Setting : Department of Respiratory Medicine, B.Y.L. Nair Hospital, Mumbai, India. Objective : To study pre-treatment sputum smear, culture and drug susceptibility testing for mycobacterium tuberculosis in fresh cases of pulmonary tuberculosis, the extent of laboratory related problems and correlation of the laboratory results with clinical outcome. Design : This study is a prospective analysis of 57 cases of pulmonary tuberculosis that denied previous treatment with anti tuberculosis drugs. Cases with associated human immunodeficiency virus (HIV) infection and diabetes mellitus (DM) were excluded. Pre-treatment smear, culture and drug susceptibility were performed by standard culture techniques. Patients were treated with short course chemotherapy (SCC) on the basis of World Health Organisation (WHO) category I. Laboratory results were correlated with initial clinical data and treatment outcomes. Results : Of the 57 cases selected, there were 34 males and 23females, age range 18-65 years, mean age 27.86 years. Clinical data was lacking in 16 patients who defaulted on treatment and hence were excluded from the analysis. Of the 41 cases with complete data, 37 patients were declared cured (91.25%) while 4 patients failed on therapy (9.75%), 17/41 (41.46%) had laboratory results consistent with clinical data and treatment results whereas 24/41 (58.53%) had poor correlation between laboratory results, clinical data and treatment outcomes. The major laboratory related problems were: 1) Smear positive / culture negative (S+/C-) in 16/41 (39%) cases at the start of treatment; 2) HR pattern of resistance in 4/41 (9.75%) and R resistance 3/41 (7.31%) on initial culture susceptibility tests but response to SCC suggesting incorrect susceptibility results. Conclusions : Discrepant reports between clinical findings, laboratory reports and treatment outcomes were found in 58.53% cases. Treatment should not be decided only on the basis of the initial culture susceptibility testing to avoid unnecessary and toxic second line therapy. Improvement in standardisation and new reliable diagnostic techniques are required for management of TB.

Background: Miliary tuberculosis is often treated empirically in India in the absence of a positive diagnosis based on sputum examination. We investigated the role of fiberoptic bronchoscopy for diagnosis of this disease. Methods : Records of patients undergoing fiberoptic bronchoscopy and bronchoscopic lung biopsy, and diagnosed to have miliary tuberculosis, over a four year period were evaluated. Two to four lung biopsy specimens were obtained from each patient and examined microscopically after Hematoxylin-eosin and Zeihl-Neelson staining. Results : Thirty one patients of miliary tuberculosis (19 men and 12 women) underwent fiberoptic bronchoscopy during the study period. No endobronchial abnormality was noted in any patient. Bronchoscopic lung biopsy yielded adeqaute specimen in all but one patient. Granulomatous inflammation was noted in 21 (67.7%) patients on histopathological evaluation of biopsy specimens; of them, acid-fast bacilli were demonstrated in one patient. One patient (3.2%) had normal alveolar architecture. In the other 8 patients (25.8%), nonspecific pulmonary interstitial inflammation and/or mild fibrosis were seen. Bronchial wash specimens showed acid-fast bacilli in only one patient; this patient also had granulomatous inflammation on lung biopsy. All patients tolerated bronchoscopy well and there were no procedure-related complications. Conclusion: Bronchoscopic lung biopsy is a safe procedure and an effective method of establishing diagnosis of miliary tuberculosis in a majority of patients with this disease. Bronchial washings do not provide significant additional information in this regard.

Spontaneous drainage of a tuberculosis cavity by way of caverno­chest wall fistula is an extremely uncommon occurrence. We describe a patient of cavitary pulmonary tuberculosis, whose cavity herniated into the chest wall and formed a caverno-chest wall fistula. The patient responded to antitubercular treatment.

Rifampicin is an essential component of the treatment regimen for tuberculosis. Extensive clinical experience has shown that the drug is well tolerated, but on rare occasions it can cause life threatening adverse reactions like acute renal failure and thrombocytopenia. At the Tuberculosis Research Centre, we have treated more than 8000 patients with pulmonary and extra-pulmonary tuberculosis with rifampicin-containing regimens over the past 30 years and we are reporting a case of acute thrombocytopenia probably rifampicin induced, in a patient who was retreated for tuberculosis. The physician treating tuberculosis patients must be aware of this rare life threatening complication, which if detected early, is completely reversible.

We report a rare and unusual presentation of tubo-ovarian tuberculosis managed conservatively with transvaginal ultrasound guided aspiration.

Pharynx is not a common site for clinical manifestation of tuberculosis. Primary tuberculosis of pharyngeal wall is uncommon. Usually its symptoms mimic malignancy causing delay in diagnosis. We report a case of primary pharyngeal tuberculosis in a 60 years old male.

Mycobacterium tuberculosis causes one of the insidious infec­tions affecting the musculoskeletal system. A rare case of primary tuberculosis of the left soleus muscle in a 55 year old diabetic is reported here. There was no underlying bony lesion and no demonstratable pulmonary involvement. Diagnosis was established on the basis of histological findings and subsequently confirmed by microbiology reports.

An unusual combination of tuberculosis and malaria which can pose clinical problems is reported and its implications discussed.