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Biomedical subjects

J B Mehta

Publications and source records attributed to J B Mehta.

At least 37 records · Page 2Linked to original sources
PubMed1996

Extrapulmonary tuberculosis in Tennessee: lessons from the last decade.

In conclusion, extrapulmonary TB remains a significant fraction of the total TB cases in Tennessee. During the last few years, the percentage of extrapulmonary TB in Tennessee has been on the increase. Understanding these changes in the epidemiology of extrapulmonary TB will help the clinician in making a prompt diagnosis, leading to appropriate therapy. Understanding the changing trends at the national level may aid state health departments in reorganizing disease control programs, thus, facilitating the eradication of TB and other communicable diseases in Tennessee.

AIDS-Related Opportunistic Infections↗
PubMed1996

Nutritional status and mortality in respiratory failure caused by tuberculosis.

A retrospective analysis of the records of all patients admitted to the intensive care unit with respiratory failure and nonmiliary tuberculosis was conducted to determine variables that might be predictive of survival. Nutritional status, as reflected by the patient's serum albumin and hemoglobin, were the best predictors of survival and were more helpful than the widely accepted APACHE II scoring system. This observation suggests that early and aggressive attention to improving the patient's nutritional status may be as important as effective antitubercular therapy and mechanical ventilation in salvaging these individuals.

Adult↗
PubMed1995

Pseudoepidemic of nontuberculous mycobacteria in a community hospital.

Soon after our hospital instituted the BACTEC mycobacterial isolation system, the proportion of cultures positive for nontuberculous mycobacteria increased dramatically. After eliminating other possible sources of contamination, the BACTEC probe's sterilization time and temperature were increased, and the incidence of positive mycobacterial cultures returned to its former rate.

Bacteriology↗
PubMed1995

Outbreak of tuberculosis in a church.

A 48-year-old white man (index case) with an abnormal chest radiograph remained undiagnosed for tuberculosis for 4 years. Investigation by purified protein derivative (PPD) tuberculin test revealed positive tuberculin reactions (> or = 10 mm induration) in seven of eight (88%) initial close contacts, and in 12 of 46 (26%) coworkers. On the suspicion that transmission had also occurred among members of the index case's church congregation, a PPD tuberculin test survey of 184 of 200 of the members revealed 77 (42%) positive reactors. Thirty percent of the members under the age of 35 years were infected, suggesting transmission of infection. Eight cases of active tuberculosis (including the index case) were detected, yielding a high case rate (4.3%) among the parishioners. Three of the cases were confirmed recent PPD converters. Although bacteriologic findings were available in only three of the eight cases, two cases had phage typing of organism identical to the index case; the third had recrudescent tuberculous disease. Of the remaining five cases without bacteriologic confirmation, two had pleural tuberculosis, one child had progressive primary tuberculosis, and two persons had localized pulmonary nodules suggestive of primary infection progressing to disease. Because transmission of tuberculous infection may occur in any closed environment, including a church, physicians must be conversant with tuberculosis control measures and preventive therapy guidelines to preclude unforeseen transmission of disease.

Adult↗
PubMed1995

Underutilization of isoniazid chemoprophylaxis in tuberculosis contacts 50 years of age and older. A prospective analysis.

STUDY OBJECTIVES: To examine the utilization of chemoprophylaxis for tuberculosis in certain high-risk groups, ie, infected contacts 50 years and older, and to study the safety of isoniazid (INH) preventive therapy in such persons. DESIGN: From 1987 to 1992, two-part questionnaires were sent to each of the regional health offices within the 95 counties of Tennessee to document cases of purified protein derivative skin test conversion or reaction among close contacts of new patients with active tuberculosis. Infected contacts 50 years and older were included in the study. METHODS: Data collected from these questionnaires were grouped according to age, sex, race, liver functions test (LFT), and whether chemotherapy was completed. Reasons for early discontinuation were also recorded. High values of LFTs were classified in the various groups as either twofold elevation or greater than threefold elevation. RESULTS: Of the 829 responses for persons fitting the criteria for INH chemoprophylaxis, 415 began treatment; 249 (60%) of those completed the full course (9 months) and 166 stopped prematurely. Of the 414 persons (50%) who did not start preventive therapy, 233 (56.5%) respondents listed age as the reason. No patients started on a regimen of therapy developed hepatitis. Of those completing therapy, 6.9% had a rise in liver enzyme values but remained asymptomatic for hepatitis. Liver enzyme level elevation was significantly higher among patients who discontinued therapy, particularly white women, than those who completed the full course. Asymptomatic liver enzyme level elevation (> or = 3 times normal value), private practitioners' preferences, and patients arbitrarily stopping therapy were the leading reasons for incomplete INH preventive therapy. CONCLUSION: We conclude that 30% of tuberculosis-infected contacts deserving chemoprophylaxis were actually provided the full benefit of INH preventive therapy, indicating underutilization of this prevention strategy, particularly in contacts older than 50 years.

