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Tuberculosis
Surendra K Sharma, Alladi Mohan
CHAPTER 1:
Introduction
INTRODUCTION
TUBERCULOSIS EPIDEMIC
TUBERCULOSIS DIAGNOSTICS
NEWER ANTITUBERCULOSIS DRUG DISCOVERY
VACCINE
CORRELATES OF IMMUNOPROTECTION FROM TUBERCULOSIS
Response to the Challenge of Multidrug-resistant and Extensively Drug-resistant Tuberculosis
Other Innovations
CHAPTER 2:
History
INTRODUCTION
TUBERCULOSIS IN ANCIENT TIMES
DIAGNOSIS
TREATMENT
TUBERCULOSIS IN ARTS AND LITERATURE
HUMAN IMMUNODEFICIENCY VIRUS INFECTION
INDIA AND TUBERCULOSIS CONTROL
Tuberculosis Research Centre, Chennai
The Madras Experiment
National Tuberculosis Institute
Revised National Tuberculosis Control Programme
EPILOGUE
ACKNOWLEDGEMENTS
CHAPTER 3:
Epidemiology
INTRODUCTION
INFECTION AND ITS PROGRESS IN INDIVIDUALS AND COMMUNITY: THE BACKGROUND BEHIND EPIDEMIOLOGICAL LOAD
Experience from Animal Models of Pulmonary Tuberculosis
Progress of Infection into Clinical Tuberculosis
The Course of Tuberculosis Epidemic
INDICES USED AND DEFINITIONS
Definitions Used
Death
Prevalence and Incidence of Infection
Prevalence of Disease
Incidence of Disease
Concepts Regarding the Use of the Indices
Death
Prevalence and Incidence
Data Source and Indices Used for Observing Trend
SETTING THE GOAL OF INTERVENTION IN INDIA: THE EPIDEMIOLOGICAL CONTEXT
TUBERCULOSIS PROBLEM: STUDIES ON INDIAN SITUATION
Epidemiological Methods: Some Prominent Indian Studies
A Community-wide Tuberculosis Study in Madanapalle, South India [Madanapalle Study]
Tuberculosis Sample Survey in India
Tuberculosis Studies in Bengaluru Area: National Tuberculosis Institute Longitudinal Epidemiological Studies
Tuberculosis Prevention Trial, Madras [Variously known as Feasibility Study, Chingleput Trial or BCG-Trial]
Tuberculosis Trends in New Delhi [New Delhi Study]
India: Distribution of the Problem
Annual Risk of Infection
Prevalence of Pulmonary Tuberculosis
Area-wise Distribution
Prevalence and Incidence by Age
Distribution of Prevalence and Incidence by Gender
Tuberculosis by Socio-Economic Criteria
Epidemiological Classes of Tuberculosis States in the Community and Relative Risks
EPIDEMIOLOGICAL TREND OF TUBERCULOSIS IN INDIA
Tuberculosis Trend in the Bengaluru Rural Area
Tuberculosis Trend in a Rural Area of Tamil Nadu
Annual Risk of Infection
Prevalence of Cases
Incidence of Cases
X+ Cases
Comments on Findings
Tuberculosis Trend in an Urban Area
Tuberculosis Trend in a Tribal Area
Tuberculosis in India: Current Status
REVIEW OF RECENT FACTORS THREATENING ESCALATION
Tuberculosis and HIV/AIDS
Tuberculosis and Multidrug-resistant and Extensively Drug-resistant Tuberculosis
ASSESSING TUBERCULOSIS SITUATION THROUGH MATHEMATICAL MODELLING
Tuberculosis Across the Globe
Tuberculosis Modelling in the Indian Context
EPIDEMIOLOGICAL EVALUATION: FUTURE DIRECTIONS
ACKNOWLEDGEMENTS
CHAPTER 4:
Epidemiology: Global Perspective
INTRODUCTION
ISSUES IN MEASUREMENT
Case Notification and Passive Case Detection
Active Case Detection
Aggregating Data and Geographical Heterogeneity
Mathematical Models and Epidemic Prediction
THE GLOBAL SCENARIO
Historical Trajectory
GLOBAL TUBERCULOSIS EPIDEMIC: CURRENT STATUS
Expansion of DOTS
Human Immunodeficiency Virus Co-infection
Drug-resistant Tuberculosis
GLOBAL TARGETS
CHAPTER 5:
Pathology
INTRODUCTION
CLASSIFICATION
HISTOPATHOLOGICAL APPEARANCE
Granuloma
Granulomatous Inflammation in Tuberculosis
DIFFERENTIAL DIAGNOSIS
PATHOGENESIS OF TUBERCULOSIS
PRIMARY TUBERCULOSIS
Primary Complex
Congenital and Perinatal Tuberculosis
Skin
Gastrointestinal Tract and Liver
Head and Neck
Genitourinary Tract
Eye
GENERALIZED [DISSEMINATED] TUBERCULOSIS
PULMONARY TUBERCULOSIS
Primary Pulmonary Tuberculosis
Progression of Tuberculosis
Further Changes of the Primary Complex
Healing
Early Generalization
Liquefaction and Progressive Primary Tuberculosis
Lobar and Segmental Lesions
Epituberculosis
Primary Tuberculosis in Adults
Post-Primary Pulmonary Tuberculosis
Early Lesions
Nodular Lesions
Fibrocaseous Tuberculosis
Other Lesions
Bronchial Lesions
Whole Lung Tuberculosis
Complications
Pleural Tuberculosis
ABDOMINAL TUBERCULOSIS
Intestinal Tuberculosis
Gross and Microscopic Pathology
Complications
Differential Diagnosis
Peritoneal Tuberculosis
Tuberculosis of the Liver
GENITOURINARY TUBERCULOSIS
Urinary Tract
Male Genital Tract
Female Genital Tuberculosis
NEUROTUBERCULOSIS
Macroscopic Features
Microscopic Features
SKELETAL TUBERCULOSIS
TUBERCULOSIS IN THE IMMUNOCOMPROMISED
NONTUBERCULOUS MYCOBACTERIAL INFECTIONS OF LUNG
Pathology
CHAPTER 6:
The Mycobacteria
INTRODUCTION
CLASSIFICATION
MYCOBACTERIUM TUBERCULOSIS
Morphology
Mycobacterial Cell Wall
Cultural Characters
Growth Requirements
Culture Media
Colony Characteristics
Virulence in Animals
Susceptibility to Physical and Chemical Agents
Antigenic Structure
Soluble Antigens
Polysaccharide Antigens
Biochemical Properties
Pathogenesis
Mycobacteriophages
Bacteriocins
Immunity and Hypersensitivity
Koch's Phenomenon
Laboratory Diagnosis
Drug Susceptibility Testing
NONTUBERCULOUS MYCOBACTERIA
MYCOBACTERIA PRODUCING SKIN ULCERS
Mycobacterium ulcerans
Mycobacterium marinum
SAPROPHYTIC MYCOBACTERIA
CHAPTER 7:
Immunology of Tuberculosis
INTRODUCTION
CHRONOLOGY OF IMMUNOPATHOGENESIS OF TUBERCULOSIS
INITIAL ENCOUNTER AND INNATE IMMUNITY
Tumour Necrosis Factor-α
Interleukin-1β and Interleukin-6
Interleukin-12 and Interleukin-18
Interferon-γ
Interleukin-10
Interleukin-4
Transforming Growth Factor-β
IMMUNE EFFECTOR MECHANISMS AGAINST MYCOBACTERIUM TUBERCULOSIS
ACQUIRED T-CELL MEDIATED IMMUNE MECHANISM
CD4+ AND CD8+ T-CELLS IN TUBERCULOSIS
CYTOKINES, CHEMOKINES AND GRANULOMA FORMATION
FINE T-CELL SUBSETS WITH AN IMMUNOREGULATORY ROLE
γδ T-cells
