PCR for MTB (Sputum) Test

Pneumonia is a type of lung infection that may affect one or both lungs. In this condition the air sacs, also known as alveoli, fill with pus or fluid, which makes it difficult to breathe. Moreover, pneumonia is known to cause inflammation in the air sacs. This disease may range from mild to life threatening and the severity depends on cause of inflammation, the organism fostering your infection, your age and general health. 

Symptoms:
Most common symptoms associated with the condition are:

1. Chest pain
2. Difficulty in breathing
3. Shaking chills
4. Rapid heartbeat
5. Fever
6. Rapid breathing
7. Dry cough
8. Vomiting
9. Wheezing
10. Nausea 
11. Muscle aches
12. Bluish skin tone due to oxygen deficiency 
13. Blood in sputum that is coughed up mucus
14. Labored breathing
15. Confusion 
16. High fever

Causes: 

1. Bacteria: One of the most common causes of pneumonia is the bacteria named as Streptococcus pneumoniae. This type of pneumonia may occur after you have had flu or a cold or maybe even on its own. Moreover, it may affect only one part of the lung i.e. the lobe and is also known as lobar pneumonia. 
2. Viruses: Viruses are one of the main reasons why children below 5 years of age suffer from pneumonia. Viruses that cause pneumonia may also cause cold or flu. Viral pneumonia is usually mild and may be treated at home itself. However, in some cases, it may be very severe and life-threatening. 
3. Mycoplasmas: Mycoplasma is a type of bacteria that doesn't have a cell wall around the cell membrane which is why they are usually unaffected by most antibiotics which target cell wall synthesis. The symptoms of pneumonia caused by mycoplasmas are mild and the patient does not require bed rest. This type of pneumonia is known as 'Walking Pneumonia'. 
4. Fungi: People with weakened immune systems or chronic health problems usually develop pneumonia due to fungi. You may also develop fungal pneumonia by inhaling large doses of it mainly found in soil or bird droppings. In case you have a concern or query you can always consult an expert & get answers to your questions!

COPD, short for Chronic Obstructive Pulmonary Disease, is an inflammatory disease of the lungs. The disease obstructs the flow of air in the lungs and subsequently causes difficulty in breathing. Prolonged exposure to cigarette smoke, gases or particulate matter can lead to this condition. The condition transcends all age brackets meaning it can affect anyone from young teenagers to aged adults. People who contract this disease are at an increased likelihood of developing cardiovascular conditions and lung diseases, in addition to a horde of other conditions.

Causes of COPD
1. The chief cause of COPD is smoking tobacco and being subjected to fumes from cooking and heating. A study estimated that in and around 25% of long-standing smokers develop symptoms of this condition. Yet, statistics show that COPD is often misdiagnosed until an elaborate evaluation is diagnosed.
2. Conditions like Emphysema and chronic bronchitis are also known to cause the disease. Your lungs depend on the intrinsic elasticity of the air sacs and bronchial tubes that help facilitate the passage of air through the lungs. Chronic Obstructive Pulmonary Disease causes these passages to lose their elasticity thus rendering them partially ineffective.

Symptoms of COPD 
The symptoms of COPD do not appear until the lungs are significantly damaged and the condition tends to deteriorate if smoking persists. Apart from coughing and production of sputum, other apparent symptoms include:

1. Difficulty in breathing
2. Stiffness and tightness of chest
3. A persistent cough
4. Fatigue and weakness
5. Weight loss
6. Frequent allergic reactions of the respiratory glands

Along with the aforementioned symptoms, patients who are diagnosed with COPD are likely to experience bouts of exacerbation, during which their symptoms heighten and tend to grow worse for several days.
Although anyone can contract the condition, certain people are at an increased risk of condition. Such risk factors include:

• Chronic smoking
• A medical history of asthma
• Exposure to chemicals and dusts
• Weakening of the immune system with increasing age
• Heredity

If you experience or entertain symptoms or suspicions of this disease, consulting a pulmonologist is duly advised.

This green gourd may be bitter in taste, but is packed with so many benefits, people who use it swear by it. Whether it is diabetes or asthma, the green bitter gourd has helped in many ways. Read on to know some of the health benefits of this wonder gourd. Hope that makes you learn to relish it beyond its bitter taste.

