Multivariate Analysis of Tuberculous Pleural Effusion and Evaluation of Serological Response to A 60 Antigen Complex.

Kalaiselvi, G (2006) Multivariate Analysis of Tuberculous Pleural Effusion and Evaluation of Serological Response to A 60 Antigen Complex. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Tuberculosis, “the captain of all the men of death”, a reemergent killer, is threatening to assume serious proportions all over the world. India is one of the worst affected countries bears about 28.4% of the entire world’s population. There are 15 million estimated cases in India with 8.8 million new cases, of which 3.9 million cases are smear positive. Every year 2.2 million contact tuberculosis and every second an Indian over 20 years of age is infected. (RNTCP statistical report, 2005). Tuberculosis became a problem with the emergence of HIV/AIDS pandemic, because HIV not only reactivates a latent infection but also makes the disease more serious and treatment ineffective. Another factor that has made the situation more grave is the emergence of multidrug resistant tuberculosis (MDR TB). So serious is the global threat of tuberculosis WHO in 1993 took the unprecedented step of declaring this disease, a global emergency. Extra Pulmonary tuberculosis is increasing worldwide. The global increase is believed to be fuelled by the HIV related immune competence, more than 70% of the HIV positive individual with tuberculosis have had extra pulmonary presentation, while its prevalence is 15–30% in immuno compromised individuals. Tuberculosis of the pleura is considered to be one among the severe form of extra pulmonary tuberculosis. It can occur alone or in combination with the pulmonary variety. AIMS AND OBJECTIVES : 1. Isolation of Mycobacterium tuberculosis in Tuberculous pleural effusion employing conventional bacteriological methods. 2. Identification of Mycobacteria employing standard phenotypic methods. 3. Species level confirmation employing high performance liquid chromatography. 4. Identification of Mycobacteria employing molecular methods such as PCR. 5. Performing drug susceptibility on the isolates confirmed as Mycobacterium tuberculosis. 6. Screening of the study subjects for the presence of HIV infection. 7. To evaluate the diagnostic potential of the A60 antigen complex by ELISA in Tuberculous pleural effusion patients. MATERIALS AND METHODS : This study was carried out at Department of Microbiology, Coimbatore Medical College, Coimbatore, Tamil Nadu from October 2004 to September 2005. All the Patients who were clinically diagnosed as pleural effusion got admitted during the study period with pleural effusion in the Department of Medicine, Coimbatore Medical College Hospital, Coimbatore were considered for the study. Those patients who fulfilled the following inclusion criteria were included as study population Inclusion criteria: 1. Radiological evidence of pleural effusion with or without pulmonary infiltrates (Plate I). 2. Ultrasound and C.T scan (Thorax) evidence of pleural effusion. 3. Biochemical analysis of pleural fluid demonstrated straw colured fluid, total count more than 500 cells /mm3, lymphocytic predominance (> 80%) and pleural fluid glucose more than 60 mg/ dl. 105 patients who fulfilled the above criteria were included in the study. Among the 105 cases 10 were < 20 years and 95 were >20 years of age. 71 were male and 34 were female. RESULTS : The results obtained are as follows: Of the 105 cases, 10 (10%) were <20yrs, 74(70%) were in between 20-50yrs and 21(20%) are above 50yrs. Maximum cases were recorded in the age group between 20 and 50yrs (Figure 1). In all the age groups the sex distribution was predominantly male(71%) with a ratio of 2:1 (Figure 2). All the patients included in the study were belonging to low socio economic status. 20% of them were working in the textile industries and 10% of them were residing in an area close to textile units. Their educational status was poor. Co morbid conditions like smoking; alcohol, diabetes, hypertension and previous exposure to tuberculosis were found in 48 (46%) (Figure 3) of patients. CONCLUSION : We have successfully established a panel of diagnostic tests for paucibacillary tuberculous plural effusion at Coimbatore Medical College, Coimbatore. • Delay in diagnosis leads to sequelae as well as spread of infection to other organs. • More than one diagnostic procedure is often needed for confirmation of TPE. • Bacteriological, chemical (HPLC), molecular (PCR), and serological confirmation may aid in current diagnosis of TPE. • Sputum smear examinations in TPE cases were useful only if there is concomitant pulmonary infiltrates. • PCR is the rapid and sensitive test, which can be carried out where facilities are available. • Drug susceptibility tests on culture positive cases will detect MDR – TB. • Since NTM are resistant to all first line drugs, the principle of therapy for NTM requires attention. • Despite of large number of studies carried out over the past several years, serology has found little place in the routine diagnosis of tuberculosis. Sensitivity and specificity depends on the antigen used. • This study shows that serodiagnosis is as equally sensitive as PCR. So serology can be carried out as a diagnostic test along with clinical evidence to diagnose tuberculous pleural effusion cases especially in peripheral centers where PCR facilities are not available.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Multivariate Analysis ; Tuberculous Pleural Effusion ; Evaluation ; Serological Response ; A 60 Antigen Complex.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 14 Aug 2017 06:40
Last Modified: 14 Aug 2017 06:40

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