Natural Killer T-cells
Treg-Cells
IMMUNE EVASION BY MYCOBACTERIUM TUBERCULOSIS
IMMUNOMODULATORS IN TUBERCULOSIS
CHAPTER 8:
Genetic Susceptibility Parameters in Tuberculosis
INTRODUCTION
HOST IMMUNE RESPONSE AGAINST MYCOBACTERIUM TUBERCULOSIS
NON-GENETIC FACTORS INFLUENCING THE INCIDENCE OF TUBERCULOSIS
Demographic Factors
Socio-economic Factors
Malnutrition
Occupation
Alcoholism and Cigarette Smoking
Corticosteroids and Other Immunosuppressive Agents
Human Immunodeficiency Virus Infection
Other Diseases
GENETIC SUSCEPTIBILITY TO TUBERCULOSIS
Racial Differences
Twin Studies
ABO and Rh Blood Groups
IMMUNE RESPONSE GENES
MOLECULAR GENETICS AND ORGANIZATION OF HUMAN MAJOR HISTOCOMPATIBILITY COMPLEX GENES
Major Histocompatibility Complex Class I Genes
Major Histocompatibility Complex Class II Genes
Major Histocompatibility Complex Class III Genes [Central Genes]
BIOLOGICAL FUNCTIONS OF HUMAN LEUCOCYTE ANTIGEN
HUMAN LEUCOCYTE ANTIGEN AND DISEASE ASSOCIATIONS
IMMUNOGENETICS OF TUBERCULOSIS
Population Studies
Human Leucocyte Antigen Class I Association Studies
Human Leucocyte Antigen Class II Association Studies
Family Studies
High Resolution Analysis of Molecular Subtypes of HLA-DR2 in Mycobacterial Diseases
NON-HUMAN LEUCOCYTE ANTIGEN GENES IN MYCOBACTERIAL INFECTIONS
Genome-wide Linkage Analysis
CANDIDATE GENES IN TUBERCULOSIS
Cytokine Genes and Receptors
INNATE IMMUNITY TO TUBERCULOSIS: ROLE OF TOLL–LIKE RECEPTORS
THE FUTURE
CHAPTER 9:
Genetics of Susceptibility to Tuberculosis
INTRODUCTION
Population Variability in Susceptibility to Tuberculosis
Pathogenesis and Genetic Studies
Host-pathogen Interplay
METHODS IN THE GENETIC DISSECTION OF COMPLEX INFECTIOUS DISEASES
MOUSE MODELS
Solute Carrier Family 11 [Proton-Coupled Divalent Metal Ion Transporters] Member 1 [SLC11A1] Studies
Mouse Knock-out Studies
Cellular Immunity
Cytokines
Chemokines
Adhesion Molecules
Pattern Recognition Receptors
Major Histocompatibility Complex
Quantitative Trait Locus Analysis
GENETIC STUDIES IN HUMAN POPULATIONS
Mendelian Susceptibility to Mycobacterial Disease [OMIM 209950]
CANDIDATE GENES
Interleukin-12/Interleukin-23/Interferon-γ [IL-12/IL-23-IFN-γ] Pathway
Interferon-γ
Solute Carrier Family 11 [Proton-coupled Divalent Metal Ion Transporters] Member 1 [SLC11A1]
Vitamin D Receptor
Major Histocompatibility Complex
Mannose Binding Lectin
Linkage Studies
CHAPTER 10:
Laboratory Diagnosis
INTRODUCTION
CLINICAL SPECIMENS: COLLECTION AND TRANSPORTATION
Sputum
Collection Procedure
Collection of Specimens Other Than Sputum
Fibreoptic Bronchoscopy
Gastric Lavage
Urine
Cerebrospinal Fluid
Serous Fluids
Tissue
DIRECT DEMONSTRATION OF MYCOBACTERIA BY STAINING TECHNIQUES
Other Staining Methods Using Carbol Fuchsin
Fluorescent Staining
Petroff's Method
Value of Smear Examination in Extra-pulmonary Specimens
Gastric Washings
Laryngeal Swabs
Pus and Thick Aspirates
Pleural and Pericardial Fluid
Cerebrospinal Fluid
Urine
ISOLATION OF MYCOBACTERIA BY CULTURE
Cultural Characters
Culture Media
Colony Characteristics
Rapid Culture Methods
Septi Chek Acid-fast Bacilli Method
Rapid Liquid Tuberculosis Culture
Mycobacteriophage-based Detection Tests
TESTS FOR CONFIRMATION OF IDENTITY
Biochemical Properties
Niacin Test
Nitrate Reduction
Tween 80 Degradation [Tween Hydrolysis]
Neutral Red Test
Arylsulphatase Test
Catalase at Room Temperature
Catalase at 68 °C
Peroxidase Test
Nicotinamidase and Pyrazinamidase Activity
Susceptibility to Pyrazinamide
Susceptibility to P-Nitrobenzoate
Susceptibility to Thiophen-2-Carboxylic Acid Hydrazide [TCH]
Identification of Mycobacterium tuberculosis
Identification of Nontuberculous Mycobacteria
ANIMAL INOCULATION
IMMUNODIAGNOSIS
Antibody Detection Tests
Antigen Detection Test
Lipoarabinomannan Urine Test
Flow-through Filter Tests
Nucleic Acid Amplification Tests
Nucleic Acid Probes
Polymerase Chain Reaction
Amplified Mycobacterium tuberculosis Direct Test
GenoType Assays
Polymerase Chain Reaction Sequencing
Identification of Mycobacteria by High Performance Liquid Chromatography
DRUG SUSCEPTIBILITY TESTING
Direct Method
Indirect Test
Absolute Concentration Method
Resistance Ratio Method
Proportion Method
E Test
Microscopic-Observation Drug-Susceptibility Assay
BIOCHEMICAL AND IMMUNOLOGICAL MARKERS
Adenosine deaminase and Interferon-γ
TUBERCULOSIS LABORATORY RELATED SAFETY ISSUES
CHAPTER 11:
The Tuberculin Skin Test
INTRODUCTION
HISTORICAL BACKGROUND
THE TUBERCULINS
IMMUNOLOGICAL BASIS OF TUBERCULIN TEST
SKIN CHANGES IN TUBERCULIN SKIN TEST
THE STANDARD TUBERCULIN SKIN TEST
Product and Dosage
Storage
Administration of Test
Adverse Effects
Reading of the Test
SKIN SENSITIVITY TO TUBERCULIN
Infection with Environmental Mycobacteria
Bacille Calmette-Guerin Vaccination
Infection with Mycobacterium tuberculosis
SEPARATION OF REACTIONS DUE TO INFECTION WITH TUBERCLE BACILLI FROM REACTIONS DUE TO OTHER CAUSES
FALSE-POSITIVE AND FALSE-NEGATIVE REACTIONS
INTERPRETATION OF TUBERCULIN TEST
Interpretation of Tuberculin Skin Test Among Human Immunodeficiency Virus Infected Persons
REVERSION, BOOSTER PHENOMENON AND CONVERSION
DETECTION OF NEWLY INFECTED PERSONS
HEALTH CARE WORKERS AND TUBERCULIN TEST
BACILLE CALMETTE GUERIN TEST
EPIDEMIOLOGICAL USES OF TUBERCULIN TEST
Tuberculin Skin Test, Tuberculosis and Sarcoidosis
NEWER TUBERCULINS
THE FUTURE
CHAPTER 12:
Diagnosis of Latent Tuberculosis Infection: Recent Advances and Future Directions
INTRODUCTION
CURRENT APPROACH TO DIAGNOSIS OF TUBERCULOSIS INFECTION: THE TUBERCULIN SKIN TEST
INTERFERON-GAMMA RELEASE ASSAYS: BIOLOGY AND DEVELOPMENT
COMMERCIALLY AVAILABLE INTERFERONGAMMA RELEASE ASSAYS TESTS AND THEIR LABORATORY CHARACTERISTICS
WHAT IS KNOWN ABOUT INTERFERON-GAMMA RELEASE ASSAYS TEST PERFORMANCE?
