Presence Of BCG Scar Research Articles

Socio-cultural and Environmental Risk Factors for Leprosy in Jaffna District, Sri Lanka

This study was conducted to determine the socio-cultural and environmental risk factors of leprosy in Jaffna. A case-control study was conducted in dermatology clinic, teaching hospital, Jaffna from July 2015 to July 2016. All 97 cases and 291 controls by systematic sampling were recruited using interviewer-administered questionnaire.The mean age of cases was 41 (SD=21) and control was 48 (SD=20). Of 97 cases, 54.6 %( n=53) males; 99 %( n=96) Tamils; 79.4 %( n=77) Hindus; 60 %( n=59) above secondary education. Of 291 controls, 42.3 %( n=123) were males; 99.3 %( n=289) Tamils; 85.6 % (n=249) Hindus; 78.4 % ( n=225) above secondary education.Socio demographic factors (12 variables), house and environmental factors (11 variables), and behavioral factors (18 variables) were included in bivariate analysis and many were found to be significantly (p<0.05) associated with leprosy. Marital status, displacement, monthly income, presence of BCG scar, firewood as cooking fuel, and hunting reptiles were not found to be associated with leprosy. Multiple logistic regression analysis showed significant association between leprosy and - crowded household [OR4.5, (1.5-13.6)], non-availability of drinking water within 30 minutes walking [OR15.1, (2.3-98.3)], environment with shrub [OR2.9, (1.4-6.1)], exposure to shrub [OR2.7, (1.2-5.9)], exposure to leprosy patient [OR10.6, (4.1-27.5)], exposure to fishing [OR4.5, (1.5- 13.6)], visits to leprosy affected area [OR10.8, (4.7-24.5)] and unavailability of safe water source [OR3.3, (1.2- 9.1)]. In addition to the well-known risk factors environment-related risk factors, especially exposure to jungle/shrubs could play a role in the transmission of leprosy.

Surveillance of close contacts of patients with infectious tuberculosis: a prospective cohort study

BackgroundA long-term follow-up of close contacts to monitor their infection status is essential to formulate a promising screening strategy. The study aimed to assess the dynamics of tuberculosis (TB) infection using Interferon-γ release assay (IGRA) and determine risk factors associated with TB infection.MethodsDefinite TB patients were interviewed and their household contacts were screened for TB infection by IGRA during 12-month longitudinal investigation.ResultsWe included in our analyses 184 household contacts of 92 index TB patients. 87 individuals (47.3%) in contact group progressed to TB infection, of whom 86 developed into IGRA positive within 24 weeks. Close contacts with a higher age and comorbidities are easier to exhibit TB infection. Analysis showed that risk factors for becoming IGRA-positive individuals included residence, older age, comorbidities, BCG scar and high bacterial load. Contacts with BCG scar had a lower IGRA-positive rate.ConclusionIGRA conversion generally occurs within 24 weeks after exposure. The TB transmission happens since subclinical TB stage and the presence of BCG scar is an independent protective factor reducing risk of TB infection among close contacts. Repeated IGRA tests are sensible to conducted among close contacts at 24 weeks after exposure to identify the IGRA-positive individuals.

Percentage and Absolute CD4+ Count and Factors Influencing Their Levels in Tuberculosis Patients in a Tetiary Hospital, Kaduna, Nigeria

Background: The role of CD4+ T cells in immunity against tuberculosis have been widely acknowledged. This study determined CD4+ absolute, CD4 percentage and haemoglobin (HB) levels in tuberculosis (TB) patients undergoing TB treatment and compared these levels with presence of some factors which could modify the quantities of CD4+, CD4% and HB in TB patients. Methods: A cross-sectional study of eighty-five persons attending TB DOTS clinic in tertiary hospital between 2020 to 2021. Multicolour fluorescence imaging and absorbance spectrometry microscopy was used to enumerate CD4+ absolute count, CD4+ percentage and HB concentration in whole blood. Questionnaire and interviews were used to determine history, demographic data, BCG vaccination, BCG scar, vitamin A supplementation, awareness of zoonotic diseases and zoonotic TB, maternal BCG vaccination status, maternal BCG scar and undernutrition for each respondent. Results: CD4% significantly differed between forty-seven males (mean age: 33.5) and thirty-eight females (mean age: 32.2) (p <0.05). T-test indicated no significant difference in CD4+ count, CD4% and HB compared with BCG vaccination status, presence of BCG scar, knowledge of zoonotic diseases, knowledge of zoonotic TB and with vitamin A supplementation (p <0.05). There was also significant difference in CD4% compared with undernutrition and in absolute CD4+ counts compared with drug resistance (p <0.05). Conversely, there was significant difference in CD4% and absolute CD4+ count when compared with maternal BCG vaccination, presence of maternal BCG Scar. Pearson correlation coefficient indicated weak negative relationship between CD4%, absolute CD4+ count and age. Also, weak positive relationship between HB and age. Both relationships were not significant (p <0.05). Conclusion: Undernutrition, gender, maternal BCG vaccination (with or without scaring) and age influence levels of CD4+ in TB patients.

