Positive Contact History Research Articles

Bartonella henselae- and quintana-associated uveitis: a case series and approach of a potentially severe disease with a broad spectrum of ocular manifestations.

To evaluate the clinical manifestations of intraocular inflammation associated with Bartonella infection and describe the assessment and management of patients with cat-scratch disease (CSD). This is a retrospective review of the clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2011 to 2018 in the Department of Ocular Inflammations and Infections of the University Eye Clinic of Ioannina (Greece). An analysis of the current literature concerning Bartonella-related intraocular infections was also carried out. This is a retrospective study of 13 patients (7 males and 6 females) with a mean age of 39.2years that were diagnosed with unilateral intraocular inflammation, except one case with bilateral affection, attributed to Bartonella (either henselae or quintana). Twelve (12) patients (92.3%) had a positive history of traumatic cat contact. The main ocular clinical findings with regard to the type of uveitis included neuroretinitis in 5 eyes (38.5%), vasculitis in 3 eyes (23.1%), iridocyclitis in 2 eyes (15.4%), intermediate uveitis in 2 eyes (15.4%), posterior uveitis in 1 eye (7.7%), panuveitis in 2 eyes (15.4%), retinochoroiditis in 2 eyes (15.4%), vitritis in 1 eye (7.7%), peripheral choroidal granuloma in 1 eye (7.7%). Immunoglobulin (Ig) G was positive in all cases. All patients were treated with antibiotics (mainly rifampicin, doxycycline and azithromycin). The visual acuity was noted to be improved in all patients after treatment, but some of them experienced disturbing complications. CSD may manifest with various ocular pathological findings. Taking into consideration the increasing frequency of infections by B. henselae and B. quintana, clinicians should always incorporate CSD in the differential diagnosis of such presentations of uveitis. Educating vulnerable groups (children, immunosuppressed, etc.) and also general population, the appropriate preventing measures can contribute in limiting the risk of infection.

Epidemiology of Influenza in Patients with Acute Lower Respiratory Tract Infection in South of Iran (2015-2016)

Summary Influenza is of particular importance because of the pace of epidemics, the extent and number of infected people, and the severity of the side effects. The aim of this study was to investigate the epidemiological and clinical aspects of this disease during the last epidemic in southern Iran. The present cross-sectional study was performed on the basis of secondary data analysis and information in medical records of patients with acute lower respiratory system infection in hospitals affiliated to Jahrom University of Medical Sciences. Data were analyzed by SPSS 18 using descriptive statistics, Chi-square test and logistic regression at 0.05 significance level. From 1st September 2015 to 20th March 2016, 108 patients with acute lower respiratory tract infection with a mean age of 42.92 ± 19.65 years were admitted to Jahrom hospitals, of which 43 were diagnosed with definite influenza, all of which (100%) had H1N1 type A influenza. There were eight deaths in all, of which five were positive for H1N1, and of these five cases, three cases had delayed diagnosis and treatment, and four cases had underlying diseases. The results of multivariate logistic regression analysis showed a significant relationship between positive H1N1 cases and history of contact with definite influenza, traveling abroad, and clinical symptoms of chills (p < 0.05). The results of this study showed that 39.81% of the patients with acute lower respiratory tract infections suffered from influenza. Furthermore, the delayed treatment and the underlying diseases were the most important cause of death.

