Mycobacterium Health Dictionary

Tuberculosis results form infection with Mycobacterium tuberculosis. The lungs are the site most often affected, but most organs in the body can be involved in tuberculosis. The other common sites are LYMPH NODES, bones, gastrointestinal tract, kidneys, skin and MENINGES.

The weight loss and wasting associated with tuberculosis before treatment was available led to the disease’s popular name of consumption. Enlargement of the glands in the neck, formerly called scrofula, was known also as the ‘king’s evil’ from the supersition that a touch of the royal hand could cure the condition. Lupus vulgaris (see under LUPUS) is another of the skin manifestations of the disease.

The typical pathological change in tuberculosis involves the formation of clusters of cells called granulomas (see GRANULOMA) with death of the cells in the centre producing CASEATION.

It is estimated that there are 7–8 million new cases of tuberculosis worldwide each year, with 2–3 million deaths. The incidence of tuberculosis in developed countries has shown a steady decline throughout the 20th century, mainly as a result of improved nutrition and social conditions and accelerated by the development of antituberculous chemotherapy in the 1940s. Since the mid-1980s the decline has stopped, and incidence has even started to rise again in inner-city areas. In 2002, 7,239 cases of tuberculosis were noti?ed in the UK compared with 6,442 a decade earlier; more than 390 deaths in 2003 were attributed to the disease. Factors involved in this rise are immigration from higher-prevalence areas, poorer social conditions and homelessness in some urban centres and the association with HIV infection and drug abuse. The incidence of tuberculosis is also rising in many developing countries because of the emergence of resistant strains of the tubercle bacillus (see below). In the UK recently there have been serious outbreaks in a handful of urban-based schools.... tuberculosis

Also known as Hansen’s disease, this is a chronic bacterial infection caused by Mycobacterium leprae affecting the skin, mucous membranes, and nerves. Infection is now almost con?ned to tropical and subtropical countries – mostly in Africa and India. There are two distinct (polarised) clinical forms: tuberculoid and lepromatous. The former usually takes a benign course and frequently burns out, whereas the latter is relentlessly progressive; between these two polar forms lies an intermediate/dimorphous group. Susceptibility may be increased by malnutrition. Nasal secretions (especially in lepromatous disease) are teeming with M. leprae and constitute the main source of infection; however, living in close proximity to an infected individual seems necessary for someone to contract the disease. M. leprae can also be transmitted in breast milk from an infected mother.

Only a small minority of those exposed to M. leprae develop the disease. The incubation period is 3–5 years or longer. The major clinical manifestations involve skin and nerves: the former range from depigmented, often anaesthetic areas, to massive nodules; nerve involvement ranges from localised nerve swelling(s) to extensive areas of anaesthesia. Advanced nerve destruction gives rise to severe deformities: foot-drop, wrist-drop, claw-foot, extensive ulceration of the extremities with loss of ?ngers and toes, and bone changes. Eye involvement can produce blindness. Laryngeal lesions produce hoarseness and more serious sequelae. The diagnosis is essentially a clinical one; however, skin-smears, histological features and the lepromin skin-test help to con?rm the diagnosis and enable the form of disease to be graded.

Although the World Health Organisation had originally hoped to eliminate leprosy worldwide by 2000, that has proved an unrealistic target. The reason is an absence of basic information. Doctors are unable to diagnose the disorder before a patient starts to show symptoms; meanwhile he or she may have already passed on the infection. Doctors do not know exactly how transmission occurs or how it infects humans – nor do they know at what point a carrier of the bacterium may infect others. The incidence of new infections is still more than 650,000 cases a year or about 4.5 cases per 10,000 people in those countries worst affected by the disease.

Treatment Introduction of the sulphone compound, dapsone, revolutionised management of the disease. More recently, rifampicin and clofazimine have been added as ?rst-line drugs for treatment. Second-line drugs include minocycline, o?oxacin and clarithromycin; a number of regimens incorporating several of these compounds (multi-drug regimens – introduced in 1982) are now widely used. A three-drug regime is recommended for multi-bacillary leprosy and a two-drug one for parcibacillary leprosy. Dapsone resistance is a major problem worldwide, but occurs less commonly when multi-drug regimens are used. Older compounds – ethionamide and prothionamide

– are no longer used because they are severely toxic to the liver. Corticosteroids are sometimes required in patients with ‘reversal reaction’. Supportive therapy includes physiotherapy; both plastic and orthopaedic surgery may be necessary in advanced stages of the disease. Improvement in socio-economic conditions, and widespread use of BCG vaccination are of value as preventive strategies. Early diagnosis and prompt institution of chemotherapy should prevent long-term complications.... leprosy

Leprosy. Progressive infection by Mycobacterium leprae. Two forms: (1) tuberculoid; infection of the nerve endings and membranes of the nose, with loss of feeling and pale patches on the body. (2) Lepromatous; with inflamed thickened painful red skin exacerbated by ulceration, fever, neuritis and orchitis. Distorted lips and loss of nasal bone as infection progresses.

Symptoms: numbness, nerves may swell like iron rods. Infected nerves kill all sensation. In endemic areas, pins and needles in hands may call attention to it. A disease of nerves rather than skin. NOTIFIABLE DISEASE.