A Case–control Study on Risk Factors for Development of Tuberculous Meningitis in Adults

Abstract Introduction: Tuberculous meningitis remains the most severe and devastating form of tuberculosis with relatively severe morbidity and mortality. Risk factors for TB meningitis have not focused on the role of the BCG vaccine or social and food insecurity which are known to have a role in pulmonary TB. Methods: We prospectively conducted a Case-Control study among 65 patients with TB meningitis and 41 controls with other forms of meningitis. We evaluated the role of the BCG vaccine, the Household Food Insecurity Access Scale (HFIAS) and the Social Readjustment Rating Scale (SRRS) to look for food and social stress respectively. We also evaluated the known risk factors for TB meningitis including age, HIV co-infection, alcoholism, malignancies, use of immunosuppression, head injury among others. A bivariate followed by multivariate regression analysis was performed. Results: The presence of BCG scar was seen in 64.6 percent of patients with Tuberculous meningitis and 61.0 percent of control (P= 0.71). There was no difference in the size of the scars (P= 0.45) . Household food insecurity using the Household Food Insecurity Access Scale (HFIAS) ( a positive answer in any of the 9 items) was present in 16.9% of the patients in the TBM group and in 14.6% of the patients in the control group. (P= 0.75). Social stress assessed using the Social Readjustment Rating Score (< 150 suggest no social stress, 150 – 300 moderate social stress,> 300 high social stress) showed that a majority of the patients in both the groups reports no social stress. Only 9.8% of patients in the TBM group and 18.5% in the control group reports moderate presence of social stress whereas none of the patients had severe social stress. Logistic regression analysis suggested that only higher BMI was associated with lesser incidence of Tuberculous meningitis, odds ratio 0.83 (95% confidence interval of 0.73 – 0.930) and individuals performing clerical and unskilled and under-skilled jobs- odds ratio 0.13 (95% confidence interval of 0.02 – 0.93) had lower risk for TB Meningitis. Conclusions: In our sample of TB meningitis patients the BCG vaccine, food insecurity nor social stress appear to be risk factors. Bigger BMI and certain occupations appear to be possibly protective.

Socio-Demographic and Clinical Profile of Health Care Workers Diagnosed for COVID-19 by Truenat at a Tertiary Care COVID Hospital

Background: In December 2019, in Wuhan, China; a new coronavirus emerged that had not been previously identified in humans. Hence is crucial to characterize the infection risk among infected health care workers (HCWs), being responsible for secondary transmission to patients, and others. Objectives: The current study aimed to assess the disease burden among the front-line warriors and efficiently planned the preventive and management strategies for such infections. Methods: HCWs with clinical suspicion of COVID-19 infection, who reported to Fever Clinic for possible diagnosis by Truenat testing, were enrolled through a self-reporting Risk Assessment form. An oropharyngeal swab was subjected to Truenat testing based on the principle of Real time reverse transcription polymerase chain reaction (RT-PCR). Results: Doctors comprised 60% of our HCWs. Eighty-three percent of the HCWs under study reported either the presence of BCG scar or gave a history of BCG immunization at birth. The maximum number of HCWs (29.16%) took Hydroxychloroquine prophylaxis for four weeks. Seventy-four percent of the HCWs affirmed the use of personal protective equipment (PPE) at the time of exposure. The most common mode of infection reported was the exposure to COVID-19 patients. Fever was the most common reported symptom. Truenat was positive in 9 of 100 HCWs who were tested, giving an infection rate of 9%. Conclusion: The study provides insights into the burden of COVID-19 infection among HCWs, and guides us to evaluate and plan our preventive measures and management strategies for such infections.

Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan

ObjectiveTo investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas.DesignCommunity-based comparison study.SettingOutpatient diabetes clinics at 4 hospitals and 13 health centres in urban and...

Comparison of IFN-γ Levels in Children with Tuberculosis Disease (TB) and Latent Tuberculosis Infection (LTBI).

AIM:This study aimed to evaluate the importance of IFN-γ in the diagnosis of pediatric TB and LTBI and to compare the IFN-γ levels.METHODS:We analysed 100 patients examined for possible M. tuberculosis infection or disease at the Institute of Respiratory Diseases in Children, Kozle, Skopje. Patients were divided into 2 groups: TB disease and LTBI. The following parameters were analyzed: demographic characteristics, history of previous exposure to active TB, BCG vaccination and presence of BCG scar, lung X-ray findings, tuberculin skin test by the Monteux method and the value of INF-γ according to the Quantiferon TB gold test, direct samples of acid-alcohol-resistant bacilli of sputum and Löwenstein Jensen cultures. Informed parental consent was obtained for each child included in the study.RESULTS:In the LTBI group 60.9% had a scar from the vaccination while in the TB group 50% had BCG scar. TST induration diameters in children with or without BCG scar were significantly larger in patients with active TB. Children with active TB had significantly higher IFN-γ levels than children with LTBI. The IFN-γ for the cut-off of 0.35 IU/ml, has 64% sensitivity for detection of LTBI, versus 80.6% sensitivity for active disease. Children with close TB contact had significantly higher IFN-γ levels. Correlation between TST induration diameter and IFN-γ levels was stronger in the TB group.CONCLUSION:IFN-γ levels are significantly higher in children with active TB, and children with close contact with TB patient. It has better sensitivity in active TB. Using both tests (IFN-γ and TST) can improve the diagnose of LTBI and TB in countries where vaccination with BCG is widespread.

Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts.

BackgroundHousehold contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs.MethodsWe have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations.Results/Principal findingsThe positivity of peripheral blood qPCR of seropositive contacts was 40.6% (71/175) whereas only 8.6% (3/35) were qPCR positive in seronegative contacts (p = 0.0003). For the slit-skin smear, only 4% (7/175) of seropositive contacts presented positive bacilloscopy, whereas the qPCR detected 47.4% (83/175) positivity in this group compared with only 17.1% (6/35) in seronegative contacts (p = 0.0009). In the ENMG evaluation of contacts, 31.4% (55/175) of seropositives presented some neural impairment, and 13.3% (4/35) in seronegatives (p = 0.0163). The presence of neural thickening conferred a 2.94-fold higher chance of ENMG abnormality (p = 0.0031). Seropositive contacts presented a 4.04-fold higher chance of neural impairment (p = 0.0206). The peripheral blood qPCR positivity presented odds 2.08-fold higher towards neural impairment (OR, 2.08; p = 0.028). Contrarily, the presence of at least one BCG vaccine scar demonstrated 2.44-fold greater protection against neural impairment (OR = 0.41; p = 0.044).Conclusions/SignificanceELISA anti-PGL-I is the most important test in determining the increased chance of neural impairment in asymptomatic leprosy household contacts. The combination of the two assays (ELISA anti-PGL-I and peripheral blood qPCR) and the presence of BCG scar may identify individuals with higher chances of developing leprosy neuropathy, corroborating with the early diagnosis and treatment.

