Male Tuberculosis Patients Research Articles

Knowledge and Practice of TB Patients on TB and its Treatment in Alamata District Tigray Region Northeast Ethiopia

Background: Tuberculosis (TB) leftovers the leading cause of death among a curable infectious disease, regardless of the availability of short-course therapy that can be both inexpensive and effective. The aim of the present study was to assess the level of knowledge about TB in clients who were initiating anti-TB drug treatment in Alamata District, northeast Ethiopia. Methods: A cross-sectional study was conducted in TB patients who were initiating anti-TB drug treatment in the district. Study participants were interviewed using a structured questionnaire to evaluate level of knowledge about TB. Data was entered and cleared using SPSS version 16. Results: A total of 200 study participants were interviewed, of whom 116 (58.0%) were male TB patients and 84 (42.0%) female TB patients. Among the study participants, 77.5% were new cases. 50% of them were extra pulmonary TB (EPTB) case, 23.5% were smear-positive pulmonary TB (SPPTB) cases and 26.5% were smearnegative PTB (SNPTB) cases and. The overall knowledge about TB of the study participants was 36.5%. Conclusions: There is significant knowledge breach in the study area among TB patients registered on treatment. Consolidation the awareness of TB patients using health education by health care providers on TB throughout the time of enrollment to treatment possibly will increase patients’ knowledge thus upgrading in treatment outcomes and overall TB control.

Knowledge and Awareness of Tuberculosis Among Pulmonary Tuberculosis Patients in a Rural Area of West Bengal

Introduction: India has more new tuberculosis (TB) cases annually than any other country and contributing of about twenty percent to the global burden of TB. The objective of the present study was to understand the knowledge and awareness of TB among adult male pulmonary TB patients in a rural area of West Bengal.Methodology: The present cross-sectional study was carried out among the TB patients registered under the Revised National Tuberculosis Control Programme (RNTCP). A structured questionnaire was used for data collection.Results: The mean age of the study participants was 41.46 (14.3) years.52% of the subjects never heard of TB before diagnosis of their disease. Majorities of the participants thought that smoking and chewing tobacco was the cause of TB. With regard to the mode of spread, 21% thought that TB spread through unclean food and water followed by through sharing materials for drink (21%). Most of the participants were unaware or had no idea about the fact that transmission of TB is preventable. With regard to the occurrence of TB in life time, 64% had no idea. With regard to the curability of TB, 38% said that it is curable and majorities (60%) said don’t know, 40% subjects thought that good food and drinking water can reduce the chance of getting TB.Conclusion: This study showed that lack of knowledge and misconceptions regarding TB were widespread among the TB patients. Thus, the present study emphasizes the need for health education programmes to improve knowledge, awareness and removing misconceptions about TB.SAARC J TUBER LUNG DIS HIV/AIDS, 2015 XII (2), page: 13-19

The Characteristics of TB Epidemic and TB/HIV Co-Infection Epidemic: A 2007-2013 Retrospective Study in Urumqi, Xinjiang Province, China.

ObjectiveThis study was aimed to find out epidemiologic characteristic of tuberculosis (TB) cases, and Human Immunodeficiency Virus (HIV) positive cases among TB patients (TB/HIV co-infection) through demographic, temporal, and spatial study in Urumqi.MethodsDescriptive statistics and multivariate logistic regression were applied to identify the epidemiologic characteristics and risk factors of TB epidemic and TB/HIV co-infection epidemic. All addresses of each TB case, TB/HIV co-infection case, and administrative street were transformed into geographical coordinate. Subsequently, the geocoded address for 82 streets was transformed into a dot map used as the basis of spatial datasets. In addition, the paper also used quantile map and the spatial scan statistic in order to identify the spatial distribution and spatial clusters of TB epidemic and TB/HIV co-infection epidemic.ResultThere was a declining trend of the notification rates of TB epidemic from 2007 to 2009, as well as a rising trend from 2010 to 2013. However, the notification rates of TB/HIV co-infection epidemic showed a rising trend from 2007 to 2010, and a declining trend from 2011 to 2013. Moreover, a significant share of TB epidemic and TB/HIV co-infection epidemic happened between the age of 15 to 45 years old, indicating an increase in risk of TB and TB/HIV infection. It is worth noting that the risk of HIV infection for male TB patients was 2.947 times (95% CI [2.178, 3.988]) than that of female patients. Han ethnicity and Uygur ethnicity in urban region accounted for a large proportion of total TB and TB/HIV co-infection cases. Most of the TB cases of minorities in Urumqi showed a statistically significant increase in risk of HIV infection than Han ethnicity in Urumqi. In addition, the spatial distribution of TB epidemic and TB/HIV co-infection epidemic was highly skewed. Most of the local clusters were located in urban area and rural-urban continuum where showed an increase in risk of TB and TB/HIV infection.ConclusionThe epidemiologic and spatial-temporal analysis of TB epidemic and TB/HIV co-infection epidemic demonstrates a potential connection between TB and HIV in Urumqi. Demographic, temporal, geographic factors are the reasons of causing TB and TB/HIV co-infection epidemic.

