A grey, nodular mass found in tissues affected by tuberculosis.
The term also refers to a small rounded protrusion on the surface of a bone.
The term also refers to a small rounded protrusion on the surface of a bone.
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
A pre-vaccination tuberculin test is necessary in all age-groups except newborn infants, and only those with negative tuberculin reactions are vaccinated. Complications are few and far between. A local reaction at the site of vaccination usually occurs between two and six weeks after vaccination, beginning as a small papule that slowly increases in size. It may produce a small ulcer. This heals after around two months, leaving a small scar. (See IMMUNITY; TUBERCULIN.)... bcg vaccine
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 asiaticaHin: Akasgaddah;
Mal: Kadamba, KollankovaTam: Akashagarudan, Gollankovai;Tel: Murudonda, NagadondaCorallocarpus is a prostrate or climbing herb distributed in Punjab, Sind, Gujarat, Deccan, Karnataka and Sri Lanka. It is monoecious with large root which is turnip-shaped and slender stem which is grooved, zigzag and glabrous. Tendrils are simple, slender and glabrous. Leaves are sub-orbicular in outline, light green above and pale beneath, deeply cordate at the base, angled or more or less deeply 3-5 lobed. Petiole is long and glabrous. Male flowers are small and arranged at the tip of a straight stiff glabrous peduncle. Calyx is slightly hairy, long and rounded at the base. Corolla is long and greenish yellow. Female flowers are usually solitary with short, stout and glabrous peduncles. Fruit is stalked, long, ellipsoid or ovoid. Seeds are pyriform, turgid, brown and with a whitish corded margin. It is prescribed in later stages of dysentery and old veneral complaints. For external use in chronic rheumatism, it is made into a liniment with cumin seed, onion and castor oil. It is used in case of snakebite where it is administered internally and applied to the bitten part. The root is given in syphilitic rheumatism and later stages of dysentery. The plant is bitter, sweet, alexipharmic and emetic. The root is said to possess alterative and laxative properties (Kirtikar and Basu, 1988). Root contains a bitter principle like Breyonin (Chopra et al, 1980).Agrotechnology: Cucurbits can be successfully grown during January-March and September- December. For the rainfed crop, sowing can also be started after the receipt of the first few showers.Pits of 60cm diameter and 30-45cm depth are to be taken at the desired spacing. Well rotten FYM or vegetable mixture is to be mixed with topsoil in the pit and seeds are to be sown at 4-5/pit. Unhealthy plants are to be removed after 2 weeks and retained 2-3 plants/pit. FYM is to be applied at 20-25t/ha as basal dose along with half dose of N (35kg/ha) and full dose of P (25kg) and K (25kg). The remaining dose of N (35kg) can be applied in 2 equal split doses at fortnightly intervals. During the initial stages of growth, irrigation is to be given at an interval of 3-4 days and at alternate days during flowering and fruiting periods. For trailing cucumber, pumpkin and melon, dried twigs are to be spread on the ground. Bitter gourd, bottle gourd, snake gourd and ash gourd are to be trailed on Pandals. Weeding and raking of the soil are to be conducted at the time of fertilizer application. Earthing up may be done during rainy season. The most dreaded pest of cucurbits is fruit flies which can be controlled by using fruit traps, covering the fruits with polythene, cloth or paper bags, removal and destruction of affected fruits and lastly spraying with Carbaryl or Malathion 0. 2% suspension containing sugar or jaggery at 10g/l at fortnightly intervals after fruit set initiation. During rainy season, downy mildew and mosaic diseases are severe in cucurbits. The former can be checked by spraying Mancozeb 0.2%. The spread of mosaic can be checked by controlling the vectors using Dimethoate or Phosphamidon 0.05% and destruction of affected plants and collateral hosts. Harvesting to be done at least 10 days after insecticide or fungicide application (KAU,1996).... cucurbitsAction: anti-tubercle, haemostatic, powerful astringent, anti-microbial.
Uses: Basis of treatment for tuberculosis with Umckaloabo in the 1920s. See: UMCKALOABO. Spongy bleeding gums, bleeding piles, nasal polyps (powder used as snuff), haemoptysis, incontinence of urine. Preparations. Average dose, half-2g. Thrice daily.
Decoction. Half-l teaspoon to each large cup water gently simmered 20 minutes. Dose: one-third to half a cup.
Tincture Krameria BPC (1949). Dose 30-60 drops (2-4ml).
Liquid extract BPC 1923. Dose: 2-4ml. ... krameria root
An epidemic disease is usually infectious from person to person, but not necessarily so since many persons in a locality may simply be exposed to the same cause at one time; for example, outbreaks of lead-poisoning are epidemic in this sense.
The conditions which govern the outbreak of epidemics are poorly understood, but include infected food supplies, such as drinking water contaminated by waste from people with CHOLERA or typhoid fever (see ENTERIC FEVER); milk infected with TUBERCLE bacillus; or ‘fast food’ products contaminated with salmonella. The migrations of certain animals, such as rats, are in some cases responsible for the spread of PLAGUE, from which these animals die in great numbers. Certain epidemics occur at certain seasons: for example, whooping-cough occurs in spring, whereas measles produces two epidemics – as a rule, one in winter and one in March. In?uenza, the common cold, and other infections of the upper respiratory tract, such as sore throat, occur predominantly in the winter.
There is another variation, both as regards the number of persons affected and the number who die in successive epidemics: the severity of successive epidemics rises and falls over periods of ?ve or ten years.... epidemic
BURSITIS, TENDINITIS and non-speci?c back pain (see BACKACHE).