Many laymen and practitioners will never have seen a case. In the absence of modern medicine some good can be achieved by traditional remedies. Ancient Hindu and Chinese records refer to the use of Gotu Kola (internally and externally). Dr C.D. de Granpre? (1888) refers. (Martindale 27; p.441)

Oil of Chaulmoogra was used up to one hundred years ago before introduction of modern drugs. It fell into dis-use until discovered by a Director of Health in the Philippine Islands during World War I when he used it successfully in combination with camphor. In South America, where the disease is still active, Sarsaparilla has a long traditional reputation. Walnut oil is used as a dressing, in China. An anti- staphylococcal fraction has been isolated from the seeds of Psoralea corylifolia for use in leprosy. (Indian Journal of Pharmacy 26: 141, 1964)

Tea. Gotu Kola. Half a teaspoon to each cup boiling water; infuse 15 minutes. Drink freely. Stronger infusions may be used externally to cleanse ulceration.

Decoction. Combine: Sarsaparilla 1; Gotu Kola 1; Echinacea 2. Half an ounce to 1 pint water gently simmered 20 minutes. Dose: Half a cup 3 times daily.

Formula. Echinacea 2; Sarsaparilla 1; Gotu Kola 2. Dose. Powders 500mg. Liquid Extracts 3-5ml. Tinctures 5-10ml. Thrice daily.

Note: Antibody-positive cases of AIDS are vulnerable to leprosy, both diseases being caused by a similar bacterium.

To be treated by infectious diseases specialist. ... hansen’s disease

auct non L.

Synonym: A. pilosa Hook.f. non Ledeb.

A. pilosa Ledeb. var. nepalensis (D. Don) Nakai

Family: Rosacae.

Habitat: The Himalayas from Kashmir to West Bengal at 9003,000 m, and in Arunachal Pradesh, Nagaland and Meghalaya.

English: Agrimony, Stickle Wort.

Unani: Ghaafis.

Folk: Belu.

Action: Astringent, anti- inflammatory, hepatic, cholagogue, diuretic, mild haemostatic, antibacterial. Used for irritations and infections of the intestinal tract, gallbladder diseases, hyperacidity, colic, urinary disorders (bed- wetting, incontinence), sluggish liver, mucus membrane inflammations; externally for ulcerated and discharging skin, psoriasis and seborrhoic eczemas.

Key application: In mild, nonspecific, acute diarrhoea and in inflammation of oral and pharyngeal mucosa; as astringent. (German Commission E, The British Herbal Pharmacopoeia.)

The herb contains condensed tannins up to 8%, coumarins, flavonoids (glucosides of luteolin, apigenin and quercetin), polysaccharides, volatile oil. Luteolin 7-glucoside shows a chole- gogic action. Aqueous extracts inhibited Mycobacterium tuberculosis, also strains resistant to streptomycin and p-aminosalicylate. Essential oil is antibacterial, active against Bacillus sub- tilis.

The ethanolic extracts of the herb are used for their antiviral properties. (Natural Medicines Comprehensive Database, 2007.)

Coumarins interact with anticoagulants, and drugs that increase the risk of bleeding Furanocoumarin content increase photosensitivity. (Sharon M. Herr.)... agrimonia eupatoria

A group of antibiotics usually reserved for use in patients with severe infections. They are e?ective against a wide range of BACTERIA including some gram-positive and many gram-negative organisms (see GRAM’S STAIN). Aminoglycosides must be used cautiously because they can damage the inner ear – thus affecting hearing – and the kidneys. Examples of this group are AMIKACIN and GENTAMICIN (e?ective against Pseudomonas aeuriginosa), NEOMYCIN (used only for topical administration for skin infections), and STREPTOMYCIN (e?ective in combination with other drugs against Mycobacterium tuberculosis).... aminoglycosides

Antibiotic is the term used to describe any antibacterial agent derived from micro-organisms, although most of them are now prepared synthetically. Such agents destroy or inhibit the growth of other micro-organisms: examples are penicillin, cephalosporin, amino-glycosides, streptomycin, and tetracycline.

Penicillin was the ?rst antibiotic to be discovered and used in the 1940s. The discovery and isolation in 1958 of the penicillin nucleus, 6-amino penicillanic acid (6-PNA), allowed many new penicillins to be synthesised. These are now the largest single group of antibiotics used in clinical medicine. Most staphylococci (see STAPHYLOCOCCUS) have now developed resistance to benzylpenicillin, the early form of the drug, because they produce penicillinases – enzymes which break down the drug. Other types of penicillin such as cloxacillin and ?ucoxacillin are not affected and are used against penicillin-resistant staphylococci.

The cephalosporins are derived from the compound cephalosporin C, which is obtained by fermentation of the mould cephalosporium.

The cephalosporin nucleus 7 amino cephalosporanic (7-ICA) acid has been the basis for the production of the semi-synthetic compounds of the cephalosporin nucleus. The ?rst semi-synthetic cephalosporin, cephalothin, appeared in 1962; it was followed by cephaloridine in 1964. The original cephalosporins had to be given by injection, but more recent preparations can be given by mouth. The newer preparations are less readily destroyed by betalactamases and so they have a much broader spectrum of antibacterial activity. The newer cephalosporins include cephalexin, cefazolin, cephacetrile, cephapirin, cefamandole, cefuroxine, cephrodine, cefodroxil and cefotaxine. Inactivation of beta-lactamase is the basis of bacterial resistance both to the penicillins and to the cephalosporins, so that attempts to prepare these antibiotics with resistance to betalactamase is of great importance. A synthetic inhibitor of beta-lactamase called clavulanic acid has been synthesised; this is used in combination with the penicillins and cephalosporins to prevent resistance. The cephamycins are a new addition to the beta-lactam antibiotics. They are similar in structure to the cephalosporins but are produced, not by fungi, but by actinomycetes.