Polyparasitism in tuberculosis patients and apparently healthy individuals in Benue State, Nigeria

Co-infection with intestinal parasites and tuberculosis infection is one of the leading causes of morbidity and mortality especially in resource poor countries in sub-Saharan Africa. A cross-sectional study in seven LGAs of Benue State was conducted to determine the prevalence of polyparasitism in tuberculosis patients and apparently healthy individuals. The TB patients were recruited from individuals already participating in the Directly Observed Short-course Treatment (DOTS) programme. These patients had varying degrees of tuberculosis severity and were categorized into scanty infection, light infection (1+), moderate infection (2+) and heavy infection (3+). Stool samples were examined using formal-ether concentration technique. A total of 661 tuberculosis patients were examined for intestinal parasites. 254 (38.4%) had at least one or more intestinal parasites. 153 (23.1%) of them harboured multiple parasites. However, of the 826 apparently healthy individuals, 333 (40.3%) were positive for at least one intestinal parasite. Out of these 333 positive individuals, 191 (23.1%) had multiple infections. Tarka Local Government Area had the highest prevalence (47%) of intestinal parasites which was significantly higher than Apa, the Local Government Area with the least prevalence of 17.7% parasitic infection, and this had no significant difference from the prevalence of multiple parasitism in the remaining six Local Government Areas sampled. On the whole; 1487 individuals were investigated, 557 (36.5%) had intestinal parasites and 364 (24.5%) had multiple parasitism. Eight different type of co-infections were encountered with the most frequent being hookworm and E. histolytica which was significantly higher than other types ( p < 0.05) and was consistently higher in male tuberculosis patients. The occurrence of these co infections increased significantly ( p < 0.05) with TB status of moderate (2+) to heavy infections (3+). The high prevalence of multiple intestinal parasites in tuberculosis patients poses a serious challenge to the current tuberculosis management strategy. Keywords: polyparasitism, tuberculosis, Benue State, Nigeria

GeneXpert assay for rapid detection of Mycobacterium tuberculosis complex in respiratory specimens from a high TB endemic area of Pakistan

Tuberculosis is a global health problem, and its early diagnosis is the ultimate strategy for prevention and control. The current study was undertaken to evaluate conventional and molecular diagnostic assays for the detection of mycobacteria in pulmonary tuberculosis (TB) patients from Khyber Pakhtunkhwa region of Pakistan. A total of 259 clinically suspected patients of TB were processed for Zeihl Neelsen (ZN) microscopy, BACTEC MGIT liquid culture and GeneXpert assay. Among 259 samples, 28 (10.81%) were positive for acid fast bacilli (AFB) on ZN microscopy. In liquid culture, the growth of mycobacterium species was obtained in 36 (13.89%) samples while the GeneXpert assay detected Mycobacterium tuberculosis (MTB) in 49 (18.91%) samples. Detection rate of MTB was significantly high (n = 49, p < 0.0095) on GeneXpert as compared to microscopy (n = 28); however no significant difference (p = 0.1230) was observed on GeneXpert (n = 49) and culture (n = 36) based detection of MTB. The strength of agreement between GeneXpert and microscopy was also poor (Kappa value < 0.114, 95% CI: −0.72 – 0.301) which support our results. MTB detection rate among female was high as compared to male TB patients while in age wise, the age group 55–64 years has almost high detection rate on microscopy, culture and GeneXpert assay. Findings of the present study highlighted that GeneXpert is more efficient tool for timely diagnosis and proper TB control in high TB endemic area.

