Antituberculous Regimen Research Articles

Cure Rates for Tuberculous Cervical Lymphadenopathy after 6-month or 9-month Anti-tuberculous Therapy.

The purpose of this prospective case series was to describe the difference in cure rates between a 6-month and a 9-month anti-tuberculous treatment regimen in patients with newly diagnosed tuberculous cervical lymphadenitis. Thirty-eight consecutive participants were enrolled in the study. Thirty participants were ultimately analyzed at the end of six months, nine months, and 12 months using serial neck ultrasound to assess for the presence of lymphadenopathy. At the end of six months, participants with residual lymphadenopathy larger than 1 cm extended treatment to complete nine months of treatment. Among the 30 participants who completed 6-month treatment, 63.3% (n=19) were cured while 36.7% (n=11) had residual lymphadenopathy and extended to 9-month treatment. At the end of 9-month treatment, 36.4% (n=4) were cured while 63.6% (n=7) had persistent lymphadenopathy greater than 1 cm on ultrasound. At 12 months, 15.8% (n=3) of those treated for six months and 45.5% (n=5) of those treated for nine months had recurrent/residual lymphadenopathy. There were no significant differences between cure rates for age, sex, concomitant pulmonary tuberculosis, the number of nodes, skin changes, TB-PCR results, and presence of paradoxical reaction whether at six or at 12 months. Due to the low cure rates in this study, there was not enough evidence to support current recommendations of a 6-month treatment period for tuberculous cervical lymphadenitis or to claim its effectiveness over a longer treatment duration.

TUBERCULOSIS OFINTRAMUSCULAR HEMATOMA POST ACL RECONSTRUCTION: A CASE REPORT

Introduction: Tuberculosis (TB) is considered well-eradicated in many developed countries however, in Saudi Arabia, it is still regarded as uncontrolled. Many organs can be affected by TB, the most common being the lungs. Presentation Of the Case: a 34-year-old male patient presented 8 months post Anterior Cruciate Ligament (ACL) reconstruction complaining of a 2 cm swelling in the left lateral aspect of the left knee along with a decrease in range after an aggressive physiotherapy session. reddish, warmth, and pain, with a limited range of movement and then diagnosed with tuberculosis of the knee, histopathologically confirmed following surgical debridement Furthermore, the patients underwent the administration of an anti-tuberculous drug regimen. Discussion: This case is unique due to the unspecific clinical manifestations of the disease, which contributed to delayed diagnosis. Aggressive physiotherapy led to endobutten flipping resulting in hematoma development infected with M. Tuberculosis. Conclusion: Extraarticular Knee Hematoma infected with M. tuberculosis is a rare disease often misdiagnosed. Clinical manifestations need a further surgical approach followed by a histopathology examination to diagnose the level of injury. Good physiotherapy instructions with proper technique post-ACL repair are crucial steps to prevent complications, especially post-ACL reconstruction.

Expert consensus on the treatment of chronic kidney disease with tuberculosis (2022 version)

China is a country with a high burden of chronic kidney disease(CKD) and tuberculosis. Patients with CKD are at increased risk of Mycobacterium tuberculosis infection, and the prevalence of CKD is also significantly higher in patients with tuberculosis. The coexistence of the two diseases brings great difficulties for clinical treatment. In this consensus, the general situation, clinical characteristics, metabolic characteristics of anti-tuberculous drugs, and the principles of protocol formulation of such patients were discussed and summarized. When making anti-tuberculosis regimen for patients with chronic renal failure, drugs that metabolized through liver, liver and kidney channels or metabolic pathways other than liver and kidney should be selected as far as possible. Drugs with significant renal toxicity and mainly metabolized by the kidney should be avoided. For CKD patients with mild decrease in GFR (60-89 ml·min-1·1.73 m-2), anti-tuberculosis regimen should be carried out according to the national standards and guidelines, without reducing the dose of anti-tuberculosis drugs. For CKD patients with significantly reduced GFR, mainly CKD3b, stages 4-5, and those receiving dialysis, the anti-tuberculosis regimen must be adjusted according to the GFR. For CKD patients with GFR less than 30 ml·min-1·1.73 m-2, this consensus also recommended anti-tuberculous regimen for initial, retreated and multi-drug-resistant tuberculosis patients. This consensus aimed to improve clinicians' understanding of CKD complicated with tuberculosis, standardize the clinical treatment, improve the curative effect, and reduce adverse reactions. Data from previous trials of CKD combined with TB treatment are still scarce. We look forward to further investigation and evidence-based medical research on CKD with tuberculosis in the future, and make positive efforts for the control of CKD and tuberculosis in China.

