Search PubMed⌕ Search

Biomedical subjects

A K Dutt

Publications and source records attributed to A K Dutt.

17 recordsLinked to original sources
PubMed1992

Tuberculous pleural effusion: 6-month therapy with isoniazid and rifampin.

We have shown that 6-month therapy with isoniazid (INH) and rifampin (RIF) is adequate for pulmonary tuberculosis when tubercle bacilli are less numerous, i.e., smear negative, culture positive. Tuberculous exudative pleural effusion contains small bacterial populations, as often demonstrated by negative smears and fewer positive cultures. Therefore, in 1980, we started treating tuberculous pleural effusion with a therapy protocol consisting of INH 300 mg plus RIF 600 mg daily for 1 month, followed by INH 900 mg plus RIF 600 mg twice weekly for another 5 months (total, 6 months). From January 1980 to September 1990, 198 patients with an average age of 62.6 years were treated in this manner. Associated pulmonary infiltration was present in 92 patients, of whom 50% yielded positive sputum cultures. Other medical conditions as "risk factors" were present in 30%. Therapy was not completed in 36 patients because of death, relocation, noncompliance, and drug side effects. Treatment failed during therapy in only 1 patient. Side effects of the drugs occurred in 13 (6.6%) patients, but major side effects were encountered in only three (1.5%), two with toxic hepatitis and one with thrombocytopenia. The full 6-month therapy was completed by 161 patients. During follow-up from 2 to 133 months (median, 46 months), none of the 161 patients had relapse. An overall success rate of 99% was achieved in 162 patients with only 1 failure during therapy. Thus, 6-month therapy with INH plus RIF is adequate in tuberculous exudative pleural effusion, even when associated with smear-negative (3 specimens) culture-positive pulmonary tuberculosis.

Arkansas↗
PubMed1992

Tuberculosis.

In the United States, the incidence of tuberculosis (TB) is higher in elderly persons than in any other segment of the population, except in HIV-infected persons. The diagnosis of TB, however, is all too often not considered in geriatric patients. Although elderly nursing home residents are at a greater risk for TB than the aging population in the community setting, the majority (80%) of active TB cases in elderly persons occur in community dwellers. The diagnosis, treatment, and prevention of TB are reviewed in this article.

Age Factors↗
PubMed1991

Tuberculosis in elderly persons.

As tuberculosis has been controlled in the western world, it has retreated into enclaves. The largest of these is among persons who are now over age 65, many of whom carry tubercle bacilli in dormant lesions implanted in earlier years and still capable of causing tuberculosis as life forces wane. The diagnosis is all too often not thought of in this age group; as a result, a patient with what was thought to be an episode of bronchitis or bronchopneumonia may die after having exposed a number of young health workers to tuberculosis in a country where it should have been eliminated several years ago. The purpose of this paper is to heighten the index of suspicion of tuberculosis among physicians caring for the elderly.

Aged↗
PubMed1990

Smear-negative, culture-positive pulmonary tuberculosis. Six-month chemotherapy with isoniazid and rifampin.

We have shown in Arkansas that 9 months of therapy with isoniazid (INH) and rifampin (RIF) can achieve lasting success in 95% of cases with sputum-smear-positive pulmonary tuberculosis. It seemed likely that when the tubercle bacilli were less numerous, i.e., could not be seen on microscopy, less therapy would suffice. Thus, in January 1980, we began giving only 6 months of treatment to patients in whom at least one sputum culture showed M. tuberculosis but at least three sputum smears showed no organisms. The regimen for adults is INH 300 mg and RIF 600 mg daily for 1 month followed by INH 900 mg and RIF 600 mg twice weekly for another 5 months. To date, 286 patients with an average age of 68.2 yr have been treated in this manner. Associated medical conditions were present as "risk factors" in 23.7%. The full course of therapy could not be completed in 75 patients (26.2%), largely because of side effects of the drugs and non-TB deaths in this group of elderly patients. Side effects of the drugs requiring change of drug(s) occurred in 33 patients (11.5%), but major side effects occurred in only eight (2.8%), four (1.4%) with toxic hepatitis and four with hematologic toxicity. The side effects in 25 patients (8.7%) were not life-threatening and were due to drug intolerance. Treatment failed during therapy in only one patient. The full 6-month course of therapy was completed by 211 patients. During follow-up from 3 to 107 months (median, 45 months), five of 211 patients (2.4%) relapsed, all with drug-susceptible organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Tuberculosis in the elderly.