Overuse and misuse of antibiotics have resulted in many bacteria becoming resistant to them. Hospitals, in particular, have problems with METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA). Combinations of antibiotics are needed to combat resistant strains of bacteria, another example being Mycobacterium tuberculosis.... antibiotics

A group of mycobacteria which differ in their growth characteristics from Mycobacterium tuberculosis but which they resemble in being acid-fas t. The atypical mycobacteria are also known as the PotentiallyPathogenic Environmental Mycobacteria (P.P.E.M.). They can cause a spectrum of human disease which in some cases can resemble tuberculosis. Mostly they cause disease in immunologically compromi sed humans such as those suffering from AIDS.... atypical mycobacteria

One of the anti-tuberculous drugs. It has the advantages of being relatively non-toxic and of being active when taken by mouth. Unfortunately, like streptomycin, it may render the Mycobacterium tuberculosis resistant to its action. This tendency to produce resistance is considerably reduced if it is given in conjunction with RIFAMPICIN and PYRAZINAMIDE.... isoniazid

An antibiotic derived from Streptomyces kanamyceticus. It is active against a wide range of organisms, including Staphylococcus aureus and Mycobacterium tuberculosis.... kanamycin

The original name for Mycobacterium tuberculosis, which causes TUBERCULOSIS. It stems from the name of the German doctor who ?rst identi?ed the bacillus.... koch’s bacillus

A test for TUBERCULOSIS. It consists in injecting into the super?cial layers of the skin (i.e. intradermally) a very small quantity of old TUBERCULIN which contains a protein ANTIGEN to TB. A positive reaction of the skin – swelling and redness – shows that the person so reacting has been infected at some time in the past with Mycobacterium tuberculosis. However, it does not mean that such a person is suffering from active tuberculosis.... mantoux test

(Singular: bacterium.) Simple, single-celled, primitive organisms which are widely distributed throughout the world in air, water, soil, plants and animals including humans. Many are bene?cial to the environment and other living organisms, but some cause harm to their hosts and can be lethal.

Bacteria are classi?ed according to their shape: BACILLUS (rod-like), coccus (spherical – see COCCI), SPIROCHAETE (corkscrew and spiral-shaped), VIBRIO (comma-shaped), and pleomorphic (variable shapes). Some are mobile, possessing slender hairs (?agellae) on the surfaces. As well as having characteristic shapes, the arrangement of the organisms is signi?cant: some occur in chains (streptococci) and some in pairs (see DIPLOCOCCUS), while a few have a ?lamentous grouping. The size of bacteria ranges from around 0.2 to 5 µm and the smallest (MYCOPLASMA) are roughly the same size as the largest viruses (poxviruses – see VIRUS). They are the smallest organisms capable of existing outside their hosts. The longest, rod-shaped bacilli are slightly smaller than the human erythrocyte blood cell (7 µm).

Bacterial cells are surrounded by an outer capsule within which lie the cell wall and plasma membrane; cytoplasm ?lls much of the interior and this contains genetic nucleoid structures containing DNA, mesosomes (invaginations of the cell wall) and ribosomes, containing RNA and proteins. (See illustration.)

Reproduction is usually asexual, each cell dividing into two, these two into four, and so on. In favourable conditions reproduction can be very rapid, with one bacterium multiplying to 250,000 within six hours. This means that bacteria can change their characteristics by evolution relatively quickly, and many bacteria, including Mycobacterium tuberculosis and Staphylococcus aureus, have developed resistance to successive generations of antibiotics produced by man. (METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)) is a serious hazard in some hospitals.

Bacteria may live as single organisms or congregate in colonies. In arduous conditions some bacteria can convert to an inert, cystic state, remaining in their resting form until the environment becomes more favourable. Bacteria have recently been discovered in an inert state in ice estimated to have been formed 250 million years ago.

Bacteria were ?rst discovered by Antonj van Leewenhoek in the 17th century, but it was not until the middle of the 19th century that Louis Pasteur, the famous French scientist, identi?ed bacteria as the cause of many diseases. Some act as harmful PATHOGENS as soon as they enter a host; others may have a neutral or benign e?ect on the host unless the host’s natural immune defence system is damaged (see IMMUNOLOGY) so that it becomes vulnerable to any previously well-behaved parasites. Various benign bacteria that permanently reside in the human body are called normal ?ora and are found at certain sites, especially the SKIN, OROPHARYNX, COLON and VAGINA. The body’s internal organs are usually sterile, as are the blood and cerebrospinal ?uid.

Bacteria are responsible for many human diseases ranging from the relatively minor – for example, a boil or infected ?nger – to the potentially lethal such as CHOLERA, PLAGUE or TUBERCULOSIS. Infectious bacteria enter the body through broken skin or by its ori?ces: by nose and mouth into the lungs or intestinal tract; by the URETHRA into the URINARY TRACT and KIDNEYS; by the vagina into the UTERUS and FALLOPIAN TUBES. Harmful bacteria then cause disease by producing poisonous endotoxins or exotoxins, and by provoking INFLAMMATION in the tissues – for example, abscess or cellulitis. Many, but not all, bacterial infections are communicable – namely, spread from host to host. For example, tuberculosis is spread by airborne droplets, produced by coughing.