Latent tuberculosis infection in rural China: baseline results of a population-based, multicentre, prospective cohort study

Prophylactic treatment of individuals with latent Mycobacterium tuberculosis infection is an essential component of tuberculosis control in some settings. In China, the prevalence of latent tuberculosis infection, and preventive interventions against this disease, have not been systematically studied. We aimed to assess the prevalence of latent tuberculosis and its associated risk factors in rural populations in China. Between July 1, and Sept 30, 2013, we undertook a baseline survey of a population-based, multicentre, prospective cohort study of registered residents (≥5 years old) at four study sites in rural China. Eligible participants were identified by door-to-door survey with a household sampling design. We screened participants for active tuberculosis and history of tuberculosis then used a tuberculin skin test and an interferon-γ release assay (QuantiFERON [QFT]) to test for latent infection. We used odds ratios (ORs) and 95% CIs to assess variables associated with positivity of QFT and tuberculin skin tests. 21,022 (90%) of 23,483 eligible participants completed a baseline survey. Age-standardised and sex-standardised rates of skin-test positivity (≥10 mm) ranged from 15% to 42%, and QFT positivity rates ranged from 13% to 20%. Rates of positivity for the tuberculin skin test and the QFT test were low in study participants younger than 20 years and gradually increased with age (p for trend <0·0001). Rates of latent tuberculosis infection were higher for men than women (p<0·0001). Overall agreement between the tuberculin skin test and the QFT test was moderate (81·06%; kappa coefficient 0·485), with skin-test-only positive results associated with the presence of BCG scar, male sex, and ages of 60 years and older, and QFT-only positive results associated with male sex and ages of 60 years and older. On the basis of findings showing that the performance of the tuberculin skin test might be affected by various factors including BCG vaccination and age, our results suggest that the prevalence of latent tuberculosis in China might be overestimated by skin tests compared with interferon-γ release assays. The National Science and Technology Major Project of China, the Program for Changjiang Scholars and Innovative Research Team in University of China.

The Association of BCG Vaccination with Atopy and Asthma in Adults.

Introduction: There are few studies investigating the association between BCG vaccination and atopy or asthma in adults.Objective: We investigated the association between BCG scar and the occurrence of atopy and asthma in Korean adults.Methods: We carried out a retrospective study of Korean adults who underwent skin prick testing, and, in some cases, spirometry and bronchial provocation tests in a secondary care hospital from April 2010 to February 2011. Atopy status was classified according to allergen/histamine (A/H) ratio of wheal (A/H ratio ≥ 1, atopy; 0 < A/H ratio < 1, intermediate; A/H ratio = 0, non-atopy). A patient with asthma was defined as one who has symptoms compatible with asthma and showed either a positive provocation testing or bronchodilator reversibility.Results: Among 200 participants, neither the presence (intermediate vs. non-atopy: adjusted odds ratio (aOR) 0.83; 95% CI 0.26, 2.60; p = 0.75, atopy vs. non-atopy: aOR 0.89; 95% CI 0.33, 2.37; p = 0.81, respectively). nor the size of BCG scar was significantly associated with atopy status. However, among those patients who underwent either bronchodilator response testing or bronchial provocation testing, the presence of BCG scar (aOR 0.33; CI 0.14, 0.77; p = 0.01) and the size of BCG scar were inversely associated with asthma. (p = 0.01)Conclusions: We found a significant association between BCG scar and asthmatic status in Korean adults, although there was no significant association between either the presence or size of BCG scar and atopy.

Evaluation of Tuberculin Skin Test Results among Students of the University of Medical Sciences and Technology, Sudan

Introduction: Tuberculosis is an endemic infectious disease in Sudan and other developing countries. Healthcare workers, including students, are at a great risk of exposure and possible infection. This study is conducted to determine the pattern and prevalence of positive tuberculin skin test (TST) among students of the University of Medical Sciences and Technology during distinct periods of their training, and to study the influencing factors for positive results. Design and Setting: A cross-sectional study conducted among 100 students in the period between October 2010 to March 2011 using questionnaires, and administration of the Tuberculin Skin Test (TST) by a licensed professional. Students were divided into two groups, high risk group (medical students), and low risk group (non-medical students) according to their level of exposure. Demographics, BCG vaccination, potential exposure to TB patients and symptomatology were obtained and analyzed. Results: The overall prevalence of positive TST was 19%, 2% were strongly positive, 17% being moderately positive. The high risk group exhibited a significantly higher rate of positive TST (26%). Positive TST was found to correlate significantly with contact with TB patients (P 0.08). No significant correlation was found between positive TST and gender (P 0.834), country of residence (P 0.242), vaccination (P 0.094), presence of BCG scar (P 0.793), drinking unpasteurized milk (p 0.647), immunosuppressive therapy (P 0.674) and crowding (P 0.872). Conclusion: The TST positivity rate was high among our students; it correlates with in-hospital training stage. More attention should be paid to prevention strategies in medical students prior to and during their clinical training.

