescent↗

PubMed2004

[World Health Organization guidelines for prevention of tuberculosis in healthcare facilities in countries with limited resources (measures for prevention of tuberculosis)].

Nearly 95% of people with M. tuberculosis infection live in countries with limited resources. Patients who do not suffer from tuberculosis and healthcare workers treating patients with tuberculosis in healthcare facilities are at increased risk of M tuberculosis infection. In 1999, the World Health Organization identified guidelines for prevention of tuberculosis in healthcare facilities in countries with limited resources. The guidelines include recommendations on two levels: district and referral. They are based upon three levels of infection control: administrative, environmental and personal respiratory protection. The first priority in infection control is use of administrative control measures in order to prevent the generation of infectious droplet nuclei. These measures contain an infection control plan, training of healthcare workers, patient education, sputum collection, triage and evaluation of patients suspected to have tuberculosis, reduction of exposure to M. tuberculosis of healthcare workers in laboratories, isolation of patients with multidrug-resistant tuberculosis, etc. The second priority would include environmental control methods in order to reduce the concentration of infectious droplet nuclei in the air. These measures include: natural ventilation, mechanical ventilation, ultraviolet germicidal irradiation, etc. The third priority is protection of healthcare workers (and patients) by means of personal respiratory protection (respirators) from inhaling infectious droplet nuclei. Environmental control methods and personal respiratory protection should not be implemented without or serve as replacement for administrative (first priority) control measures.

Cross Infection↗

PubMedDate not supplied

Serological markers of pulmonary tuberculosis and of response to anti-tuberculosis treatment in a patient population in Guinea.

The aim of the study was to evaluate serological correlates of active tuberculosis and of response to antituberculosis treatment in a cohort of HIV-negative patients with pulmonary tuberculosis studied at diagnosis and during treatment at the Service de Pneumo-Phtisiologie, Centre Hospitalier-Universitaire Ignace Deen, Conakry, Republic of Guinea. Two similar cohorts of HIV-negative healthy households of patients and healthy community controls were included in the study. Plasma samples were obtained from 168 untreated tuberculosis patients, 167 healthy household controls, and 168 healthy community controls. Serial plasma samples were also obtained from the tuberculosis patients at 2 and 8 months after initiation of chemotherapy. IgG antibody levels were measured by an enzyme-linked immunosorbent assay (ELISA) using ten purified M. tuberculosis antigens. ELISA results were analysed by comparing geometric means of data. Of the ten antigens tested, five (14kDa Ag, 19kDa Ag, AlaDH, MS, and MPT83) elicited similar antibody responses in untreated TB patients and controls. In contrast, levels of three antibodies (ESAT-6, LAM, and 38kDa Ag) were higher in untreated TB patients than in household or community controls (p<0.0001). Levels were higher in untreated patients than in community controls also for the anti-Rv2626c antibody (p = 0.0001) and, at a lower significance level, for the anti-FdxA antibody (p<0.025). Antibody levels against ESAT-6 and Rv2626c decreased during therapy, while antibody levels to the 38 kDa antigen and LAM increased during therapy; FdxA antibody levels did not vary with treatment. Neither severity of presentation nor chest X-ray patterns affected levels of these antibodies before treatment. In contrast, after the 8-month therapeutic course, patients who presented with moderate/severe disease had higher levels of anti-ESAT-6, anti-FdxA, and anti-38kDa antibodies than those of patients with mild disease onset. Patients with bilateral lung lesions had significantly higher anti-38kDa and anti-LAM levels, both at diagnosis and after 8-month treatment, than patients with lesions involving only one lung. Antibodies to alanine dehydrogenase and malate synthetase measured at initiation of treatment were higher in tuberculosis patients who subsequently failed therapy than in those who were cured. The main conclusions of the study are: a) plasma levels of antibodies to a number of M. tuberculosis represent serological correlates of active disease; b) these correlates are affected in an antigen-specific fashion by anti-tuberculosis treatment; c) particular serological markers may be predictive of treatment outcome.

Adolescent↗

PubMedDate not supplied

[Analysis of hospitalized tuberculosis patients at the Institute for Pulmonary Diseases and Tuberculosis in Belgrade, Serbia during 1988].

