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Sarin R, Vohra V, Singla N, Singla R, Puri MM, Munjal SK, Khalid UK, Myneedu VP, Verma A, Mathuria KK. Early efficacy and safety of Bedaquiline and Delamanid given together in a "Salvage Regimen" for treatment of drug-resistant tuberculosis. Indian J Tuberc 2019; 66:184-188. [PMID: 30878066 DOI: 10.1016/j.ijtb.2019.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug-Resistant Tuberculosis (DR-TB) patients for whom a WHO recommended regimen along with Bedaquiline (BDQ) cannot be prescribed, Delamanid (DLM) was added along with other drugs to provide a "Salvage Regimen". The experience of the Institute in respect of early efficacy and safety of both drugs given together is presented. OBJECTIVE To ascertain the early efficacy, safety and tolerability of Bedaquline and Delamanid given together as a part of salvage regimen. METHODS BDQ and DLM were used together to make regimens along with other drugs where four effective anti TB drugs could not be prescribed as per WHO recommendations. Patients were followed up for sputum smear and culture conversion and adverse events during the treatment. RESULTS In this cohort study, 53 DR-TB patients (Median age-24) were initiated on regimens containing both BDQ and DLM. Sputum smear conversion was seen in 35% and 94% patients at the end of 1st week and 3rd month respectively. 84% patients had culture conversion at the end of 4th month. 29 adverse events (AE) were reported among 17 patients and there were 11 deaths. QTc prolongation more than 500 MS was seen in only 1 patient. CONCLUSION BDQ and DLM given together in a salvage regimen is efficacious with low rate of adverse events. The combination provides hope to DR-TB patients with limited treatment options and should be provided as a life saving option.
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Affiliation(s)
- Rohit Sarin
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India.
| | - Vikram Vohra
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - Neeta Singla
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - Rupak Singla
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - M M Puri
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - S K Munjal
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - U K Khalid
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - V P Myneedu
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - Ajoy Verma
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
| | - K K Mathuria
- National Institute of Tuberculosis & Respiratory Disease, Sri Aurobindo Marg, Delhi 110030, India
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Arora P, Kumar L, Vohra V, Sarin R, Jaiswal A, Puri MM, Rathee D, Chakraborty P. Evaluating the technique of using inhalation device in COPD and bronchial asthma patients. Respir Med 2014; 108:992-8. [PMID: 24873874 DOI: 10.1016/j.rmed.2014.04.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/07/2014] [Accepted: 04/27/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In asthma management, poor handling of inhalation devices and wrong inhalation technique are associated with decreased medication delivery and poor disease control. The key to overcome the drawbacks in inhalation technique is to make patients familiar with issues related to correct use and performance of these medical devices. The objective of this study was to evaluate and analyse technique of use of the inhalation device used by patients of COPD and Bronchial Asthma. METHODS A total of 300 cases of BA or COPD patients using different types of inhalation devices were included in this observational study. Data were captured using a proforma and were analysed using SPSS version 15.0. RESULT Out of total 300 enrolled patients, 247 (82.3%) made at least one error. Maximum errors observed in subjects using MDI (94.3%), followed by DPI (82.3%), MDI with Spacer (78%) while Nebulizer users (70%) made least number of errors (p = 0.005). Illiterate patients showed 95.2% error while post-graduate and professionals showed 33.3%. This difference was statistically significant (p < 0.001). Self-educated patients committed 100% error, while those trained by a doctor made 56.3% error. CONCLUSION Majority of patients using inhalation devices made errors while using the device. Proper education to patients on correct usage may not only improve control of the symptoms of the disease but might also allow dose reduction in long term.
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Affiliation(s)
- Piyush Arora
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
| | - Lokender Kumar
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India.
| | - Vikram Vohra
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
| | - Rohit Sarin
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
| | - Anand Jaiswal
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
| | - M M Puri
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
| | - Deepti Rathee
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
| | - Pitambar Chakraborty
- National Institute of TB and Respiratory Diseases (Erstwhile L.R.S Institute of TB and Respiratory Diseases), New Delhi, India
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Puri MM, Jain AK, Kumar L, Sarin R. Total replacement of a lung by tuberculosis pneumatocele--an unusual post-tuberculosis sequel. Indian J Tuberc 2014; 61:162-165. [PMID: 25509941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Total replacement of a lung by pneumatocele in pulmonary tuberculosis is rare. The formation of pneumatoceles in adult pulmonary tuberculosis can occur before, during or after anti-tuberculosis treatment. A case of pneumatocele formation in a 19-year young female following pulmonary tuberculosis is reported. The left lung was completely replaced by pneumatocele. Total replacement of a lung by pneumatocele inspite of successful chemotherapy of tuberculosis is rare and should be considered as one of the differential diagnosis for acquired cysts of the lung.