Prospective study to find out the role of gastric aspirate examination by Ziehl-Neelsen staining (ZN staining) and cartridge based nucleic acid amplification test (CB-NAAT) as a diagnostic method in childhood tuberculosis

Background: Tuberculosis in children has been relatively neglected mainly because clinical diagnosis has low specificity, radiological interpretation is subject to inter-observer variability and the tuberculin skin test is a marker of exposure, not disease. The recent introduction of Cartridge based nucleic acid amplification test has significantly transformed the diagnostics of tuberculosis in adults but its application for Paediatric Tuberculosis is under evaluation. Therefore, authors conducted a study on role of gastric aspirate examination by ZN stain and Cartridge based nucleic acid amplification test in the diagnosis of childhood Tuberculosis.Methods: Authors did a prospective hospital-based study from Nov 2016 to Nov 2017 consisting of 100 randomly selected patients suspected of tuberculosis who had their gastric aspirate tested for CBNAAT and ZN stain for acid fast bacilli (AFB) along with Mantoux test and other routine investigations. Chi square test was used.Results: Culture positive tuberculosis was found in 21 out of 100 children. The sensitivity, specificity, positive predictive value and negative predictive value for CBNAAT were 76.1%, 98.7%, 94.1% and 93.9% and for ZN stain were 47.6%, 98.7%, 90.9% and 87.6% respectively. Positive history of contact (p value 0.0217), reactive Mantoux test (p value < 0.001) and low socioeconomic status were independently associated with a positive CBNAAT result.Conclusions: Analysis of gastric aspirate samples with CBNAAT is a sensitive and specific method for rapid diagnosis of pulmonary tuberculosis in children who cannot produce sputum. Compared with microscopy, CBNAAT offers better sensitivity and its scale up will improve access to tuberculosis diagnostics in children.

A Case of Melioidosis Presenting as Acalculous Cholecystitis

We describe a case of melioidosis presenting as acalculous cholecystitis in a middle-aged Chinese male. The patient presented with clinical features of cholecystitis and computed tomography (CT) imaging did not reveal other obvious sources of sepsis other than acalculous cholecystitis. The decision was made by the hepatobiliary team to proceed with an urgent cholecystectomy in view of patient's septic presentation. Cultures from peripheral blood and intraoperatively obtained bile fluid grew Burkholderia pseudomallei. The patient subsequently completed one month of meropenem, followed by another three months of eradication therapy. The patient denied soil contact in his work but he comes from a melioidosis-endemic country. He was also newly diagnosed with diabetes mellitus during his admission. We believe this to be the first reported case of melioidosis presenting as acalculous cholecystitis with a positive bile fluid culture. Urgent cholecystectomy in susceptible cases, with positive contact history or from endemic countries, might present another modality to achieve source control. Appropriate antibiotics with melioidosis coverage should be started early as well.

Primary Squamous Cell Carcinoma of Pleura Masquerading as Tuberculous Abscess: A Rare Case Report and Review of Literature

Primary pleural SCC is a rare pleural malignancy which has seldom been reported. Here we report a case of a 47 year male who presented with low grade fever, persistent chest pain and loss of appetite for 3 months along with a positive history of contact. CECT thorax demonstrated fluid collection in the pleural space along with fibrotic patch and cytology revealed extensive necrosis. Based on above findings provisional diagnosis of tuberculous abscess was made and subsequently anti- tuberculous treatment was started. Later on after 3 months patient again presented with similar complaints and physical examination revealed a bulging mass on back which was aspirated and sent for cytology which revealed features consistent with the diagnosis of poorly differentiated squamous cell carcinoma. This was later confirmed by CECT thorax, showing heterogeneous mass with pleural thickening and invasion. Histopathology eventually confirmed the diagnosis of primary pleural squamous cell carcinoma.

Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka

BackgroundLeishmaniasis, a vector borne tropical/subtropical disease caused by the protozoan Leishmania is transmitted to humans by sandfly vectors Phlebotomus and Lutzomyia. The principal form found in Sri Lanka is cutaneous leishmaniasis (CL) and is caused by Leishmania donovani. A rising trend in disease prevalence has been observed recently in Sri Lanka and the island is in fact the newest endemic focus in South Asia. Determining the prevalence of smear positivity among clinically suspected CL patients, identifying risk factors and specific clinical presentations of CL in order to implement preventive and early treatment strategies were the objectives of this study.MethodsA sample of 509 clinically suspected cases of CL referred to the Department of Parasitology from all across Sri Lanka between 2005 and 2015 was selected consecutively. Diagnosis was confirmed by microscopic visualization of the Leishmania amastigote from the slit skin smear. A structured questionnaire was used to identify exposure related risk factors and a clinical examination was performed to identify lesion characteristics.ResultsOut of 509 clinical cases, 41.5% (n = 211) were smear positive. The study population ranged from ages 1 to 80 years (mean age = 34.76) and the most affected age group was 40–49. Of the smear positives, 58.85% were males. Majority (47.86%) were from the North Western region (Kurunegala) of the country and were exposed to scrub jungles. Sand fly exposure (p = 0.04) and positive contact history (p = 0.005) were significant risk factors for smear positivity.Erythema (p = 0.02), lack of pruritus (p = 0.02) and scaly appearance (p = 0.003) were significant lesion characteristics in smear positivity. Lesions were commonly found in the exposed areas and the commonest morphological type was papulo-nodular.ConclusionsAn increasing trend in the spread of cutaneous leishmaniasis from endemic to non-endemic areas has become evident. Positive contact history and sandfly exposure were significant risk factors for smear positivity which may indicate the possibility of human reservoir hosts in infection transmission. Lack of pruritus, scaly appearance and erythema were highly significant lesion characteristics associated with Leishmania positive smears which can be used for the clinical diagnosis of CL.

Clinical Profile of Novel H1N1 Influenza in Children at a Tertiary Care Centre: Pune

Background: With worldwide presence, Novel influenza virus (H1N1) carries great potential for causing a pandemic,there are limited studies about clinical profile of H1N1 in paediatric age group in India hence the present study was undertaken at Aditya Birla Memorial Hospital in Pune. Methods: This was a prospective observational study, conducted during the time period from 01/03/2015 to 31/05/2016. Patients with influenza-like illness (Category B and C) aged 1 month to 16 yrs were included. Epidemiological, clinical and laboratory data was collected. For each patient one nasal and one throat swab was collected and sent to laboratory for RT-PCR (Real Time Polymerase Chain Reaction). All cases were treated with oral Oseltamivir according to MOHFW (Ministry Of Health and Family Welfare) guidelines. Data was analyzed for patients with positive RT-PCR. Results: Total 148 patients were enrolled in the study. H1N1 Influenza infection was confirmed on RT-PCR in 24.32% (n=36) patients. Majority of H1N1 infected patients (66.66%; n=24) were between 1-6 yrs and 22.22% were more than 6 yrs with mean age of 5.2 yrs. Male: Female ratio was 1.57:1. History of positive contact was obtained in 22.22% (n=8). In spite of earlier vaccination for H1N1 22.22% (n=8) suffered from infection.Common symptoms were fever (100%), cough (88.88%), rhinorrhoea (83.33%), vomitings (22.22%) and loose stools (22.22%). Normal chest X-ray was found in 38.88% of them, patchy consolidation in 33.33%, prominent broncho-vascular markings in 22.22% and pleural effusion in 5.55%. Fever lasted for more than 7 days in 33.33%. Secondary bacterial infection was found in 16.66% and 5.55% had evidence of myositis. 5.55% had evidence of encephalitis. Mechanical ventilation was required in 11% during the course of treatment. Mean duration of hospitalization was 4.1 days. One deaths occurred.

Late Presentation of Post Diphtheritic Myocarditis in a 15-year male

A 15-year old male patient presented to us with dyspnoea for four days. He had a history of fever, pseudo-membranous tonsillitis and cervical adenopathy twenty-five days prior to the presentation. On examination and laboratory investigations, he had features suggestive of myocarditis with biventricular failure. There was no reliable history of immunisation and he had a positive history of contact. He was planned for anti-diphtheria toxin but before the anti-toxin could be initiated, the patient succumbed to refractory cardiogenic shock. This was a rare case of late onset diphtheritic myocarditis in an unimmunised adult. With the advent of universal immunisation, there has been a significant decline in the incidence but there is still some road to cover.