Tomographic findings in peritoneal tuberculosis: case report

Introduction: Peritoneal tuberculosis (TBCP) is a diagnostic challenge because the clinical, radiological and laboratory findings are nonspecific and can be confused with other pathologies. Presentation of the clinical case: Patient who consulted for intense abdominal pain, fever and diarrhea. TBCP was suggested based on abdominal CT findings, which was confirmed by histopathological analysis of parietal peritoneum biopsy and granulomatous lesions of the small intestine mesentery. The patient received an antituberculous regimen and was discharged from the hospital. Discussion and literature review: CPTB represents between 25-50% of abdominal tuberculosis cases and 0.1-0.7% of all tuberculosis cases, its clinical presentation includes ascites, abdominal pain, fever and diarrhea, making it indistinguishable from tuberculosis. Bacterial peritonitis and other chronic abdominal conditions. Conclusions: The diagnosis of TBCP is a challenge, however, the tomographic findings provide information that increases its suspicion and helps to avoid treatment delay and complications.

Paediatric progressive primary tuberculosis

A previously healthy 13-year-old Japanese girl with a BCG vaccination history and no tuberculosis (TB) exposure history presented to the hospital with mild dyspnea for 1 month and fever for 5 days. Computed tomography showed consolidation with a pleural effusion, obstructed left main bronchus with an air bronchogram, and traction bronchiectasis of the left upper lobe (Fig. 1A, B). No improvement was observed with ampicillin. Computed tomography on day 23 showed a new granular shadow in the right upper lobe (Fig. 1C). Despite a negative interferon-gamma release assay (IGRA) result, the sputum on day 55 was positive for acid-fast bacilli on a ZiehlNeelsen stain and Mycobacterium tuberculosis on polymerase chain reaction. A fourdrug antituberculous regimen was initiated and she recovered rapidly. TB exposure history, positive tuberculin skin test or IGRA, and typical imaging findings are the triad for primary TB diagnosis (Perez-Velez and Marais, 2012; Lewinsohn et al., 2017; Ahmed et al., 2020). In pediatric primary TB, consolidation may be present and can be misdiagnosed as bacterial pneumonia; however, massive consolidation is rare (GriffithRichards et al., 2007). Primary pulmonary TB should be considered in children with lung consolidation that is unresponsive to antibiotics, despite negative IGRA and TB exposure history.

Tuberculosis in kidney transplant recipients: A retrospective study from a tertiary care center - An observational study