A study of adherence to DOTS regimen among pulmonary tuberculosis patients in West Tripura District

BackgroundNoncompliance to the DOTS regimen leads to treatment failure, relapse, MDR tuberculosis, XDR tuberculosis etc. requiring more prolonged & expensive therapy. AimTo assess the adherence rate among pulmonary tuberculosis patients in west Tripura district and to study the factors affecting adherence to DOTS regimen among pulmonary tuberculosis patients. Material and methodsThis community based cross-sectional study was conducted among 220 pulmonary tuberculosis patients registered for treatment with DOTS therapy; under six randomly selected DMC of West Tripura District. ResultsThe study revealed that the adherence rate among the pulmonary TB patients was 84.50 percent. Male tuberculosis patients had 87.10 percent less chance of being adherent to the DOTS regimen in reference to females, and Cat I patients were 8.96 times (C.I. 2.689–29.857) more adherent to the therapy compared to the retreatment cases. Again, patients whose continuation phase was supervised as per the guidelines of DOTS were 12.07 times more adherent to the therapy. PTB patients who had the knowledge of supervised therapy in DOTS and curability of the disease, were 4.70 times (C.I. 1.39–15.79) and 9.39 times (C.I. 1.03–85.99) more adherent to the therapy, respectively. ConclusionThe study showed good adherence to the regimen among pulmonary tuberculosis patients in spite of being a difficult area. It may also help in planning and implementation of tuberculosis control measures by addressing and overcoming the barriers regarding treatment completion.

Mortality of tuberculosis patients during treatment in Israel, 2000-2010.

Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged ≥65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.

Poverty and Substance Use in South African Tuberculosis Patients

To determine whether social support and depressive symptoms mediate the relationship between poverty and substance use in tuberculosis (TB) patients in South Africa. We performed structural equation modeling with the latent constructs socioeconomic status (SES), social support and "substance use" (tobacco smoking, alcohol problem, illicit drug use) in 1005 male TB patients. Higher SES directly (standardized coefficient= -0.27) and indirectly reduced substance use. Indirectly SES provided increased social support (coefficient=0.37), which was associated with reduced substance use (coefficient=-0.15). Higher SES diminished depressive symptoms. Model fit was acceptable. Separate models for tobacco smoking, illicit drug use or alcohol problem produced similar findings. Poverty alleviation and social support-based interventions may benefit male TB patients with substance use.

The impact of nutrition and glucose intolerance on the development of tuberculosis in Japan

Although Japan is categorised as an intermediate tuberculosis (TB) burden country, the incidence of TB is nevertheless decreasing. To identify metabolic and nutritional risk factors for the development of TB. We compared 522 TB in-patients (350 males, 172 females) with age- and sex-matched 522 controls randomly selected from among individuals undergoing comprehensive medical examinations. Patients with relapsed or multidrug-resistant TB were excluded. The proportion of males with glucose intolerance was significantly higher in TB patients than in controls (34.2% vs. 14.4%). Among females, the proportion with glucose intolerance was higher in TB patients than in controls (18.3% vs. 10.0%). In male and female controls and female TB patients, individuals with glucose intolerance had significantly higher body mass index (BMI) than those without glucose intolerance. Low BMI was prevalent in male TB patients; there was no significant difference between the BMIs of TB patients with glucose intolerance and those without. Significant associations were found between BMI, peripheral white blood cell count, serum albumin concentration and glucose intolerance and the development of TB in males. Albumin was a parameter significantly associated with TB development in females. In Japan, the development of TB is still associated with glucose intolerance and malnutrition.

Gender Differentials in Tuberculosis: An Experience from a Rural Tuberculosis Unit of Burdwan District, West Bengal, India

AIM: In India, RNTCP reports more male tuberculosis patients than female. In this study we aimed to find out the gender differences in clinical presentation and treatment outcome. METHOD: A record based study was conducted in Bhatar tuberculosis unit of Burdwan district among 758 registered tuberculosis patients of November 2010 to December 2011. Data were analyzed by SPSS software. RESULT: Male was 76.1%, female was 23.9% with male preponderance in each age group. In category I, majority of the male and female patients were new sputum smear positive. In category II, majority of the male and female patients belonged to relapse (35.8%) and other group (69.2%) respectively. Cure rate and treatment completion rate was more among males and females respectively. In category I, female defaulters were more, while in category II, male defaulter was higher. CONCLUSION: Integrated research is necessary to find out these differences that will be helpful in improving the efficacy of the programme.

