Document Detail

The use of immunomodulators as an adjunct to antituberculous chemotherapy in non-responsive patients with osteo-articular tuberculosis.
MedLine Citation:
PMID:  16434536     Owner:  NLM     Status:  MEDLINE    
We studied 51 patients with osteo-articular tuberculosis who were divided into two groups. Group I comprised 31 newly-diagnosed patients who were given first-line antituberculous treatment consisting of isoniazid, rifampicin, ethambutol and pyrazinamide. Group II (non-responders) consisted of 20 patients with a history of clinical non-responsiveness to supervised uninterrupted antituberculous treatment for a minimum of three months or a recurrence of a previous lesion which on clinical observation had healed. No patient in either group was HIV-positive. Group II were treated with an immunomodulation regime of intradermal BCG, oral levamisole and intramuscular diphtheria and tetanus vaccines as an adjunct for eight weeks in addition to antituberculous treatment. We gave antituberculous treatment for a total of 12 to 18 months in both groups and they were followed up for a mean of 30.2 months (24 to 49). A series of 20 healthy blood donors served as a control group.Twenty-nine (93.6%) of the 31 patients in group I and 14 of the 20 (70%) in group II had a clinicoradiological healing response to treatment by five months. The CD4 cell count in both groups was depressed at the time of enrolment, with a greater degree of depression in the group-II patients (686 cells/mm(3) (sd 261) and 545 cells/mm(3) (sd 137), respectively; p < 0.05). After treatment for three months both groups showed significant elevation of the CD4 cell count, reaching a level comparable with the control group. However, the mean CD4 cell count of group II (945 cells/mm(3) (sd 343)) still remained lower than that of group I (1071 cells/mm(3) (sd 290)), but the difference was not significant. Our study has shown encouraging results after immunomodulation and antituberculous treatment in non-responsive patients. The pattern of change in the CD4 cell count in response to treatment may be a reliable clinical indicator.
A Arora; B Nadkarni; G Dev; D Chattopadhya; A K Jain; S M Tuli; S Kumar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. British volume     Volume:  88     ISSN:  0301-620X     ISO Abbreviation:  J Bone Joint Surg Br     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-25     Completed Date:  2006-05-23     Revised Date:  2010-11-10    
Medline Journal Info:
Nlm Unique ID:  0375355     Medline TA:  J Bone Joint Surg Br     Country:  England    
Other Details:
Languages:  eng     Pagination:  264-9     Citation Subset:  AIM; IM    
University College of Medical Sciences and GTB Hospital, Shahdara, Delhi-110095, India.
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MeSH Terms
Adjuvants, Immunologic / administration & dosage*
Antibiotics, Antitubercular / therapeutic use
Antitubercular Agents / therapeutic use*
BCG Vaccine / administration & dosage
CD4 Lymphocyte Count
Child, Preschool
Diphtheria Toxoid / administration & dosage
Drug Therapy, Combination
Levamisole / administration & dosage
Middle Aged
Tetanus Toxoid / administration & dosage
Treatment Outcome
Tuberculosis, Osteoarticular / blood,  drug therapy*,  immunology
Reg. No./Substance:
0/Adjuvants, Immunologic; 0/Antibiotics, Antitubercular; 0/Antitubercular Agents; 0/BCG Vaccine; 0/Diphtheria Toxoid; 0/Tetanus Toxoid; 14769-73-4/Levamisole

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