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Puri MM, Kumar L, Vishwakarma PD, Behera D. Seizures with single therapeutic dose of isoniazid. Indian J Tuberc 2012; 59:100-102. [PMID: 22838208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Isoniazid (INH) is an integral component of treatment of tuberculosis. An acute overdose is potentially fatal and is characterised by the clinical triad of repetitive seizures unresponsive to the usual anticonvulsants, metabolic acidosis with a high anion gap and coma. A case of isoniazid induced seizures after therapeutic dose of 600 mg. as a part of CAT I thrice weekly intermittent anti-tuberculosis regimen for pulmonary tuberculosis is reported. The frequency of the usage of Isoniazid as antituberculosis therapy requires that physicians be aware of such toxicity.
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Affiliation(s)
- M M Puri
- Department of Tuberculosis and Respiratory Diseases, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi.
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Kumar L, Gupta R, Puri MM, Jaiswal A, Murar A, Behera D. Unilateral and painless development of isoniazid induced gynecomastia during re-treatment of pulmonary tuberculosis. J Assoc Physicians India 2011; 59:733-735. [PMID: 22616343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A case of isoniazid induced gynecomastia is being reported in an 18-year old male, who received a re-treatment regimen for the relapse of pulmonary tuberculosis (TB). At the end of two months of the treatment, the patient developed a painless unilateral gynecomastia, which completely disappeared after a month of the cessation of isoniazid. A review of literature on isoniazid induced gynecomastia is discussed.
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Affiliation(s)
- Lokender Kumar
- Department of Tuberculosis and Respiratory Diseases, LRS Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi--110030
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Affiliation(s)
- M M Puri
- Department of Tuberculosis and Respiratory Diseases, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
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Sarin R, Singla R, Visalakshi P, Jaiswal A, Puri MM, Khalid UK, Mathuria K, Singla N, Behera D, Sharma PP. Smear microscopy as surrogate for culture during follow up of pulmonary MDR-TB patients on DOTS Plus treatment. Indian J Tuberc 2010; 57:134-140. [PMID: 21043311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND DOTS Plus site at LRS Institute, New Delhi, covering 1.8 million population. AIMS To ascertain if sputum smear could be used as a surrogate for culture during intensive phase of treatment of MDR-TB patients thereby enabling early shift from intensive phase to continuation phase, reducing the need for frequent cultures and saving time and cost in their management. METHODS The study is a retrospective analysis of 138 MDR-TB patients on DOTS Plus treatment whose sputum samples were simultaneously subjected to smear microscopy and culture, monthly during Intensive Phase and once in two months during Continuation Phase. Sputum results in the treatment card were supplemented from laboratory register, if required, and analyzed. Predictive values, sensitivity and specificity of smear were compared with culture results. RESULTS The Negative Predictive Value (NPV) of smear was high from the 3rd month onwards (above 91%), at four months 98% or more and approached 100% from eight months onwards. The specificity of smear test gradually increased during treatment and from five months onwards, it was above 90%. CONCLUSIONS Considerable correlation was observed between sputum smear and culture during follow up of DOTS Plus treatment in the Intensive Phase. Accordingly, sputum smears can be recommended instead of culture.
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Affiliation(s)
- R Sarin
- Department of TB Control & Training, LRS Institute of TB & Respiratory Diseases, New Delhi.
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Puri MM, Kumar S, Prakash B, Lokender K, Jaiswal A, Behera D. Tuberculosis pneumonia as a primary cause of respiratory failure--report of two cases. Indian J Tuberc 2010; 57:41-47. [PMID: 20420044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Tuberculosis (TB) is one of the treatable diseases rarely causing Acute Respiratory Failure (ARF). Hypoxic respiratory failure is often fatal in miliary tuberculosis and acute tuberculous bronchopneumonia. We describe two patients of tuberculous pneumonia with ARF who were successfully treated with early appropriate anti-tuberculosis therapy.
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Affiliation(s)
- M M Puri
- Department of Tuberculosis and Respiratory Diseases, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi.
