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Chopra K.K.,New Delhi Tuberculosis Center
Indian Journal of Tuberculosis | Year: 2015

The emergence of M. tuberculosis strains resistant to at least, Isoniazid (INH) and Rifampicin (RIF), the two most potent drugs of first-line anti-TB therapy is termed multidrug drug-resistant TB (MDR-TB). This is a cause of concern to TB Control Programmes worldwide. When MDR-TB strains become resistant to the major second-line drugs, one of the fluouroquinolones and one of the three injectable drugs (Amikacin, Kanamycin and Capreomycin), it is defined as extensively drug resistant TB.1,2 MDR-TB is a manmade, costly and deadly problem. Rapid diagnosis of MDR-TB is essential for the prompt initiation of effective second-line therapy to improve treatment outcome and limit transmission of the disease. © 2015 Published by Elsevier B.V. on behalf of Tuberculosis Association of India.

Grover M.,Maulana Azad Medical College | Bhagat N.,Maulana Azad Medical College | Sharma N.,Maulana Azad Medical College | Dhuria M.,New Delhi Tuberculosis Center
Lung India | Year: 2014

Background: In order to put extrapulmonary tuberculosis patients early on treatment, it is important to study pathways, which these patients adopt in for seeking treatment. Materials and Methods: In order to study the treatment pathways of extrapulmonary patients and assess appropriate points for intervention, a cross-sectional study was conducted in chest clinic of a tertiary care hospital in Delhi. Results: Factors associated with longer paths included reason for going to first health facility (nearness and known provider), availing more than one health facilities, presenting symptoms of fever, joint pain, nodular skin swelling and skin lesion. Self-referral to the chest clinic was associated with shorter paths. Lower level of education, occupation, non-serious perception of the disease and visiting five health facilities were significantly associated with patient delay of more than 3.5 weeks. Symptoms of fever, joint pain and skin lesion, visiting private health facility first, availing more than two health facilities and travelling distance of more than 100 km to reach chest clinic were significantly associated with the health facility delay of more than 4.5 weeks. Conclusions: Increasing public awareness, training of private practitioners and capacity building of government facilities will help in reducing delay.

Singh M.,Jawaharlal Institute of Postgraduate Medical Education & Research | Sethi G.R.,Maulana Azad Medical College | Mantan M.,Maulana Azad Medical College | Khanna A.,Chest Clinic TB | Hanif M.,New Delhi Tuberculosis Center
International Journal of Tuberculosis and Lung Disease | Year: 2016

SETTING: A tertiary care teaching hospital in New Delhi, India. OBJECTIVE : To determine the sensitivity and specificity of the Xpertw MTB/RIF assay in paediatric pulmonary tuberculosis (PTB) using MGITTM culture as gold standard. METHODS : After ethical approval had been obtained, 50 patients aged 0-14 years with suspected PTB were enrolled. Sputum/induced sputum and gastric lavage from the participants were sent for direct smear, MGIT culture and Xpert testing. Chest X-ray and tuberculin skin test (TST) were also performed. PTB diagnosis was made without considering Xpert results according to the Revised National Tuberculosis Control Programme (RNTCP) algorithm. The sensitivity and specificity of Xpert were calculated using culture as gold standard. RESULT S : Of 50 individuals with suspected PTB, 23 (46%) were diagnosed with PTB based on the RNTCP algorithm. Sixteen children from the PTB group (69.5%) were Xpert-positive. None in the 'ñot PTB' group were Xpert-positive. With culture as gold standard, Xpert sensitivity and specificity were respectively 91.6% (95%CI 59.7-99.5) and 86.8% (95%CI 71.1-95.05). CONCLUS ION: In almost 70% of PTB cases, a definitive diagnosis could be made within 2 h using Xpert, establishing its role as a sensitive and specific point-ofcare test. © 2016 The Union.

Mashta A.,National Institute of Immunology | Mishra P.,National Institute of Immunology | Philipose S.,National Institute of Immunology | Tamilzhalagan S.,National Institute of Immunology | And 3 more authors.
Journal of Negative Results in BioMedicine | Year: 2011

This work describes the experience at a tuberculosis clinical laboratory where relatively new TB diagnosis technologies; nucleic acid detection of two target strands, IS6110 and devR, by PCR and microscopic observation drug susceptibility (MODS) were used. The LJ culture was the gold standard. This evaluation was done from August 2007 to July 2009 on 463 sputum samples of tuberculosis suspects at a specialized tuberculosis clinic in Delhi, India. None of the tests we evaluated can accurately detect the presence or absence of Mycobacterium tuberculosis in all the samples and smear microscopy was found to be the most reliable assay in this study. The PCR assay could detect down to 2 pg of H37Rv DNA. Sensitivity, specificity was 0.40, 0.60 and 0.19, 0.81 for smear positive (n = 228) and negative samples (n = 235) respectively. In the MODS assay, sensitivity, specificity of 0.48, 0.52 and 0.38, 0.76 was observed for smear positive and negative samples. Sputum smear microscopy had sensitivity of 0.77 and specificity of 0.70. © 2011 Mashta et al; licensee BioMed Central Ltd.

Sharma S.,PGIMER and DR. RML Hospital | Gupta H.K.,PGIMER and DR. RML Hospital | Chopra K.K.,PGIMER and DR. RML Hospital | Chopra K.K.,New Delhi Tuberculosis Center | And 4 more authors.
Indian Journal of Tuberculosis | Year: 2014

Background: Liver abscess is fairly common in developing countries and its incidence is ever-rising. Though amoebic and pyogenic liver abscesses form majority of cases in our country, tubercular liver abscess (TLA) should also be considered as differential diagnosis.Aims: To study the clinical and imaging profile of tubercular liver abscess while establishing its increased incidence.Methods: A prospective observational study was carried out on 72 indoor cases of liver abscess, presenting to Department of Medicine, from November 2011 to February 2013. All cases were subjected to abscess tap and tapped abscess was sent for microbiological examination.Results: Though amoebic liver abscess was most common type diagnosed, five cases came out to be tubercular (AFB positive). Mean age of TLA patients was 28.4 years (all males). All cases were sub-acute in presentation. Splenomegaly and ascites were noted in 60% and 40% cases respectively. ESR was raised in 80% cases with mean value of 52.8 mm at first hour. Haemoglobin was low in 80% cases. Serum Alkaline phosphatise (ALP) was raised in all cases, mean value being 1034.4 U/ L. On ultrasonography, all abscesses were < 5 centimetres in size, most commonly involving seventh segment. They were multiple in numbers in 60% cases. All cases responded well to anti-tubercular treatment.Conclusions: Tubercular liver abscess has increased in incidence, and in majority of cases in our study, they were incidentally found with no associated foci of infection in lung or gastrointestinal tract. So, keeping high index of suspicion, TLA should be considered in all patients with subacute presentation and associated anaemia, splenomegaly or ascites. Also, TLA is associated with raised ESR and comparatively higher levels of ALP in serum. They are more commonly multiple in number on ultrasonography. © 2014, Tuberculosis Association of India. All rights reserved.

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