RESUMO
SETTING: Tertiary level tuberculosis (TB) institute in Delhi, India. OBJECTIVE: To study the risk factors for new pulmonary TB (PTB) patients failing treatment. DESIGN: Prospective case-control study. The profile of new PTB patients failing treatment (i.e., sputum smear-positive at 5 months of treatment) and responders under the Revised National Tuberculosis Control Programme (RNTCP) were compared and risk factors associated with treatment failure were analysed. RESULTS: A total of 42 treatment failure cases and 76 controls were enrolled in the study. The presence of cavity on chest X-ray (CXR), sputum acid-fast bacilli (AFB) smear positivity at 2 months of treatment and the number of interruptions in treatment were independently associated with failures. Among failure patients at 5 months, 17 (40.5%) had negative sputum culture for Mycobacterium tuberculosis, and only six (14.3%) had multidrug-resistant TB (MDR-TB). When put on retreatment, patients with smear-positive, culture-negative sputum had cure rates of 88.2% compared to 28.6% among culture-positive patients. CONCLUSIONS: The presence of cavity on CXR, sputum smear positivity at 2 months of treatment and the number of interruptions of treatment are risk factors for failure. Among failures based on smear examination, the prevalence of MDR-TB is low and many patients have negative cultures for M. tuberculosis. Smear positivity at the end of treatment may not be a reliable indicator of treatment failure.
Assuntos
Tuberculose Pulmonar/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Índia , Masculino , Estudos Prospectivos , Radiografia Torácica , Fatores de Risco , Escarro/microbiologia , Falha de Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/microbiologiaRESUMO
A twenty year old man presented with pain in the upper part of right hip. CT scan showed multiple osteolytic areas in the right ilium, suggesting malignancy. CT guided needle biopsy was done and diagnosis of tuberculosis was made. The patient was cured with medical management only. Isolated tuberculosis of the ilium is an extremely rare condition. It is important to have a high clinical suspicion to diagnose early and manage the patient without surgical intervention.
Assuntos
Ílio/microbiologia , Tuberculose Osteoarticular/diagnóstico , Antituberculosos/uso terapêutico , Biópsia por Agulha , Humanos , Ílio/efeitos dos fármacos , Masculino , Tomografia Computadorizada por Raios X , Teste Tuberculínico , Adulto JovemRESUMO
Tuberculosis of the parotid gland is an unusual occurrence. We describe here a case of bilateral parotid gland tuberculosis showing diffuse involvement, which is even more rare. The patient was diagnosed on fine needle aspiration cytology and treated with WHO-approved Directly Observed Treatment Short Course (DOTS) category III regimen under Revised National Tuberculosis Programme with effective remission.