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Singla R, Sarin R, Khalid UK, Mathuria K, Singla N, Jaiswal A, Puri MM, Visalakshi P, Behera D. Seven-year DOTS-Plus pilot experience in India: results, constraints and issues. Int J Tuberc Lung Dis 2009; 13:976-981. [PMID: 19723377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND India is initiating the DOTS-Plus strategy at the national level. OBJECTIVES To highlight the results, constraints and issues of a pilot DOTS-Plus experience in an urban setting in India. METHODS Records of 126 patients with multidrug-resistant tuberculosis (MDR-TB) enrolled from January 2002 to December 2006, who received a daily fully supervised standardised treatment regimen under a pilot DOTS-Plus study in India, were analysed retrospectively. RESULTS Of the 126 patients enrolled, 61% were cured, 19% died, 18% defaulted and 3% failed treatment. There was an average delay of 5 months in the diagnosis of MDR-TB and a subsequent delay of approximately 3.3 months in initiating treatment. Of the 24 patients who died, 29% did so within a month of starting treatment. Migration was the most common reason for default. Cycloserine (CYC) had to be stopped in 15 patients and kanamycin (KM) in five due to major adverse effects. CONCLUSIONS The DOTS-Plus programme in resource-poor settings may provide reasonable results; however, it may confront significant operational difficulties in the timely diagnosis and early initiation of treatment. Early diagnosis and start of treatment may prevent some deaths. Default is commonly due to migration. CYC proved to be the most toxic drug, followed by KM.
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Affiliation(s)
- R Singla
- Department of Tuberculosis and Chest Diseases, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Puri MM, Gupta K, Arora VK. A case of Hodgkin's disease presenting as lymphocytic interstitial pneumonitis. Indian J Chest Dis Allied Sci 2003; 45:139-42. [PMID: 12715939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Lymphoproliferative disorders of lung have a broad clinical and pathologic spectrum. The clinical and radiographic features are non-specific. Accurate diagnosis is required to initiate appropriate therapeutic intervention. We report a case of Hodgkin's disease mimicking lymphocytic interstitial pneumonitis in a 21-year-young male.
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Affiliation(s)
- M M Puri
- Department of Tuberculosis and Chest Diseases, L.R.S. Institute of Tuberculosis and Respiratory Diseases, New Delhi
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Puri MM, Arora VK. Role of gallium arsenide laser irradiation at 890 nm as an adjunctive to anti-tuberculosis drugs in the treatment of pulmonary tuberculosis. Indian J Chest Dis Allied Sci 2003; 45:19-23. [PMID: 12683708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Tuberculosis is a global emergency with about nine million people developing disease every year. The long duration of treatment has emerged as a major obstacle in the control of tuberculosis. There is a need for development of new drugs and or shortened therapy. METHODS The present study was carried out to explore whether any benefit could be achieved by the addition of low level energy laser therapy (LLLT) to the conventional anti-tubercular chemotherapy. One-hundred-thirty new sputum smear positive patients of pulmonary tuberculosis were enrolled to evaluate the bio-stimulatory effects of Gallium Arsenide laser irradiation at 890 nm, as an adjuvant therapy. These patients were randomly divided into two groups to receive either LLLT or sham irradiation (control) concomitantly with anti-tuberculosis chemotherpy. RESULTS The patients treated with semiconductor laser as an adjuvant therapy along with anti-tuberculosis drugs had a faster clearance of tubercle bacilli from the sputum as compared to the control group (P value at :45 days=0.1392, 60 days=0.0117, 75 days=0.00805, 90 days=0.00739). CONCLUSIONS These findings provide preliminary evidence that low level laser therapy with Gallium Arsenide laser may be a promising adjunctive therapy for patients with tuberculosis. Faster conversion of sputum should prevent the development of resistant mutants.
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Affiliation(s)
- M M Puri
- Department of Tuberculosis and Chest Diseases, LRS Institute of Tuberculosis and Allied Diseases, Sri Aurobindo Marg, New Delhi, India
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Puri MM, Dougall P, Arora VK. A case of tuberculosis of the thyroid gland. Med J Malaysia 2002; 57:237-239. [PMID: 24326661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of tuberculosis of the thyroid gland associated with mediastinal lymphadenitis in a 30 years-old male, who presented with dysphagia and a mid line anterior neck swelling. Fine needle aspiration was positive for acid fast bacilli. He made an uneventful recovery with antituberculous drugs. Although seldom observed, tuberculosis should be kept in mind in te differential diagnisis of nodular lesions of the thyroid.