Mantoux Positivity among Institutionalized Vulnerable Children

Background: Vulnerable Children (VC) have various needs and challenges some of these are environmental, social, and health risk factors that have been associated with tuberculosis (TB). These risk factors coupled with challenges in diagnosis, treatment and the prevention of tuberculosis in the developing tropical countries like Nigeria, places VC at a higher risk of TB infection especially if they are institutionalized. This study therefore sought to describe the mantoux positivity and clinical profile of institutionalized VC living in House of Love, a Faith Based institution in Jos Plateau state North-Central Nigeria. Methodology: All residents of the orphanage were interviewed with a structured questionnaire; afterward a clinical examination was done including measurements of weight and height. A mantoux test and HIV screening were carried out. All subjects with PPD reaction of > 10mm or > 5mm if immune-deficient (HIV, malnutrition, steroid) were considered mantoux positive. Thereafter subjects adjudged to be mantoux positive had a chest radiograph done. Results: Forty people were resident in the institution, out of which 35 were VC and 5 were caregivers. Out of the 35 VC, 31 were orphans, 4 were non orphan vulnerable children, with a male female ratio of 1:0.7 and a mean, median age of 13.6 years and 15 years respectively. Clinical features of either chronic cough, night sweat or weight loss was reported by 31.4%, a BCG scar was seen on 54.3% of VC. Twenty percent of the studied population were HIV positive, 5.8% had moderate malnutrition. The range of the mantoux was between 0-20mm with a mean and mode of 8.1+6.8 and 7mm respectively. Based on gender, age group, VC type, presence of clinical features, HIV status, nutritional status and presence of BCG scar no difference was found in relationship with the mean mantoux reaction, P > 0.05. The prevalence of mantoux positivity amongst the VC was 48.6%. Comparatively the prevalence was 17.1% in males against 31.4% in females, 8.6% in HIV positive VC and 11.4% in HIV negative VC, orphan had a 40.0% prevalence against 8.6% nonorphan VC, normal nourished and malnourished VC had 37.1% and 5.8% respectively, while VC with BCG scar and VC without BCG scar had 31.4% and 17.5% respectively. None of these differences was statistically significant. Conclusion: This study showed that tuberculosis infection is a burden amongst institutionalized vulnerable children in the orphanage studied and therefore call for further in-depth research on the subject matter. Meanwhile Pre - placement and period screening of institutionalized VC and their caregivers should be emphasized.

Nível de exposição ao Mycobacterium tuberculosis em estudantes de medicina de uma universidade do sul de Minas

Objetivos. Verificar o nível de exposição ao Mycobacterium tuberculosis e os fatores de risco associados, utilizando o teste tuberculínico como marcador para tuberculose latente em universitários do curso de medicina da UNIVÁS em Pouso Alegre, MG, Brasil. Métodos. Estudo transversal com 120 estudantes divididos em três grupos: básico, intermediário e internato. Informações relativas ao gênero, faixa etária, presença de cicatriz BCG, segunda dose de BCG, contato prévio com portador de tuberculose e história pessoal de tuberculose foram obtidas por meio de questionário. O teste tuberculínico foi realizado por profissional habilitado e foi definido como positivo quando a enduração foi maior de 5mm. Resultados. A prevalência de expostos ao Mycobacterium tuberculosis foi de 28,3%, sendo mais frequente nos alunos do internato. Observou-se uma maior positividade no gênero feminino (p &gt; 0,05). O teste tuberculínico foi positivo naqueles maiores de 21 anos, com cicatriz vacinal (BCG) e que não tiveram contato com indivíduo com tuberculose, (p &gt; 0,05). Os estudantes que receberam a segunda dose de BCG tiveram maior chance de apresentar teste positivo quando confrontados com os que não foram vacinados (RC = 0,35; 95% IC = 0,1-0,9; p = 0,023). Conclusões. A maior prevalência de tuberculose latente ao final do curso médico sugere que os estudantes de medicina estão possivelmente expostos a transmissão nosocomial de Mycobacterium tuberculosis. Este estudo mostrou a vulnerabilidade desta população em relação à tuberculose e revelou a necessidade de implementação de programas de biossegurança para os estudantes de medicina, além de alertar para o uso de medidas de controle

Leprosy among patient contacts: a multilevel study of risk factors.