1. Weight management: 100 g of the vegetable contains just about 20 calories, and is one of the best low-calorie foods. Coupled with its other benefits (listed below), this should find its way to anyone wanting to improve overall health
2. Diabetes: Karela has the chemical polypeptide-P which is also known as plant insulin. It works as insulin and helps in blood sugar control. A glass of bitter gourd juice is one of the most well-known and successful home remedies for diabetics.
3. Rich in folate: Bitter gourds are rich in folates and one can get up to 20% of the recommended daily from about 100 g of this vegetable. Widely used in menstruating women and pregnancy to prevent anemia and blood iron levels. In pregnancy, it also helps reduce neural tube defects in the developing baby
4. Loaded with antioxidants: Alpha and beta carotenes, xanthenes, and lutein. All these help in controlling the release of free radicals and reduce bodily inflammation. This is the most important reason for the development of diseases like diabetes, cancer, and premature ageing. Therefore, bitter gourd helps in preventing and/or prolonging the onset of these diseases. Another independent antioxidant is vitamin C, and about 100 g of karela provides more than 100% of daily required dose
5. Good for digestion: Bitter gourd is widely used for its digestive properties. It improves mobility, relieves constipation, and reduces problems of indigestion
6. Good for respiratory system: Respiratory benefits of bitter gourd include clearing up of sputum, improving breathing, and relief from cough. Widely used in asthma patients
7. Blood purifier: It is an excellent blood purifier and juice consumed in the morning is one of the best ways to detox the body

Though still to be proven, karela is known to help HIV/AIDS patients, as they contain phytochemicals, which improve immunity and reduce overall infection and inflammation in the body

Methods of Use:

1. Both the leaves and the bitter gourd per se can be consumed for their health benefits
2. The juice is the most beneficial method, though it might take you some time to acquire this taste. Whether it is for weight loss or diabetes, this offers the best medicinal value
3. Curries are usually prepared with karela in different styles depending on cooking preferences in that area
4. It can also be baked, boiled, and fried.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Diagnosis of tuberculosis is based on a combination of clinical features, smear examination of sputum where available, tuberculin skin testing or Mantoux test, chest X-ray and Histopathologic / cytologic examination as appropriate. Common clinical features are weight loss, persistent fever and /or cough of more than 2 weeks duration and history of close contact with another Tuberculosis patient.

Mantoux test also known as Tuberculin skin test is used for the detection of infection by Mycobacterium Tuberculosis bacteria. The test consists of slowly injecting a liquid intradermally (superficially within the layers of the skin) on the forearm, leading to formation of a raised vesicle which should be easily visible to the naked eye. This liquid, used in India, is Tuberculin PPD RT 23 strain. Tuberculin is a glycerol extract of the Tuberculosis bacteria. This is one of the two WHO accepted standard tuberculins, apart from PPD-S. In India, where the prevalence of tuberculosis is high, the recommended dose of this liquid is 0.1 ml of 1 TU (TU stands for tuberculin units) .1 TU is the strength of the liquid mentioned on the vial. This liquid is usually administered by a very tiny syringe, usually of 26 gauge. (Needle diameter).

Please click on the link to watch a video  demonstrating  how this procedure is performed.

Test principle : The individual who has been infected with Tubercle bacilli responds with a hypersensitivity reaction at the test site in the form of induration. Induration is the palpable raised hardening of the skin, while erythema refers to redness of skin. Only induration is clinically significant and measured after 48 to 72hours following injection. Diameter of the Induration is measured by a scale in millimetres perpendicular to the long axis of the forearm.

Interpretation of the tuberculin test

1. Size of induration 15 mm and above : - signifies infection with tubercle bacilli
2. Size of induration 10-14 mm : - could be due to infection with tubercle bacilli, BCG induced sensitivity, or due to cross reaction with other environmental mycobacteria.

It is more likely to be attributable to infection with tubercle bacilli in case of history of contact with smear positive case of pulmonary TB, clinically confirmed TB OR X-ray consistent with active TB.

1. Size of induration 5 -9 mm: usually non tuberculous in nature generally
2. Size of induration <5 mm : indicates absence of any type of mycobacterial infection.