Infections caused by bacteria are commonly treated with antibiotics, which were widely introduced in the 1950s. However, the con?ict between science and harmful bacteria remains unresolved, with the overuse and misuse of antibiotics in medicine, veterinary medicine and the animal food industry contributing to the evolution of bacteria that are resistant to antibiotics. (See also MICROBIOLOGY.)... bacteria

Rottl.

Family: Caesalpiniaceae.

Habitat: Bengal, Assam and Andamans up to 1,000 m.

English: Teri Pods.

Ayurvedic: Vaakeri.

Siddha/Tamil: Nunigatcha.

Action: Root—astringent and antipyretic, used in phthisis and scrofulous affections.

The roots gave a phenolic compound vakerin, identical with bergenin. The ethanol-water extract of roots inhibits the growth of Mycobacterium tuberculosis.

The pods contain 28% tannin (without seeds, more than 54%). The bark contains 28% tannin (without seeds, more than 54%). The tannin is pure gallo-tannin and gallic acid.

Dosage: Root—3-5 g powder. (CCRAS.)... caesalpinia digyny

A term applied to signs or symptoms which are especially characteristic of certain diseases, and on the presence or absence of which the diagnosis depends. Thus the discovery of the Mycobacterium tuberculosis in the sputum is said to be pathognomonic of pulmonary tuberculosis.... pathognomonic

The atypical mycobacteria. The commonest PPEM to cause human disease is the Mycobacterium avium-intracellulare complex. PPEM differ from M. tuberculosis in their source (environmental or zoonotic), rate of growth, temperature of growth and ability to produce pigment on culture. Mostly infect immunologically compromised humans and the disease caused by some species may be clinicallyindistinguishable from true human tuberculosis.... potentially pathogenic environmental mycobacteria (ppem)

The term is used in two distinct senses. As a descriptive term in anatomy, a tubercle means a small elevation or roughness upon a BONE, such as the tubercles of the ribs. In the pathological sense, a tubercle is a small mass, barely visible to the naked eye, formed in some organ as the starting-point of TUBERCULOSIS. The name of tubercle bacillus was originally given to the micro-organism that causes this disease, but was subsequently changed to Mycobacterium tuberculosis. The term ‘tubercular’ should strictly be applied to anything connected with or resembling tubercles or nodules, and the term ‘tuberculous’ to anything pertaining to the disease tuberculosis.... tubercle

Schult.

Family: Gentianaceae.

Habitat: Throughout India, ascending to 1,500 m.

Ayurvedic: Daakuni (used as a substitute for Shankhapushpi in West Bengal)

Unani: Sankhaahuli.

Folk: Daankuni.

Action: Anticonvulsant, CNS depressant, anti-inflammatory, hepatoprotective.

The plant contains calcium 0.38; magnesium 0.16; potassium 1.66 and iron 0.23 g/100 g; copper 18.97, zinc 70.50; manganese 9.60, cobalt 3.15 and chromium 0.60 mcg/g.

Roots contain beta-amyrin, friede- lin, genianine and 16 xanthones including mangiferin. Mangiferin is protective activity against induced liver injury in albino rats. Xanthones also showed activity against Mycobacterium tuberculosis.

Dried crude powder of the whole plant exhibited anticonvulsant activity in albino rats.

Canscora diffusa (Vahl) R. Br. ex Roem. & Schultes (synonym C. lawii Wt.), found throughout India at 1,100 m, is used as a substitute for C. decussata.... canscora decussata

(Linn.) Urban.

Hydro cotyle asiatica

Family: Umbelliferae; Apiaceae.

Habitat: In marshy places throughout India up to 200 m.

English: Asiatic Pennywort, Indian Pennywort.

Ayurvedic: Manduukaparni, Manduukaparnikaa, Maanduuki, Saraswati, Brahma-manduuki.

Siddha/Tamil: Vallaarai.

Action: Adaptogen, central nervous system relaxant, peripheral vasodilator, sedative, antibiotic, detoxifier, blood-purifier, laxative, diuretic, emmenagogue. Used as a brain tonic for improving memory and for overcoming mental confusion, stress, fatigue, also used for obstinate skin diseases and leprosy.

Key application: Extracts orally to treat stress-induced stomach and duodenal ulcers; topically to accelerate healing, particularly in cases of chronic postsurgical and post trauma wounds; also to treat second and third degree burns. Patients suffering from venous insufficiency were treated with a titrated extract of the drug. (WHO.)

Used in Indian medicine as a brain tonic and sedative. (Indian Herbal Pharmacopoeia.)

Major constituents of the plant are: triterpenoid saponins—brahmoside, asiaticoside, thankuniside; alkaloids (hydrocotyline); bitter principles (vel- larin).

Brahmoside, present in the plant, is reported to exhibit tranquilizing and anabolic activity. Raw leaves are eaten or plant decoction is drunk to treat hypertension.

Asiaticoside, extracted from leaves, gave encouraging results in leprosy. It dissolves the waxy covering of Bacillus leprae. Centelloside has also been found useful in leprosy. Asiaticoside reduced the number tubercular lesions in the liver, lungs, nerve ganglia and spleen in experimental animals. Another derivative of asiaticoside, oxyasi- aticoside, inhibits growth of Tubercle bacillus at a concentration of 0.15 ml/ml Asiaticosides are also hyperglycaemic.

The asiatic acid acts against resistant bacteria, particularly Mycobacterium tuberculosis and M. leprae as well as Gram-positive cocci.