Risk factors of multi-drug resistant tuberculosis in urban Allahabad, India

Background: India has the highest burden of tuberculosis globally while second highest in estimated MDR-TB cases after China. The prevalence of MDR-TB is estimated to be 3% among new cases and 14-17% amongst the re-treatment cases. The Objective of the study was to identify the risk factors of MDR-TB in patients registered at tuberculosis units of urban Allahabad.Methods: A cross-sectional study was carried out on TB patients registered at the urban tuberculosis units of Allahabad district in the year 2015. A total of 54 MDR-TB and 1016 non-MDR TB patients were included in the study. A pre-tested structured questionnaire was used to collect the data on the various factors. The chi-square test was used to study the association of various risk factors for MDR-TB patients.Results: MDR-TB was more common in 26-45 year age group (59.26%), males (62.96%), previously treated TB case (83.34%), positive history of contact with MDR-TB patient (5.55%), patients previously on non-DOTS treatment (37.78%), patients with associated co-morbidities (37.03%) and in substance abuse (74.07%) while Non-MDR is more common in >45 years (46.75%) age group, females (56.69%), new cases (87.20%), patients on DOTS therapy (85.16%), without any co-morbidities (83.46%) and in patients having positive history of substance abuse (60.04%).Conclusions: The younger age, male gender previous TB treatment, patients previously on Non-DOTS treatment, incomplete previous TB treatment, positive contact history of MDR-TB cases, presence of associated co-morbidities and substance abuse was significantly associated with MDR-TB patients than Non-MDR-TB patients (p<0.05).

A study on validity of reading Mantoux test at 24 hours

Background: Tuberculosis (TB) is a chronic infectious disease caused by mycobacterium tuberculosis and one of the major disease affecting children throughout the world. Prevalence of active disease in adults in India is 18 per 1000 population. The aim of the current study was to see whether reading Mantoux test at 24 hours can predict Mantoux positivity at 48 hours.Methods: A Prospective observational study was conducted in Tertiary care hospital which caters for people in and around Madurai, Tamil Nadu, India. Total 6560 children in the age group of 6 months to 12 years with suspicion of Tuberculosis. (Positive contact history or Low weight for age or persistent fever for more than 2 weeks or cough for more than two weeks or significant lymphadenopathy) were given Mantoux test. Of these 5904 (90%) children turned up for 24hours and 48 hours reading. Transverse diameter of the induration was measured. More than 10mm was considered as Mantoux positivity. The size of induration at 24 hours and 48 hours were compared.Results: Out of 5904 children, 206 (3.48%) children had Mantoux positivity at 48 hours. Of these 206 children, 131 (63.6%) children had more than 10 mm at 24 hours. Remaining 75 (36.4) showed less than 10 mm at 24 hours, but become more than >10 mm at 48 hours. Overall tuberculin positivity is 3.5%.Conclusions: Positivity of tuberculin test must be confirmed at 48 hours only. There is no standard reading at 24 hours which can be presumed to become positive at 48 hours.

Ivermectin in the Management of Ophthalmomyiasis in an Elderly Immuno-compromised Female