Tobacco use patterns in tuberculosis patients with high rates of human immunodeficiency virus co-infection in South Africa

BackgroundTuberculosis (TB) patients who smoke tobacco are at an increased risk for adverse TB treatment outcomes. This study describes tobacco use patterns among newly diagnosed TB patients, their readiness to quit, and their beliefs about tobacco-related health effects in a high HIV-burden setting in South Africa. Socio-economic and demographic factors associated with smoking were also determined.MethodsThis was a cross-sectional analysis of baseline data collected for a smoking cessation study at six large tuberculosis clinics in a South African township (N = 1926). We collected information on current and past tobacco use, socio-economic and demographic status, beliefs regarding the harmful effects of smoking and quit behaviour, and motivation, using structured interviewer-administered questionnaires. TB- and HIV-related information was obtained from patient records. Data analysis entailed descriptive statistics, followed by multivariate logistic regression with backward elimination, adjusted for clustering by facility.ResultsJust over one fifth of respondents (21.8%, 420/1924) reported currently smoking tobacco (males 37.6%, females 4.6%). By contrast, only 1.8% (35/1918) of all respondents reported being past smokers. Of the current smokers, about half (51.8%, 211/407) had previously attempted to quit, mainly for health reasons. The majority of respondents (89.3%, 1675/1875) believed tobacco smoking was harmful for their health and smokers were highly motivated to quit (median score 9, interquartile range 7–10). Smoking was less common among female respondents (Odds Ratio [OR] 0.10, 95% Confidence Interval [CI] 0.06-0.19) and respondents who had completed high school (OR 0.57, 95% CI 0.39-0.84), but was more common among respondents who do occasional work (OR 2.82, 95% CI 1.58-5.02), respondents who to bed hungry regularly (OR 4.19, 95% CI 2.42-7.25), those who have an alcohol problem (OR 5.79, 95% CI 3.24-10.34) and those who use illicit substances (OR 10.81, 95% CI 4.62-25.3).ConclusionsDespite documented evidence of its harmful effects, smoking is prevalent among male TB patients in this high HIV-prevalence population. Few patients have managed to quit smoking on their own. However, patients are highly motivated to stop smoking. We recommend implementing and evaluating a smoking cessation programme in tandem with TB services.

The role of anthropometric and other predictors for diabetes among urban Tanzanians with tuberculosis

As diabetes impairs tuberculosis (TB) treatment outcomes, it is essential to identify diabetes among TB patients. While little is known about predictors of diabetes among healthy individuals in Africa, predictors among TB patients are almost non-existent. To assess potential predictors for diabetes among newly diagnosed pulmonary TB patients in Tanzania. TB patients were tested for diabetes using an oral glucose tolerance test, demographic information was collected and anthropometric measurements taken. The association between diabetes and possible predictors were examined using logistic regression analyses. Of 1205 TB patients, 16.4% (n = 197) had diabetes, 9.0% (n = 108) were aged ≥55 years, 3.3% (n = 40) were overweight (body mass index [BMI] ≥ 25 kg/m(2)) and 12.7% (n = 152) severely underweight (BMI < 16 kg/m(2)). Diabetes was most prevalent in the 45-55 year age group, and increasing weight, BMI and waist circumference were associated with diabetes. Severe underweight (BMI < 16 kg/m(2)) among male TB patients (sex-BMI interaction, P = 0.02) was associated with diabetes (OR 2.52, P = 0.004). Diabetes is a common comorbidity among TB patients. Although diabetes was associated with obesity and was more prevalent among the middle-aged, the majority of TB patients with diabetes comorbidity were young and lean. With diabetes as a major risk factor for TB, and with the lack of strong predictors for diabetes, universal diabetes screening should be implemented in the TB programme.

The burden and characteristics of tuberculosis/human immunodeficiency virus (TB/HIV) in South Korea: a study from a population database and a survey.