Asiaticosides elevate blood glucose, triglycerides and cholesterol levels. They seem to decrease blood urea nitrogen and acid phosphatase levels. (Pharmacological findings. Natural Medicines Comprehensive Database, 2007.)

Boiled leaves are eaten for urinary tract infections, and unfiltered juice for scrofula and syphilis.

Extract of the fresh plant significantly inhibits gastric ulceration by cold restraint stress in rats.

In research, using rats, the herb exhibited protective effect against alcohol-induced and aspirin-induced ulcers. (JExp Biol, 2001, Feb, 39(2), 13742.)

Dosage: Whole plant—3-6 g (API Vol. IV.)... centella asiatica

Lam.

Synonym: E. variegata Linn. var. orientalis (Linn.) Merril.

Family: Papilionaceae; Fabaceae.

Habitat: Grown as an ornamental.

English: Indian Coral tree.

Ayurvedic: Paaribhadra, Paarib- hadraka, Paarijaataka, Mandaara, Dadap. Kantaki-palaasha, Kant- kimshuka, Raktapushpa; Nimba- taru. (Erythrina suberosa Roxb. is also equated with Paaribhadra.)

Siddha/Tamil: Kaliyanamurukkan.

Folk: Farhad.

Action: Leaf—cathartic, diuretic, antiseptic, anti-inflammatory. Applied externally for dispersing venereal buboes. Bark—antibilious, anthelmintic, febrifuge, astringent, expectorant. (E. variegata is an adulterant to the Ayurvedic drug Rohitaka.) Different parts of the plant are used as nervine sedative, antiepileptic, astringent, antiasthmatic and antiseptic. Bark is used in liver ailments, fever and rheumatism.

A number of tetracyclic alkaloids have been isolated from the plant.

The alkaloids showed a muscle relaxant activity and increased the sedative effects of hexabarbital. The alkaloids extracted from the leaves are reported to have anti-inflammatory activity. Bark alkaloids are neuromus- cular blocking, smooth muscle relaxant, CNS depressant, hydrocholeretic and anticonvulsant. The bark contains 0.05% alkaloids.

The root extracts exhibited antimicrobial activity in vitro against Staphy- lococcus aureus and Mycobacterium smegmatis.

The seeds of many of the species of Erythrina contain alkaloids with curare-like activity. Clinical trials on biologically standardized beta-ery- throidine hydrochloride and dihydro- beta-erythroidine hydrochloride have shown promising results in the treatment of conditions involving certain types of muscular rigidity.

Dosage: Stem bark—6-12 g powder; 12-24 g for decoction. (API Vol. II.)... erythrina indica

The term given to any skin lesion which is the result of infection with the tubercle bacillus, or Mycobacterium tuberculosis as it is now known.... tuberculide

Tuberculin is the name originally given by Koch in 1890 to a preparation derived from the tubercle bacillus, or Mycobacterium tuberculosis as it is now known, and intended for the diagnosis or treatment of TUBERCULOSIS.... tuberculin

(L.) R. Br.

Synonym: Periploca indica Linn.

Family: Asclepiadaceae, Periplo- caceae.

Habitat: Throughout India; common in Bengal, Maharashtra and extending to Travancore.

English: Indian Sarsaparilla (white var.). Sarsaparilla root is equated with Smilax sp. in Western herbal.

Ayurvedic: Shveta Saarivaa, Anant- muula, Gopi, Gopaa, Gopakanyaa, Gopavalli, Gopasutaa, Krishodari, Sphotaa, Utpalsaarivaa, Kapuuri, Dugdhgarbhaa.

Unani: Ushbaa Hindi.

Siddha/Tamil: Nannaari, Sugan- thipala.

Action: Blood purifier, antisyphilitic, antileucorrhoeic, galactogenic, antidiarrhoeal, antirheumatic, febrifuge, alterative. Roots used against gonorrhoea, leucoderma, bleeding piles, jaundice and dysentery.

Key application: Smilax sp.—in skin diseases and urinary infections. (German Commission E included Smilax sp. among unapproved herbs.)

Hemidesmus indicus does not contain the same saponins or other principal constituents which are found in sarsaparilla. (Tyler's Honest Herbal.)

The root contains coumarino-lig- noids, hemidesmine, hemidesmin-1, 2. The stem contains pregnane glyco- sides, hemidine, hemidescine, emidine and indicine, a triterpene lactone, a lu- panone, besides lupeol acetate, sitos- terol and hexadecanoic acid and several hydroxy- methoxybenzaldehydes.

Aqueous extract of the root is bacteriostatic against Mycobacterium leprae.

Dosage: Root—20-30 g for decoction. (API Vol. I.) palmitoleic, stearic, oleic, linoleic and arachidic. Pyrocatechol, tannins, fla- vonoids and amino acids were also present.... hemidesmus indicus

Linn.

Synonym: L. hirta Roxb. ex Hornem.

Family: Vitaceae.

Habitat: Northern Eastern India, West Peninsula and the Andamans.

Ayurvedic: Kaakajanghaa, Nadikaantaa, Sulomaasha, Paaraa- vatapaadi.

Folk: Surapadi (Telugu).

Action: Stem and root—astringent, anthelmintic. Used for indigestion, jaundice, chronic fever and malaria. Essential oil—inhibits the growth of Mycobacterium tuberculosis (Schroeter) Lehmann & Neumann; also inhibits the growth of Micro- coccus pyogenes var. aureus and Pasteurella pestis. Root, tuber and stem—mucilaginous, astringent. Leaves and twigs—antiseptic; used for poulticing wounds.... leea aequata

Linn.