Precautions during this procedure :

1. If a raised vesicle does not appear it means that the liquid has been injected too deeply, and the test should be repeated on the other arm. If the same arm is used the injection site should be should be separated at least 5 cm from the first injection site.
2. Occasional patients may experience severe allergic reaction to the tuberculin PPD

Comments :

1. Larger the size of the induration, higher the probability of presence of infection with tubercle bacilli.
2. Almost all reactions with induration more than 15 mm maybe considered attributable to infection with tubercle bacilli.
3. Formation of necrosis (ulcer) at the test site, indicates high degree of tuberculin sensitivity and suggests presence of infection with tubercle bacteria.
4. Tuberculin reaction may be suppressed (falsely low) in presence of immunosuppressive states. Like HIV, malnutrition, patient on steroid therapy etc.
5. Mantoux test is generally not recommended for infants less than 12 weeks old. If the test turns out to be positive, then it is significant, but if the test is negative, then the test needs to be repeated again.
6. The tuberculin test detects only the presence or absence of tuberculosis infection. The presence of infection is not synonymous with disease. It simply means, that even if you have tuberculosis infection in your body, as detected by positive Mantoux test, it does not mean you have active Tuberculosis in your body and require anti tuberculosis drugs in all cases. The clinician will correlate your mantoux test result with other tests ( as mentioned at the top of the blog) to give you a final picture.  
7. For more such interesting articles please visit my blogsite www.doctors4patients.com

Cancer like most other diseases has the best rates of recovery with early detection and intervention. As there are no regular health screenings for blood cancer, only the awareness about the early warning signs can save your life. November is designated as the Lung Cancer Awareness Month, to ensure every individual is equipped to fight against lung cancer right from the start. Here are 4 vital facts you must know to win your fight against blood cancer.
Lung cancer is also known as pulmonary carcinoma or cancer of the lung. It occurs when DNA mutations develop in the cells/ tissues of the lungs leading up to uncontrolled growth in the tissues of the lung. By far, it is known to be the most common cancer in Asia.

1. Type: lung cancers can present as one of the following types: 

1. Non-Small Cell Lung Cancer (NSCLC): Most common type of lung cancer and constitutes nearly 85% of all lung cancers. The sub-types of NSCLC are as follows:
   • Large cell carcinoma
   • Squamous cell carcinoma (SqCC) (Epidermoid)
   • Adenocarcinoma – accounts for majority of the NSCLC.
2. Small Cell Lung Cancer (SCLC): It is also known as oat meal cancer and tends to spread (metastasize) quickly. This constitutes about 15% of the lung cancers.
3. Mesothelioma: It is a rare cancer that develops in the mesothelial cells of the pleural or peritoneal surfaces. It usually arises in the pleural membrane lining the lungs, known as pleural mesothelioma. One that arises from the peritoneum is called the peritoneal mesothelioma and the one that arises from the pericardium is known as pericardial mesothelioma. Lastly, it can also arise from the tunica vaginalis known as testicular mesothelioma. People working with or prior exposure to asbestos are mostly at risk of developing mesothelioma. The latency period between time of exposure and development of mesothelioma can be somewhere between 20 to 40 years. Maximum of the patients who develop mesothelioma are men.

2. Gender: It affects the male populace predominantly. It is more common in men than in women and in those of lower economic status. However, the incidence of lung cancer, in women too, is on the rise of late.

3. Etiology: Cigarette/ Tobacco smoking remains the most important cause of lung cancer accounting for 85 – 90% of the cases. Incidence/ risk is proportionate to the number of cigarettes smoked irrespective of the age. Also, environmental toxins including smoke from burning black tar, exhaust gases from automobiles etc. too contribute actively to various lung diseases including cancer. People working in asbestos manufacturing factories who are exposed to asbestos dust are also likely to get lung cancer. Tuberculosis too is an additive risk factor. Again, people who have received ionizing radiation especially to treat Hodgkin Lymphoma or other malignancies also run the risk of developing lung cancer. Above-mentioned causes apart, genetic factors may also play a role.