The report presents the analysis of TB patients treated at the Institute for lung diseases and tuberculosis of SR of Serbia during 1988--a total of 567 or 10.18% of discharged patients. There were 77% TB patients from Belgrade and 23% from the province. Tuberculosis retains the characteristics of a social disease with a morbidity peak in the fourth decade of age. There were 93% of cases discovered due to disease symptoms. In 82% of patients it was a case of newly discovered specific process, 7.5% had a recurrent disease and 10.5% of patients had a chronic form of the disease. The patients had almost all forms of the specific process: primary tuberculosis 0.35%, postprimary phthisis 84.4%, specific pleuritis 10.6%, tuberculom 1.9%, miliary tuberculosis 1.8%, lymphoglandular tuberculosis 0.9%, while 1.4% had extrathoracic specific lesions associated with pulmonary lesions. Cavernous tuberculosis was observed in 89% of TB patients and extensive phthisis in 14% of cases. Atypical forms of parenchymal specific process were observed in 12% patients. Bacteriological or histological confirmation of tuberculosis existed for 82%. In 13% of patients treatment lasted longer than 3 months. Six or 1% of patients died due to pulmonary tuberculosis.

Adolescent↗

PubMed1989

Overview and epidemiological assessment of the current global tuberculosis situation: with an emphasis on tuberculosis control in developing countries.

This paper reviews the global epidemiological situation to tuberculosis, with an emphasis on the disappointing tuberculosis control achievements in developing countries over the last three decades. It is concluded tht in low prevalence developed countries it will take at least 35-40 years to eliminate tuberculosis because of endogenous exacerbation in subjects remotely infected. In developing countries most of the estimated 4 million new smear-positive and 4 million new smear-negative and extra-pulmonary cases with some 2-3 million deaths from tuberculosis occur each year. It is evident that a low cure rate is the most important reason for failure of tuberculosis control programmes in poor developing countries. Canetti stressed the urgent need to develop chemotherapeutic methods adapted to the conditions prevailing in developing countries. Based on a 9-year experience in IUATLD-assisted national tuberculosis programmes in 10 developing countries, it became apparent that the basic chemotherapeutic regimen consisting of Thiazina (combined tablet of isoniazid and thiacetazone) for 12 months supplemented by streptomycin for the first 2 months is not suitable for achieving a high cure rate in those countries. A high cure rate (90%) under routine conditions can be achieved with an inexpensive 8-month short-course regimen with a 2-month strictly supervised initial intensive phase with daily isoniazid, rifampicin, pyrazinamide and streptomycin, followed by 6 months of self-administered Thiazina daily. A substantial decrease in the risk of tuberculous infection in developing countries is essential, since we are facing their serious problems concerning tuberculosis with the increasing number of AIDS patients. BCG vaccination alone at least with the present type of vaccine, cannot substantially influence the epidemiological situation. It goes without saying that it should be applies to children to prevent tuberculosis whenever its use is justified for its purpose.

Acquired Immunodeficiency Syndrome↗

PubMed1995

[Epidemic of tuberculosis in Meiji and Taisho eras in Japan and excess deaths from tuberculosis in females].

Acute increase in tuberculosis mortality between 1885 and 1910 could be explained by rapidly increased birth rate, consequently large expansion of noninfected population, and gradual increase in opportunity of contact with infectious patients by changing working environments and living conditions. Prevalence of tuberculosis patients was not so few in the beginning of Meiji era. Vicious spiral of increased young susceptibles, many infectious sources and increased opportunity of infection had been continued for long. Lower nutrition from infant to adult, hard work and poor living conditions had worsen prognosis of the patients. Nation-wide tuberculosis control campaign, mainly avoiding contact with patients and contaminated materials had started around 1910 and then issued Factory act which had been improved working conditions in the factories, although the speed was very slow. Tuberculosis mortality began to decrease in 1910s, but sharp temporary rise of tuberculosis mortality was marked in 1918-19 by epidemic of influenza, then the mortality had been declined again. Excess mortality by influenza caused temporary reduction of infectious sources, which had affected mortality rate of tuberculosis in the younger ages after 1920. Large raise-up of wages for factory workers around 1920 and increase trend in income for other workers by economic growth since 1900 had been improved not only working and living conditions, but also dietary life with increased higher intake of animal foods. Female excess deaths from tuberculosis comparing those of males had continued until 1930, then male mortality exceeded females. Mobilization of young women to spinning and textile industries in Meiji and Taisho eras forced to increase in tuberculosis mortality among them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2006

Drugs for preventing tuberculosis in people at risk of multiple-drug-resistant pulmonary tuberculosis.