Background: The incidence of tuberculosis (TB) among transplant recipients varies from 5% to 15% across the globe. We conducted a retrospective study to identify the incidence of TB among kidney transplant recipients in our transplant unit. Materials and Methods: We assessed the patients who underwent kidney transplantation in our transplant unit during the study period from January 2014 to June 2018 and included those recipients who had bacteriologically confirmed TB. We excluded the patients who had TB before transplant and those recipients who were initiated on antituberculosis treatment (ATT) empirically. The details collected were: 1. Clinical data, the presenting symptoms, and clinical findings. 2. Diagnostic investigation: Microbiological/histopathological/radiological/bronchoalveolar lavage/fluid (pleural/peritoneal/cerebrospinal fluid) analysis. 3. Antituberculous regimen, dose, and duration of the therapy. 4. Relapse/patient and graft outcome after treatment.Results: The total number of patients who underwent kidney transplantation during the study period was 177. TB occurred in 21 patients after transplantation. The incidence of TB in our transplant unit was 11.86%. In these 21 recipients, 8 had pulmonary TB and the remaining 13 had extrapulmonary/disseminated TB, which included two patients with disseminated TB and one patient with allograft dysfunction with thrombotic microangiopathy which was attributed to TB as it responded to first-line antituberculous drugs. The mortality rate was 23.8%, as five patients expired. After excluding patients who expired, the graft survival at 1 year after ATT completion was 90.5%. Conclusion: For most developing nations, the World Health Organization's “End TB Strategy” remains far from their dream. An ideal investigation to detect TB in its early stage is essential in posttransplant recipients to reduce the morbidity and mortality associated with it.

Misdiagnosis of chronic pulmonary aspergillosis as pulmonary tuberculosis at a tertiary care center in Uganda: a case series

BackgroundDiagnosis of chronic pulmonary aspergillosis (CPA) is based on a combination of clinical symptomatology, compatible chest imaging findings, evidence of Aspergillus infection and exclusion of alternative diagnosis, all occurring for more than 3 months. Recently, a rapid, highly sensitive and specific point-of-care lateral flow device (LFD) has been introduced for the detection of Aspergillus-specific immunoglobulin (Ig)G, especially in resource-limited settings where CPA is underdiagnosed and often misdiagnosed as smear-negative pulmonary tuberculosis (PTB). Therefore, in our setting, where tuberculosis (TB) is endemic, exclusion of PTB is an important first step to the diagnosis of CPA. We used the recently published CPA diagnostic criteria for resource-limited settings to identify patients with CPA in our center.Case presentationThree Ugandan women (45/human immunodeficiency virus (HIV) negative, 53/HIV infected and 18/HIV negative), with a longstanding history of cough, chest pain, weight loss and constitutional symptoms, were clinically and radiologically diagnosed with PTB and empirically treated with an anti-tuberculous regimen despite negative microbiological tests. Repeat sputum Mycobacteria GeneXpert assays were negative for all three patients. On further evaluation, all three patients met the CPA diagnostic criteria with demonstrable thick-walled cavities and fungal balls (aspergilomas) on chest imaging and positive Aspergillus-specific IgG/IgM antibody tests. After CPA diagnosis, anti-TB drugs were safely discontinued for all patients, and they were initiated on capsules of itraconazole 200 mg twice daily with good treatment outcomes.ConclusionsThe availability of simple clinical diagnostic criteria for CPA and a LFD have the potential to reduce misdiagnosis of CPA and in turn improve treatment outcomes in resource-limited settings.

Genome sequencing of Mycobacterium tuberculosis clinical isolates revealed isoniazid resistance mechanisms undetected by conventional molecular methods

A combination of targeted molecular methods and phenotypic drug-susceptibility testing is the most widely used approach to detect drug resistance in Mycobacterium tuberculosis isolates. We report the delay in the introduction of an efficient anti-tuberculous drug regimen because of a M. tuberculosis strain displaying a high level of resistance to isoniazid, in the absence of the common mutations associated with isoniazid-resistance, including katG mutations and inhA promoter mutations. Whole-genome sequencing (WGS) identified a large loss-of-function insertion (>1000 pb) at the end of katG in the isolate together with a −57C>T ahpC mutation, a resistance mechanism that would have remained undetected by a conventional molecular targeted approach. A retrospective search using publicly available WGS data of more than 1200 isoniazid-resistant isolates and a similar sized control dataset of isoniazid-susceptible isolates revealed that most (22/31) isoniazid-resistant, KatG loss-of-function mutants had an associated rare ahpC promoter mutation. In contrast, only 7 of 1411 isoniazid-susceptible strains carried a rare ahpC promoter mutation, including shared mutations with the 31 isoniazid-resistant KatG loss-of-function mutants. These results indicate that rare ahpC promoter mutations could be used as a proxy for investigating simultaneous KatG loss-of-function or missense mutations. In addition, WGS in routine diagnosis would improve drug susceptibility testing in M. tuberculosis clinical isolates and is an efficient tool for detecting resistance mechanisms undetected by conventional molecular methods.

