Anti TB Research Articles

Tuberculoma of the conus medullaris

A 52 year old female presented with a one month history of progressive back pain radiating to the right lower limb. She reported unintentional weight loss of seven kilograms over three months and drenching night sweats. There was no history of cough. Her physical examination was unremarkable. A HIV ELISA test was positive. Her CD4 count was 27 cells/mm3 and viral load was 1.8 million copies/ml. An MRI spine (A,B) to evaluate the back pain revealed a single spinal ring enhancing lesion at T12 with minimal perilesional edema. A chest CT scan was in keeping with miliary tuberculosis. Sputum TB GeneXpert was positive for Mycobacterium tuberculosis. Anti TB therapy was initiated with subsequent resolution of back pain. Back pain in a patient with miliary TB may indicate vertebral involvement or rarely, as in this case, intramedullary tuberculomas. Prognosis is usually good.

Fatal diffuse pleural calcification due to Tuberculosis- An unexplained entity

Diffuse pleural thickening has many causes and often need to be diagnosed early as delay in treatment can be lethal. Diffuse pleural thickening can be due to calcifications and may occur as a result of chronic infections including Tuberculous effusion. Primary pleural calcification due to Tuberculosis is extremely rare. A 28 year old patient was presented with exertional dyspnea, chronic cough and pleuritic type chest pain for a period of 4 months. CXR showed left sided diffuse pleural calcifications and ultrasonography showed calcified pleura with thick echogenic material suggestive of an empyema. Further evaluation with a CECT showed left sided diffusely calcified, septated pleura with empyema and contralateral early pleural and peritoneal calcification. Pleural aspiration showed a hemorrhagic exudative lymphocytic effusion with high ADA titer. Cytology did not reveal malignant cells. His serum calcium level was normal. He was diagnosed to have extra-pulmonary tuberculosis and was treated with standard anti TB treatment with an intercostal tube drainage. Despite TB treatment he passed away due to respiratory distress caused by pleural thickening. This case highlights the importance of timely initiation of anti TB treatment and the capacity of Tuberculosis to cause diffuse pleural calcification which can be fatal in an untreated setting.

Incidence prevalence and pattern of tuberculosis treatment in HIV/AIDS patients in Regional General Hospital of Bandung city

HIV causes a decrease in immunity which makes the patient susceptible to opportunistic infections such as tuberculosis. This research aims to find out the prevalence, patient descriptions’, treatment pattern and therapeutic goals for tuberculosis in HIV/AIDS patients who were taking the medication in polyclinic of DOTS and polyclinic of VCT in Regional General Hospital Of Bandung City. This was nonexperimental research. Data was collected retrospectively with cross-sectional approach using secondary data which were TB-01 form and HIV Care Summary Form and Antiretroviral Therapy from 1 January 2016 to 31 December 2018. From 668 Tuberculosis occurrence, there were 25 patients suffered HIV/AIDS. Result obtained the most risk factors was homosexual (60%), with the most ART treatment combination were Tenofovir, Lamivudine, and Evarirenz, 4% has a drug allergic, the most TB treatment history was new case (92%), with the most kind was pulmonary TB (56%), the most Anti TB treatment was category I (92%) and 60% patients done with full therapy

Complications and residual pleural thickening after intrapleural instillation of streptokinase with pigtail catheter drainage of tuberculous pleural effusion

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was undertaken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36±0.49mm vs 9.28±1.50mm) (p <0.0001).Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.

