Title: Frequency of Pulmonary Tuberculosis in Smear Negative Patients with Suggestive Radiological Lesions in a Tertiary Care Centre
Authors: Dr Ronald Win B, Dr C Sudheendra Ghosh
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.25
Abstract
Introduction: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis, which may affect the lung, but it can also affect other part of the body. 50% of the patient will be smear positive and easy to diagnose and in smear negative cases the diagnosis is difficult. So understanding the proportion of pulmonary tuberculosis in smear negative cases within modern Cat 1 ATT will help in early diagnosis and treatment which reduce or prevent mortality and morbidity due to pulmonary tuberculosis.
Primary objective: To find out the proportion of pulmonary tuberculosis in smear negative patients with suggestive radiological shadows in a tertiary care centre.
Secondary objective: What are the characteristics of radiological shadows which indicate that it could be tuberculosis
Study design: Prospective study
Study setting: Department of pulmonary Medicine, Govt. Medical College, Thiruvananthapuram
Methodology: A total of 398 patients with sputum AFB negative and x-ray chest shows radiological lesions were investigated and treated with antibiotic. Then further investigated and grouped into different diagnosis. The non diagnosed cases with radiological lesion were subjected for Cat 1 ATT and the response is observed and proportion of smear negative tuberculosis cases were assessed.
Conclusion: Patients above the age of 40 and male population were at risk of smear negative pulmonary tuberculosis. Comorbidities like diabetes COPD and risk factors like smoking were significant factors associated with pulmonary tuberculosis. Proportion of pulmonary tuberculosis in smear negative patients with suggestive radiological shadow in a tertiary care centre was 41%. characteristics of radiological shadows which indicate that it could be tuberculosis.
Keywords: Proportion, pulmonary tuberculosis, smear negative radiological lesions.
References
- Raviglione MC, Snider DE Jr, Kochi A, Global Epidemiology of Tuberculosis: Morbidity and mortality of A world wide epidemic. JAMA 1995. 273: 220-6.
- World Health Organization Tuberculosis fact sheet world Health Organization Tuberculosis site (cited 1999 Dec 02) (3 screens)
- WHO (1998). The World Health Report 1998; Life in 21st century vision for all, Report of the Director General WHO.
- Murray CJL, Styblo K, Rouillion A. Tuberculosis in developing countries: burden, intervention and cost. Bull Int. Union Tuberc Lung disease 1990; 65: 6 - 24.
- WHO Report on the T-B Epidemic, T.B. a Global Emergency WHO/TB/94./77 Geneva World Health Organisation 1994.
- Stacher D “Tuberculosis - battling an Ancient Scourage” JAMA 1999: 282: 1996.
- Rosenblatt MB. Pulmonary Tuberculosis: Evoluation of Modern Therapy Bull NY Acade Med 1973; 49: 163 - 96.
- Zimmerman M.R Pulmonary and Osseus tuberculosis us on Egyptian mummy. Bull Ny Acad Med 1975; 55: 604-8.
- Daniel TM, Captain of Death. The story of Tuberculosis University of Rochesteri Press 1997, p.p.74-86.
- Sakula A. Robert Koch: Centenary of the Discovery of the Tubercle Bacillus. 1882 Thorax 1982; 37; 246-51.
- RNTCP Technical and operational Guidelines for Tuberculosis Control in India 2016.
- TB INDIA 2016 Annual status Report, T. B. decision DGHS, Ministry of Health and Family Welfare-2016.
- Feinsilver SH, Fein AM, Niedeman MS, Schuttz DE, Fougenberg DH. Utility of fiberoptic bronchoscopy in non resolving pneumonia. Chest 1990; 98: 133\22-6.
- Jayaprakash, Vipin Varkey K, Anithakumari. Etiology and clinical outcome of non resolving Pneumonia in a tertiary care centre JAPI Feb 2012 Vol. 6.0.
- Jaya SJ, Johnson WG Jr, Pierce AK. The radiographic resolution of streptococcus pneumonia. N Eng J Med 1975;293: 798-801.
- Arancibia F, Ewig S, Martinez JA, Ruiz M, Bauer T, Marcos MA et al Antimicrobial treatment failures in patients with community acquired pneumonia: causes and prognosis implications. Am J respire Crit care Med 2000; 162: 154-60.