Ethambutol-resistant Mycobacterium kansasii cervical lymphadenitis in an immunocompetent adult patient: A case report and literature review

Mycobacterium kansasii extrapulmonary infections are infrequent in immunocompetent adults. Rifampin (RIF), clarithromycin (CLR), isoniazid (INH) and ethambutol (EMB) are included in all the standard regimens against M.kansasii. We report a case of a healthy 65-year-old male farmer who presented with isolated right supraclavicular lymphadenopathy. The lymph node FNA showed acid-fast-bacilli and granulomatous inflammation. Quantiferon TB Gold test, HIV serology, and functional immunological studies were all negative or normal. He was put on a standard 4 drugs anti-tuberculous regimen that was switched to RIF + CLR+ INH after the Microbiology lab demonstrated an EMB–resistant Mycobacterium kansasii isotype I strain. The patient was cured after 12 months of therapy. This is the 6th reported case of M. kansasii extrapulmonary lymphadenitis in an immunocompetent adult and the 2nd showing EMB resistance in the world literature. Antimycobacterial regimens against M. kansasii, classically resistant to pyrazinamide (PZA) might also exclude EMB due to its increasing resistance in Europe. A 612 months therapy with at least 2 effective antimycobacterial drugs including RIF + CLR might be enough to treat extrapulmonary M. kansasii infections in immunocompetents.

Gastric Tuberculosis

Gastric tuberculosis is a very rare disease posing a diagnostic challenge to physicians, pathologists and radiologists. It usually occurs in females aged 25 to 45 years. Symptoms include epigastric pain, vomiting, fever, weight loss, upper gastrointestinal (GI) bleed and gastric outlet obstruction. High index of suspicion and endoscopic or endoscopic ultrasound guided biopsies may help in making an early diagnosis, particularly in patients with non-healing gastric ulcers. We report a case of gastric tuberculosis in a 55-year male, who presented with persistent vomiting, epigastric pain and significant weight loss. His upper GI endoscopy finding with histopathology results favoured the diagnosis of gastric tuberculosis. He was successfully treated with antituberculous regimen.

Tuberculosis in the Bone Marrow: A Case Report

Mycobacterium tuberculosis of bone marrow that is considered one of the rare extrapulmonary tuberculosis (TB). Herein we report one case of tuberculosis of the bone marrow. A 82-year-old Thai woman presented with fever, fatigue, and weight loss of 4 kg in one month. The physical examination revealed only pallor and the ejection murmur at the upper parasternal border. Her chest film was unremarkable but the computed tomography of the chest revealed the reticular infiltration at both lower lungs and multiple small mediastinal lymphadenopathies. Although her blood smear did not show the leukoerythroblastic blood picture with the tear drop red blood cells (RBCs) or pancytopenia, her bone marrow biopsy showed a few granulomas with positive acid fast bacilli (AFB). The common risk factors such as diabetes, human immunodeficiency virus (HIV) infection, low CD4 counts, chronic kidney disease, malnutrition, and immunosuppressant therapy which might contribute her to be vulnerable to TB, were not found. The definite diagnosis was TB in the bone marrow and she clinically responded well to the 4-drug antituberculous regimen. Our case suggests that even though the leukoerythroblastosis with the tear drop RBCs or pancytopenia, the clues of the bone marrow involvement, is not found, the study of the bone marrow should not be precluded from the plan of the investigations for the diagnosis in a case of fever of unknown origin.