CURRENT INTERNATIONAL RECOMMENDATIONS AND GUIDELINES
AREAS OF CONTROVERSY AND DIRECTIONS FOR FUTURE RESEARCH
IMPLICATIONS FOR RESOURCE-LIMITED HIGH BURDEN COUNTRIES
CHAPTER 13:
Roentgenographic Manifestations of Pulmonary Tuberculosis
INTRODUCTION
IMAGING MODALITIES
Chest Radiograph
Computed Tomography
Ultrasonography
Magnetic Resonance Imaging
IMAGING IN PULMONARY TUBERCULOSIS
PRIMARY TUBERCULOSIS
Parenchymal Involvement
Consolidation
Tuberculoma
Miliary Tuberculosis
Lymph Node Involvement
Airways Involvement
Pleural Involvement
Follow-up of Primary Tuberculosis
POST-PRIMARY TUBERCULOSIS
Parenchymal Disease
Exudative Lesion
Fibroproductive or Fibroproliferative Lesion
Cavitation
Tuberculosis Bronchopneumonia
Airway Involvement [Bronchostenosis]
Pleural Effusion
Evaluation of Activity of Tuberculosis on Imaging
SEQUELAE AND COMPLICATIONS OF TUBERCULOSIS
Parenchymal Complications
Airway Complications
Pleural Complications
Vascular Complications
TUBERCULOSIS AND HUMAN IMMUNODEFICIENCY VIRUS INFECTION
FAMILY SURVEY
RADIOGRAPHIC FOLLOW-UP SCHEDULE
CHAPTER 14:
Pulmonary Tuberculosis
INTRODUCTION
NATURAL HISTORY OF TUBERCULOSIS
Primary Tuberculosis
Post-primary Tuberculosis
SYMPTOMS
PHYSICAL SIGNS
DIAGNOSIS
Tuberculin Skin Test
Haematology
Radiology
Fibreoptic Bronchoscopy
Diagnostic Mycobacteriology
DIFFERENTIAL DIAGNOSIS
Bacterial Pneumonia
Lung Abscess
Fungal and Miscellaneous Bacterial Infections
Bronchogenic Carcinoma
Bronchiectasis
Bronchial Asthma
Sarcoidosis
Pneumoconiosis
Cardiovascular Diseases
Congenital Abnormalities
Other Diseases
PRACTICAL APPROACH TO THE DIAGNOSIS OF ACTIVE PULMONARY TUBERCULOSIS
TREATMENT
CHAPTER 15:
Lower Lung Field Tuberculosis
INTRODUCTION
TERMINOLOGY OF LOWER LUNG FIELD TUBERCULOSIS
PREVALENCE
PATHOGENESIS
CLINICAL FEATURES
Associated Conditions
Symptoms
Signs
INVESTIGATIONS
Sputum Examination
Chest Radiograph
Bronchoscopy
MANAGEMENT
CHAPTER 16:
Endobronchial Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
Mechanisms of Endobronchial Infection
Extension from the Lungs by Direct Infiltration
Implantation of Organisms from Infected Sputum
Haematogenous Dissemination
Lymphatic Spread
As a Part of the Primary Infection
Macroscopic Appearance
Microscopic Appearance
CLINICAL COURSE
LABORATORY AND RADIOLOGIC INVESTIGATIONS
Sputum Examination
Chest Radiograph
Computed Tomography
Spirometry
Bronchoscopy
Non-specific Bronchitic Endobronchial Tuberculosis
Granular Endobronchial Tuberculosis
Oedematous-hyperaemic Endobronchial Tuberculosis
Actively Caseating Endobronchial Tuberculosis
Ulcerative Endobronchial Tuberculosis
Fibrostenotic Endobronchial Tuberculosis
Tumorous Endobronchial Tuberculosis
Bronchography
DIFFERENTIAL DIAGNOSIS
SPECIAL SITUATIONS
Lower Lung Field Tuberculosis
Elderly
Human Immunodeficiency Virus Infection
Indian Experience
Endobronchial Involvement by Nontuberculous Mycobacteria
TREATMENT
Antituberculosis Treatment
Corticosteroids
Bronchoscopy
Surgery
CHAPTER 17:
Tuberculosis Pleural Effusion
INTRODUCTION
PATHOGENESIS AND IMMUNOLOGY
CLINICAL MANIFESTATIONS
RADIOLOGY
DIAGNOSIS
Sputum Examination
Tuberculin Skin Test
Pleural Fluid Analysis
Pleural Biopsy
Adenosine Deaminase
Interferon-gamma
Serodiagnosis
Lysozyme
Thoracoscopy
Nucleic Acid Amplification Techniques
NATURAL HISTORY
TREATMENT AND ITS RESPONSE
Antituberculosis Treatment
Corticosteroids
Surgery
HUMAN IMMUNODEFICIENCY VIRUS CO-INFECTION
PLEURAL EFFUSION DUE TO NONTUBERCULOUS MYCOBACTERIA
TUBERCULOSIS EMPYEMA
PSEUDOCHYLOTHORAX AND CHYLOTHORAX
CHAPTER 18:
Silicotuberculosis
INTRODUCTION
SILICOSIS
Chronic Silicosis
Acute Silicosis
Accelerated Silicosis
Radiographic Findings
Bronchoalveolar Lavage
Complications
SILICOTUBERCULOSIS
Epidemiology
Influence of Tuberculosis on the Progression of Silicosis
Pathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
CHAPTER 19:
Abdominal Tuberculosis
INTRODUCTION
PERITONEAL TUBERCULOSIS
Epidemiology
Pathogenesis
Clinical Presentation
Tuberculosis of the Peritoneum
Acute Tuberculosis Peritonitis
Chronic Tuberculosis Peritonitis
Tuberculosis of Mesentery and Its Contents
GASTROINTESTINAL TUBERCULOSIS
Epidemiology
Pathogenesis
Tuberculosis of Small Bowel and Colon
Pathology
Clinical Features
Oesophageal Tuberculosis
Gastric Tuberculosis
Duodenal Tuberculosis
Tuberculosis of Appendix
Anal Tuberculosis
HEPATOBILIARY TUBERCULOSIS
PANCREATIC TUBERCULOSIS
SPLENIC TUBERCULOSIS
ABDOMINAL TUBERCULOSIS IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME
ABDOMINAL INVOLVEMENT IN NONTUBERCULOUS MYCOBACTERIAL INFECTION
DIAGNOSIS
Haematology and Serum Biochemistry
Tuberculin Skin Test
Imaging Studies
Chest Radiograph
Plain X-ray Abdomen
Barium Studies
Abdominal Ultrasonography
Abdominal Computed Tomography
Ascitic Fluid Examination
Serodiagnosis
Polymerase Chain Reaction
Scintigraphy, Positron Emission Tomography
Endoscopy
Colonoscopy
Fine-Needle Aspiration Cytology
Peritoneal Biopsy
Laparoscopy
TREATMENT
Medical Treatment
Corticosteroids
Surgery
Surgical Options
CHAPTER 20:
Granulomatous Hepatitis
INTRODUCTION
AETIOLOGY
PATHOLOGY
CLINICAL PRESENTATION
LABORATORY ABNORMALITIES
DIFFERENTIAL DIAGNOSIS
Hepatobiliary Tuberculosis
Congenital Tuberculosis
Primary Hepatic Tuberculosis
Disseminated and Miliary Tuberculosis
Pulmonary Tuberculosis
Tuberculoma
Tuberculosis of Bile Ducts
Tuberculosis of Gall Bladder
Hepatobiliary Tuberculosis in Patients with Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome
Other Hepatic Lesions
Sarcoidosis
Primary Biliary Cirrhosis
Drugs
Chronic Hepatitis
Hepatitis C Infection
Hepatitis B Infection
Brucellosis
Systemic Mycoses
Leprosy
Schistosomiasis
Hodgkin's Lymphoma
Typhoid Fever
Q Fever
Acquired Immunodeficiency Syndrome
Idiopathic Granulomatous Hepatitis
DIAGNOSIS
TREATMENT
PROGNOSIS
CHAPTER 21:
Neurological Tuberculosis
INTRODUCTION
TUBERCULOSIS MENINGITIS
Pathogenesis
Pathology
Clinical Features
Tuberculosis Meningitis and Human Immunodeficiency Virus Infection
Diagnosis
Investigations
Radiological Studies
Tuberculin Skin Test
Interferon-Gamma Release Assays
Cerebrospinal Fluid Study
Treatment
Uncomplicated Tuberculosis Meningitis
Treatment Regimens
Duration of Treatment
Role of Corticosteroids
Drug-resistant Tuberculosis Meningitis
Treatment of Tuberculosis Meningitis Associated with Human Immunodeficiency Virus Infection
Monitoring Therapy
Complications of Tuberculosis Meningitis
CHRONIC MENINGITIS
Definition and Aetiology
Clinical Evaluation
Diagnostic Evaluation
Neuroimaging Studies
Meningeal Biopsy
Management
INTRACRANIAL TUBERCULOMAS
Definition and Pathology
Epidemiology
Diagnosis
Management
SINGLE, SMALL, ENHANCING BRAIN LESION ON COMPUTED TOMOGRAPHY AND SEIZURES
Definition
Aetiology
Follow-up
Neuroimaging
Management
