Gyanshankar Mishra

Keywords: TDM, TB, Therapeutic drug monitoring, Tuberculosis

Introduction: Tuberculosis is one of the deadly diseases claiming a mortality rate 2.7 million lives, emphasise the need for early diagnosis and treatment initiation. But the diagnosis of sputum negative pulmonary tuberculosis is challenging even with a procedure like bronchoscopy which demands technical expertise and monitoring. Also the problem experienced at the grass root level is collection and transportation of sputum for CB-NAAT mycobacterium detection to the lab and results generation takes more than 1 week. Hence, a diagnostic test which is more feasible even to the primary health centre has to be established. Gastric aspirate though performed among the paediatric age group, its role in diagnosis of sputum negative pulmonary tuberculosis among adult patients is taken up in our study. Methodology: Patients above 18 years of age with pulmonary TB suspicion are tested for sputum for AFB followed by chest skiagram. Those with sputum negative and chest X-ray features suggestive of tuberculosis are included into the study. Early morning gastric aspirate with the nasogastric tube is performed. Buffered sample is processed and examined for AFB and culture testing in LJ medium. Results: 125 patients (102 male/23 female) satisfied the inclusion criteria were divided under the following categories as a) sputum smear negative for AFB (82) b) No sputum production (26) and c) morbidly sick (17). The diagnostic yield of smear positive in gastric aspirate was 24% (31), while the gastric aspirate cultured in LJ medium found to be positive for MTB in 22% (28). Four patients were positive for post gastric aspirate sputum for AFB. Among 22 patients who underwent bronchoscopy, seven were found to be positive for AFB. Conclusions: The positivity of AFB in smear and culture in gastric aspirate was 24% and 22% respectively. Hence gastric aspirate can be employed as a tool for diagnosis among sputum negative pulmonary tuberculosis. Keywords: Acid fast bacilli; Diagnostic bronchoscopy; Gastric aspiration; Sputum Negative pulmonary tuberculosis.

Introduction: Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. Isoniazid preventive therapy (IPT) is one of the widely recommended interventions aimed to reduce the burden of TB (Tuberculosis) in people living with HIV.  Methodology: A Retrospective analysis from clinical records, of all diagnosed HIV patients registered at ART (Anti-Retroviral Therapy) center of a tertiary care health institute) & initiated on six-month IPT (INH Preventive Therapy) during the period of November 2017 to December 2018 was conducted. Results: A total of 575 HIV patients (554 (96%) adults and 21(4%) pediatric patients) were initiated on six-month IPT. These included 298 (52%) males and 277 (48%) female patients. 435 (76%) patients completed full six months of therapy. 15(2%) stopped treatment prior to completion of six months. 120(21%) patients were on regular therapy at the time of study. 5 patients were taking the IPT irregularly at the time of study. Among the 15 HIV patients who stopped IPT prior to completion of therapy duration, reasons for stopping IPT were adverse drug reactions (ADRs) in 8(53 %) patients, refusal in 4 (27%) patients and increased pill burden in 3 (20%) patients. The compliance rate of IPT in HIV patients was 97%. Discussion: IPT Compliance is a potentially important factor in the disease course of HIV and hence an important determinant of survival rates in these patients. Appropriate monitoring and counselling may further increase the compliance rate of IPT among HIV patients. Conclusion: HIV patients initiated on IPT have a good compliance rate for completion of regular six-month IPT. Keywords: Human immunodeficiency; HIV; TB.