During the past 25 years, the age distribution of tuberculosis (TB) in the United States has shifted remarkably from younger age to the later decades, ie, in persons over 70 years of age. Elderly persons, although infected many years ago, exhibit a positive tuberculin reaction in only 20% to 25% upon entry into nursing homes. Among members of this infected elderly population, case rates as high as 500 to 1,000 per 100,000 population are found. Endogenous breakdown of older lesions is the common mechanism for the development of the disease. Of the remaining 70% to 80% tuberculin-negative population, 10% are immunoincompetent and die soon upon entry into the nursing home. The remaining 90% of the nonreactors who survive are again susceptible to new infection. The point prevalence of positive tuberculin reactors approximately doubles after more than a 6 months stay at the nursing home. This inadvertent exposure usually occurs in the nursing home due to reactivation of old lesions among old reactors. Although 5% of persons over 65 years of age live in nursing homes, they account for 20% of TB cases. This gives a rate four times greater than the rate among the elderly living at home, or twelve times greater than in persons 40 to 60 years of age. In Arkansas, more than 53% of active cases occurred in persons over 65 years of age, who account for only 14% of the population. Diagnosis of TB in the elderly may be considerably delayed or even totally missed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Treatment of extrapulmonary tuberculosis.

The duration of therapy for pulmonary tuberculosis (TB) is now shortened to 6 or 9 months with the use of bactericidal drugs. There are few reports on the results of short course chemotherapy (SCC) in extrapulmonary tuberculosis (EP). It is unlikely that many controlled studies shall be forthcoming in the future because of involvement of many sites with the disease, each of which has special problems. However, available controlled studies and clinical experiences in EP indicate early success. The site of the disease appears to be less important since the bacterial population is much smaller in EP than in TB and is easily amenable to the bactericidal drugs. Present bactericidal drugs (isoniazid [INH], rifampin [RIF], pyrazinamide [PZA]) penetrate well into tissues and attain bactericidal levels to kill the organisms. Our experience with 9-month SCC consisting of INH 300 mg and RIF 600 mg daily for one month, followed by INH 900 mg and RIF 600 mg twice weekly for another 8 months in 478 cases of EP showed overall success in over 95% of those patients who completed therapy over a median follow-up of 42 months. The drugs may be given daily throughout with the same success. Thus, 9-month therapy with INH and RIF is highly effective in EP due to drug sensitive organisms. In TB, the duration may be shortened to 6-months with initial intensive four-drug therapy consisting of INH, RIF, PZA and streptomycin (SM) or ethambutol (EMB) daily for 2 months, followed by INH and RIF daily or twice weekly for another 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Short-course chemotherapy of tuberculosis with largely twice-weekly isoniazid-rifampin.

Although short-course, largely twice weekly chemotherapy for treatment of tuberculosis has been shown to be effective in other countries, when given under closely controlled conditions, it has not been adopted in this country where most patients are older and are treated as outpatients. Since January, 1976, 315 patients (mean age 55.5 years) with proven pulmonary tuberculosis have been treated with rifampin (RIF) 600 mg and isoniazid (INH) 300 mg daily for one month, followed by RIF 600 mg and INH 900 mg twice-weekly for another eight months, self-administered except for a few patients. By three months, 95 percent had converted to negative culture. There were only ten failures among 185 patients in whom final results could be assessed. There has been only one relapse during 1-21 months of follow-up in 175 patients. Serious side effects were few: six instances of jaundice, two of "flu-like syndrome," and one of thrombocytopenia. This form of initial therapy for tuberculosis is safe, effective, and economical.

Adolescent↗
PubMed1978

Follow-up of patients with tuberculosis treated in a general hospital program. Treatment largely as outpatients by community physicians.

As of December 1975, there had been 5 to 8 1/2 years of observation on 263 patients with bacteriologically proven tuberculosis who were initially admitted to a general hospital and were treated largely as outpatients by community physicians from July 1967 through December 1970. Ten patients died during hospitalization, and 253 were released to therapy as outpatients. Although smears or cultures of sputum remained positive at discharge in 136 (54 percent) of the 253 patients, no new infections were subsequently detected among their contacts. During initial therapy, 24 patients died of causes other than tuberculosis. Of the remaining 229 patients, the original 18-month treatment was successful in 197 (86 percent). The treatment failed initially in 11 patients, eight of whom represented relapses from previous therapy. During long-term follow-up of the 229 patients, there were only six relapses (3 percent) after the initial success. An overall rate of successful treatment of 92 percent (211/229) was achieved in the program, with 18 failures of treatment (8 percent); ie, 11 patients were lost to supervision, four died of tuberculosis, and in three, treatment was never successful.

Aged↗
PubMed1977

Tuberculosis bacteriologic reliability. Sputum specimens submitted by mail.

The reliability of examining mailed specimens of sputum for tubercle bacilli was studied by dividing 132 sputum specimens. One half of each specimen was examined on the same day as collection (fresh); the other half was examined after a delay of from one to eight days (mailed). There were a few discrepancies, but no advantage was shown for use of the fresh portion of the specimens. The rate of contamination was slightly greater in the mailed portions (6.6%).

Culture Media↗