RNTCP Guidelines Research Articles

Factors Related to Non-Referral of Patients with Presumptive Pulmonary TB to Designated Microscopy Centers (DMCs) by Registered Private Practitioners in Urban Areas of Punjab, India.

Early diagnosis and proper treatment under RNTCP guidelines, forms the mainstay of management of a TB patient. A large proportion of patients with presumptive tuberculosis (TB) visit a Private Practitioner (PP) in the first place. Studies have shown that PPs rely more on X-rays and other diagnostic tools rather than referring the patient to the nearest Designated Microscopy Centre (DMC) for sputum microscopy. The present study was planned to look in to factors responsible for non-referral of patients with presumptive pulmonary TB to the DMCs for diagnosis by PPs. Present study was a case-control study conducted over a period of one year among registered PPs in urban areas of Punjab. The study was carried out in five major cities which have approximately half of the urban population of Punjab. Forty three Private Practitioners per city for referral group and 43 matched PPs for non-referral group were selected. Knowledge regarding RNTCP was low in both the referral (38.1%) as well as non-referral (25.6%) group of PPs. Allopathic doctors had significantly higher knowledge regarding TB as compared to ayurvedic and homeopathy doctors, and Registered Medical Practitioners (RMP). Both the knowledge of PPs regarding nearest DMC as well as perception about accessibility of the nearest DMC for the patients were found to be significantly higher in the referral group. Only 15.3% of practitioners in the non-referral group said that they had been contacted by RNTCP staff. The main factors responsible for non-referral of pulmonary TB suspects to DMCs for diagnosis in the present study included low knowledge regarding RNTCP, lack of awareness regarding place and accessibility of nearest DMC, and inadequate sensitization of PPs by the RNTCP staff.

Study on Awareness of RNTCP Protocols and Guidelines among Private Practitioners in Urban Davangere Karnataka

Study on Awareness of RNTCP Protocols and Guidelines among Private Practitioners in Urban Davangere Karnataka

English

BACKGROUND: Tuberculosis and HIV infection together form a very grave public health hazard. Detection of HIV infection among TB patients offers the opportunity to deliver prompt HIV care, such as cotrimoxazole prophylaxis and antiretroviral treatment, which can reduce suffering and death. AIM: To know the sociodemograhic profile and prevalence of HIV among in newly diagnosed, untreated TB patients at tertiary care hospital in a rural area. MATERIALS AND METHODS: This prospective study was carried at the RNTCP center and ICTC center at tertiary care hospital, of Bangalore rural area, South India from March 2009 to February 2012.A total of 605 TB patients were studied. Diagnosis of TB was made as per RNTCP guidelines. HIV was screened as per NACO guidelines. Data were analyzed using Microsoft excel software. RESULTS: This study showed 28/605(4.62%) prevalence of HIV among TB patients. Higher prevalence was seen in males and in 21-40 age group. Pulmonary TB is the most common type of TB in HIV/TB patients. Treatment success rate in HIV positive patients was 18(64.28%) and 285(84.05%) in HIV negative patients. Higher mortality rate 4(14.28%) was observed in HIV positives TB patients compared to 34(5.89%) HIV negative TB patients. Failure rate was also high 1(3.57%) in HIV positive TB patients. CONCLUSION: There is a need for the RNTCP and NACO to collaborate on feasibility of making HIV counseling and testing routinely available to all DOTS and other TB patients throughout India.