BackgroundAlthough, in South Korea, human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS) keeps increasing and tuberculosis(TB) burden is still significant, there have been few reports on TB/HIV cases. In this study, we investigated the burden and characteristics of TB/HIV patients in South Korea, an area with intermediate burden of TB and a low prevalent area with HIV/AIDS.MethodsWe identified patients with TB and cases with HIV between January 1 2001 and December 31 2005, from nationwide reporting system (TBnet and HIV/AIDS registry) through an electronic record linkage method. A questionnaire survey was also conducted and determined the rate of diagnosis of HIV among TB cases in public health units in 2005.ResultsThe number of cases with both HIV and TB was 137 (0.07% among 197,562 TB cases) and the newly detected TB/HIV cases per 100,000 population was increasing annually: 2001, 0.025; 2002, 0.031; 2003, 0.025; 2004, 0.071; 2005, 0.095. Males between 20 and 59 years of age accounted for 87.6% of TB/HIV patients. Compared with patients with TB alone, those with TB/HIV had a higher percentage of extrapulmonary TB (8.0% vs 19.0%; p < 0.0001). The standardized prevalence ratio (SPR) of HIV among patients with TB was 18.46 (95% CI, 15.50-21.83). SPR of HIV among male TB patients aged 20-59 and extrapulmonary TB cases was 39.64 (95% CI, 32.87-47.40) and 43.21 (95% CI, 28.22-63.31) respectively. Through a questionnaire survey of public health units, six patients (0.08%) were confirmed as having HIV among 7,871 TB patients in public health centers in 2005, which is similar to the result from the study through nationwide reporting systems.ConclusionsThe prevalence rate of TB/HIV patients is still low but increasing in South Korea. Physicians should consider performing HIV tests among TB patients, especially in higher-risk groups, such as young males with extrapulmonary TB in South Korea.

Treatment default and death among tuberculosis patients in Hunan, China

We used the 2005 and 2006 national surveillance data to elucidate some of the risk factors for treatment default and death among tuberculosis (TB) patients in Hunan, China. Risk of default was higher in males (odds ratio (OR) 1.25; 95% confidence interval (CI) 1.08, 1.44); lowest in patients aged 15-24 y (OR 0.60; 95% CI 0.49, 0.75), and generally increased with increasing age; lower in patients living in cities with per capita gross domestic product (GDP) of less than 1000 US$ (OR 0.60, 95% CI 0.49, 0.72), and increased with increasing per capita GDP of city of residence; and higher in patients with previously treated smear-positive pulmonary TB (diagnostic category II according to the World Health Organization definition; OR 1.99; 95% CI 1.22, 3.23). Risk of death was lowest in patients aged 15-24 y (OR 0.07; 95% CI 0.05, 0.10), and increased with increasing age; lower in new cases (OR 0.50; 95% CI 0.33, 0.76); and highest in patients who treated themselves (OR 3.47; 95% CI 1.27, 9.46). We conclude that male TB patients, elderly TB patients, patients resident in cities with higher per capita GDP, and patients receiving category II treatment need special attention to reduce TB treatment default in the province. Furthermore, elderly TB patients and patients with a long history of TB need special attention to reduce mortality. Self-treatment also needs to be discouraged to reduce mortality.

The social reality of migrant men with tuberculosis in Kathmandu: implications for DOT in practice

To establish which of the many possible linkages between tuberculosis (TB), direct observation of treatment (DOTS), and the social reality of migrant workers in Kathmandu are the most relevant to the health outcomes and economic and social well-being of these populations, and which are amenable to possible interventions and high-yield policy changes. Fourteen semi-structured in-depth interviews were conducted through an interpreter with male migrant TB patients aged 18-50 years recruited from three DOTS clinics in the Kathmandu valley in May 2005. The interviews were coded using constant comparison and analysed using a grounded theory method. The economic burden of TB treatment is far greater than the financial reserve of migrants. Consequently remittances sent to families are reduced and migrants remain in debt long after treatment completion, tied to the treatment location paying off high interest loans. Forced to attend clinics far away from their home, and isolated by the stigma associated with TB, migrants are vulnerable without social support networks. Migrants find that daily clinic visits are incompatible with working schedules and important cultural festivals, which forces them into defaulting. The needs of migrant workers with TB living in Kathmandu are not being adequately met. Current service provision needs to be reviewed to build in greater flexibility and support for migrant men.

Facteurs associés à l'abandon du traitement anti-tuberculeux dans la ville d'Antananarivo, Madagascar

A retrospective epidemiological study of patients' medical records (n = 442) was conducted in one of the tuberculosis (TB) treatment centers in the city of Antananarivo, to identify risk factors of treatment default. Results show that males give up treatment more than women (OR=1,81 [1,13; 3,03]). Among those living farthest away from the center, patients younger than 30 years old tend to be more irregular in the follow-up of their treatment (OR=3,43 [1,16; 10,15]). There is no statistically significant relationship between TB treatment default and the patient's age, the clinical form, the therapeutic regime or the place of residence. Managers of treatment centers should be more aware and vigilant regarding male and young TB patients presenting these characteristics and should adapt methods and means for follow-up according to these risk factors.