Papilitis y neurorretinitis de etiología tuberculosa

A 57-year-old man with miliary tuberculosis reported visual loss in his right eye, a month after starting a four-drug antituberculous treatment regimen. On exploration, an inferior segmental optic disc edema was objectived and it was attributed to ischemic aetiology. Ethambutol was withdrawn and 60mg of oral prednisone daily were given with a tapering dosage. One and a half months later, he presented a sudden loss of vision in his left eye. In fundoscopy, a papillary edema accompanied by a foveal neurosensory detachment was observed but with no more accompanying uveitic signs. Treatment was intensified with moxifloxacin and corticosteroids were reduced, showing a resolution of the macular detachment but with optic atrophy.Isolated tuberculous involvement of the optic nerve may possible in the context of miliary tuberculosis. In this case, the adopted therapeutic approach to the initial papillitis, which was interpreted as ischemic, could favour the appearance of a neuroretinitis in the fellow eye.

Médiastinite secondaire à une ponction transbronchique échoguidée à l’aiguille : étiologie et prise en charge

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure used for the diagnosis of mediastinal and hilar lymphadenopathy. We describe a case of mediastinitis appearing 15 days after an EBUS-TBNA procedure in a 79 years old male patient. The mediastinitis was treated surgically by thoracotomy with a wide excision of infected tissue requiring transplantation of a serratus anterior muscle flap pedicled on a branch of the thoracodorsal artery. It was coupled with broad spectrum antibiotics. This medico-surgical management led to a favorable outcome. Microbiological analysis of the mediastinal collections revealed two pathogens: Streptococcus constellatus (a germ present in the normal flora of the oral cavity) and Mycobacterium tuberculosis. A standard first line quadruple antituberculous drug regimen was subsequently given to the patient. This episode of Streptococcus constellatus mediastinitis was a complication of the EBUS-TBNA procedure. The operating channel of the bronchoscope had probably been contaminated when aspirating the oral cavity secretions with subsequent needle contamination and a direct bacterial inoculation during the transbronchial mediastinal puncture. The severity of such a complication justifies a medical consultation in cases of fever or chest pain following an EBUS-TBNA procedure.

Is decompressive surgery the only treatment option? A case series of patients with spinal tuberculosis in advanced pregnancy.

To present cases of spinal tuberculosis in advanced pregnancy treated on anti-tuberculous drug regimen with successful outcome and proposing alternative paradigm to surgical decompression. A case series of five patients in stages of advanced pregnancy with neurologic deterioration and spinal tuberculosis were reported and treated. Five patients with backache in advanced stages of pregnancy were reported. Patients were diagnosed as cases of spinal tuberculosis on further imaging studies. Patients were treated and followed up till complete clinical and radiological recovery. Four out of five patients were treated conservatively on ATT and rest. One patient underwent decompression without instrumentation. All patients recovered neurologically. There were foetal complications in two cases with foetal demise. One patient who underwent surgical decompression had preterm labour with still birth, apparently due to adverse reactions with anaesthetic drugs. Spinal tuberculosis in pregnancy is a rare occurrence. Hesitation in performing radiographs complicates the outcome with delay in diagnosis and neurological compromise. There are no clear guidelines for treatment of such cases. Conservative treatment with ATT in pregnant patients may be a viable approach. Neurological compromise does not mandate surgical decompression, which in itself is not devoid of complications. Concern of foetal complications is high in surgical treatment.

Multiple Adjacent Level with Pott's Disease with Sever Vertebral Sequestration (Case Presentation)

Pott's disease is a known disorder that affects the spine causing various degree of disability for the patients that ranges from mild to severe kyphosis with or without neurological deficits. In most cases single level is affected and in fewer numbers two levels are affected. Rarely more than two levels are affected. In this case we present a case of Pott's disease affecting five adjacent segments with vertebral sequestration. This is 43 years old female patient presented to Assuit university hospital with history of repeated attacks of back pain and mild fever since 4 years the patient received empirical antibiotic after which she said that she partially improved and after then the patient became accustomed to repeat the antibiotic with no medical consultation. Later on the pain became sever but no neurological manifestations then she had X-ray and MRI with diagnosis of long segment vertebral osteomyelitis affecting T7-T12. Posterior costotransversectomy approach was done and the sequestrated vertebral bodies and intervening discs were excised and sent for culture sensitivity and biopsy and mesh cage was applied to bridge the defect and pedicle screws are inserted from T5 to L2, and later on antituberculous regimen was started after the diagnosis was established. Postoperatively the neurological status was intact and the pain improved; 6 month follow up showed good bone healing. Stable cage and pedicle screws and much improvement in the general status of the patient.