BackgroundThis study aimed to evaluate the risk factors associated with developing leprosy among the contacts of newly-diagnosed leprosy patients.Methodology/Principal FindingsA total of 6,158 contacts and 1,201 leprosy patients of the cohort who were diagnosed and treated at the Leprosy Laboratory of Fiocruz from 1987 to 2007 were included. The contact variables analyzed were sex; age; educational and income levels; blood relationship, if any, to the index case; household or non-household relationship; length of time of close association with the index case; receipt of bacillus Calmette-Guérin (BGG) vaccine and presence of BCG scar. Index cases variables included sex, age, educational level, family size, bacillary load, and disability grade. Multilevel logistic regression with random intercept was applied. Among the co-prevalent cases, the leprosy-related variables that remained associated with leprosy included type of household contact, [odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.02, 1.73] and consanguinity with the index case, (OR = 1.89, 95% CI: 1.42–2.51). With respect to the index case variables, the factors associated with leprosy among contacts included up to 4 years of schooling and 4 to 10 years of schooling (OR = 2.72, 95% CI: 1.54–4.79 and 2.40, 95% CI: 1.30–4.42, respectively) and bacillary load, which increased the chance of leprosy among multibacillary contacts for those with a bacillary index of one to three and greater than three (OR = 1.79, 95% CI: 1.19–2.17 and OR: 4.07–95% CI: 2.73, 6.09), respectively. Among incident cases, household exposure was associated with leprosy (OR = 1.96, 95% CI: 1.29–2.98), compared with non-household exposure. Among the index case risk factors, an elevated bacillary load was the only variable associated with leprosy in the contacts.Conclusions/SignificanceBiological and social factors appear to be associated with leprosy among co-prevalent cases, whereas the factors related to the infectious load and proximity with the index case were associated with leprosy that appeared in the incident cases during follow-up.

Prevalence of dermatological lesions in hospitalized children at the University College Hospital, Ibadan, Nigeria

Skin disorders constitute a significant proportion of consultations in children's clinics; however, there is a paucity of data on the prevalence of dermatological lesions in hospitalized children in Nigeria. This study determines the prevalence of dermatological lesions in hospitalized children. In this cross-sectional study, 402 children aged three months to twelve years admitted in the Pediatric wards of the University College Hospital, Ibadan, were enrolled over a six-month period. Examination of the skin and its appendages was done for each patient. Data on the socioeconomic status, hygiene, and health-related factors were also obtained using a structured questionnaire. Over 96% of the children had at least one identifiable skin lesion. The five leading skin lesions were post-inflammatory hyperpigmentation (49.5%), BCG scar (28.4%), Mongolian spots (27.1%), junctional melanocytic nevi (20.1%), and cafι-au-lait macules (18.4%). The leading infectious skin disease was pyoderma (13.4%), followed by tinea capitis (6.7%). Scarification marks (P=0.001), tinea capitis (P=0.014), plantar fissuring (P=0.001), and impetigo (P=0.016) were associated with low socioeconomic classes, while the presence of BCG scar (50.0%) was associated with the high socioeconomic class. This study shows that dermatologic lesions are common in hospitalized children. Identifying them will provide an opportunity for pediatricians to educate parents on the various causes as well as prevention of lesions.