First Visit
Second Visit
Third Visit
PROGNOSIS AND OUTCOME OF INTRACRANIAL TUBERCULOSIS
Clinical Stage of the Disease
Age
Cerebrospinal Fluid Parameters
Neuroimaging of the Head
Others Variables
Sequelae
TUBERCULOSIS RADICULOMYELITIS
Pathology and Clinical Features
Investigations
Management
ACKNOWLEDGEMENTS
CHAPTER 22:
Tuberculosis and Heart
INTRODUCTION
TUBERCULOSIS PERICARDITIS
Pathogenesis
Clinical Features
Pericardial Effusion
Subacute Effusive-Constrictive Pericarditis
Chronic Constrictive Pericarditis
Differential Diagnosis
Diagnosis
Chest Radiograph
Electrocardiogram
Pericardial Fluid
Pericardial Biopsy
Echocardiogram
Cross-Sectional Imaging
Cardiac Catheterization
Treatment
Role of Adjuvant Corticosteroid Treatment
Pericardiocentesis and Pericardiectomy
MYOCARDIAL TUBERCULOSIS
TAKAYASU'S ARTERITIS
CHAPTER 23:
Skeletal Tuberculosis
INTRODUCTION
SKELETAL TUBERCULOSIS
Types
Osseous Granular Type
Osseous Exudative [Caseating] Type
Synovial Granular Type
Synovial Exudative [Caseous] Type
Prognosis
SPINAL TUBERCULOSIS
Pathology of Spinal Tuberculosis
Infection of Bone
Formation of Cold Abscess
Paraplegia
Clinical Features
Vertebral Disease
Cold Abscess
Paraplegia
Radiological Features
Differential Diagnosis
Management
Antituberculosis Treatment
Antibiotics
Surgery
Cold Abscess
Paraplegia
TUBERCULOSIS OF HIP JOINT
Pathology
Clinical Features
Stage of Synovitis [Stage I]
Stage of Early Arthritis [Stage II]
Stage of Advanced Arthritis [Stage III]
Radiological Features
Normal Type
Perthes’ Type
Dislocating Type
Wandering Acetabulum, Protrusio Acetabuli, Mortar and Pestle Type
Atrophic Type
Management
TUBERCULOSIS OF KNEE JOINT
Pathology
Clinical Features
Radiological Features
Management
TUBERCULOSIS OF ANKLE AND FOOT
Pathology
Clinical Features
Radiological Features
Management
TUBERCULOSIS OF THE SHOULDER JOINT
Pathology
Clinical Features
Radiological Features
Management
TUBERCULOSIS OF ELBOW JOINT
Pathology
Clinical Features
Radiological Features
Management
TUBERCULOSIS OF WRIST JOINT
Pathology
Clinical Features
Radiological Features
Management
TUBERCULOSIS OF SACROILIAC JOINT
Pathology
Clinical Features
Radiological Features
Management
TUBERCULOSIS AT RARE SITES
Sternoclavicular Joint
Acromioclavicular Joint
Symphysis Pubis
Ilium, Ischium and Ischiopubic Ramus
Sternum and Ribs
Scapula
Clavicle
TUBERCULOSIS TENOSYNOVITIS AND BURSITIS
Tuberculosis Tenosynovitis
Tuberculosis Bursitis
TUBERCULOSIS OSTEOMYELITIS
TUBERCULOSIS INFECTION OF PROSTHETIC JOINT
CHAPTER 24:
Musculoskeletal Manifestations of Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
AETIOPATHOGENESIS AND PATHOLOGY
CLINICAL SETTING FOR SUSPECTING TUBERCULOSIS ARTHRITIS
CHANGING CLINICAL PATTERN OF TUBERCULOSIS ARTHRITIS
REACTIVE [PARA-INFECTIOUS] ARTHRITIS [PONCET'S DISEASE]
Pathogenesis
ARTHRITIS ASSOCIATED WITH ADJUVANT MYCOBACTERIAL TREATMENT OF URINARY BLADDER CANCER
PANNICULITIS ASSOCIATED WITH TUBERCULOSIS
UNUSUAL PRESENTATIONS OF MUSCULOSKELETAL TUBERCULOSIS
MUSCULOSKELETAL DISEASE ASSOCIATED WITH NONTUBERCULOUS MYCOBACTERIA
ANTITUBERCULOSIS TREATMENT INDUCED ARTHRALGIAS
IMAGING OF MUSCULOSKELETAL TUBERCULOSIS
DIAGNOSIS
Indications for Synovial Biopsy
TREATMENT
CHAPTER 25:
Cutaneous Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
World Scenario
Indian Scene
CLINICAL FEATURES
Tuberculosis Chancre
Acute Miliary Tuberculosis of the Skin
Lupus Vulgaris
Tuberculosis Verrucosa Cutis
Scrofuloderma
Tuberculosis Gumma
Tuberculosis Cutis Orificialis
Tuberculids
Lichen Scrofulosorum
Papulonecrotic Tuberculids
Erythema Induratum
Erythema Nodosum
Others
CUTANEOUS TUBERCULOSIS IN IMMUNOCOMPROMISED HOSTS
LABORATORY DIAGNOSIS
BACILLE CALMETTE-GUÉRIN AND CUTANEOUS LESIONS
CUTANEOUS LESIONS DUE TO NONTUBER-CULOUS MYCOBACTERIA
TREATMENT
CHAPTER 26:
Lymph Node Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION
Tuberculosis Lymphadenitis
Tuberculosis Lymphadenitis in Patients with Human Immunodeficiency Virus Infection
Nontuberculous Mycobacterial Lymphadenitis
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
Tuberculin Skin Test
Imaging
Cytopathology and Histopathology
Molecular and Other Methods
TREATMENT
CHAPTER 27:
Tuberculosis in Otorhinolaryngology
INTRODUCTION
TUBERCULOSIS IN HEAD AND NECK REGION
TUBERCULOSIS OF CERVICAL LYMPH NODES
TUBERCULOSIS OF SPINE
TUBERCULOSIS OF ORAL CAVITY
TUBERCULOSIS OF LARYNX
Pathogenesis
Epidemiology
Pathology
Clinical Features
TUBERCULOSIS OF THE SALIVARY GLANDS
TUBERCULOSIS OF PHARYNX
TUBERCULOSIS OF THE EAR
Pathogenesis
Clinical Manifestations
TUBERCULOSIS OF THE NASOPHARYNX
TUBERCULOSIS OF THE PARANASAL SINUSES
NASAL TUBERCULOSIS
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
IMAGING IN HEAD AND NECK TUBERCULOSIS
IMPACT OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION
TREATMENT OF TUBERCULOSIS IN THE HEAD AND NECK
CHAPTER 28:
Ocular Tuberculosis
INTRODUCTION
PRIMARY AND SECONDARY OCULAR TUBERCULOSIS
EYELID TUBERCULOSIS
CONJUNCTIVAL TUBERCULOSIS
CORNEAL TUBERCULOSIS
SCLERAL TUBERCULOSIS
TUBERCULOSIS OF LACRIMAL SYSTEM
ORBITAL TUBERCULOSIS
TUBERCULOSIS OF THE UVEAL TRACT
CHOROIDAL TUBERCULOSIS
TUBERCULOSIS IRITIS AND IRIDOCYCLITIS
Tuberculosis Endophthalmitis and Panophthalmitis
Presumed Intraocular Tuberculosis
OCULAR TUBERCULOSIS IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED INDIVIDUALS
PATHOLOGY
DIAGNOSIS
Tuberculin Skin Test
Serological and Molecular Methods
TREATMENT
Antituberculosis Treatment Induced Ocular Toxicity
CHAPTER 29:
Breast Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
MODE OF INFECTION
CLINICAL PRESENTATION
Age and Sex
Clinical Presentation
CLASSIFICATION OF BREAST TUBERCULOSIS
Nodular Tuberculosis Mastitis
Disseminated or Confluent Tuberculosis Mastitis
Sclerosing Tuberculosis Mastitis
Tuberculosis Mastitis Obliterans
Acute Miliary Tuberculosis Mastitis
INVESTIGATIONS
Tuberculin Skin Test
Chest Radiograph
Mammography
Ultrasonography of the Breast
Computed Tomography of the Breast
Magnetic Resonance Imaging of the Breast
Fine Needle Aspiration Cytology
Open Biopsy
DIFFERENTIATION FROM CARCINOMA BREAST
TREATMENT
Antituberculosis Treatment
Surgical Treatment
CHAPTER 30:
Tuberculosis in Pregnancy
INTRODUCTION
EPIDEMIOLOGY
CLINICAL PRESENTATION OF TUBERCULOSIS DURING PREGNANCY
EFFECT OF PREGNANCY ON TUBERCULOSIS
EFFECT OF TUBERCULOSIS ON PREGNANCY
Abortions
Preterm Delivery
PLACENTAL TRANSMISSION OF TUBERCULOSIS
CONGENITAL TUBERCULOSIS
DIAGNOSIS
Chest Radiograph
Detection of Tuberculosis Infection
Microbiological Methods
TREATMENT OF ACTIVE TUBERCULOSIS DURING PREGNANCY
Isoniazid
Rifampicin
Ethambutol
Streptomycin
Pyrazinamide
Principles of Treatment
Second-Line Drugs
Treatment of Drug-resistant Tuberculosis During Pregnancy