BACKGROUND: The emergence and spread of multiple-drug-resistant tuberculosis (MDR-TB), caused by strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, is a potential threat to global tuberculosis control. Treatment is prolonged, expensive, more toxic than treatment of susceptible tuberculosis, and often unsuccessful. Experts are still undecided on the management of people exposed to MDR-TB. OBJECTIVES: To evaluate antituberculous drugs given to people exposed to MDR-TB in preventing active tuberculosis. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (January 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to January 2006); EMBASE (1974 to January 2006), LILACS (1982 to January 2006), conference proceedings, and reference lists. We also contacted researchers and organizations. SELECTION CRITERIA: Randomized controlled trials comparing antituberculous drug regimens with an alternative antituberculous drug regimen, placebo, or no intervention given to people exposed to MDR-TB for preventing active tuberculosis. DATA COLLECTION AND ANALYSIS: Two authors independently inspected titles and abstracts identified by the search in order to identify potentially relevant publications for inclusion and analysis. MAIN RESULTS: No randomized controlled trials met the inclusion criteria. AUTHORS' CONCLUSIONS: The balance of benefits and harms associated with treatment for latent tuberculosis infection in people exposed to MDR-TB is far from clear. Antituberculous drugs should only be offered within the context of a well-designed randomized controlled trial, or when people are given the details of the current evidence on benefits and harms, along with the uncertainties.

Antitubercular Agents↗

PubMed1995

Trend of initial drug resistance of tubercle bacilli isolated from new patients with pulmonary tuberculosis and its correlation with the tuberculosis programme in Beijing.

SETTING: The tuberculosis control programme of Beijing. OBJECTIVE: To observe the trend of initial drug resistance of tubercle bacilli and to try to correlate it with the Beijing tuberculosis control programme. DESIGN: Susceptibility testing of randomly collected isolates of positive sputum culture from new patients with pulmonary tuberculosis without a history of prior antituberculosis therapy, in 1962 and continuously since 1978. Collection of treatment data from the Beijing tuberculosis control programme. RESULTS: The trend of initial drug resistance in Beijing began to decline in 1978. The Beijing tuberculosis treatment programme has been very successful, resulting in rapid reduction of prevalence of smear-positive cases. CONCLUSION: It appears that the trend of initial drug resistance correlates with progress made in the implementation of the successful tuberculosis programme in Beijing. It is recommended that continuous observation of initial drug resistance be one of the indices of tuberculosis surveillance.

Antitubercular Agents↗

PubMed2002

A pantothenate auxotroph of Mycobacterium tuberculosis is highly attenuated and protects mice against tuberculosis.

With the advent of HIV and the widespread emergence of drug-resistant strains of Mycobacterium tuberculosis, newer control strategies in the form of a better vaccine could decrease the global incidence of tuberculosis. A desirable trait in an effective live attenuated vaccine strain is an ability to persist within the host in a limited fashion in order to produce important protective antigens in vivo. Attenuated M. tuberculosis vaccine candidates have been constructed by deleting genes required for growth in mice. These candidate vaccines did not elicit adequate protective immunity in animal models, due to their inability to persist sufficiently long within the host tissues. Here we report that an auxotrophic mutant of M. tuberculosis defective in the de novo biosynthesis of pantothenic acid (vitamin B5) is highly attenuated in immunocompromised SCID mice and in immunocompetent BALB/c mice. SCID mice infected with the pantothenate auxotroph survived significantly longer (250 days) than mice infected with either bacille Calmette-Guerin (BCG) vaccine or virulent M. tuberculosis (77 and 35 days, respectively). Subcutaneous immunization with this auxotroph conferred protection in C57BL/6J mice against an aerosol challenge with virulent M. tuberculosis, which was comparable with that afforded by BCG vaccination. Our findings highlight the importance of de novo pantothenate biosynthesis in limiting the intracellular survival and pathogenesis of M. tuberculosis without reducing its immunogenicity in vaccinated mice.

Animals↗

PubMed2005

Multiple metastatic tuberculosis abscesses in a patient with Pott disease and lung tuberculosis: a case report.