Case Report 97 year old female presented with pain, swelling and discharge from right eye for seven days, with history of loss of vision of right eye for 3 days. Patient was a known diabetic, on irregular treatment, with positive history of direct contact with livestock. On examination, in right eye there was no perception of light. There was extensive erosion of the periocular tissues extending upto the orbital rim on all sides, over an area of approximately 6X6 cm2. Both upper and lower lids were absent (Figure 1). On exploration of the wound, maggots were seen crawling on the wound and attempts at their removal were quite painful for the patient. Hence wound was cleaned with hydrogen peroxide and daily dressing of the wound was done with povidone iodine. Patient was investigated (TLC=13000; Blood Sugar=336mg%; HbA1C= 9.8) and started on oral antibiotics and hypoglycemics. Tab. Ivermectin 12 mg/day was given for three days. All the larvae were dead within 12 hours of starting treatment with Ivermectin. CT scan showed inflammatory lesions around right orbit with involvement of paranasal sinuses (Figure 2). Biopsy of the lesion revealed tumor tissue in dermis, attached to overlying epidermis, with a solid infiltration pattern and cells arranged in nests with prominent peripheral palisading, surrounding stroma showing desmoplastic reaction, features suggestive of Basal Cell Carcinoma (Figure 3). Patient’s condition slowly improved with treatment (Figures 4,5,6), and even though the eye was lost, we were able to prevent further damage and consequent morbidity without resorting to extensive mechanical debridement as is often required in such cases.

The demographic and clinical characteristics of leprosy in Saudi Arabia.

Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom (65%) were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently (33%), and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum (E.N.L.) developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers.

Clinico-epidemiological study of Hansen's disease patients attending a tertiary care centre in South India

Background: Leprosy (also known as Hansen’s diseaese) is a chronic disease caused by a slow multiplying bacillus, Mycobacterium leprae (M. leprae). Incubation period of the disease is about 5 years, but the symptoms can take as long as 20 years to appear. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and also the eyes. Leprosy is curable with multidrug therapy (MDT). Although not highly infectious, leprosy is transmitted via droplets, from nose and mouth, during close and frequent contacts with untreated cases. The main objectives were to describe the clinico-epidemiological profile of Hansen’s disease patients. Methods: Hospital based cross-sectional study using convenience sampling method was carried out. A total of 114 patients were enrolled in the study. Results: Around 25.27% of males presented with ulcer at the time of examination whereas in females, the common mode of presentation was the hypo-pigmented patch (48.47%). Out of the total 114 patients 55% had already developed residual disability at the time of examination. The mean age at onset of illness for males was 34 years and 31.60 years for females. About 25% of the patients gave positive history of contact with Hansen’s disease patient and the most common source of contact was another family member with the disease. On clinical examination most common nerve involved was ulnar nerve followed by lateral popliteal nerve. Conclusions: Study recommends periodic nerve examination of patients with hypopigmented patches to identify any abnormality in nerve and patients also need to be educated on self-care.

Outbreak of serotype W135 Neisseria meningitidis in central river region of the Gambia between February and June 2012: a hospital-based review of paediatric cases.

Meningitis still accounts for many deaths in children especially during epidemics in countries within the African meningitis belt. Between February and May 2012, the Gambia witnessed an outbreak of meningitis in two of its six regions. This study presents a clinical perspective of this outbreak in central river region of the Gambia. It evaluated the outbreak pattern, clinical features, and mortality among suspected cases that presented to the hospital during the outbreak. This is a prospective observational study of suspected cases of meningitis that presented to the pediatric ward of the Bansang Hospital during the outbreak period. Confirmed cases of meningitis were consecutively enrolled, and those with negative blood cultures presenting during the same period were employed as controls. Two hundred and four suspected cases of meningitis presented to the pediatric ward during the outbreak. Ninety were confirmed as meningitis cases. The W135 strain of Neisseria meningitidis was responsible for 89 (98.9%) of meningitis cases seen with an incidence rate of 74.9/100,000 in children (0-14 years) and in-hospital case fatality rate of 7.9%. Highest attack rate was among the 12-49 months age group. Clinical features such as meningeal signs (neck stiffness), conjunctivitis, and joint swelling were seen more in cases than controls. Contact history with relatives, who had fever in previous 2 weeks prior to illness was significantly seen more in cases. Adjusted regression analysis showed 7.5 more likelihood of infection with positive contact history (odds ratio [OR]: 7.2 confidence interval [CI]: [3.39-15.73]). There was no significant difference in death outcome between cases and controls (OR: 0.78 CI: [0.29-2.13]). The double peak wave-like pattern of the epidemic curve noted during this outbreak suggests a disseminated outbreak originating from an index case with propagated spread. There is need for more effective surveillance and incorporation of vaccine against meningitis into the expanded program on immunization schedule of the Gambia and other countries within the meningitic epidemic belt.