Efficacy of intrapleural instillation of streptokinase with pigtail catheter drainage in the treatment of tuberculous pleural effusion

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. The present study was undertaken to evaluate the efficacy of intrapleural instillation of streptokinase with pigtail catheter drainage in the treatment of tuberculous pleural effusion.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70 IU/L (48%) and only 6% had ADA levels below 40 IU/L. The mean pleural drainage was 2615±126.1 ml in the study group (intrapleural streptokinase) and 1858 ± 93.3 ml in the control group (p <0.0001). Mean duration of intercostal drainage in the study group was 3.76 ± 0.144 days and it was 5.08±0.199 days in the control group (p <0.0001). The mean duration of hospitalization in the study group was 6.60±0.91 days and it was 8.60 ± 0.57 days in the control group (p=0.06). Conclusion: Intrapleural streptokinase instillation is successful in increasing the total drainage of pleural fluid and results in effective drainage of tuberculous pleural effusion. It is also associated with increased amount of pleural fluid drainage, decreased duration of intercostal drainage, decreased length of hospital stay.

Predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a man-made problem when bacteria are resistant to at least two anti TB drugs (Rifampicin and Isoniazid). Currently from tuberculosis infected patients, two out of ten are developing MDR-TB and it is an emerging public health problem in Ethiopia. Despite high burden of MDR-TB in Ethiopia, the treatment outcomes and predictors related to incidence among MDR-TB patients is not studied in Oromia region, Ethiopia. Therefore, the present study assessed the predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, EthiopiaMethodFacility based retrospective cohort study was conducted at hospitals in Oromia Region. All registered MDR-TB patient charts from 2015 to 2017 were considered for the study. Data entry was done by using EPI data version 3.1 Statistical Software and data analysis was done by SPSS version 20. The descriptive statistics, frequency, median and range were employed. Bivariate and multivariate Cox proportional hazard regression analysis was used to identify predictors of time to unfavorable treatment outcomes of multidrug resistant tuberculosis. In multivariate Cox proportional hazard regression analysis, the variables with P- value less than and equal to 0.05 were considered as predictor variables for time to unfavorable treatment outcome of MDR-TB.ResultFrom the total of 415 (92.84%) complete MDR-TB charts, the overall cumulative probability of unfavorable treatment outcome at the end of the treatment (two years) was 21.21%. In multivariate Cox proportional hazard analysis initial culture result [AHR = 0.52; 95% CI: 0.29, 0.96], HIV test result [AHR = 3.76; 95% CI: 2.45, 5.78] and culture at the end of continuation phases [AHR = 0.12; 95% CI: 0.08, 0.20] were the predictors of unfavorable treatment outcome.ConclusionThe magnitude of unfavorable treatment outcome at Oromia hospitals was lower than WHO regional report of 2018. This finding demonstrated that low unfavorable treatment outcomes for MDR-TB patients can be achieved in a resource-constrained and high TB-burden setting. Whereas, Initial culture result, HIV test result and culture at the end of continuation phases were determined as predictor factors with associated unfavorable treatment outcomes. Culture positive and HIV positive MDR-TB patients need special attention at the time of treatment.

An uncommon cause of young stroke

Central nervous system tuberculosis (CNS TB) which accounts for 1-10% of all cases of TB can rarely present with cerebrovascular disease which is a serious complication. We present a young patient with an acute stroke as the first manifestation of CNS tuberculosis. 15 year boy presented with sudden left hemiplegia. He was previously well apart from a few days of loss of appetite. He additionally had unexplained neurology of a dilated, reactive pupil on the left. His CSF was infected with a lymphocytic pleocytosis, high protein and a significant sugar drop. In spite of empirical anti – meningitis therapy he deteriorated. MRI brain revealed a right basal ganglia T2 Hyper intensities which later became bilateral on T2/Flair with diffusion restriction on DWI and patchy contrast enhancement. [Fig 1and 2] He also developed autonomic instability. Empirical treatment with anti TB drugs and corticosteroids was commenced. PCR Gene-X pert subsequently confirmed the diagnosis of CNS TB. Tuberculous cerebrovascular disease is a serious complication of CNS TB. Most TBM associated brain infarcts are multiple, bilateral, symmetric, located in the deep gray matter. Infiltrative, proliferative and necrotising vessel pathologies have been described. There is some evidence that vasospasm may mediate stroke early in the course of the disease and proliferative intimal disease in later. CNS TB should be considered a cause in young stroke patients with unexplained cranial neuropathy and constitutional symptoms. A delay in diagnosis can lead to serious complications.