The incidence of tuberculosis in Western countries is rising, and continued vigilance together with an awareness of its protean manifestations is essential. Cutaneous tuberculosis is a relatively rare manifestation of the disease, accounting for only 1% of extrapulmonary cases of tuberculosis and 0.14% of all reported cases of tuberculosis. A 19-year-old male patient was admitted to our clinic with skin lesions both at the front and at the back of his body. With clinical findings, histopathology, polymerase chain reaction, PA lung graph, and computerised tomography, the patient was diagnosed with metastatic tuberculosis abscess associated with lung tuberculosis and Pott's disease. Antituberculosis drugs were administered. An increased awareness of the re-emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasing common skin disorder.

Abscess↗

PubMed1996

Tuberculosis antigen A60 serodiagnosis in tuberculous infection: application in extrapulmonary and smear-negative pulmonary tuberculosis.

An ELISA diagnostic test for tuberculosis antigen A60 (TBA60) IgG/IgM was used in a tertiary referral hospital in Taiwan. From June 1992 to December 1993, serum samples obtained from 907 patients were analyzed for TBA60 IgG and IgM titres. The final diagnosis of these patients was confirmed by microbiological study and clinical follow up for 18-24 months. Among 147 patients with active pulmonary tuberculosis, IgG was positive in 112 (76.2%), IgM was positive in 14 (9.52%). Among 90 patients with active extrapulmonary tuberculosis, IgG was positive in 53 (58.9%), IgM was positive in 9 (10%). Among 153 patients with inactive tuberculosis, IgG was positive in 28 (18.3%), IgM was positive in 1 (1.6%). Among 517 patients with nontuberculous disease, IgG was positive in 50 (9.7%), IgM was positive in 3 (0.6%). In this study population with 26% (237/907) active tuberculous infection rate, the TBA60 ELISA IgG had a diagnostic sensitivity of 69.6% and a specificity of 92.1%. These results indicate a positive predictive value of 67.9% and a negative predictive value of 89.2%. The sensitivity of IgM was 10.5% and specificity, 99.4%. The serum IgG tire had good correlation with the extent of pulmonary TB had a higher percentage of IgG seropositivity (83.9%) than those with smear-negative pulmonary TB (70.6%) and extrapulmonary TB (58.9%). In 50 cases with active tuberculosis, follow-up examinations were carried out one month after treatment. In 18 cases with initially negative IgG and IgM titres, 13 showed elevation of serum IgG titres into positive level, one had positive seroconversion of IgM which was the only serological marker indicating active infection. Therefore, 77.8% (14/18) gained diagnostic benefit from follow-up serological examination. It was concluded that TBA60 IgG and IgM ELISA is a useful test when diagnosing tuberculosis. This test also assists in the clinical judgement of tuberculosis when used as an adjunct to symptoms and sputum smear, and for monitoring therapeutic response at the commencement of treatment.

Adolescent↗

PubMedDate not supplied

[Drug resistance of Mycobacterium tuberculosis in Orizaba, Veracruz. Implications for the tuberculosis prevention and control program].

BACKGROUND: Tuberculosis, declared a global emergency by the World Health Organization, continues to be an important public health problem in Mexico, included in the first twenty causes of death. OBJECTIVE: To know the impact of drug resistance of Mycobacterium tuberculosis on treatment outcome, need of re-treatment and mortality in a cohort of patients with pulmonary tuberculosis receiving directly observed therapy, short course (DOTS). METHODS: We conducted a population-based study in a suburban region in Southern Mexico. People who had been coughing for more than two weeks underwent sputum acid-fast bacilli smear. Patients with a positive smear were recruited and underwent clinical exam, chest X-ray, HIV testing, and sputum cultures. Identification, drug susceptibility testing and restriction fragment length polymorphism analysis (RFLP) were performed in all isolates. Patients were followed every 12 months for new episodes of tuberculosis and vital status. Patients were referred for clinical care to the local program of tuberculosis. Deaths were corroborated with death certificates. Informed consent was obtained from participants. RESULTS: Between March 1995 and February 1999, tuberculosis was diagnosed in 371 patients who were followed for an average of 32 months. M. tuberculosis was cultured from 316 patients; resistance to any drug occurred in 25.0% of isolates (primary 18.8%, acquired 49.2%); only to isoniazid in 6.8% (primary 7.3%, acquired 4.8%); to isoniazid and rifampin in 6.2% (primary 1.6%, acquired 23.8%). Patients with drug resistance had a higher probability of treatment failure (OR = 16.9, CI 95% 4.5-63.0) and patients with MDR strains had a higher probability of need of re-treatment (RR = 24.4, CI 95% 8.8-67.6), and of death (RR = 4.0, CI 95% 1.5-10.7). Additional variables were found to be associated with subsequent episodes of disease and mortality: Cocaine use, chronic disease, type of radiological lesions, HIV co-infection, non-compliance and treatment delay, as well as RFLP clustering. CONCLUSIONS: In this study, we observed that drug resistance showed a severe impact on the outcome and survival; drug-resistance was the most significant factor for these negative outcomes; DOTS may not be sufficient in areas where drug resistance is considerable, and patient follow-up for longer periods of time, as compared to evaluation at the end of treatment, provides additional information which is useful for prevention and control programs.