Diagnostic key-point of the pulmonary tuberculosis

I have been engaged in the diagnosis and treatment of pulmonary tuberculosis for about 25 years. I have presented many interesting tuberculosis cases such as cavity, nodule, infiltration, miliary pattern, and bronchial tuberculosis. I summarized that the key point of the diagnosis for pulmonary tuberculosis is, 1) X-ray diagnosis shows no specific findings, so it is important to remind pulmonary tuberculosis as not unusual disease. I will make a proposal to insert pulmonary tuberculosis in the guideline for the diagnosis of pneumonia by the Japanese Respiratory Society. 2) Sputum PCR examination is very rapid and useful diagnostic method. The diagnostic evaluation of PCR is equal or over that of AFB culture. 3) CT diagnosis is useful for the detection of minimal pulmonary shadow or cavity lesion. 4) Brocho-fiberscopic examination is useful for the detection of the Mycobacterium in the bronchial brushing smear or washing samples. We should suspect bronchial tuberculosis in the cases with strongly positive sputum smear without cavity shadow. 5) The rate of complication with diabetes mellitus is significantly higher than that of 10 years ago in adult male tuberculosis patients. Recently 1 of 4 patients complicated with diabetes mellitus in adult male patients.

A case control study on human immunodeficiency virus-1 (HIV-1) infection as a risk factor for tuberculosis and leprosy in Western Kenya

A case control study was undertaken in Western Kenya from April 1989 to August 1990 to evaluate HIV-1 infection as a risk factor for tuberculosis and leprosy. The study involved 144 newly diagnosed sputum smear positive tuberculosis cases with 432 age, sex and neighbourhood-matched controls, and 132 diagnosed leprosy cases with 384 matched controls. Odds ratios obtained by conditional logistic regression (matched) analysis were 4.9 (95% CI 2.6, 6.8), and 1.8 (95% CI 0.9, 3.2), for the association between HIV-1 and tuberculosis and leprosy respectively. Approximately 31% of tuberculosis cases among males, and 11% of cases among females, were attributable to HIV infection.

Pectus Excavatum and Scoliosis: Thoracic Anomalies Associated with Pulmonary Disease Caused byMycobacterium aviumComplex

We studied the frequency of pectus excavatum or otherwise abnormally narrowed anterior-posterior thoracic dimension and of thoracic scoliosis among consecutive series of 67 patients with pulmonary disease due to Mycobacterium avium complex and 55 patients with pulmonary Mycobacterium tuberculosis. Among those with M. avium, pectus excavatum and abnormal narrowing was present in 27% and scoliosis was seen in 52%; overall, 47 of the 67 (70%) had one or both of these anomalies. By comparison, of those with M. tuberculosis only 5% had pectus excavatum or abnormal narrowing, only 13% had scoliosis; and none had both. The prevalence of pectus excavatum and abnormal narrowing among female M. avium complex patients was significantly greater than among female tuberculosis patients (p = 0.05) or in the general population (p less than 0.001). Among male M. avium complex patients, pectus excavatum and abnormal narrowing was significantly more common than in the general population (p less than 0.001) but not significantly different than among male tuberculosis patients (p = 0.264). For all M. avium complex versus all M. tuberculosis patients the prevalence of pectus excavatum abnormal narrowing was significantly greater (p = 0.013). Scoliosis was significantly more common among all M. avium complex patients than among M. tuberculosis patients or the general population. We believe that these anomalies, which are associated with a variety of heritable connective disorders, are phenotypic markers of patients who are at increased risk for pulmonary disease due to environmental mycobacteria, such as M. avium complex.

Isoniazid and Cancer Risks

To the Editor.— The report on the effectiveness of isoniazid in preventing clinically manifest tuberculosis (229:528, 1974) did not take into account the potential carcinogenicity of the drug. Isoniazid-induced leukemia and tumors in laboratory animals cannot be generalized to man, but they justify careful scrutiny of the potential risk. An increase over expected numbers of deaths due to neoplasms in male tuberculosis patients treated with isoniazid has been observed, although the relative risk (1.4) was not significant statistically.1In one section of the randomized trials of the Public Health Service, mental patients under intensive care who had received isoniazid prophylactically experienced a higher rate of death due to neoplasms than did the control group on placebo.2The increase in neoplasia was not observed in other test populations. This discrepancy has not been clarified, but it is conceivable that the group under intensive care actually took the prescribed dose