Coagulopathy on TB treatment naive HIV negative patients initiating anti TB medications at Thika level five hospital in Kenya

Coagulopathy on TB treatment naive HIV negative patients initiating anti TB medications at Thika level five hospital in Kenya

Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

Background: Drug-resistant tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in particular represent a major threat to the fight against tuberculosis globally. MDR-TB presents with similar features and is transmitted in the same way as drug sensitive TB but its progression is rapid and its treatment, associated drug toxicity and monitoring constitute a heavy burden to the patients and the health system. MDR-TB affect people of all age groups but very little is known about the magnitude of this problem in children.
 Aims/Objectives: To determine the prevalence of multidrug resistant tuberculosis among children in Port Harcourt.
 Materials and Methods: Information on Paediatric tuberculosis was retrieved from the patients’ case notes, TB registers at the directly observed treatment short course (DOTs) clinic and the Multidrug resistant tuberculosis (MDR-TB) treatment center of the University of Port Harcourt Teaching Hospital from January 2018 to June 2019. Obtained data was analysed and presented in prose and tables. 
 Results: There was a total of 1,860 patients records of which 37 were Paediatrics cases giving a prevalence of Paediatric tuberculosis cases of 2.0% Out of these 37cases, four were multidrug resistant tuberculosis cases giving a prevalence of MDR-TB cases of 10.8%. There were three males and one female giving a male female ratio of 3: 1. and their ages ranged from 3months to 24months. All belonged to social class 5. Common presentation was chronic cough, prolonged fever, weight loss and lymph node swellings. Three (75%) had no prior treatment for tuberculosis while one (25%) completed 6months of anti TB drugs. All had BCG immunization within one week of delivery. One (25%) child had extra-pulmonary TB while 3(75%) children had pulmonary tuberculosis. Xpert MTB/RIF assay for all (100%) showed MTB detected, RIF resistant detected. Three (75%) of the mothers had MDRTB and the medications for their children was based on the drug sensitivity testing (DST) of their mothers. One (25%) of the children and his mother were HIV positive and the mother had died while still on the intensive phase of second line antiTB drugs. Three (75%) had completed the intensive phase of the conventional therapy with second line antiTB drugs and are closely followed up weekly on the continuation phase while one child is still on admission.
 Conclusions: The prevalence of MDR-TB in children in PH is high. All childhood TB (whether drug susceptible or drug resistant) is usually traced to an adult, thus effectively diagnosing and treating all adults as well as a high index of suspicion in presumptive cases is required to curb MDR-TB.
 Recommendations: We recommend strict use of the DOTs strategy in TB management to ensure drug adherence. Also, proper contact tracing, investigation and treatment of children of infected parents to reduce cases of MDR-TB is advocated.

Pediatric TB Management under RNTCP: What and Why?

Childhood tuberculosis does not get the attention it deserves, both in the general child health services and the TB specific services. The difficulty in identification of the organism due to lack of proper sample as well as lower sensitivity of the smear, made it harder to detect cases with ease in the community. Newer diagnostic methods like cartridge based nucleic acid amplification tests (CBNAAT) and line probe assays (LPA) have the capacity to rapidly identify Mycobacterium tuberculosis with an improved sensitivity over the smear testing and have been employed under Revised National Tuberculosis Control Programme (RNTCP) across the country. As the symptoms suggestive of TB are very common and overlapping, the final yield of TB testing is better if the microbiological confirmation is done on good quality specimen from cases suspected of TB based on clinical and radiological abnormalities. Newer tests also provide simultaneous detection of much critical Rifampicin resistance. A Rifampicin resistantcase is not only unlikely to respond to first-line standard therapy but such a treatment can result in further amplification of resistance to other companion drugs. Prevention of spread of the drug resistant disease thus requires that the treatment is guided byuniversal drug sensitivity testing (U-DST) of all TB cases. Furthermore, several changes have come up in the treatment of TB and are discussed.The dosages of anti TB drugs have been revised upwardly for optimal drug levels and now the fixed drug combinations are used under RNTCP. With the awareness about high initial Isoniazid (INH) resistance and its contribution to failure of retreatment regime, a companion third drug (Ethambutol) has been added to the continuation phase of the first-line therapy. The standard retreatment regime, better known as category II therapy, has been replaced by specific therapy as per the resistance pattern detected. The TB control activities have thus evolved a lot and the present article discusses the evolution and the current status of diagnostics and therapy of TB in children.