Age Distribution↗
PubMed1993

Rifabutin in the treatment of cavitary lung disease due to Mycobacterium gordonae.

We have described a case of progressive pulmonary disease caused by M gordonae that failed to show any improvement in disease status after 9 months of intensive therapy with a conventional four-drug regimen. When rifabutin became available and was included in the regimen, the disease was cured. Although considered a saprophyte of the respiratory tract, M gordonae can cause clinically significant disease in rare instances. Initiation of appropriate therapy with rifabutin and other antituberculous agents could prevent the destructive lesions and prolonged morbidity of patients with disease caused by M gordonae.

Antitubercular Agents↗
PubMed1993

Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population.

OBJECTIVE: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population. DESIGN: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (< 65 years) and Group B (> or = 65 years). Natural sputum smears and cultures positive for M. tuberculosis (M. TB) in each group were compared with FOB specimens, acid-fast bacilli (AFB) smears and cultures. Data were analyzed by chi-square tests of independence for each year, then compared to determine statistical significance. SETTING AND PATIENTS: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC-approved criteria for diagnosis of tuberculosis. MEASUREMENTS: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only. MAIN RESULTS: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age < 65), the difference in rates for those in Group B (age > or = 65) was statistically significant (P < 0.05). CONCLUSIONS: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.

Age Factors↗
PubMed1992

Intravenous immunoglobulin therapy of immune thrombocytopenia.

High dose intravenous gamma globulin has been used in the therapy of immune thrombocytopenia with variable success. Nine non-splenectomized patients with immune thrombocytopenia (8 ITP, 1 Evans syndrome) were treated with IV IgG. One patient with ITP and the case of Evans syndrome had chronic disease, and the others had acute ITP. All patients had been pretreated with steroids with variable response. The patient with chronic ITP and the one with Evans syndrome responded completely to IgG; remission has lasted for 18 months in both. Two patients with acute ITP responded fully to IgG, but one relapsed after 8 months and the other was lost to follow-up after 1 month. Two patients with acute ITP had partial response to IgG, which could be maintained off steroids in one and on a low dose of steroids in the other. Three patients with acute ITP had no response at all to IgG. High dose IV IgG is useful in selected cases of acute as well as chronic ITP, and previous response to steroids increases the likelihood of response. Splenectomy is not a prerequisite for response.

Adolescent↗
PubMed1992

Impact of HIV infection on mycobacterial disease.

The current epidemic of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome has resulted in a worldwide resurgence of tuberculosis. In the United States, the number of new cases of tuberculosis has increased in the past five years, leading to a cumulative excess of about 15,000 cases. The clinical and epidemiologic picture of tuberculosis in AIDS patients differs drastically from the standard presentation of tuberculosis cases in HIV-negative patients. The diagnosis and management of tuberculosis, particularly atypical mycobacterial infections, present a challenge in HIV-infected patients. Prevention of the transmission of disease is a major concern. Since atypical mycobacterial infection and disease pose a greater management challenge, this article summarizes diagnosis and treatment of atypical mycobacterial infection in HIV-positive patients.

Adult↗
PubMed1991

Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era.

To study the changes in the epidemiology of extrapulmonary tuberculosis in Tennessee, we compared the 454 cases of extrapulmonary tuberculosis reported between 1977 and 1981 with 356 cases encountered between 1982 and 1986. The data were analyzed by age, sex, race and site of the disease which were compared with the national statistics during the periods. We observed that 11.3 percent of the total TB cases were extrapulmonary. Unlike national statistics, the proportion of extrapulmonary tuberculosis had remained unchanged between the two study periods. Except for a significant decline (p less than 0.001) in genitourinary tuberculosis, the incidence of other extrapulmonary TB had remained the same. The higher incidences of lymphatic, miliary, and meningeal TB were noted in nonwhites, particularly in the younger population, during both study periods. While the national trend showed a steady increase in the percentage of extrapulmonary TB cases, there was no change in Tennessee. The reason for a continued decline of GU TB remains unclear. Although AIDS may have contributed toward the increase nationally, fewer cases of AIDS in the state have not influenced the proportion of extrapulmonary TB. Awareness of such regional differences in the epidemiology of TB, and the impact of HIV infection, will be very useful to physicians and other health care providers involved in the diagnosis, treatment, and prevention of tuberculosis.

Acquired Immunodeficiency Syndrome↗