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Affiliation(s)
- M M Puri
- L.R.S. Institute of Tuberculosis and Allied Disease, Sri Aurobindo Marg, New Delhi-I 10030" India
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Puri MM, Arora VK. Contralateral pleural effusion during chemotherapy for tuberculous pleural effusion. Med J Malaysia 2000; 55:382-4. [PMID: 11200723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A 25 year old woman developed a right pleural effusion 6 weeks after commencement of short course chemotherapy for left sided tuberculous pleural effusion. Since the patient improved following continuation of the same treatment, it is presumed to be a case of paradoxical response to anti-tuberculosis treatment.
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Affiliation(s)
- M M Puri
- LRS Institute of Tuberculosis and Allied Diseases, Sri Aurobindo Marg, New Delhi-110030, India
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Puri MM. Management of drug resistant tuberculosis. Indian J Med Sci 1999; 53:220-7. [PMID: 10695233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- M M Puri
- L.R.S. Institute of T.B. & Allied Diseases, Sri Aurobindo Marg, New Delhi
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Puri MM, John T. Nurses and fight against tuberculosis--II. Nurs J India 1998; 89:9-10. [PMID: 10670362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Puri MM, John T. Nurses and fight against tuberculosis. Nurs J India 1997; 88:269-72 contd. [PMID: 10531953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- M M Puri
- L.R.S. Institute of Tuberculosis and Allied Diseases, New Delhi
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Puri MM, Singla R, Jaiswal A, Gupta K, Jain RC. CASE REPORTS ON THE RÔLE OF LASER THERAPY IN THE TREATMENT OF TUBERCULOSIS OF THE LYMPH NODES. Laser Ther 1997. [DOI: 10.5978/islsm.9.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rajalingam R, Mehra NK, Chopra GS, Puri MM, Jain RC. Anti-IgG autoantibodies and possible immune regulatory mechanisms in patients with pulmonary tuberculosis. Tuber Lung Dis 1996; 77:502-9. [PMID: 9039442 DOI: 10.1016/s0962-8479(96)90047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
SETTING Anti-Ig antibodies are known to have important clinical and biological implications. OBJECTIVES To determine naturally occurring anti-F(ab')2 gamma and anti-Fc gamma antibodies in patients with pulmonary tuberculosis (PTB) in relation to various clinical manifestations and human leukocyte antigen (HLA). DESIGN Antibodies to F(ab')2 and Fc portions of IgG were detected in the sera of normal healthy individuals (n = 41), patients with pulmonary tuberculosis (n = 50) and their household family contacts (n = 20) using an enzyme immuno assay (EIA) system. RESULTS As compared to controls (0.110 +/- 0.01 optical density [OD]), the levels of anti-F(ab')2 gamma were significantly increased in PTB patients (0.998 +/- 0.08 OD, P < 0.0001) and in their contacts (0.486 +/- 0.04 OD, P < 0.001) suggesting that the occurrence of these autoantibodies is related to infection/exposure to Mycobacterium tuberculosis. Anti-F(ab')2 gamma antibodies were significantly increased in both sputum positive and negative patients (P < 0.0001) and no deviation was observed between these two groups. The levels of these antibodies were positively correlated with disease severity assessed by chest X-ray. The drug failure patients had higher activity of anti-F(ab')2 gamma than drug responders and no impact of anti-tuberculosis chemotherapy was observed. A statistically significant increase of anti-F(ab')2 gamma levels (1.25 +/- 0.21 OD) was observed in HLA-DR2 positive patients as compared to the DR2 negative groups (1.02 +/- 0.09 OD), P < 0.01. No deviation was observed in the levels of anti-Fc gamma levels between controls and any group of PTB patients. CONCLUSION The present data suggests that the elevated levels of anti-F(ab')2 gamma antibodies in PTB patients represent an anti-idiotypic antibody response to anti-M. tuberculosis antibody caused by an immune imbalance following M. tuberculosis infection.
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Affiliation(s)
- R Rajalingam
- Department of Histocompatibility and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
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Plant U, Puri MM, Bhatia MS. Prevention of blindness: role of nurses. Nurs J India 1983; 74:214-5. [PMID: 6557525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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