Synthesis, Screening and Docking Analysis of Hispolon Pyrazoles and Isoxazoles as Potential Antitubercular Agents.

Hispolons are natural products known to possess cytoprotective, antioxidant and anti-cancer activities. We have found recently anti TB activity in these compounds. Efforts were made to optimize the structure with bioisosteric replacement of 1,3-diketo functional group with the corresponding pyrazole and isoxazole moieties. The goal of this paper is designing new hispolon isoxazole and pyrazole and the evaluation of their biological activities. The designed compounds were prepared using classical organic synthesis methods. The anti- TB activity was evaluated using the MABA method. A total of 44 compounds were synthesized (1a- 1v and 2a-2v) and screened for anti TB activity and antibacterial activity. The compounds 1b and 1n showed the highest potency with MIC 1.6µg/mL against M. tuberculosis H37Rv. Bioisosteric replacement of 1,3-diketo functional group in hispolons with pyrazole or isoxazole rings have resulted in potent anti TB molecules. Docking simulations of these compounds on mtFabH enzyme resulted in a clear understanding of bioactivity profiles of these compounds. Docking scores are in good agreement with the anti TB activity obtained for these compounds. Computational studies and in vitro screening results indicate mtFabH as the probable target of these compounds.

Evaluation of Thin Layer Agar 7H11 for Direct Susceptibility Testing of Mycobacterium Tuberculosis Complex against Second Line Anti Tuberculosis Drugs on Smear Positive Specimens.

To evaluate performance of thin layer agar (TLA) 7H11 method for detection of ofloxacin (OFX) and kanamycin (KM) resistance in smear positive clinical specimens of patients with tuberculosis comparing the results with gold standard MGIT 960 system. Cross-sectional validation study. Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from April to September 2017. Acid fast bacilli (AFB) smear positive specimens submitted at the study place, were inoculated on TLA 7H11 agar. Growth was examined along with susceptibility of OFX and KM and compared with gold standard MGIT 960 system. One hundred and sixty specimens were evaluated. Sensitivity and specificity of TLA for OFX was found to be 100% and 99.3%, respectively; and PPV and NPV was found to be 90.9% and 100%, respectively. Overall diagnostic accuracy was 99.38%. Sensitivity and specificity of TLA for KM was found to be 80% and 100%, respectively. PPV and NPV was found to be 100% and 99.36%, respectively. Overall diagnostic accuracy was 99.38%. Thin layer agar is reliable, easy to perform and cost effective technique not only for rapid detection of MTB but also for drug susceptibility (DST) of second line anti TB agents. It is a suitable alternative to culture on LJ medium and can also be alternative to MGIT 960 system in resource-poor settings.

