Tuberculosis – Treatment, Counseling and Motivation of The Patient

Though age old stigma with tuberculosis has educed but people still have misconceptions about the disease, its contagiousness and the way it can affect others.

Clear communication is the keystone of patient diagnosis and it begins with telling the correct diagnosis and counseling the patient and family.

It is preferable to counsel the family together to begin with, to educate them and to dispel myths and to gain their support towards regular compliance by the patient. Read more

Natural killer Cells, Immune Response and MHC

Natural killer cells are sonamed because they are potent cytotoxic cells whose targets are not restricted i.e., they are not antigen-specific. They make up 5-10 percent of the  lymphocyte population.

They are activated by IL-15.

They have the appearance on light microscopy of large lymphocytes with numerous cytoplasmic granules and are sometimes called large granular lymphocytes. The granules contain substances that facilitate target cell lysis including perforin (a pore-forming protein) and granzymes. They classically express the CD16 and CD56 cell-surface markers. Read more

Mantoux Test In Tuberculosis

The Mantoux test is very widely used test for tuberculosis. Its interpretation however complex. It is also called tuberculin test.

Tuberculin is a glycerol extract of the tubercle bacillus. Purified protein derivative (PPD) tuberculin is a precipitate of non-species-specific molecules obtained from filtrates of sterilized, concentrated cultures.

The test is named after Charles Mantoux, a French physician who developed on the work of Koch.

Procedure

A standard dose of 5 Tuberculin units (0.1 mL) is injected intradermally and read 48 to 72 hours later. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins. Read more

Chest Xray and Computed Tomography in Tuberculosis of Lungs

Chest Xray

The radiological opacities in a chest x-ray are a result of the pathological processes taking place in the lungs. TB causes alveolar consolidation, necrosis, cavitation and fibrosis, features, which it shares with a variety of lung diseases.

TB also shares its radiological features with many other pulmonary diseases. There is no radiological feature that is absolutely typical of pulmonary TB and other diseases may mimic TB radiologically. The following features, however, when seen on a chest skiagram, suggest a diagnosis of TB: Read more

Treatment of Esophageal Variceal Bleeding

Sclerotherapy: Sclerosing agents like sodium tetradocyl sulphate and 3 percent phenol in water are injected through upper GI endoscopy, around the varices. They obliterate the blood vessels and prevent future bleeds.

It stops variceal bleed in 80 percent of patients and can be repeated if bleeding recurs. However, if there is active bleeding, sclerotherapy is hazardous and first the bleeding should be controlled by balloon tamponade. Read more

Side Effects of Drugs During Treatment of Tuberculosis

Isoniazid

Common side effects: Hepatitis, peripheral neuropathy
Uncommon side effects: Cutaneous reactions, arthralgia, drug induced lupus, optic neuritis, convulsions, mental symptoms aplastic anaemia, haemolytic anaemia agranulocytosis, gynaecomastia.

Read more

Need For Family Contact Survey In Tuberculosis

Mycobacterium tuberculosis can survive or a long time in darkness, away from sunlight.Those persons who stay indoors for prolonged periods with a patient of pulmonary TB are most likely to get infected.

A patient of tuberculosis is likely to have infected some of his own family members prior to reporting to you.

Of those infected, some may develop the disease. Read more

Investigations That Aid In Diagnosis of Pulmonary Tuberculosis

Routine blood and urine examinations in pulmonary tuberculosis are as non-specific as those of physical examination. The patient may be found to be anaemic with a normal or raised WBC count.

Erythrocyte sedimentation rate (ESR)

ESR is o a non-specific investigation which may become rapid in a large variety of clinical conditions ranging from anaemia to any chronic infectious, inflammatory or malignant disease. Read more

Role of Complement In The Immune Response?

Complement components have immunologic activity both individually and in an activation cascade leading to a polymer formed by C5, C6, C7, C8, and C9 (the membrane attack complex, or MAC), which results in lysis of target cell membrane.

Early classic complement components (especially C3 products) act as opsonins and assist in the phagocytosis of bacterial particles by neutrophils and macrophages.

Certain complement split products (C3a and C5a) are chemotactic for phagocytic neutrophils and also act as “anaphylatoxins,” which directly stimulate mast cells and basophils to release histamine resulting in increasedvascular permeability.

Deficiency of early complement components is associated with increased pyogenic infections (C3 deficiency) and an increased incidence of autoimmune diseases, possibly owing to impaired clearance of immune complexes. The MAC appears especially important in host defense against Neisseria infection. Deficiency of any one of the terminal complement components can result in recurrent infections with Neisseria.

The complement system can be activated by three pathways:

Classical-IgM and IgG binding to antigen forming immune complexes that can bind Clq activating Clr and Cls to cleave c4. other proteins including c-reactive protein (binds Clq), serum amyloid P, and C4 nephritic factor can activate this pathway.

Alternative-activated by lipopolysaccharide on microbial cell surfaces in the absence of antibody. C3 and factor B bind to cell surface forming C3bBb, which functions to cleave more C3 molecules. This is part of the innare immune system. IgA complexes and C3 nephritic factor can also activate this pathway.

Lectin-mannan-binding lectin is secreted by the liver and binds to microbial ligands. This activates mannan-binding lectin-associated proteases that are related to Clr and Cls and can cleave C4 resulting in complement activation.

Neutrophils and Eosinophils In Immune Response

Neutrophil granulocytes, generally referred to as neutrophils, are the most abundant type of white blood cells in mammals and form an essential part of the immune system. Neutrophils are important in phagocytosing and digesting foreign particles at sites of inflammation and antigen entry. Neutrophils kill and dissolve microbes by

• Release of enzymes and bactericidal products from their intracytoplasmic granules
• By generation of toxic oxygen radicals and hypohalous acids.

Clinical deficiency of leukocytes manifests as recurrent skin and soft tissue infections with pyogenic organism and sepsis. Read more

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