TREATMENT OF LATENT TUBERCULOSIS INFECTION
MANAGEMENT OF TUBERCULOSIS IN INFANTS BORN TO MOTHERS WITH TUBERCULOSIS
Breast Feeding
ANTITUBERCULOSIS TREATMENT AND CONTRACEPTION
CHAPTER 31:
Female Genital Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
Genital Tuberculosis in Infertile Women
Genital Tuberculosis in Women with Abnormal Uterine Bleeding
Age Distribution
PATHOGENESIS
Fallopian Tube Tuberculosis
Endometrial Tuberculosis
Ovarian Tuberculosis
Tuberculosis of Cervix
Tuberculosis of the Vagina, Vulva and Bartholin Gland
CLINICAL PRESENTATION
Symptoms
Infertility
Chronic Lower Abdominal or Pelvic Pain
Alterations in Menstrual Pattern
Persistent and Abnormal Vaginal Discharge
Unusual Symptoms
Physical Signs
DIAGNOSIS
Endometrial Biopsy
Mycobacterial Isolation
Endometrial Culture versus Histopathology
Hysterosalpingography
Laparoscopy and Hysteroscopy
Subacute Stage
Chronic Stage
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Serodiagnosis
Polymerase Chain Reaction
TREATMENT
Minimal Genital Tuberculosis
Advanced Genital Tuberculosis
Pregnancy Following Treatment of Female Genital Tuberculosis
Tuboplasty
In Vitro Fertilization
CHAPTER 32:
Genitourinary Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION
Tuberculosis of the Kidney
Tuberculosis of the Ureter
Tuberculosis of the Urinary Bladder
Genital Tuberculosis
Tuberculosis of the Testis
Tuberculosis of the Epididymis
Tuberculosis of the Prostate
Tuberculosis of the Penis
Tuberculosis of the Urethra
DIAGNOSIS
Urine Examination
Microbiological Methods
Polymerase Chain Reaction
Plain Radiograph
Intravenous Urography
Magnetic Resonance Urography
Retrograde Pyelography
Percutaneous Antegrade Pyelography
Arteriography
Voiding Cystourethrogram
Retrograde Urethrography
Ultrasonography
Computed Tomography
Cystoscopy
TREATMENT
Antituberculosis Treatment
Surgery
Nephrectomy
Partial Nephrectomy
Stricture of the Upper Third of the Ureter
Stricture of the Middle Third of the Ureter
Stricture of the Lower Third of the Ureter
Complete Ureteric Stricture
Surgery for Urinary Bladder Tuberculosis
Surgery for Other Forms of Genitourinary Tuberculosis
CHAPTER 33:
Tuberculosis in Chronic Renal Failure
INTRODUCTION
PATHOGENESIS
MAGNITUDE OF THE PROBLEM
CLINICAL PRESENTATION
Clinical Presentation of Tuberculosis during Maintenance Haemodialysis
Clinical Presentation of Tuberculosis following Renal Transplantation
DIAGNOSIS
MANAGEMENT
Isoniazid
Rifampicin
Pyrazinamide
Streptomycin
Ethambutol
Second Line Antituberculosis Drugs
Treatment of Tuberculosis in Patients on Dialysis
Treatment of Latent Tuberculosis Infection in Patients with Chronic Renal Failure on Dialysis Treatment
Treatment of Tuberculosis in Recipients of Renal Transplantation
Treatment of Latent Tuberculosis Infection in Renal Transplant Recipients
Therapeutic Response and Prognosis
NONTUBERCULOUS MYCOBACTERIAL INFECTION IN CHRONIC RENAL FAILURE
CHAPTER 34:
Disseminated and Miliary Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
Age and Gender Distribution
PATHOGENESIS
CLINICAL PRESENTATION
Rare Manifestations
Disseminated and Miliary Tuberculosis in the Immunosuppressed Patients
LABORATORY FINDINGS
Haematology and Serum Biochemistry
Tuberculin Skin Test
Interferon-gamma Release Assays
Imaging
Chest Radiograph
Ultrasonography
Computed Tomography and Magnetic Resonance Imaging
Pulmonary Functions, Gas Exchange Abnormalities
Cardiopulmonary Exercise Testing
Immunologic Abnormalities and Bronchoalveolar Lavage
DIAGNOSIS
Serodiagnostic and Molecular Methods
Differential Diagnosis
TREATMENT
Corticosteroids
Antiretroviral Drugs
COMPLICATIONS
PROGNOSIS
CHAPTER 35:
Complications of Pulmonary Tuberculosis
INTRODUCTION
HAEMOPTYSIS
ASPERGILLOMA [MYCETOMA; “FUNGUS BALL”]
Clinical Features
Diagnosis
Treatment
Mycetoma and Human Immunodeficiency Virus Infection
POST-TUBERCULOSIS BRONCHIECTASIS
TUBERCULOSIS ENDOBRONCHITIS AND TRACHEITIS
SPONTANEOUS PNEUMOTHORAX
CALCIFICATION
TUBERCULOSIS LARYNGITIS
TUBERCULOSIS ENTERITIS
“OPEN-NEGATIVE” SYNDROME
SCAR CARCINOMA
PULMONARY FUNCTION CHANGES
CHRONIC RESPIRATORY FAILURE
PULMONARY ARTERY HYPERTENSION AND CHRONIC COR-PULMONALE
AMYLOIDOSIS
CHAPTER 36:
Tuberculosis and Acute Lung Injury
INTRODUCTION
DEFINITION
PATHOGENESIS
INCIDENCE
PREDISPOSING FACTORS
CLINICAL SYNDROMES
Acute Lung Injury in Miliary Tuberculosis
Acute Lung Injury in Tuberculosis Pneumonia
Acute Lung Injury in Cavitary Pulmonary Tuberculosis
Acute Lung Injury After Initiation of Antituberculosis Treatment
Other Manifestations
DIAGNOSIS
MANAGEMENT
Oxygen Therapy
Mechanical Ventilation
Antituberculosis Drugs
Corticosteroids
PROGNOSIS
CHAPTER 37:
Haematological Manifestations of Tuberculosis
INTRODUCTION
ANAEMIA
LEUCOCYTE CHANGES
PLATELET ABNORMALITIES
PANCYTOPENIA
COAGULATION ABNORMALITIES
BONE MARROW CHANGES IN TUBERCULOSIS
NONTUBERCULOUS MYCOBACTERIAL INFECTION
DRUG-INDUCED HAEMATOLOGICAL CHANGES
ACQUIRED IMMUNODEFICIENCY SYNDROME
CHAPTER 38:
Adrenocortical Reserve in Tuberculosis
INTRODUCTION
TUBERCULOSIS ADDISON'S DISEASE
Clinical Manifestations
Imaging Appearances
ESTIMATION OF ADRENOCORTICAL RESERVE
Effect of Rifampicin on Corticosteroids
Effect of Malnutrition of Adrenal Function
Overview of Past Experience
Adrenocortical Reserve in Patients Co-infected with Human Immunodeficiency Virus and Tuberculosis
CHAPTER 39:
Endocrine Implications of Tuberculosis
INTRODUCTION
TUBERCULOSIS AND HYPOTHALAMUS-PITUITARY INVOLVEMENT
ALTERED WATER AND ELECTROLYTE METABOLISM IN TUBERCULOSIS
TUBERCULOSIS AND THE THYROID GLAND
HYPERCALCAEMIA AND TUBERCULOSIS
VITAMIN D DEFICIENCY AND TUBERCULOSIS
DIABETES MELLITUS AND TUBERCULOSIS
TUBERCULOSIS AND DIABETES MELLITUS
CHAPTER 40:
Tuberculosis and Human Immunodeficiency Virus Infection
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION
Paediatric Tuberculosis
DIAGNOSIS
MANAGEMENT OF TUBERCULOSIS AND HUMAN IMMUNODEFICIENCY VIRUS CO-INFECTION
Highly Active Antiretroviral Therapy
Lamivudine
Zidovudine and Stavudine
Nevirapine
Efavirenz
Antituberculosis Treatment
Highly Active Antiretroviral Treatment and Rifampicin-based Antituberculosis Treatment
Highly Active Antiretroviral Treatment and Rifabutin-based Antituberculosis Treatment
Treatment and Response to Therapy
IMMUNE RECONSTITUTION SYNDROME IN HUMAN IMMUNODEFICIENCY VIRUS–TUBERCULOSIS CO-INFECTED PATIENTS
Drug-Resistant Tuberculosis
Extensively Drug-resistant Tuberculosis [XDR-TB]
CONTROLLING TUBERCULOSIS TRANSMISSION IN SETTINGS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTED PERSONS
ROLE OF BACILLE CALMETTE-GUERIN VACCINATION IN PREVENTING TUBERCULOSIS IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED INDIVIDUALS
PREVENTION
CHAPTER 41:
Tuberculosis in Children
INTRODUCTION
EPIDEMIOLOGY