Analytical techniques for Pirfenidone and Terizidone: A review

Analytical techniques for Pirfenidone and Terizidone: A review - IJPCA- Print ISSN No: - 2394-2789 Online ISSN No:- 2394-2797 Article DOI No:- 10.18231/j.ijpca.2019.001, International Journal of Pharmaceutical Chemistry and Analysis-Int J Pharm Chem Anal

Mycobacterium tuberculosis enhances macrophage P-glycoprotein (MDR-1) expression and activity to promote intracellular survival

Abstract Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis (M.tb), a serious problem worldwide with over one third of the global population being infected; resulting in 1.3 million deaths. TB treatment includes a combination of 3 or more anti-TB drugs over a prolonged period of time. In the last few decades, multi drug resistant (MDR-TB) and extensively drug resistant TB (XDR-TB) strains have emerged due to the mismanaged use of anti-TB drugs. In this study, we discovered that M.tb infection increases the expression of macrophage drug efflux pump P-Glycoprotein (MDR-1) to extrude various chemical substances including the anti-TB drugs to benefit the M.tb survival. M.tb infection in macrophages suppresses the heat shock factor-1 (HSF1), a transcriptional regulator of MDR-1 through the up regulation of miR-431. Notably, the non pathogenic mycobacterium M. smegmatis or BCG did not increase the MDR-1 expression in human macrophages. Additionally, the inhibition of M.tb phoPR secretion system by pharmacological inhibitor reverses the M.tb mediated up regulation of MDR-1 in macrophages. Finally, inhibition of MDR-1 in macrophages enhances the anti TB drug mediated killing of M.tb. In conclusion, we report a novel finding that M.tb up regulates the MDR-1 in macrophages which limits the exposure of M.tb to sub-lethal concentrations of drugs that promotes M.tb survival and emergence of resistant variants.

Tuberculous Meningitis: The Microbiological Laboratory Diagnosis and Its Drug Sensitivity Patterns

Background: Tuberculosis continues one of the major challenges to global health. Mycobacterium tuberculosis complex can affect any organ other than the lung parenchyma, include central nervous system. The mortality rate of tuberculous meningitis (TBM) are high worldwide with up to half of survivors suffering irreversible sequelae. Diagnosis of TBM is difficult due to paucibacillary, various clinical manifestation, and invasive procedure to appropriate specimens. Objective: The objectiveis to study the positivity rate of microbiological laboratory diagnosis and its drug sensitivity patterns of TBM patients in Dr. Soetomo Hospital Surabaya during October 2015 until September 2016. Methods: Specimens were cerebrospinal fluids. Identification and drug anti TB sensitivity test were done by BACTEC MGIT 960 system in Clinical Microbiology Laboratory Dr. Soetomo Hospital Surabaya. Result: Most patients with TBM were women (54.29%). Based on age groups, most dominant was adult population (65.71%). Proportion percentage of positive M. tuberculosis complex among 180 specimens were 19.44%. First line anti TB drug sensitivity pattern of 35 isolates were 1 monoresistant, 1 poly-resistant, no multiple drug resistant (MDR), and 33 pan-susceptible. Conclusion: Positivity rate of Mycobacterium tuberculosis complex laboratory diagnosis from TBM suspect patients were low. There was no MDR TB in this study, but mono-resistant and poly-resistant. Microbiological diagnosis was important to give information of active disease and drug sensitivity pattern. Resistance to first line anti TB drugs is alarming to properly manage TBM patients.

Pulmonary Tuberculosis Characteristics in a Patient with Type 2 Diabetes Mellitus

Abstract Tuberculosis (TB) and diabetes mellitus (DM) are two chronic diseases with major impact on worldwide morbidity and mortality. DM significantly increases the risk of death, therapeutic failure and relapse of TB, requiring a much more careful monitoring of these patients. In this article we present the case of a patient with type 2 DM in the stage of major chronic complications, with numerous risk factors for TB and atypical symptomatology, pulmonary X-ray showing active TB lesions. The patient did not follow the diabetologist's recommendations, discontinuing the antidiabetic treatment on his own initiative. The glycemic imbalance and chronic alcoholism caused the failure of the anti TB therapy.