Adult↗

PubMed1964

EPIDEMIOLOGICAL BASIS OF TUBERCULOSIS ERADICATION. 2. DYNAMICS OF TUBERCULOSIS MORBIDITY AND MORTALITY.

In most countries there have been signs in recent years of an accelerated decline in tuberculosis, but only the most superficial knowledge exists of what underlies the remarkable changes. It is therefore imperative to document the changing picture of tuberculosis by means of parameters that are not only descriptive but will also serve as guidelines for the development of methods to eradicate the disease.The authors describe the present system of tuberculosis reporting and control in Denmark, where the requisite conditions for obtaining meaningful statistics are, to a large extent, fulfilled, discussing its potentialities for depicting the forces behind the recent changes and pointing out its inherent deficiencies.The advantages of the Danish system, in which rates for the prevalence and incidence of respiratory tuberculosis are broken down into those for new cases and those for relapses, are stressed, as is the significance of the recently introduced practice of reporting cures and thus obtaining cure rates on a nation-wide scale.As an indicator of the lethal effect of tuberculosis in a country, the mortality rate suffers from several limitations, which will play an increasingly important role as the downward trend in tuberculosis continues. The authors suggest that a more objective measure than the specific mortality rate would be the so-called "lethality index" - an index based on all deaths occurring among persons with active tuberculosis, irrespective of whether they were attributed directly to the disease.

Communicable Disease Control↗

PubMed2005

Application of nested polymerase chain reaction (nPCR) using MPB 64 gene primers to detect Mycobacterium tuberculosis DNA in clinical specimens from extrapulmonary tuberculosis patients.

BACKGROUND & OBJECTIVE: The conventional culture technique for diagnosis of extrapulmonary tuberculosis is time consuming. In order to find a sensitive and rapid technique nested polymerase chain reaction (nPCR) targeting the conserved MPB 64 gene of Mycobacterium tuberculosis was evaluated for detection of M. tuberculosis DNA directly from clinical specimens of extrapulmonary origin. METHODS: A total of 400 clinical specimens from clinically suspected cases of extrapulmonary tuberculosis and 30 control specimens of nontuberculous aetiology were processed by smear and culture and by nPCR technique for detection of M. tuberculosis. The specimens were divided into 3 groups, (group I--280 specimens [104 peritoneal fluid (PF), 120 cerebrospinal fluid (CSF), 44 lymph node biopsies 3 pericardial fluid and 9 other biopsy specimens], group II--120 aqueous humour (AH) from idiopathic granulomatous uveitis cases, and group III--30 control specimens (10 CSF and 20AH). RESULTS: The conventional culture was positive only in 16 of 400 specimens. The overall positivity of nPCR was 35.2 per cent (141/400). Among the 280 specimens from extrapulmonary lesions (group I), 15 were bacteriologically positive, while 115 of 265 bacteriologically negative specimens (43.4%) were positive by nPCR. All the 30 control specimens were negative by nPCR. INTERPRETATION & CONCLUSION: The nPCR using MPB64 gene primers might be a rapid and reliable diagnostic technique for detection of M. tuberculosis genome in clinically suspected extrapulmonary tuberculosis specimens, as compared to the conventional techniques.