Family: Apocynaceae.

Habitat: Native to Mexico; grown throughout India.

English: Red Jasmine.

Ayurvedic: Kshira Champaka (red-flowered var.).

Action: Root bark—used in blennorrhagia. Flower—bechic (used in pectoral syrups). Bark— a decoction is used in venereal diseases and leprosy.

The bark contains cytotoxic iridoids (including fulvoplumierin which also inhibits the growth of Mycobacterium tuberculosis) and the lignin, lirioden- drin.

The plant contains the triterpene rubrinol which showed antibacterial activity against Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa (a causative agent responsible for infecting burns, wounds, urinary tract and infection in cystic fibrosis) and Pseudomonas pseu- domallei (which causes melioidosis or pseudoglandess).

The herb contains cardiac glycosides which have a narrow-margin of safety. (Sharon M. Herr.)... plumeria rubra

Benth.

Synonym: P. patchouli var. sauvis Hook. f.

Family: Labiatae; Lamiaceae.

Habitat: Native to the Philippines; introduced in India.

English: Patchouli.

Ayurvedic: Paachi.

Folk: Paanari.

Action: Plant—insecticidal. Leaves—an infusion is given in menstrual troubles.

The oil, extracted from dried leaves, is reported to possess antibacterial activity against E. coli, Staphylococcus au- reus, Streptococcus pyogenes, Bacterium coli and B. typhosum. It is also found effective against Mycobacterium tuberculosis. The oil is used in insect- repellent preparations.... pogostemon cablin

see Mycobacterium. [G. H. A. Hansen (1841–1912), Norwegian physician]... hansen’s bacillus

see Mycobacterium. [R. Koch (1843–1910), German bacteriologist]... koch’s bacillus

a group of bacteria comprising Mycobacterium avium and M. intracellulare, which are responsible for *opportunistic infections of the lung. See Mycobacterium.... mai complex

adj. denoting a disease that occurs when the patient’s immune system is impaired by, for example, an infection, another disease, or drugs. The infecting organism, which is also described as opportunistic, rarely causes the disease in healthy persons. Opportunistic infections, such as *Pneumocystis pneumonia and that caused by the MAI complex (see Mycobacterium), are common in patients with AIDS.... opportunistic

Halle.

Synonym: Hippocratea indica Willd. Pristimera indica A. C. Smith.

Family: Celastraceae; Hippo- crateaceae.

Habitat: North-eastern India.

Siddha/Tamil: Odangod.

Folk: Kazurati, Tirruli (Maharashtra), Atari-lataa, Kathapahaariaa, Lokhandi (Bengal).

Action: Root bark—used for the treatment of respiratory troubles. Stem—febrifuge. Leaves—scorched and given to women during confinement. Powdered leaves and roots are applied to sores and wounds.

The roots contain dulcitol. The root bark contains an antibiotic principle, pristimerin (0.1%) which shows considered in vitro activity against several Gram-positive cocci, both haemolyt- ic and non-haemolytic. Pristimerin also inhibits in vitro growth of different strains of Mycobacterium tuberculosis. Clinical trials have shown that pristimerin is effective in the treatment of inflammatory conditions of the naso-pharyngeal mucosa resulting from common cold and influenzal infections. It is found useful as an adjunct to the common antibiotic therapy of respiratory inflammations of both bacterial and viral origin, and is reported to possess antitumour properties, but its high toxicity precludes its use as a cancero-static agent.... reissantia indica

In?ammation affecting the membranes of the BRAIN or SPINAL CORD, or usually both. Meningitis may be caused by BACTERIA, viruses (see VIRUS), fungi, malignant cells or blood (after SUBARACHNOID HAEMORRHAGE). The term is, however, usually restricted to in?ammation due to a bacterium or virus. Viral meningitis is normally a mild, self-limiting infection of a few days’ duration; it is the most common cause of meningitis but usually results in complete recovery and requires no speci?c treatment. Usually a less serious infection than the bacterial variety, it does, however, rarely cause associated ENCEPHALITIS, which is a potentially dangerous illness. A range of viruses can cause meningitis, including: ENTEROVIRUSES; those causing MUMPS, INFLUENZA and HERPES SIMPLEX; and HIV.

Bacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.

Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.

Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.

Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.

Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.

Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.

Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.

Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.

The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)

Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.... meningitis

been recognised from earliest times. Evidence of the condition has been found in Egyptian mummies; in the fourth century BC Hippocrates, the Greek physician, called it phthisis because of the lung involvement; and in 1882 Koch announced the discovery of the causative organism, the tubercle bacillus or Mycobacterium tuberculosis.

The symptoms depend upon the site of the infection. General symptoms such as fever, weight loss and night sweats are common. In the most common form of pulmonary tuberculosis, cough and blood-stained sputum (haemoptysis) are common symptoms.

The route of infection is most often by inhalation, although it can be by ingestion of products such as infected milk. The results of contact depend upon the extent of the exposure and the susceptibility of the individual. Around 30 per cent of those closely exposed to the organism will be infected, but most will contain the infection with no signi?cant clinical illness and only a minority will go on to develop clinical disease. Around 5 per cent of those infected will develop post-primary disease over the next two or three years. The rest are at risk of reactivation of the disease later, particularly if their resistance is reduced by associated disease, poor nutrition or immunosuppression. In developed countries around 5 per cent of those infected will reactivate their healed tuberculosis into a clinical problem.