English

BACKGROUND: HIV & Tuberculosis is a common co- infection that we come across in developing countries. Diagnosis is done by demonstration of acid fast bacilli (AFB) &Tuberculin skin test (TST). Skin test depends on cell mediated immune response which is generally compromised in HIV infected. OBJECTIVE: To compare the demonstration of AFB &TST reactivity in tuberculosis patients who are HIV seropositive & seronegative MATERIALS & METHODS: The study was conducted in the tuberculosis hospital which is attached to the Mysore medical college, Mysore. All patients clinically suspected or diagnostically confirmed as pulmonary tuberculosis were subjected for HIV screening test as per NACO guidelines .Total of 200 patients included for the study out of which 100 each were HIV seropositive & seronegative. They were subjected for microscopic examination of sputum& TST. Sputum microscopy was performed as per RNTCP guidelines. PPD antigen was injected intra- dermally on the left forearm & read after 48 hours & results were noted down. RESULTS: Study group divided into two categories. Category A: Pulmonary tuberculosis patients with HIV seropositivity Category B: Pulmonary tuberculosis patients with HIV seronegativity. Male preponderance was observed in both 79% & 70% with the mean age of 32.7 ± 7.3 years, in females seronegativity was more i.e.30% compared to 21% in seropositive with mean age of 29.3 ± 5.6 years. AFB demonstrated by Sputum microscopy in 99% HIV seronegatives & 54% of HIV seropositives. TST results classified into groups with No response, induration of 1-5mm,6-9mm & >10mm. Among category A 9 of them exhibited No response,32 of them 1-5mm,27 of them 6-9mm & 32 of them >10mm.All category B has responded to TST with only one patient with 1-5mm,25 with 6-9mm,74 with >10mm. DISCUSSION: There is statistically significant difference (p>0.05) in TST &AFB demonstration in pulmonary tuberculosis patients with HIV seropositive & seronegative. Sensitivity of TST is reduced as TST is indicator of cell mediated immune response which is generally compromised in HIV seropositive. Demonstration of AFB is also reduced in HIV seropositive cases. CONCLUSION: TST & demonstration of AFB are common tests done to screen for HIV-TB co infection in HIV seropositive. As the sensitivity of these tests are reduced in HIV seropositive it needs to be interpreted with care.

Directly observed treatment, short course in tuberculous meningitis: Indian perspective

Background:Effectiveness of intermittent short course chemotherapy for tuberculous meningitis (TBM) has not been well studied. There are scarce reported studies on this issue in the world literature. Neurologists all over India are reluctant to accept Directly Observed Treatment Short course (DOTS) for TBM since its introduction in India.Aim:We did a prospective study to assess effectiveness of Revised National TB Control Program (RNTCP-DOTS) regimes among TBM patients.Materials and Methods:In this study we include the TBM patients admitted from September 2008 to March 2011. All were referred to RNTCP for treatment. Diagnostic Algorithm as per RNTCP guidelines was strictly followed and treatment outcome and follow-up status were recorded. We exclude HIV and pediatric age group.Results:A total of 42 cases registered for DOTS regimen were included in the study, of which 35 completed the treatment (83%). All the patients were started with DOTS but finally 78% received actual DOTS. All patients were given 9 months intermitted regimen as per RNTCP guidelines. Seven patients died during the treatment (16%).Conclusion:We found intermitted short course chemotherapy was effective in TBM.

A study of an association between tuberculosis and HIV among ICTC attendees at a tertiary care hospital of Shimla, Himachal Pradesh, India

Background: In India, HIV epidemic and tuberculosis (TB) have posed enormous challenges in the control of TB. Objectives: To determine the proportion of TB in HIV positive and HIV negative patients. Materials and Methods: This hospital based cross-sectional study was conducted in the ICTC of Indira Gandhi Medical College, Shimla from 1 st January 2007 to 31 st August 2007. A sample of 525 consecutive attendees in the age group of 15 to 50/> years were included as study subjects. After counseling, confirmation of HIV status was done according to NACO and diagnosis of TB as per the RNTCP guidelines. Their clinical presentations, PTB and site of EPTB were studied.A pretested questionnaire was used to collect a detailed history followed by a physical examination. Laboratory and radiological investigations were carried out appropriately. Results: Among the 525 attendees, 198 (37.7%) were seropositives and 327 (62.3%) were seronegatives. Of the seropositives more affected were females, 105 (53%) than males, 93 (47%). Wherein among seronegatives, male to female ratio was 2:1. The most common symptoms of PTB among seropositives were cough >3 weeks in 40%, followed by production of purulent sputum in 33.8% and fever >3 weeks in 23% as compared to seronegatives, where the commonly reported symptom was cough >3 weeks in 25.4% (P < 0.00002). EPTB was observed in almost double the proportion, 24.2% of seropositives as compared to seronegatives, 12% (P < 0.0001). However, 17.7% of seropositives as compared to 10.1% of seronegatives were suffering from PTB infection (P < 0.006). Conclusion: TB in HIV patients presentas extra-pulmonary involvement more frequently.

Primary Nasal Tuberculosis

ABSTRACTTuberculosis of nose, nasopharynx and paranasal sinus is extremely rare even in countries with a high incidence of pulmonary disease. We present two cases of primary nasal tuberculosis managed in last three years in our department with 2500 to 3000 patient visits per month. One case simulated basal cell carcinoma while other case was an ATT defaulter. Both the cases were managed on RNTCP guidelines. Nasal tuberculosis needs high level of suspicion and is diagnosed with laboratory support.