The use of immunomodulators as an adjunct to antituberculous chemotherapy in non-responsive patients with osteo-articular tuberculosis

Abstract

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.

Conservative treatment of TB Spondylitis in Dorsolumbar and Lumbar spine

“…Five patients responded with resolution of symptoms in another six weeks but one patient did not respond. This patient underwent immunomodulation therapy as advised by Arora et al 13 This patient Þ nally responded after three months of ATT and three episodes of aspiration of the superÞ cial lumbar abscess. Six patients underwent USG guided aspiration of the superÞ cial abscess and two underwent open drainage of their psoas abscess.…”

Multidrug resistant tuberculosis: A challenge in clinical orthopedics

“…These cells carry CD4 antigens on their surface (CD4 + lymphocytes). In patients who were considered therapeutically refractory CD4 + count was found to be lowered 11. The above mentioned immunomodulation regime in conjunction with second line drugs demonstrated upgradation of CD4 + count after 4-6 months of therapy 511.…”

“…Immunomodulatory therapies should be rational and attractive however currently most of the efforts are like preclinical trails 789. Pending such advances the following modality has been used by us as an adjunct to anti TB drugs 1011. Levamisol (150) mg is given at night for 3 consecutive days at weekly intervals for a total of 45 tablets.…”

“…The first and second are 0.1 ml intradermal Bacillus Calmette-Guerin (BCG) injections and the third and fourth are intramuscular diphtheria + pertussis + tetanus vaccine injections. Clinically a favorable response was observed in 85% of patients 511. The helper subset of T lymphocytes is central to cell mediated immunity against tuberculous infection.…”

Hiv Infection and Hiv-Associated Tuberculosis in Children in Ukraine

“…Проблема туберкулеза и ВИЧ для жителей Украины также приобрела угрожающий характер [3][4][5] беременных и рожденных ими детей [1,6,7]. Процент инфицированности ВИЧ беременных (в большей степени) и доноров (в меньшей степени) отражает общий уровень инфицированности населения в стране.…”