Lichen scrofulosorum: A prospective study of 39 patients

Lichen scrofulosorum is considered a rare form of cutaneous tuberculosis. Current information is based on case reports and case series with a small number of patients. Thirty-nine patients with Lichen scrofulosorum were followed during the period January 1996 to December 2002. Clinical details (age, sex, duration of disease, associated tubercular lesions, extent and distribution of skin lesions), laboratory parameters (hemoglobin, total leucocytic counts, erythrocyte sedimentation rate, Mantoux test, presence of BCG scar), and response to antitubercular treatment were recorded and analyzed. 7.6% patients of all (511) patients with cutaneous tuberculosis had LS. 22 (56.4%) were males and 32 (84%) were below 15 years of age. Twenty-eight (72%) had an associated focus of tuberculosis elsewhere in the body; 13 (33%) had tubercular lymphadenopathy, while 11 (28%), three (8%) and six (15%) had pulmonary tuberculosis, intracranial tuberculosis and other forms of cutaneous tuberculosis, respectively. Six (15%) had tubercular focus at multiple sites. Eleven (28%) had no other identifiable focus of tuberculosis. Twenty-eight (72%) had evidence of receiving BCG vaccination. Trunk was the commonest (100%) affected site. The two groups with and without associated tubercular focus were not different with respect to age, sex, duration of disease, hemoglobin, total leukocyte count, erythrocyte sedimentation rate, Mantoux test positivity, and presence of BCG scar. Mycobacteria tuberculosis could not be detected either on acid fast bacilli (AFB) staining or on culture from biopsies of LS lesions. All patients (including those without evidence of tubercular focus) responded to antitubercular treatment, signifying an underlying occult tubercular focus as etiology. Lichen scrofulosorum is an uncommon but not rare cutaneous manifestation of tuberculosis. A high index of suspicion and awareness is required for diagnosis. Systemic tuberculosis is often associated with LS and a prior BCG inoculation does not protect against development of LS. Response to antitubercular treatment is good irrespective of the presence or absence of associated tubercular focus.

Protective effect of BCG among children vaccinated under universal immunization programme.

A case-control study was conducted to estimate the protective effect of BCG vaccination against tuberculosis among children. The children with suspicion of tuberculosis (TB) attending two hospitals in Bangalore city were registered into the study and subjected to detailed clinical examination and investigations. The presence of BCG scar was taken as evidence of vaccination. Modified Stegen-Jones scoring method was adopted for diagnosing TB. The hospital children with score of 7 were considered as TB cases. Children residing in the neighbourhood of cases were similarly investigated and those scoring 4 were labeled as controls. A total of 118 age-sex matched case-control pairs were identified and final analysis was confined to 113 cases and 109 controls after excluding children with doubtful BCG scar. A low protective effect of BCG vaccination at 31% (not significant, statistically) was observed against TB - all forms combined, among children vaccinated as under Universal Immunization Programme. Though the protective efficacy against extra-pulmonary TB was observed to be higher than for pulmonary TB, it was also not significant, statistically. It will be appropriate to conduct further studies on protection rendered by BCG vaccination against tuberculous meningitis and other severe forms of TB. Besides, the quality of vaccination programme including cold chain maintenance also needs to be evaluated.

Comparative skin testing with PPD tuberculin, Mycobacterium avium and M. scrofulaceum sensitin in schoolchildren in Saudi Arabia

Setting: Jizan region, Saudi Arabia. Objective: To test methodology for studies of tuberculin sensitivity and effectiveness of BCG vaccination programme. Design: School children (n = 315) aged 6–12 years simultaneously tested intradermally with PPD tuberculin RT23, 2TU and 0.1 μg Mycobacterium avium or M. scrofulaceum sensitin. Presence of BCG scar as evidence of previous BCG vaccination. Cervical lymph nodes palpated. Results: BCG coverage was 75%. The prevalences of positive reactions (induration ⪰ 6mm) were higher among children with than without scar. Prevalences of positive reactions to PPD and M. scrofulaceum sensitin were higher among girls than boys. In children with scar, the mean size of positive reactions to PPD was larger among girls than boys, and the prevalence of positive reactions was smaller in this group among children with than without palpable cervical lymph nodes. The sizes of reactions both to M. avium and to M. scrofulaceum sensitin were correlated to the size of the tuberculin reactions. Previous admission to hospital was reported less often by children with than without scar. Conclusions: The technique applied and training of staff was satisfactory. In further studies, however, we will apply three simultaneous tests to each person.

Prevalence of tuberculous disease and infection in an urban slum area.

A tuberculosis prevalence survev was carried out among 1222 children of an urban slum area. All of them were interrogated and then clinically examined for the presence of the disease. The presence of BCG scar was noted and the prevalence of infection was noted by doing aMantoux test in selected children. The prevalence of infection was highest in the 7–12yr range and lowest in the age group below 1 yr. In the vaccinated group of children, the incidence of illness was significantly lower (1.8%) than in the unvaccinated group (3.9%). The presence of tuberculous disease among children with grade III malnutrition was significantly higher.