Immunosuppressed patients such as those infected with HIV are at much greater risk of developing clinical tuberculosis on primary contact or from reactivation. This is a particular problem in many developing countries, where there is a high incidence of both HIV and tuberculosis.

Diagnosis This depends upon identi?cation of mycobacteria on direct staining of sputum or other secretions or tissue, and upon culture of the organism. Culture takes 4–6 weeks but is necessary for di?erentiation from other non-tuberculous mycobacteria and for drug-sensitivity testing. Newer techniques involving DNA ampli?cation by polymerase chain reaction (PCR) can detect small numbers of organisms and help with earlier diagnosis.

Treatment This can be preventative or curative. Important elements of prevention are adequate nutrition and social conditions, BCG vaccination (see IMMUNISATION), an adequate public-health programme for contact tracing, and chemoprophylaxis. Radiological screening with mass miniature radiography is no longer used.

Vaccination with an attenuated organism (BCG – Bacillus Calmette Guerin) is used in the United Kingdom and some other countries at 12–13 years, or earlier in high-risk groups. Some studies show 80 per cent protection against tuberculosis for ten years after vaccination.

Cases of open tuberculosis need to be identi?ed; their close contacts should be reviewed for evidence of disease. Adequate antibiotic chemotherapy removes the infective risk after around two weeks of treatment. Chemoprophylaxis – the use of antituberculous therapy in those without clinical disease – may be used in contacts who develop a strong reaction on tuberculin skin testing or those at high risk because of associated disease.

The major principles of antibiotic chemotherapy for tuberculosis are that a combination of drugs needs to be used, and that treatment needs to be continued for a prolonged period – usually six months. Use of single agents or interrupted courses leads to the development of drug resistance. Serious outbreaks of multiply resistant Mycobacterium tuberculosis have been seen mainly in AIDS units, where patients have greater susceptibility to the disease, but also in developing countries where maintenance of appropriate antibacterial therapy for six months or more can be di?cult.

Streptomycin was the ?rst useful agent identi?ed in 1944. The four drugs used most often now are RIFAMPICIN, ISONIAZID, PYRAZINAMIDE and ETHAMBUTOL. Three to four agents are used for the ?rst two months; then, when sensitivities are known and clinical response observed, two drugs, most often rifampicin and isoniazid, are continued for the rest of the course. Treatment is taken daily, although thrice-weekly, directly observed therapy is used when there is doubt about the patient’s compliance. All the antituberculous agents have a range of adverse effects that need to be monitored during treatment. Provided that the treatment is prescribed and taken appropriately, response to treatment is very good with cure of disease and very low relapse rates.... nature of the disease tuberculosis has

(Willd.) Miers ex Hook. f. & Thoms.

Family: Menispermaceae.

Habitat: Tropical India and the Andamans.

Ayurvedic: Guduuchi, Gudu- uchikaa, Guluuchi, Amrita, Am- ritaa, Amritalataa, Amritavalli, Chinnaruuhaa, Chinnodbhavaa, Madhuparni, Vatsaadani, Tantrikaa, Kundalini. Guduuchi sattva (starch).

Unani: Gilo, Gulanchaa. Sat-e-Gilo (starch).

Siddha: Seenil, Amrida-valli.

Folk: Giloya.

Action: Herb—antipyretic, an- tiperiodic, anti-inflammatory, antirheumatic, spasmolytic, hypo- glycaemic, hepatoprotective. Water extract increases urine output. Stem juice—prescribed in high fever; decoction in rheumatic and bilious fevers. Aqueous extract of the plant—fabrifuge. Starch—antacid, antidiarrhoeal and antidysenteric.

The Ayurvedic Pharmacopoeia of India, along with other therapeutic applications, recommends the dried stems in jaundice, anaemia, polyuria and skin diseases.

The stem contains alkaloidal constituents, including berberine; bitter principles, including columbin, chas- manthin, palmarin and tinosporon, tinosporic acid and tinosporol.

The drug is reported to possess one- fifth of the analgesic effect of sodium salicylate. Its aqueous extract has a high phagocytic index.

Alcoholic extract of the stem shows activity against E. coli. Active principles were found to inhibit in vitro the growth of Mycobacterium tuberculosis.

Oral administration of alcoholic extract of the root resulted in a significant reduction in blood and urine glucose and in lipids in serum and tissues of alloxan diabetic rats. (Phytother Res. 2003 17 (4), 410-3.)

A significant reduction in levels of SGOT, SGPT, ALP and bilirubin were observed following T. cordifolia treatment during CCl4 intoxication in mature rats. (J. Toxicol Sci. 2002, 27 (3), 139-46.) The plant extract showed in vitro inactivating activity in Hepatitis- B surface antigen. (Indian Drugs, 1993, 30, 549.)

A new hypoglycaemic agent was isolated from the plant; it was found to be 1,2-substituted pyrrolidine.

The starch from roots and stem, used in chronic diarrhoea and dysentery, contains a polysaccharide having 1-4 glucan with occasional branching points.

Dosage: Stem—3-6 g powder; 2030 g for decoction. (API, Vol. I.)... tinospora cordifolia

Linn.

Family: Cruciferae; Brassicaceae.

Habitat: Cultivated in Uttar Pradesh, Punjab, Maharashtra and Gujarat.

English: Radish.

Ayurvedic: Muulaka, Laghu- muulaka, Muulakapotikaa, Visra, Shaaleya, Marusambhava. Pods— Sungraa, Singri, Mungraa.