4. Features: Lung cancer clinically presents in the following ways mainly. Signs & symptoms of malignant mesothelioma are as enumerated below

• Difficult/ labored breathing (Dyspnea)
• Chest pain
• Palpable chest wall mass
• Discordant chest wall expansion
• Weight loss (Cachexia)
• Loss of appetite (Anorexia)
• Night sweats

Signs & symptoms of non-small cell lung cancer (NSCLC) are as enumerated below. Majority of patients are symptomatic at diagnosis

• Chronic cough
• Difficult/ labored breathing (Dyspnea)
• Chest pain
• Blood stained sputum (Hemoptysis)
• Hoarseness
• Weight loss (Cachexia)
• Loss of appetite (Anorexia)
• Weakness
• Bone pain
• Pleural or pericardial effusion
• Superior vena cava syndrome
• Brachial plexopathy
• Neurologic pain
• Hypercalcemia of malignancy

Signs & symptoms of small cell lung cancer (SCLC) are as enumerated below

Symptoms as per the points 8 – 18 depicted above for NSCLC are applicable for SCLC as well. Additionally, patients suffering from SCLC may have:

• Fever associated with chest infections like bronchitis/ pneumonia that refuse to go away or keep coming back
• Horner syndrome
• Paraneoplastic syndromes including encephalitis/ sub-acute sensory neuropathy, hyponatremia, acromegaly, cancer associated retinopathy, ectopic corticotropic syndrome etc all.

5. Screening: is generally recommended for asymptomatic/ symptomatic populations as surveillance for high-risk individuals – who are either current or former smokers (quit smoking within the last 15 years) have at least a 30 pack-year smoking history and those who do not have any prior history of lung cancer. The goal of screening, as usual, is to be able to detect & diagnose lung cancer at an early stage which is potentially curable. It is mostly radiologic with a low dose helical computed tomography (CT) scan being more effective in detecting early-stage lung cancer than a chest radiograph can.

6. Diagnosis: Abnormal blood test results may be indicative of malignancy, but a follow-up imaging/ biopsy is always the gold standard for an accurate diagnosis. Following are the diagnostics employed mainly:

1. Blood: Hb may be low, TLC, ESR and polymorphs increased. Adenocarcinomas are likely to express thyroid transcription factor 1 (TTF-1) or carcinoembryonic antigen (CEA). On the other hand, mesotheliomas are likely to express Wilms Tumor -1 (WT-1) protein and Calretinin.
2. Imaging: Thoracoscopy, Bronchoscopy, X-Ray, CT Scan etc all. Positron Emission Tomography (PET) / CT scan and Magnetic Resonance Imaging (MRI) scan help detect metastasis if any.
3. Biopsy: It clinches the histologic diagnosis and the nature of the disease.

7. Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment are key for effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for early-stage lung cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. The primary determinant of prognosis in NSCLC is the stage at which the cancer is diagnosed. For non-metastatic cancers, however, it is the nodal status that determines the stage and hence the prognosis.

9. Prevention: Rightly said, prevention is always a better choice. Cigarette smoking is to be avoided by all means as it is the single major cause of lung cancer. Even exposure to cigarette smoke (passive or secondhand) is also an established cause of lung cancer and is known to increase the risk of lung cancer in non-smokers as well. Preventing exposure to secondhand smoke can be helpful in decreasing the incidence and mortality of primary lung cancers. Above-mentioned apart, other important risk factors such as exposure to ionizing radiation, environmental carcinogens like smoke from burning black tar, exhaust gases from automobiles, outdoor air pollution, and occupational exposure to asbestos, arsenic, beryllium, nickel, cadmium, chromium etc all too are known to increase the risk for lung cancer and mortality thereof. In fact, cigarette smoking is known to potentiate the effect and hence the lung cancer risk of many of the above-mentioned carcinogens, multi-fold, in smokers. Thus, either eliminating or reducing the exposure to the above-mentioned carcinogens can lead to a decrease in the risk of lung cancer and incidences thereof. Furthermore, randomized clinical trials indicate that high-intensity smokers (only) who take supplementation of beta-carotene have an increased risk/ incidence of lung cancer. Vitamin E supplementation, on the other hand, does not affect the risk of lung cancer as indicated by the trials. 

In case you have a concern or query you can always consult an expert & get answers to your questions!