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INTRODUCTION : Tuberculosis is a disease of great antiquity. There is evidence of spinal tuberculosis in Neolithic, pre Columbian and early Egyptian remains. It was described in the Vedas and other Hindu texts as Rajyakshma-the king of diseases. Tuberculosis became a major problem during the industrial revolution, when crowded living conditions favoured its spread. Though the disease was known since ancient times, the organism causing tuberculosis was described only a century ago by Robert Koch on 24th March 1882. AIMS AND OBJECTIVES : 1. To analyse the risk factors that had led to retreatment of the study group. 2. To study the profile of drug sensitivity pattern of CAT II patients and correlate it with the socio demographic status of these patients. 3. To assess the influence of risk factors like socio demographic characteristics, DM, HIV status, smoking and previous treatment as a marker for the development of Drug Resistant TB in the study group. MATERIALS AND METHODS : The present study was conducted at the Department of Thoracic Medicine, Tirunelveli Medical College, Tirunelveli for a period of one year from May 2007 to April 2008 to assess the drug susceptibility profile of Category II patients registered under RNTCP. Inclusion criteria: The study population constituted; 1. Smear positive patients, with history of previous anti tuberculous treatment for more than one month comprising cases of Failure, treatment after Default and Relapse started on the CAT-II regimen. 2. Patients who had completed or defaulted Category II treatment, found to be still sputum positive and referred to Tuberculosis Research Centre, Chennai for Drug Susceptibility Testing. 3. The above cases that had been previously treated under RNTCP were alone included. Exclusion criteria: 1. Extra pulmonary cases of Category II and 2. Cases who had been previously treated privately were not included for the study. Socio demographic and clinical characteristics such as smear status, type of case, type of disease, category, treatment details such as drug regularity, number of doses taken by the patients and reasons for default were obtained from patient. Information on patient’s literacy, occupation, and personal habits like smoking, other diseases like diabetes and HIV were also obtained. Early morning sputum specimens were collected in a sterile container from the study group who were smear positive by Ziehl Neelsen method. Surface decontamination was done by immersing the specimen container in Lysol solution before transferring to the laboratory. All the laboratory works were carried out as per standard laboratory procedures and Bio-safety norms in Class II Biosafety cabinet. RESULTS : The collected data were edited for completeness, consistency and accuracy. They were analysed by the parameters like mean, median and percentages. The differences of above parameters were tested by the parametric tests like ‘Z’ and‘t’ and non-parametric test like c2 test, which was applicable wherever. The statistical package used for analysis and interpretation is SPSS (version-13) with the level of significance P=0.05. CONCLUSION : Age, sex, residence, education, income, diabetes were not risk factors for retreatment tuberculosis and multidrug resistant tuberculosis. Smoking was a significant risk factor among relapse, failure and MDR cases. There is a need to devise effective strategies for counselling patients about the impact of smoking on their cure. Irregular and interrupted treatment was a risk factor among defaulters, failures and multidrug resistant cases. Ensuring adherence to a full course of treatment is the key to cure TB patients and prevent the emergence of drug resistance. Drug related problems like nausea, vomiting, giddiness were the leading cause to default from treatment. The innovative strategies in health education are the need of the hour. HIV reactivity was noted among defaulters in the present study and not among MDR cases. As drug sensitivity testing is not routinely performed, NTM cases had been registered for retreatment unnecessarily. Though registered for retreatment, most of the isolates were sensitive to all the first line drugs and hence can be successfully treated with a category II regimen if they are compliant enough. Drug resistance was more among prior treatment failure cases, necessitating the need for timely culture and sensitivity testing for those who remain sputum positive during the course of treatment to curb the spread of multidrug resistant strains.