TRANSMISSION
NATURAL HISTORY
Outcome of Bronchial Obstruction
CLINICAL FEATURES
Intrathoracic Tuberculosis
Extra-thoracic Tuberculosis
DIAGNOSIS
Laboratory Tests
Radiology
Tuberculin Skin Test
Scoring Systems for Predicting Childhood Tuberculosis
DIAGNOSTIC ALGORITHM FOR PULMONARY TUBERCULOSIS
DRUG-RESISTANT TUBERCULOSIS
TREATMENT
Corticosteroids
Management of an Infant Born to a Mother with Tuberculosis
Management of a Child in Contact with an Adult with Tuberculosis
Monitoring of Therapy
Clinical Criteria
Radiological Criteria
Microbiological Criteria
Other Measures
CHAPTER 42:
Diagnosis of Childhood Tuberculosis: Recent Advances and Applicability of New Tools
INTRODUCTION
CHILDHOOD TUBERCULOSIS: A DIAGNOSTIC DILEMMA
ADVANCES IN SYMPTOM-BASED DIAGNOSIS
Screening for Disease
Diagnosing Disease
ADVANCES IN IMMUNE-BASED DIAGNOSIS
Serological Tests
Interferon-gamma Release Assays
ADVANCES IN BACTERIOLOGY-BASED AND MOLECULAR DIAGNOSIS
Traditional Methods
Novel Culture Systems and Detection Methods
Nucleic Acid Amplification Tests
CHAPTER 43:
Surgical Aspects of Childhood Tuberculosis
INTRODUCTION
GENITOURINARY TUBERCULOSIS
Clinical Presentation
Role of Surgery
ABDOMINAL TUBERCULOSIS
Role of Surgery
PERIPHERAL LYMPH NODE TUBERCULOSIS
Nontuberculous Mycobacterial Lymphadenitis in Children
Role of Surgery
PULMONARY TUBERCULOSIS
Role of Surgery
Major Airways Obstruction
Post-tuberculosis Pulmonary Destruction
Tuberculosis Pleural Disease
NEUROLOGICAL TUBERCULOSIS
Surgical Therapy
CHAPTER 44:
Tuberculosis in Elderly
INTRODUCTION
EPIDEMIOLOGY
REACTIVATION AND REINFECTION
LATENT TUBERCULOSIS INFECTION IN ELDERLY
CLINICAL FEATURES
Pulmonary Tuberculosis
Extra-pulmonary Tuberculosis
Generalized Tuberculosis
Tuberculosis and Human Immunodeficiency Virus Co-infection in the Elderly
DIAGNOSIS
TREATMENT
Treatment Ex-juvantibus or ‘Trial Treatment’
Adverse Effects of First-line Antituberculosis Drugs
Treatment of Tuberculosis and Human Immunodeficiency Virus Co-infection in the Elderly
Treatment of Latent Tuberculosis Infection
CHAPTER 45:
Tuberculosis in Health Care Workers
INTRODUCTION
TUBERCULOSIS CARE AS AN OCCUPATIONAL HAZARD
RECOGNITION OF TRANSMISSION OF TUBERCULOSIS
Tuberculin Skin Test
Interferon-gamma Release Assays
RISK OF INFECTION
FACTORS INFLUENCING NOSOCOMIAL TRANSMISSION OF TUBERCULOSIS
Level of Exposure
Environmental Factors
Immune Status and Comorbidities
Bacille Calmette-Guérin Vaccination
Clinical Factors
RISK ASSESSMENT
CONTROLLING OCCUPATIONAL TUBERCULOSIS
Early Diagnosis and Treatment
Preventive Strategies
Infection Control Measures
Individual Protection
CHAPTER 46:
Nutrition and Tuberculosis
INTRODUCTION
IMPACT OF NUTRITION ON THE RISK OF ACTIVE TUBERCULOSIS INFECTION AND ITS NATURAL HISTORY
Evidence from Animal Models
Clinical Evidence
THE IMPACT OF TUBERCULOSIS ON NUTRITION
CLINICAL IMPLICATIONS AND INTERVENTIONS
Malnutrition and the bacille Calmette-Guerin Vaccine
Diagnosis
Natural History of Tuberculosis in Malnourished Patients
Isoniazid and Vitamin B Deficiency
Nutritional Interventions in Patients with Active Tuberculosis
Adjuvant Immunotherapy for Improving Nutritional Status in Tuberculosis
Monitoring Nutritional Status in Tuberculosis Patients
CONFRONTING THE VICIOUS CYCLE OF HUNGER AND DISEASE
CHAPTER 47:
Reactivation and Reinfection Tuberculosis
INTRODUCTION
NATURAL HISTORY OF TUBERCULOSIS INFECTION
CLINICAL PRESENTATION
PATHOGENESIS
MOLECULAR EPIDEMIOLOGY
DISTINGUISHING TREATMENT FAILURE AND EXOGENOUS REINFECTION
CHAPTER 48:
Nontuberculous Mycobacterial Infections
INTRODUCTION
DISTRIBUTION IN THE ENVIRONMENT
PREDISPOSING FACTORS
CLINICALLY IMPORTANT MYCOBACTERIA
Mycobacterium avium intracellulare Complex
Mycobacterium kansasii
Mycobacterium paratuberculosis
Mycobacterium scrofulaceum
Mycobacterium interjectum
Mycobacterium xenopi
Mycobacterium simiae
Mycobacterium szulgai
Mycobacterium fortuitum-Mycobacterium chelonae complex
Mycobacterium marinum
Mycobacterium terrae Complex
Mycobacterium genavense
Mycobacterium haemophilum
EMERGING NEW MYCOBACTERIAL PATHOGENS
CLINICAL MANIFESTATIONS
Diagnosis
Pulmonary Disease
Other Clinical Forms
Specimens
Histopathology
Cultivation
Identification of Isolates
Biochemical Tests
Lipid Patterns
Identification Techniques for Established, Reference Laboratories
New Molecular Methods for Identification and Characterisation
MANAGEMENT
Prevention
Treatment
Monitoring for Toxicity
CHAPTER 49:
Drug-Resistant Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
Molecular Epidemiology of Multiple Drug-Resistant Strains
Tools for Studying Molecular Epidemiology
MECHANISMS OF DRUG RESISTANCE
MOLECULAR BASIS OF MULTIPLE DRUG-RESISTANCE
Rifampicin
Rifampicin Resistance
Rifabutin Resistance
Isoniazid
Isoniazid Resistance
Streptomycin
Ethambutol
Pyrazinamide
Fluoroquinolones
Other Anti-mycobacterial Agents
Drug Efflux Pumps
POTENTIAL CAUSES OF DRUG RESISTANCE
MULTIDRUG-RESISTANT TUBERCULOSIS IN THE IMMUNOCOMPROMISED
Extensively Drug-resistant Tuberculosis
MANAGEMENT
Principles of Management
Need for Standard Definitions
Principles of Treatment
DOTS-Plus Strategy
Monitoring Response to Treatment
Global Experience in the Management of Drug-resistant Tuberculosis
Multidrug-resistant Tuberculosis
Extensively drug-resistant Tuberculosis
Prognostic Markers
Newer Antituberculosis Drugs
Surgery
Nutritional Enhancement
POST-GENOMICS EFFORTS TO UNRAVEL THE MYSTERIES OF MYCOBACTERIUM TUBERCULOSIS
TREATMENT OF LATENT MULTIDRUG-RESISTANT TUBERCULOSIS INFECTION
PREVENTION OF TRANSMISSION OF MULTIDRUG-RESISTANT TUBERCULOSIS
CHAPTER 50:
Antituberculosis Drug Resistance Surveillance
INTRODUCTION
GLOBAL PREVALENCE OF DRUG RESISTANT TUBERCULOSIS
Extensively Drug-resistant Tuberculosis
PREVALENCE OF DRUG-RESISTANT TUBERCULOSIS IN INDIA
Drug Resistance in Newly Diagnosed Cases
Resistance in Previously Treated Tuberculosis Cases
Multidrug Resistance
Treatment Outcome of Drug-Resistant Tuberculosis
The Relevance of These Studies
DOTS-PLUS
The World Health Organization Working Group on DOTS-Plus for Multidrug-resistant Tuberculosis
PREVENTION OF MULTIDRUG-RESISTANT TUBERCULOSIS IN INDIA'S REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME
DOTS-Plus in India's Revised National Tuberculosis Control Programme
Indian Efforts at Antituberculosis Drug Resistance Surveillance
GLOBAL EFFORTS TO PROVIDE ACCESS TO BETTER DIAGNOSTICS IN HIGH BURDEN COUNTRIES
ACKNOWLEDGMENTS
CHAPTER 51:
Evolution of Chemotherapeutic Regimens in the Treatment of Tuberculosis and Their Scientific Rationale
INTRODUCTION
SCIENTIFIC BASIS OF TUBERCULOSIS TREATMENT
Bacteriological Factors
The Numerical Factor
The Metabolic Factor
Environmental Factors
The Anatomical Factors
The Biochemical Factors