RECHALLENGING TREATMENT PLAN FOR MULTIDRUG-RESISTANT TUBERCULOSIS IN DIABETIC PATIENT: A CASE REPORT

Multidrug-resistant tuberculosis (MDR-TB) currently considers as the biggest issue and its subcategory, rifampicin-resistant TB (RR-TB). MDR-TB is defined as a resistant to isoniazid (H) and rifampicin (R), while the latter is resistant to rifampicin (R) only. Poorly controlled diabetes mellitus increases the risk of TB and leads to poor TB treatment outcomes as well it is consider potentially threating TB control. Difference in patients’ response and side effect developments toward anti-TB (ATB) medications requires rechallenging procedure that can be complicated at times. The management of MDR-TB can be complicated, especially, when the patient cannot tolerate the short regimen. Difference in patients’ response and side effect developments toward ATB medications requires rechallenging procedure which can have prolonged treatment time, hospital stay, and make patients exposed to hospital-acquired infection. This challenges and obstacles, however, could be prevented earlier by having strong DOTS strategy to prevent the development of resistance and reactivation of TB.

Pharmacological activities of hybrid derivatives of -s-triazine: A review

Heterocyclic compouds portray as a major part in medicinal chemistry. Distinct derivatives of heterocyclic compounds are effectives for the numerous medicinal activity. S-triazine is the earliest known heterocyclic compouns. They are available in cheap price and have distinct biological activity. Because of this researchers get attracted toward this heterocyclic compound for the synthesis of newly derivatives. They are weak base and utilize to make a potent drug, & have a different pharmacological actions. Triazine compounds are six membered hetrocyclic compound bearing triple nitrogen atoms. Based on the position of a nitrogen atoms there are 3 different triazines compound called as 1, 2, 3 triazine, 1, 2, 4 triazine, & s- triazine respectively. TriazineS are the significant core structure with bioactive characteristics. Number of triazines derivative are synthesize and assess for it abundant biological activities. Several derivative of triazine are better and have higher pharmacological action when compared to the standard drugs. The triazine reveals broad biological actions comprising antimicrobial, PI3K inhibitors, Antileshmanial, Anticancer, Anti HIV, Anti Plasmodial, Anti TB. Thus the triazines are believed to be the lead molecule for drug design and for drug discovery.

Early efficacy and safety of Bedaquiline and Delamanid given together in a “Salvage Regimen” for treatment of drug-resistant tuberculosis

BackgroundDrug-Resistant Tuberculosis (DR-TB) patients for whom a WHO recommended regimen along with Bedaquiline (BDQ) cannot be prescribed, Delamanid (DLM) was added along with other drugs to provide a “Salvage Regimen”. The experience of the Institute in respect of early efficacy and safety of both drugs given together is presented. ObjectiveTo ascertain the early efficacy, safety and tolerability of Bedaquline and Delamanid given together as a part of salvage regimen. MethodsBDQ and DLM were used together to make regimens along with other drugs where four effective anti TB drugs could not be prescribed as per WHO recommendations. Patients were followed up for sputum smear and culture conversion and adverse events during the treatment. ResultsIn this cohort study, 53 DR-TB patients (Median age-24) were initiated on regimens containing both BDQ and DLM. Sputum smear conversion was seen in 35% and 94% patients at the end of 1st week and 3rd month respectively. 84% patients had culture conversion at the end of 4th month. 29 adverse events (AE) were reported among 17 patients and there were 11 deaths. QTc prolongation more than 500 MS was seen in only 1 patient. ConclusionBDQ and DLM given together in a salvage regimen is efficacious with low rate of adverse events. The combination provides hope to DR-TB patients with limited treatment options and should be provided as a life saving option.

An unusual case of tuberculous otitis media (TB otitis)

We herein report a case of rare disease, Tuberculous otitis with unusual presentation, radiographic and pathologic findings. The granulations and bone erosion were extensive. He also developed extensive cold abscess in the pre-auricular region and rapid regrowth of granulations in the ear after mastoid exploration before starting anti TB treatment.