Aqueous Humor↗

PubMed1996

[Cellular immune response in tuberculosis: analysis of T-lymphocytes and their subsets, B-lymphocytes and natural cytotoxic cells in different tuberculosis states and body fluids].

BACKGROUND: The immune response to Mycobacterium tuberculosis is primarily mediated by T lymphocytes. In this study an investigation was made of T lymphocytes and their subsets, B lymphocytes and natural cytotoxic cells (Natural Killer, NK) in blood and organic fluids in different tuberculosis conditions. METHODS: Patients with localized pulmonary tuberculosis (LPT, n = 12), extensive pulmonary tuberculosis (EPT, n = 24), pleural tuberculosis (PLE, n = 14), disseminated tuberculosis (DIS, n = 10), recent Mantoux converters (MAN, n = 15) and healthy subjects (CON, n = 19) were studied. HIV+ and immunosuppressed patients were excluded. Total lymphocytes and T subsets (CD3, CD4, CD8, TCR alpha beta and gamma delta), B (CD19) and NK cells (CD56) in blood and pleural fluid (n = 7) and ascitic fluid (n = 3) were determined. RESULTS: An increase was observed in total lymphocytes and all T subsets (CD3, CD4, CD8, alpha beta and gamma delta) in MAN group compared with CON group (p < 0.05 for all determinations). A progressive lymphopenia of total lymphocytes and CD4 was observed with more extensive disease, particularly in the DIS group (p < 0.05). No differences were observed between groups regarding B lymphocytes and NK cells. In pleural effusions and ascitic exudates an accumulation of T lymphocytes, mainly CD4, was observed, with no increase in gamma delta T lymphocytes. CONCLUSIONS: 1) In patients with recent tuberculosis infection T lymphocytosis (total and subsets) occurs. 2) In the absence of HIV infection, a progressive lymphopenia occurs, particularly CD4, with extending disease. 3) In tuberculous pleural effusions and ascitic exudates and accumulation of CD4 T lymphocytes occurs, but not TCR gamma delta lymphocytes.

Adolescent↗

PubMed1998

[Comparison of cases of isolated pulmonary tuberculosis with cases of other localizations of tuberculosis in the course of an active surveillance (Gironde, 1995-1996)].

PURPOSE: Data collected during the years 1995 and 1996 in the course of an epidemiological survey of tuberculosis in Gironde allowed comparison of pulmonary tuberculosis with extrapulmonary localizations, evaluation of the importance of each localization and highlighting of potential risk factors. METHODS: Patients living in Gironde who had evidence of either clinical, radiological or bacteriological expression of tuberculosis were included in the survey. Statistical comparisons were done using either Pearson's Chi 2 or Fisher's exact test. RESULTS: The survey included 292 cases subdivided into 183 cases of pulmonary tuberculosis (63%) and 109 cases in which another localization had been diagnosed (37%). Extrapulmonary localizations that were the most often encountered either alone or in association with pulmonary localization were the following: lymphadenopathy (32%), pleural (28%), genito-urinary (12%) and osteo-articular localizations (7%). The survey showed that patients in whom tuberculosis localization was extra-pulmonary were more frequently under 20 years of age or over 60 years of age (P < 0.04). These patients also presented more often with HIV-infection (P < 0.02). CONCLUSION: Extrapulmonary localizations of tuberculosis should be systematically investigated in young and elderly patients as well as in HIV-infected patients.

AIDS-Related Opportunistic Infections↗

PubMed1990

An ELISA for the serodiagnosis of tuberculosis using a 30,000-Da native antigen of Mycobacterium tuberculosis.

An ELISA was established for the measurement of IgG antibody in human serum to the 30,000-Da native antigen of Mycobacterium tuberculosis and evaluated for its utility in the diagnosis of tuberculosis at the Instituto Nacional de Enfermedades Respiratorias in Mexico City. The test had a sensitivity of 70% in patients with sputum-positive active pulmonary tuberculosis and a specificity in control subjects of 100%. The accuracy of positive prediction was 100% and of negative prediction 93% for patients with pulmonary tuberculosis at this institute. Less favorable test characteristics were obtained for patients with miliary and pleural tuberculosis, in which the test had sensitivities of 22% and 14%. These results offer the promise of an accurate serodiagnostic test for pulmonary tuberculosis using readily obtained reagents.

Antibodies, Bacterial↗