Pharmacological Factors
Dosage
Combinations of Drugs
CURRENT RECOMMENDATIONS FOR STANDARD REGIMENS
Initial Intensive Phase
Continuation Phase
Antituberculosis Drugs
THE SCIENTIFIC BASIS OF INTERMITTENT TREATMENT
Standard Intermittent Regimens
Evolution of Short-course Chemotherapeutic Regimens
Intermittent Short-course Chemotherapy Regimens
Short-course Chemotherapy Regimens in the Treatment of Sputum Smear-positive Pulmonary Tuberculosis
Terminology of Standard Tuberculosis Treatment Regimens
Short-course Chemotherpay Regimens of Less Than Six Months
Optimum Duration of Standard, Non-rifampicin Containing Regimens
SMEAR-NEGATIVE PULMONARY TUBERCULOSIS
EXTRA-PULMONARY TUBERCULOSIS
Challenges in Diagnosis
SURGERY
Monitoring of Adverse Drug Reactions to Antituberculous Drugs
Adverse Drug Reaction
Adverse Event
Serious Adverse Event
Treatment of Tuberculosis Under Special Situations
Clinically Significant Drug Interactions Due to Rifampicin
TREATMENT OF TUBERCULOSIS IN PERSONS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME
Fixed-dose Combinations of Antituberculosis Drugs
Potential Advantages
Potential Disadvantages
Phenomenon of Drug Resistance
Reasons for Special Precautions to Protect Rifampicin
RESEARCH AGENDA AND FUTURE FOR TUBERCULOSIS TREATMENT
Newer Antituberculosis Drugs
OTHER INTERVENTIONS TO IMPROVE THE EFFICACY OF TUBERCULOSIS TREATMENT PROGRAMMES
METHODS TO IDENTIFY AND MANAGE HIGH- AND LOW-RISK PATIENTS
DOTS
HEALTH EDUCATION
CHAPTER 52:
Treatment of Tuberculosis
INTRODUCTION
HISTORY OF CHEMOTHERAPY OF TUBERCULOSIS
Biological Characteristics of Mycobacterium tuberculosis and Basis of Short-course Chemotherapy
AIMS OF TREATMENT
Treatment of Smear-positive Pulmonary Tuberculosis
DOTS
Treatment of Smear-negative Pulmonary Tuberculosis
Treatment of Monodrug-resistant Pulmonary Tuberculosis
Treatment of Multidrug-resistant Pulmonary Tuberculosis
DEVELOPMENT OF NEW ANTITUBERCULOSIS DRUGS
DOSAGES AND ADVERSE REACTIONS OF ANTITUBERCULOSIS DRUGS
TREATMENT OF EXTRA-PULMONARY TUBERCULOSIS AND OTHER SPECIFIC SETTINGS
SURGICAL TREATMENT OF MULTIDRUG-RESISTANT PULMONARY TUBERCULOSIS
IMMUNOTHERAPY OF PULMONARY TUBERCULOSIS
CORTICOSTEROIDS AS ADJUNCTIVE TREATMENT IN TUBERCULOSIS
THERAPEUTIC DRUG MONITORING IN ANTITUBERCULOSIS TREATMENT
CHAPTER 53:
Treatment of Latent Tuberculosis Infection
INTRODUCTION
DIAGNOSTIC TESTS
Performance Characteristics of Latent Tuberculosis Infection Diagnostic Tests
Tuberculin Skin Test
Interferon-gamma Release Assays
TREATMENT REGIMENS
Isoniazid
Rifamycin-based Regimens
On the Horizon: Moxifloxacin-based Regimens
PROGRAMMATIC ISSUES IN LATENT TUBERCULOSIS INFECTION TREATMENT: THE CASE OF INDIA
Tuberculosis is too Endemic to Treat Latent Tuberculosis Infection
Massive Campaigns to Treat Latent Tuberculosis Infection will only Lead to Drug-resistance
Rural Health Care Facilities and Personnel are Extremely Lacking
DECIDING WHEN TO TREAT LATENT TUBERCULOSIS INFECTION IN HIGH-PREVALENCE SETTINGS
CHAPTER 54:
Antituberculosis Treatment Induced Hepatotoxicity
INTRODUCTION
EFFECT OF ANTITUBERCULOSIS DRUGS ON THE LIVER
Isoniazid
Pathogenesis
Rifampicin
Pathogenesis
HEPATOTOXICITY DUE TO COMBINATION TREATMENT OF ACTIVE TUBERCULOSIS DISEASE WITH ISONIAZID, RIFAMPICIN AND PYRAZINAMIDE
Isoniazid and Rifampicin
Pathogenesis
Rifampicin, Isoniazid and Pyrazinamide
Pathogenesis
HEPATOTOXICITY DUE TO TREATMENT OF LATENT TUBERCULOSIS INFECTION
FACTORS IMPLICATED IN THE DEVELOPMENT OF ANTITUBERCULOSIS TREATMENT INDUCED HEPATOTOXICITY
Age
Sex
Ethnic and Racial Variation
Genetic Factors
Acetylator Status and Hepatotoxicity
Drug-Metabolizing Enzyme Polymorphisms and Predisposition to Antituberculosis Treatment Induced Hepatotoxicity
N-acetyl Transferase and Cytochrome P450 2E1
Glutathione S-transferase
Underlying Chronic Liver Disease
Hepatitis and the Human Immunodeficiency Viruses
Malnutrition
ANTITUBERCULOSIS TREATMENT INDUCED HEPATOTOXICITY AND TYPE OF TUBERCULOSIS
CLINICAL COURSE OF ANTITUBERCULOSIS TREATMENT INDUCED HEPATOTOXICITY
MANAGEMENT OF ANTITUBERCULOSIS TREATMENT INDUCED HEPATOTOXICITY
Diagnosis
Guidelines for Monitoring Patients Receiving Treatment for Active Tuberculosis Disease
Screening for Viral Hepatitis
Monitoring of Liver Functions
Guidelines for Monitoring Patients Receiving Treatment for Latent Tuberculosis Infection
Treatment of Tuberculosis in Patients with Antituberculosis Drug Induced Hepatotoxicity
Recommendations for Re-introduction of Treatment in Patients with Antituberculosis Drug-Induced Hepatotoxicity
Recurrence of Drug-Induced Hepatotoxicity on Re-treatment
Liver Transplantation
ISSUES TO BE RESOLVED
CHAPTER 55:
Surgery for Pleuropulmonary Tuberculosis
INTRODUCTION
SURGERY IN THE DIAGNOSIS OF TUBERCULOSIS
Video-assisted Thoracoscopic Surgery
SURGERY IN THE TREATMENT OF ACTIVE PULMONARY TUBERCULOSIS
The Cavernostomy Era
The Collapse Therapy Era
Phrenic Nerve Paralysis
Pneumothorax
Pneumoperitoneum
Extrapleural Pneumonolysis
Thoracoplasty
The Modern Era
Current Status of Surgery
Preoperative Work-up
Preoperative Preparation
Nutritional Build up
Incentive Spirometry
Principles of Surgery
Multidrug-Resistant Tuberculosis
SURGERY FOR THE COMPLICATIONS OF TUBERCULOSIS
Bronchopleural Fistula
Tuberculosis Empyema
Haemoptysis
Foci of Residual Disease
Tracheal or Bronchial Stenosis, Broncholiths and Bronchiectasis
Pulmonary Aspergilloma
Cold Abscess of the Chest Wall
Surgery for Complications Caused by Enlarged Mediastinal Lymph Node Tuberculosis in Children
Surgery for Complications of Previous Surgery
SURGERY FOR TUBERCULOSIS: INDIAN EXPERIENCE
CHAPTER 56:
DOTS: The Strategy that Ensures Cure of Tuberculosis Patients
INTRODUCTION
POLITICAL WILL
DIAGNOSIS BY SPUTUM MICROSCOPY OF PATIENTS ATTENDING HEALTH FACILITIES
SHORT-COURSE CHEMOTHERAPY GIVEN IN A PROGRAMME OF DIRECTLY OBSERVED TREATMENT
ADEQUATE SUPPLY OF GOOD QUALITY DRUGS
SYSTEMATIC MONITORING AND ACCOUNTABILITY
RESULTS OF DOTS
MULTIDRUG-RESISTANT AND EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS
HUMAN IMMUNODEFICIENCY VIRUS
PREVENTION OF NOSOCOMIAL SPREAD OF TUBERCULOSIS AMONG HUMAN IMMUNODEFICENCY VIRUS INFECTED PATIENTS
MOLECULAR EPIDEMIOLOGY
GLOBAL EXPANSION OF DOTS: CURRENT STATUS
LESSONS LEARNT
CHAPTER 57:
Directly Observed Therapy
INTRODUCTION
WHAT IS DIRECTLY OBSERVED THERAPY?
COMPLIANCE, ADHERENCE OR CONCORDANCE?
IS DIRECTLY OBSERVED THERAPY THE ONLY STRATEGY FOR IMPROVING TREATMENT CONCORDANCE?
HISTORY OF DIRECTLY OBSERVED THERAPY
HOW DOES DIRECTLY OBSERVED THERAPY WORK?
WHO OBSERVES TREATMENT?
IS DIRECTLY OBSERVED THERAPY ESSENTIAL?
CHOOSING A DIRECTLY OBSERVED THERAPY METHOD
CONTROVERSIES SURROUNDING DIRECTLY OBSERVED THERAPY
WHAT IS THE FUTURE OF DIRECTLY OBSERVED THERAPY?