Unani: Muuli, Turb Fajal.

Siddha/Tamil: Mullangi.

Action: Radish—preparations are used in liver, gallbladder and urinary complaints. Green leaves— diuretic and carminative. Seeds— diuretic, purgative, expectorant.

A decoction of dry radish is given orally in piles. Extract of the dry root is given for hiccough, influenza, dysentery, colic and urinary troubles.

Key application: In peptic disorders, especially those related to dyskinesia of the bile ducts; and in catarrhs of the upper respiratory tract. (German Commission E.)

The Ayurvedic Pharmacopoeia of India recommends the juice of the whole plant in sinusitis; juice of the root in diseases of the throat and sinusitis; and the seed in amenorrhoea, cough and dyspnoea.

The fleshy root and seeds contain trans-4-methyl-thiobutenyl isothio- cyanate glucoside (the pungent principle), cyanidin-5-glucoside-3-sophoro- side, pelargonidin diglycoside, cyani- din diglycoside, 5-methyl-L-cysteine- sulphoxide (methiin), steroidal sa- pogenins and sulphorophene.

The enzymes present in the radish are phosphatase, catalase, sucrase, amylase, alcohol dehydrogenase and pyruvic carboxylase.

Radish contains caffeic acid and fer- ulic acid which exhibit hepatoprotec- tive and choleretic properties. It contains choline which prevents deposition of fat in liver. Amino acids, or- nithine, citrulline, arginine, glutamic acid and asparatic acid remove toxins from the body and urea acumulation.

Radish is a good source of ascorbic acid (15-40 mg/100 g), trace elements include aluminium, barium, lithium, manganese, silicon, titanium, also iodine (upto 18 mcg/100 g) and ascor- bigen.

Roots, leaves, flowers and pods are active against Gram-positive bacteria.

The seeds are reported to contain a broad spectrum antibiotic, machro- lysin, specific against Mycobacterium tuberculosis. Raphanin, extracted from the seeds, is active against Grampositive and Gram-negative bacteria.

A purified basic protein, homologous to nonspecific lipid transfer proteins, from seeds showed antifungal activity.

Raphanus caudatus Linn., synonym R. sativus var. caudatus, is known as Rat-Tail Radish.

A native to Java, it is cultivated in northern and western India. The root is not used; pods, purple or violet in colour, are consumed for properties attributed to Raphanus sp. These are known as Mungraa or Sungraa.

Dosage: Whole plant-20-40 ml juice; root—15-30 ml juice. (API, Vol. II.) Seed—1-3 g powder. (API, Vol. III.)... raphanus sativus

OLD TUBERCULIN (OT) is the heat-concentrated ?ltrate from a ?uid medium on which the human or bovine type of Mycobacterium tuberculosis has been grown for six weeks or more.

TUBERCULIN PURIFIED PROTEIN DERIVATIVE (TUBERCULIN PPD) is the active principle of OT (see above), and is prepared from the ?uid medium on which the Mycobacterium tuberculosis has been grown. It is supplied as a liquid, a powder, or as sterile tablets. The liquid contains 100,000 units per millilitre, and the dry powder contains 30,000 units per milligram. It is distributed in sterile containers sealed so as to exclude micro-organisms. It is more constant in composition and potency than OT.

Uses The basis of the tuberculin reaction is that any person who has been infected with the Mycobacterium tuberculosis gives a reaction when a small amount of tuberculin is injected into the skin. A negative reaction means either that the individual has never been infected with the tubercle bacillus, or that the infection has been too recent to have allowed of sensitivity developing.

There are various methods of carrying out the test, of which the following are the most commonly used. The Mantoux test is the most satisfactory of all, and has the advantage that the size of the reaction is a guide to the severity of the tuberculous infection: it is performed by injecting the tuberculin into the skin on the forearm. The Heaf multiple puncture test is reliable: it is carried out with the multiple puncture apparatus, or Heaf gun. The Vollmer patch test, using an impregnated ?lter paper, is useful in children because of the ease with which it can be carried out.... varieties

Rose. ex.Sm.

Synonym: Z. spurium Koen. Amomum spurium Gmel. A. sylvestre Poir.

Habitat: Throughout India from the Himalayas, southwards. Cultivated in Asian tropics.

English: Zerumbet Ginger.

Ayurvedic: Mahaabhari-vachaa (also equated with Alpinia galanga), Sthula-granthi (also equated with Alpinia speciosa). Source of Martinique Ginger, used as Shunthi in Indian medicine.

Unani: Narkachoor, Zarambaad. (Curcuma caesia is also equated with Narkachoor.)

Folk: Karrallamu (Telugu).

Action: Rhizomes—used for cough, asthma; colic; intestinal worms, and in leprosy and skin diseases. Oil— antiseptic.

The rhizome contains several flavo- noid glycosides and curcumin.

The oil of Zerumbet contains about 13% monoterpenes and several ses- quiterpenes of which humulene and zerumbone are major constituents. The major constituent of monoter- penes is camphene. Unlike the oil of Z. officinale, Zerumbet oil does not contain any methyl heptanone; instead, it contains camphor.

Zerumbone inhibits the growth of Micrococcus pyogenes var. aureus and Mycobacterium tuberculosis.

Indian samples contain only 37.5% of zerumbone, while those from Fiji 58.7, Vietnam 72.3 and Tahiti 65.3%.... zingiber zerumbet