DRUG INDUCED HEPATITIS

Aims and Objectives: We evaluated whether HBV +ve and HCV +ve patients areat high risk for developing drug induced hepatitis than control subjects during treatment fortuberculosis with standard short course regimens. Study design: Observational cohort study.Place and duration: This study was conducted at Department of Medicine, Liaquat University ofMedical and Health Sciences Jamshoro from May 2008 to May 2011. Material and Methods: Allnewly diagnosed active tuberculosis patients were included in the study population and theywere further screened for hepatitis B surface antigen and HCV antibodies. All patients weredivided into three groups. One having no co-infection with hepatitis B and Hepatitis C and wastaken as control group, second group was co-infected with hepatitis B and third was co-infectedwith hepatitis C. short course anti tuberculous regimen was started and patients were followed forsix months. Results: One hundred and twenty eight tuberculous patients were divided into threegroups. 92 in control groups without any co-infection with hepatitis B and C, 10 were HBV +veand 26 were HCV +ve. During follow up 24 developed drug induced hepatitis, 8(38.33%, n = 24)in control group, 2(8.33%, n = 24) in hepatitis B group and 14(58.33%, n = 24) in hepatitis Cgroup. Conclusions: These findings suggest that treatment for tuberculosis in HCV seropositivepatients is a risk factor for the development of hepatitis exacerbation and HBV seropositivepatients shows no any increased risk of hepatitis exacerbation.

Impact of fluoroquinolone resistance on bactericidal and sterilizing activity of a moxifloxacin-containing regimen in murine tuberculosis

It has been shown previously that fluoroquinolone resistance (defined by resistance to at least 2 mg/liter ofloxacin) has a different impact on moxifloxacin monotherapy depending on the mutation in the sole fluoroquinolone target in Mycobacterium tuberculosis, i.e., DNA gyrase. Since tuberculosis treatment relies on multidrug therapy, we wished to determine the impact of fluoroquinolone resistance on the bactericidal and sterilizing activity of a second-line antituberculous regimen containing moxifloxacin. A total of 280 mice were inoculated with the wild-type Mycobacterium tuberculosis H37Rv strain or one of 3 isogenic fluoroquinolone-resistant mutant strains with increasing moxifloxacin resistance (the GyrB D500N, GyrA A90V, and GyrA D94G strains) and then treated for 6 months with a second-line regimen containing moxifloxacin, pyrazinamide, and ethionamide supplemented with amikacin during the first 2 months. Mice were sacrificed during treatment for measurement of bactericidal activity and 3 months after treatment completion for measurement of relapse rates (sterilizing activity). The CFU counts decreased faster in mice inoculated with the wild type than in mice inoculated with the mutant strains. The relapse rate after treatment completion was different among mice inoculated with mutant strains in relation to the drug resistance level: wild type, 0%; GyrB D500N strain, 33%; GyrA A90V strain, 50%; and GyrA D94G strain, 86%. The relapse rate observed with the GyrB D500N strain was the only one not statistically different from that observed with the wild-type strain. We demonstrated that the impact on sterilizing activity of the most active second-line drug regimen containing moxifloxacin depends on the MIC of moxifloxacin. We suggest that the precise level of moxifloxacin resistance be determined for all strains resistant to 2 mg/liter ofloxacin.