CHAPTER 58:
The Role of Medical Colleges in Tuberculosis Control
INTRODUCTION
ROLE OF MEDICAL COLLEGES
Advocacy
Medical Education
EDUCATIONAL STRATEGY
Sequential
Fully Integrated
Partially Integrated
SERVICE DELIVERY
RESEARCH
MANAGING MEDICAL EDUCATION AND PRACTICE
Tuberculosis Task Force
Guidelines Development
Continuing Education
Implementation of Tuberculosis Control in Medical Colleges: Indian Experience
CHAPTER 59:
Public-Private Mix for Tuberculosis Control
THE DIVERSE MIX OF HEALTH CARE PROVIDERS
PUBLIC-PRIVATE MIX
THE PUBLIC-PRIVATE MIX EVIDENCE BASE
IMPLEMENTING PUBLIC-PRIVATE MIX
National Situation Assessment
Developing Operational Guidelines
Formulating Objectives
Defining the Task Mix for Different Providers
Developing Practical Tools to Help Implementation
Develop a Training Strategy
Developing Standards for Certification of Providers
Developing Incentives and Enablers
Monitoring and Evaluation Plan
Implementation Proper
Preparation
Mapping on Local Level and First Contact with Provider
Implementation Proper
Advocacy and Communications
ACKNOWLEDGEMENT
CHAPTER 60:
Building Partnerships for Tuberculosis Control
INTRODUCTION
A GLOBAL PARTNERSHIP FOR TUBERCULOSIS CONTROL
TUBERCULOSIS IN THE SOUTH-EAST ASIA REGION
Progress with Tuberculosis Control
International Developmental Partners in the Region
National Partnerships for Tuberculosis Control in the South-East Asia Region
NON-GOVERNMENTAL ORGANIZATIONS AND TUBERCULOSIS CONTROL
The Bangladesh Rural Advancement Corporation, Bangladesh
THE PRIVATE HEALTH SECTOR AND TUBERCULOSIS CONTROL
Examples of ongoing Public-Private Initiatives in Tuberculosis Control in the Region
Mahavir Trust Hospital, Hyderabad, India
Kathmandu Valley, Nepal
MEDICAL COLLEGES AND THEIR ROLE IN THE FUTURE OF TUBERCULOSIS CONTROL
DOTS AT WORKPLACES
DOTS at Workplaces – An Example From Bangladesh
Bangladesh: Tuberculosis Control in the Chittagong Export Processing Zone
THE MEDIA AND TUBERCULOSIS CONTROL
COMMUNITY CONTRIBUTION TO TUBERCULOSIS CONTROL
CHAPTER 61:
Non-governmental Organizations and Tuberculosis Control
INTRODUCTION
WHY SHOULD NON-GOVERNMENTAL ORGANIZATIONS BE CONCERNED ABOUT TUBERCULOSIS?
Tuberculosis Causes a Huge Burden of Disease, Suffering and Death
DOTS is Cost-Effective
Tuberculosis is a Human Rights Issue
Tuberculosis is a Gender Issue
Tuberculosis is a Child Health Issue
Tuberculosis is a Development Issue
DOTS is a Means to Improving the Overall Quality of Health Services
The Government Alone Cannot Defeat Tuberculosis
HOW CAN NON-GOVERNMENTAL ORGANIZATIONS BE INVOLVED IN TUBERCULOSIS CONTROL?
EXAMPLES OF NON-GOVERNMENTAL ORGANIZATION APPROACHES TO TUBERCULOSIS CONTROL
Service Delivery
Health Service Management Support
Community Participation and Community-based Care
Education
Advocacy
Patient's Organizations
Research
Partnerships with the Private Sector
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Organizations and Tuberculosis Control
SUCCESSFUL PARTNERSHIPS
Information
Collaboration
Co-ordination
CHAPTER 62:
Global Tuberculosis Control: The Future Prospects
INTRODUCTION
Pre-1992
THE RESPONSE: THE DOTS STRATEGY
PROGRESS SINCE 1992
Mission of the Stop TB Initiative
CURRENT SITUATION
Priorities for Action
CHAPTER 63:
The Revised National Tuberculosis Control Programme [RNTCP]
EPIDEMIOLOGY
BRIEF HISTORY OF TUBERCULOSIS CONTROL IN INDIA
TECHNICAL FOUNDATION
DRUG PROCUREMENT AND MANAGEMENT
DOTS EXPANSION
PROGRAMME PERFORMANCE
LABORATORY NETWORK AND QUALITY ASSURANCE
Laboratory Quality Assurance
INFORMATION, EDUCATION AND COMMUNICATION
TUBERCULOSIS AND HUMAN IMMUNODEFICIENCY VIRUS
MANAGEMENT OF PAEDIATRIC TUBERCULOSIS
Diagnosis
Treatment of Paediatric Tuberculosis
Treatment of Latent Tuberculosis Infection
PRIVATE SECTOR
ACADEMIC SECTOR
RESEARCH
Measuring Epidemiological Impact
Drug Resistance Surveillance
Joint Monitoring Missions
THRUST AREAS
ACKNOWLEDGMENTS
CHAPTER 64:
Tuberculosis Vaccine Development: Current Status and Future Expectations
INTRODUCTION
THE BACILLE CALMETTE-GUERIN VACCINE HISTORY: SCIENTIFIC FABLE AND THE LESSONS LEARNED
UNIQUE FEATURES OF THE PATHOGEN
IMMUNOLOGY OF TUBERCULOSIS
COMPLICATIONS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME
CONTRIBUTION OF VARIOUS ANIMAL MODELS IN THE UNDERSTANDING OF TUBERCULOSIS IMMUNOLOGY AND DEVELOPMENT OF VACCINES
Mouse Model of Tuberculosis
Guinea Pig Model of Tuberculosis
Non-human Primate Model of Tuberculosis
Deciphering the Mystery Behind an Array of Immune Responses to Vaccination and Infection
IDENTIFICATION OF VACCINE TARGETS IN THE POST-GENOMIC ERA
VARIOUS STRATEGIES FOR THE DEVELOPMENT OF TUBERCULOSIS VACCINES
Recombinant bacille Calmette-Guérin
Live Attenuated Mutants and Auxotrophs of Mycobacterium tuberculosis
Nontuberculous Mycobacterial Vaccines
Subunit Vaccines
DNA Vaccines
Epitope Based Vaccines
Prime Boost Immunization Strategies
IMMUNOTHERAPEUTIC APPROACH TO COMBAT TUBERCULOSIS
ROLE OF DIAGNOSTICS IN THE DEVELOPMENT AND ASSESSMENT OF NEW VACCINES
KEY ISSUES SURROUNDING NEW TUBERCULOSIS VACCINES
Expectations from a New Vaccine
Groundwork for Human Trials
Human Trials: New Challenges
VACCINES IN PHASE I CLINICAL TRIAL
IMPACT OF ZOONOSIS ON TUBERCULOSIS VACCINE DEVELOPMENT
ACKNOWLEDGEMENTS
CHAPTER 65:
Ethical and Legal Issues in Tuberculosis Control
INTRODUCTION
BACKGROUND
Public Health and Tuberculosis
Infectious Disease Control and Tuberculosis
ETHICS
Ethics in the West
Ethics in the East
Ethics Principles and Tasks
Autonomy
Beneficence and Non-maleficence
Justice
The Application of Ethics in Public Health
THE LAW
What is It and What does It do?
Legislation for Infectious Disease Control in the United States and United Kingdom
Legislation in India
TUBERCULOSIS CONTROL - ETHICAL ISSUES
Relationship of a Tuberculosis Patient with the Health Care Provider
Compliance and Adherence
Direct Observation of Treatment
Interaction and Relationship of a Tuberculosis Patient with the Health Care Structure [Official and Unofficial]
The Health Care Structure
Access
Social and Cultural Burden
Stigma
Treatment and Drugs
Monitoring
TUBERCULOSIS CONTROL - LEGAL ISSUES
Legal Processes Affect the Minority of Tuberculosis Patients
High Risk Groups
Prisons
CHAPTER 66:
Tuberculosis: Some Web-based Resources on the Internet
INTRODUCTION
Books
ebooks
Reports
Clinical Trials/Registers
Drug Development, Vaccines and Diagnostics
Tuberculosis Statistics
Professional Associations/Organizations
Newsletters/Magazines
Glossaries/Dictionaries
Advocacy
Scientific Literature on Tuberculosis
Search Tools
Epidemiological Data
Literature for Lay People
Management of Tuberculosis [Recommendations, Guidelines and Decision-making Algorithms]
Research Databases
Research Groups Interested in Tuberculosis
Resources for Research, Teaching and Training
Information about Regulatory Action
General Tuberculosis Web Sites
Peer-reviewed Journals
Conference Reports/Proceedings
67:
International Standards for Tuberculosis Care (ISTC)
Acknowledgements
List of Abbreviations
Summary
Standards for Diagnosis
Standards for Treatment
Standards for Public Health Responsibilities
Research Needs
Introduction
Purpose
Audience
Scope
Rationale
Companion and Reference Documents
Standards for Diagnosis
Standards for Treatment
Standards for Public Health Responsibilities
Research Needs
References
Photo Credits
INDEX
TOC
Index
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