The use of immunomodulators as an adjunct to antituberculous chemotherapy in non-responsive patients with osteo-articular tuberculosis
- 1 February 2006
- journal article
- Published by British Editorial Society of Bone & Joint Surgery in The Journal of Bone and Joint Surgery. British volume
- Vol. 88-B (2), 264-269
- https://doi.org/10.1302/0301-620x.88b2.17197
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/mm3(sd 261) and 545 cells/mm3(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/mm3(sd 343)) still remained lower than that of group I (1071 cells/mm3(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.Keywords
This publication has 21 references indexed in Scilit:
- Immunotherapy for drug-resistant tuberculosisThe Lancet, 1992
- Extrapulmonary Tuberculosis in Patients with Human Immunodeficiency Virus InfectionMedicine, 1991
- Improved immunotherapy for pulmonary tuberculosis with Mycobacterium vaccaeTubercle, 1990
- Peripheral blood T lymphocyte subpopulations in patients with tuberculosis and the effect of chemotherapyTubercle, 1989
- The role of host factors for the chemotherapy of BCG infection in inbred strains of miceAPMIS, 1988
- T4 lymphopenia in human tuberculosisTubercle, 1987
- NUTRITION, IMMUNITY, AND INFECTION: PRESENT KNOWLEDGE AND FUTURE DIRECTIONSThe Lancet, 1983
- Patient Compliance: The Most Serious Remaining Problem in the Control of Tuberculosis in the United StatesChest, 1979
- LEVAMISOLE AS ADJUNCT TO DAPSONE IN LEPROSYThe Lancet, 1976
- CONTROLLED CLINICAL TRIAL OF FOUR SHORT-COURSE (6-MONTH) REGIMENS OF CHEMOTHERAPY FOR TREATMENT OF PULMONARY TUBERCULOSIS: SECOND EAST AFRICAN/BRITISH MEDICAL RESEARCH COUNCIL STUDYThe Lancet, 1974