Pulmonary aspergilloma is one of the forms of aspergillosis that occurs commonly due to the saprophytic colonization of the fungus in damaged lung cavities. The most common causative agent is Aspergillus fumiga- tus. Though the definitive diagnosis can be established by Histopathological demonstration in resected specimen and culture of the tissue, but the diagnosis also can be done based on radiological examination. Patients with aspergilloma should undergo surgical treatment, because there is a risk of sudden life threatening hemoptysis and because there is no effective alternate medical therapy. We report a case of aspergilloma in a 37 year old woman with no past history of tuberculosis presented with the complaint of cough and hemoptysis for two months. She was subsequently diagnosed as a case of pulmonary aspergilloma on the basis of evidence of radiological findings and sputum examination and culture. Sputum examination was negative for acid fast bacilli and culture yielded Aspergillus fumigatus from three sputum samples and treated with left upper lobectomy. 1 Aspergilloma occurs in 10-15% of patients with cavitating lung diseases like tuberculosis, sar- coidosis, bronchiectasis, cysts and bullae. 2 In many cases, the diagnosis of pulmonary aspergilloma become difficult on the basis of radiological sign by chest X-ray or computed tomog- raphy (CT) scan as it can produce wide variety of radiographic changes. 3 Often there is a diagnostic dilemma between lung malignancy and pulmonary aspergilloma. The diagnosis also can be established by sputum examination and culture. Despite the high prevalence of pulmonary tuberculosis, pulmonary as- pergilloma is rarely reported in India. The data from Southern districts of TamilNadu is lacking till date. We report the case of a patient with no previous history of any chronic lung disease with the complaint of cough and hemoptysis and diagnosed as a case of pulmonary aspergilloma on the basis of evidence of radiological findings and sputum examination and culture and treated with left upper lobectomy. Case Report A 37 year old female presented to the Cardiothoracic Surgery Clinic at Tirunelveli Medical college Hospital with complaints of productive cough since 2 months and massive hemoptysis two months back. She had chest pain and she had no history of fever, breathlessness, and anorexia. She neither had a past history of tuberculosis or any chronic lung disease nor any family history of it. The general physical status of the patient was satisfactory. On physical examination, chest auscultation revealed decreased air entry on left upper lung field. The clinical examination of the rest of the system revealed no abnormality. Patient was mildly anaemic. Other routine laboratory investigations were normal. Chest X-ray was showing evidence of round homogeneous opac- ity in left upper lobe. On further investigations, CT thorax was planned to rule out malignancy and other differential diagnosis. The CT thorax revealed presence of fungal ball like mass seen in a cavity with a partial radiolucent crescent in the upper lobe of left lung. (Figure-1)Sputum examination for acid fast bacilli (AFB) was negative. HIV (Human immune deficiency virus) screening also was negative. Sputum culture for pyogenic bac- teria showed no growth. Subsequently, sputum KOH mount was showing presence of mycelia and narrow branched hyphae with acute angle which was suggestive of Aspergillus species. (Figure-2)A provisional diagnosis of pulmonary aspergilloma was done. Sputum culture also yielded growth of Aspergillus fumigatus from three separate samples for three consecutive days. (Figure-3&4)Then the final diagnosis of pulmonary asper- gilloma was made and was treated with left upper lobectomy followed by Anti-fungal therapy with Fluconazole.

Typhoid fever is a life threatening systemic illness affecting mainly the developing countries of the world. Correct diagnosis must be made at the crucial time for early treatment and control of transmission. Diagnosis of Typhoid fever by the following tests: Widal test, Dot ELISA and to compare the effectiveness of Widal test and Dot ELISA in the diagnosis of typhoid fever. Patients attending the Tirunelveli Medical College Hospital with acute febrile illness and clinically suspecting Typhoid fever formed the subject of the study. From the blood samples collected both Widal and Dot ELISA tests were performed. A total of 86 Samples were collected and tested. Out of 86 cases, 9 were Widal Positive whereas 23 were Dot ELISA Positive. Dot ELISA is a practical alternative to Widal test in the diagnosis of Typhoid fever.