A survey of hepatitis B immune status of Taibah University medical students

Abstract Objectives This study aimed to determine the immune status of Taibah University medical students against HBV, and the possible host factors related to the poor response to a previously-administered hepatitis-B vaccine. Methods A cross-sectional study was conducted which included all 3rd year medical students of Taibah University. One hundred and five responded to a self-administered questionnaire. At the same time, a blood sample analysis was performed for hepatitis B markers (HBs Ag, HBcAb, and HBs Ab) of the participants. Results Of the total number of respondents, only 36.2% were aware that they received a hepatitis-B vaccine, 52.4% were not sure they received it, and 11.4% were not aware of receiving it. Of all, the hepatitis B markers showed that only 16 students (15.2%) had protective levels against the disease, while the rest showed negative markers, and only one student was immune due to past infection. Students with protective titers often had a family history for hepatitis B or a positive history of contact with a known case. Conclusion The low prevalence of HBV protective levels in Taibah University medical students needs further research and mandates implementation of a screening program and vaccination for all non-immune health care students.

Acute–Phase Inflammatory Response in Patients with Pulmonary Tuberculosis

Summary The main issue in patients with pulmonary tuberculosis (PTB) represents the impossibility of the host immune response to express bactericidal function and the sterilization of lesions depends exclusively on the specific antimicrobial chemotherapy. In order to investigate the value of acute-phase inflammatory response markers in patients with newly confirmed extensive PTB, there was designed a clinical study with 80 patients, of whom 40 had active disease (experimental group), while other 40 had inactive sequellar disease without comorbidity (control group). The examined groups were homogenous with respect to the patient’s general demographic characteristics. In the experimental group, 20.0% of the patients had an initial bacterial infection of the lower respiratory tract, while their average value of acute-phase systemic inflammatory markers was initially, before the antituberculosis treatment, significantly elevated compared to the control group. At the end of the treatment, values of erythrocyte sedimentation rate in the first hour (SE) and serum C-reactive protein (CRP) significantly decreased (SE-p <0.001, CRP-p<0.001), together with the value of the leukocyte count (Le) and serum fibrinogen (Le-p<0.001, fibrinogen-p<0.001). Multivariate linear regression analysis proved a significant correlation between baseline serum fibrinogen level with positive history of contact with active TB patient and initial radiological extent of PTB lung lesions. The values of the acute-phase inflammatory response markers in active PTB have its clinical significance in the assessment of unfavourable course of disease in extensive disseminated form of PTB as well as in the occurrence of complications associated with low respiratory tract bacterial superinfection.

A prospective study of the prevalence of tuberculosis and bacteraemia in Bangladeshi children with severe malnutrition and pneumonia including an evaluation of Xpert MTB/RIF assay.

BackgroundSevere malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of Mycobacterium tuberculosis is uncertain.MethodsWe prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital.Results405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24–94) and 92% (95% CI: 87–95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital.Conclusion and SignificanceTB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.