Impact of Fluoroquinolone Resistance on Bactericidal and Sterilizing Activity of a Moxifloxacin-Containing Regimen in Murine Tuberculosis

It has been shown previously that fluoroquinolone resistance (defined by resistance to at least 2 mg/liter ofloxacin) has a different impact on moxifloxacin monotherapy depending on the mutation in the sole fluoroquinolone target in Mycobacterium tuberculosis, i.e., DNA gyrase. Since tuberculosis treatment relies on multidrug therapy, we wished to determine the impact of fluoroquinolone resistance on the bactericidal and sterilizing activity of a second-line antituberculous regimen containing moxifloxacin. A total of 280 mice were inoculated with the wild-type Mycobacterium tuberculosis H37Rv strain or one of 3 isogenic fluoroquinolone-resistant mutant strains with increasing moxifloxacin resistance (the GyrB D500N, GyrA A90V, and GyrA D94G strains) and then treated for 6 months with a second-line regimen containing moxifloxacin, pyrazinamide, and ethionamide supplemented with amikacin during the first 2 months. Mice were sacrificed during treatment for measurement of bactericidal activity and 3 months after treatment completion for measurement of relapse rates (sterilizing activity). The CFU counts decreased faster in mice inoculated with the wild type than in mice inoculated with the mutant strains. The relapse rate after treatment completion was different among mice inoculated with mutant strains in relation to the drug resistance level: wild type, 0%; GyrB D500N strain, 33%; GyrA A90V strain, 50%; and GyrA D94G strain, 86%. The relapse rate observed with the GyrB D500N strain was the only one not statistically different from that observed with the wild-type strain. We demonstrated that the impact on sterilizing activity of the most active second-line drug regimen containing moxifloxacin depends on the MIC of moxifloxacin. We suggest that the precise level of moxifloxacin resistance be determined for all strains resistant to 2 mg/liter ofloxacin.

Isolated tuberculosis of scapula in a young adult

Tuberculosis (TB) of the scapula is a very rare presentation among tuberculosis of bones and joints. The following case report describes a rare case of tuberculosis involving the inferior angle of the scapula in a young, immune-competent adult presenting with pain, swelling and an osteolytic lesion over the inferior angle of the scapula with a cold abscess. The diagnosis was confirmed on histopathology and culture, with Magnetic Resonance Imaging (MRI) acting as an adjunct to an early diagnosis. The patient was managed successfully with surgical debridement and a four-drug anti-tuberculous regimen.

1140 HEPATITIS C VIRUS AND LIPID DROPLETS: ROLE OF ADIPOSE DIFFERENTIATION-RELATED PROTEIN IN LIPID DROPLET MORPHOLOGY AND VIRAL LIFE CYCLE

Aims and Objectives: We evaluated whether HBV +ve and HCV +ve patients are at high risk for developing drug induced hepatitis than control subjects during treatment for tuberculosis with standard short course regimens. Study design: Observational cohort study. Place and Duration: This study was conducted at department of Medicine, Liaquat University of Medical and Health sciences Jamshoro from May 2008 to May 2011. Material and Methods: All newly diagnosed active tuberculosis patients were included in the study population and they were further screened for hepatitis B surface antigen and HCV antibodies. All patients were divided into three groups. One having no coinfection with hepatitis B and Hepatitis C and was taken as control group, second group was co-infected with hepatitis B and third was co-infected with hepatitis C. short course anti tuberculous regimen was started and patients were followed for six months. Results: One hundred and twenty eight tuberculous patients were divided into three groups. 92 in control groups without any coinfection with hepatitis B and C, 10 were HBV +ve and 26 were HCV +ve. During follow up 24 developed drug induced hepatitis, 8 (38.33%, n = 24) in control group, 2 (8.33%, n = 24) in hepatitis B group and 14 (58.33%, n = 24) in hepatitis C group. Conclusion: These findings suggest that treatment for tuberculosis in HCV seropositive patients is a risk factor for the development of hepatitis exacerbation and HBV seropositive patients shows no any increased risk of hepatitis exacerbation.