In Malaya the author estimates that there are probably 500,000 to 600,000 tuberculous persons, representing about 10 per cent of the population, there are about 2,000 hospital beds for tuberculosis, of which 500 are in Singapore for a population of just over 1,000,000. The author states that in Malaya, for every 240 tuberculous patients, only one can have accommodation in hospital He discusses the subject and urges that mass radiography should be undertaken, and that cheaply built homes should be constructed to house infective patients under supervision He gives details of the structures he has in mind Education in health matters should be pressed, and BCG should be used.
This was an eight year (2000-2007) retrospective study of tuberculosis in patients admitted to the UMMC. A total of 131 cases were analyzed. Malays constituted the most cases, (43%), followed by Chinese (22%), Indians (17%) and others (18%). The majority of cases were within the 21-60 year old age group, which constituted 69.5% of the total. Males were more commonly affected (65%). Most cases were reported among Malaysians (83%). The majority of patients were unemployed (39%), followed by housewives (10%), laborers (9%), students (8%), shop assistants (7%), and other occupations (27%). The most common presenting complaints were prolonged productive cough, night sweats, fever, anorexia, weight loss (57%), hemoptysis (34%), and undifferentiated symptoms, such as prolonged diarrhea and dysphagia (9%). Sputum was positive for acid-fast bacilli (AFB) in 89%, but only 69% of cases had abnormal chest radiographs. The majority of patients (65%) developed no complications. The most common complications were pleural effusion, pneumothorax and pulmonary fibrosis. The majority of patients (82%) suffered either from diabetes mellitus, hypertension, ischemic heart disease or all 3 conditions. Regarding risk factors for tuberculosis, two were HIV positive and two were intravenous drug users. The majority of the patients (85%) did not complain of any side effects from their anti-tuberculosis treatment. Among those who did complain of side effects, the most common were nausea and vomiting (41%), drug induced hepatitis (37%), blurring of vision (11%) and skin rashes (11%). Two cases of death were reported.
The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology. We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002. All age groups were affected with a male predominance (Male:Female ratio = 60:40). Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%). Nearly half (45.3%) of patients had symptoms for more than one year. Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms. Fifteen percent of the patients presented with extrapulmonary diagnosis. Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done. The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical'. Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture. Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes. Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture). In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis. In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical. Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis. In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial.
The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli. Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them. The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them. Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination. Two of the cases had concomitant bronchogenic carcinoma. We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.
Despite recent advances in diagnosis, tuberculosis (TB) remains one of the ten leading causes of death worldwide. Here, we engineered Mycobacterium tuberculosis (Mtb) proteins (ESAT6, CFP10, and MTB7.7) to self-assemble into core-shell nanobeads for enhanced TB diagnosis. Respective purified Mtb antigen-coated polyester beads were characterized and their functionality in TB diagnosis was tested in whole blood cytokine release assays. Sensitivity and specificity were studied in 11 pulmonary TB patients (PTB) and 26 healthy individuals composed of 14 Tuberculin Skin Test negative (TSTn) and 12 TST positive (TSTp). The production of 6 cytokines was determined (IFNγ, IP10, IL2, TNFα, CCL3, and CCL11). To differentiate PTB from healthy individuals (TSTp + TSTn), the best individual cytokines were IL2 and CCL11 (>80% sensitivity and specificity) and the best combination was IP10 + IL2 (>90% sensitivity and specificity). We describe an innovative approach using full-length antigens attached to biopolyester nanobeads enabling sensitive and specific detection of human TB.
The present study deals with the analysis of body composition components of 86 randomly selected patients with confirmed pulmonary tuberculosis aged 16- 70 years collected from the District Tuberculosis Centre and Hospital, Amritsar. An adequate number of controls were also taken for comparison. The findings of the present study showed highly significant differences (p < or = 0.001) in all the twelve kinanthropometric variables except height. When the data was further analyzed between sputum negative and sputum positive patients with pulmonary tuberculosis, highly significant differences (p < or = 0.001) were found only in total body fat and statistically significant differences (p < or = 0.05) were observed in weight, chest circumference in normal position, abdominal circumference, right calf and buttock circumferences. It may be concluded that TB patients were more malnourished than normal people. Thus, special nutritional care should be taken to the TB patients to give them a better quality of life.
The overall incidence of clinical pulmonary tuberculosis in the University of Malaya students was found to be 3.15 per cent. This higher incidence of clinical tuberculosis is in keeping with the general morbidity and mortality figures of tuberculosis in the general public. Among students who were originally enrolled as inactive cases 26.5 per cent developed activity while in university and required treatment. No significant difference was found in the incidence and rate of reactivation of disease in students of various races. No student was obliged to quit studies permanently on account of the breakdown