High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda

BackgroundA high prevalence of tuberculosis (TB) in children presenting with severe pneumonia has previously been reported in South Africa. However, little is known about TB among children with pneumonia in Uganda and other resource limited countries. Moreover, TB is associated with high morbidity and mortality among such children. We conducted this study to establish the burden of pulmonary TB in children admitted with severe pneumonia in our setting.MethodsA cross-sectional study was conducted at Mulago, a National Referral and teaching hospital in Uganda. Hospitalised children 2 months to 12 years of age with severe pneumonia based on WHO case definition were enrolledfrom February to June 2011. Children with a previous TB diagnosis or receiving anti-TB treatment were excluded. Each child was screened for TB using Tuberculin skin test, Chest X-ray, induced sputum samples and blood culture for mycobacterium. Sputum smears were examined using fluorescent microscopy, and cultured on both Lowenstein Jensen media (LJ) and Mycobacterial Growth Indicator Tubes (MGIT).ResultsOf the 270 children with severe pneumonia who were recruited over a 5-month period in 2011, the incidence ratio of pulmonary TB in children admitted with severe pneumonia was 18.9% (95% CI 14.6 – 23.9). The proportion of culture confirmed PTB was 6.3% (95% CI 3.8 – 9.7). Age group under 1 year and 1 to 5 years (OR 2.8 (95% CI 1.7 – 7.4) and OR 2.4 (95% CI 1.05 – 5.9) respectively) were more likely to be associated with pulmonary TB compared to those children over 5 years of age. A history of TB smear positive contact was associated with pulmonary TB (OR 3.0 (95% CI 1.3–6.5).ConclusionsWe found a high burden of pulmonary TB in children admitted with severe pneumonia. These data highlight the need for TB screening in children admitted with severe pneumonia so as to improve TB case finding and child survival.

A Clinco-Bacteriological Study of Leprosy in Paediatric Age Group

Clinico-bacteriological study was done in 51 leprosy patients below 14 years of age. Majority of the patients were males in the age group of 11-14 years. Nearly 84% had not received any prior treatment because of lack of awareness and financial constraints. Only 11.76% had a positive contact history. Skin lesions were present in all cases and 84.3% had lesions mainly on the exposed areas of the body and their number was found to increase significantly with advancing age (p The most common type of skin lesion was borderline tuberculoid (BT) in 53% cases. Positivity of the skin smears increased significantly as the number of the skin lesions per patient increased (p 0.001). Multibacillary cases were seen in 15.6% of cases and found only in the age group of 10-14 years of age. No statistically significant association between BCG vaccination and prevention of leprosy was seen.

English

INTRODUCTION: Tuberculosis is major cause of morbidity and mortality in India as well in other parts of world. It is caused by mycobacterium tuberculosis which primarily affects lung and cause pulmonary tuberculosis. Diagnosis of tuberculosis rests upon a positive history of contact, clinical symptoms, x-ray chest, sputum positivity and AFB culture. Adenosine deaminase (ADA) is an enzyme which catalyzes the deamination of adenosine into inosine and ammonia. ADA level is found to be elevated in tuberculosis and typhoid fever where cell mediated immunity is elevated. The ADA level is significantly elevated in tuberculosis and helps to differentiate between tubercular and non tubercular diseases. The ADA level is also found to be elevated in serum and pleural fluid in patients of tubercular pleural effusion, tubercular ascitis and tubercular pericardial effusion. METHODS : Routine hemogram, Montoux test, X-ray chest, FNAC of lymph nodes, biopsy of lymph node whenever required, estimation of serum ADA level and T.B.IgG studies were performed in each case. RESULTS: In the present study a total of 45 cases were selected for the study. There are 30 cases of pulmonary tuberculosis and 15 controls. The values of serum ADA and tubercular IgG in pulmonary tubercular group are significantly higher as compared to those of controls. None of the control for ADA showed significant ratio of positivity (≥1.7). One of the 15 cases showed remarkable ratio of positivity (>1.2-1.6) and 14 (93.3%) cases showed insignificant ratio of positivity. Only 2 (13.33%) of the 15 cases showed positivity for TB IgG and rest 13 (86.66%) were regarded negative. CONCLUSIONS: Thus it can be concluded that determination of serum adenosine deaminase levels can effectively diagnose tuberculosis with sensitivity of 96.66% and specificity of 93.33% as compared to TBIgG showing sensitivity of 90% and specificity of 86.6%. Also cost of ADA estimation is remarkably less than that of tubercular IgG