Osteoarthritis (OA) rarely starts before 40, but by the age of 80 affects 80 per cent of the population. There are structural and functional changes in the articular cartilage, as well as changes in the collagenous matrix of tendons and ligaments. OA is not purely ‘wear and tear’; various sub-groups have a genetic component. Early OA may be precipitated by localised alteration in anatomy, such as a fracture or infection of a joint. Reactive new bone growth typically occurs, causing sclerosis (hardening) beneath the joint, and osteophytes – outgrowths of bone – are characteristic at the margins of the joint. The most common sites are the ?rst metatarsal (great toe), spinal facet joints, the knee, the base of the thumb and the terminal ?nger joints (Heberden’s nodes).
OA has a slow but variable course, with periods of pain and low-grade in?ammation. Acute in?ammation, common in the knee, may result from release of pyrophosphate crystals, causing pseudo-gout.
Urate gout results from crystallisation of URIC ACID in joints, against a background of hyperuricaemia. This high concentration of uric acid in the blood may result from genetic and environmental factors, such as excess dietary purines, alcohol or diuretic drugs.
In?ammatory arthritis is less common than OA, but potentially much more serious. Several types exist, including: SPONDYLARTHRITIS This affects younger men, chie?y involving spinal and leg joints. This may lead to in?ammation and eventual ossi?cation of the enthesis – that is, where the ligaments and tendons are inserted into the bone around joints. This may be associated with disorders in other parts of the body: skin in?ammation (PSORIASIS), bowel and genito-urinary in?ammation, sometimes resulting in infection of the organs (such as dysentery). The syndromes most clearly delineated are ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF), psoriatic or colitic spondylitis, and REITER’S SYNDROME. The diagnosis is made clinically and radiologically; no association has been found with autoantibodies (see AUTOANTIBODY). A particularly clear gene locus, HLA B27, has been identi?ed in ankylosing spondylitis. Psoriasis can be associated with a characteristic peripheral arthritis.
Systemic autoimmune rheumatic diseases (see AUTOIMMUNE DISORDERS). RHEUMATOID ARTHRITIS (RA) – see also main entry. The most common of these diseases. Acute in?ammation causes lymphoid synovitis, leading to erosion of the cartilage, associated joints and soft tissues. Fibrosis follows, causing deformity. Autoantibodies are common, particularly Rheumatoid Factor. A common complication of RA is Sjögren’s syndrome, when in?ammation of the mucosal glands may result in a dry mouth and eyes. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and various overlap syndromes occur, such as systemic sclerosis and dermatomyositis. Autoantibodies against nuclear proteins such as DNA lead to deposits of immune complexes and VASCULITIS in various tissues, such as kidney, brain, skin and lungs. This may lead to various symptoms, and sometimes even to organ failure.
Infective arthritis includes: SEPTIC ARTHRITIS An uncommon but potentially fatal disease if not diagnosed and treated early with approriate antibiotics. Common causes are TUBERCLE bacilli and staphylococci (see STAPHYLOCOCCUS). Particularly at risk are the elderly and the immunologically vulnerable, such as those under treatment for cancer, or on CORTICOSTEROIDS or IMMUNOSUPPRESSANT drugs. RHEUMATIC FEVER Now rare in western countries. Resulting from an immunological reaction to a streptococcal infection, it is characterised by migratory arthritis, rash and cardiac involvement.
Other infections which may be associated with arthritis include rubella (German measles), parvovirus and LYME DISEASE.
Treatment Septic arthritis is the only type that can be cured using antibiotics, while the principles of treatment for the others are similar: to reduce risk factors (such as hyperuricaemia); to suppress in?ammation; to improve function with physiotherapy; and, in the event of joint failure, to perform surgical arthroplasty. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) include aspirin, paracetamol and many recently developed ones, such as the proprionic acid derivatives IBUPROFEN and naproxen, along with other drugs that have similar properties such as PIROXICAM. They all carry a risk of toxicity, such as renal dysfunction, or gastrointestinal irritation with haemorrhage. Stronger suppression of in?ammation requires corticosteroids and CYTOTOXIC drugs such as azathioprine or cyclophosphamide. Recent research promises more speci?c and less toxic anti-in?ammatory drugs, such as the monoclonal antibodies like in?iximab. An important treatment for some osteoarthritic joints is surgical replacement of the joints.... joints, diseases of
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
One of the AMINOGLYCOSIDES, streptomycin has two disadvantages. The most important of these is the tendency of organisms to become resistant to it. This means that the administration of this antibiotic must be carefully supervised to ensure that correct dosage is being used. The other disadvantage is that streptomycin produces toxic effects, especially disturbance of the vestibular and hearing apparatus. This may result in DEAFNESS, VERTIGO, and TINNITUS. Whilst in many cases these toxic manifestations disappear when the antibiotic is withdrawn, they may be permanent. For this reason therefore streptomycin must always be used with special care.... streptomycin
Habitat: Common in temperate and alpine Himalayas, as a moss on trees.
English: Lichen.Unani: Ushnaa.Action: Moss—used as an expectorant and in the treatment of ulcers.
Key application: German Commission E approves Usnea (dried thallus of U. barbata, U.florida, U. hirta and U. plicata) for mild inflammations of the oral and pharyngeal mucosa.Usnea preparations are used clinically by North American herbalists for antibacterial action against Grampositive bacteria in local or systemic infections and for antifungal action against Candida albicans. (Expanded Commission E Monographs.)U. longissima contains 3-4% usnic acid, also barbatic acid and arabitol. Usnic acid and barbatic acid possess marked anti-tubercular activity. Bar- batic acid produces usnic acid, is active against Streptococcus haemolyticus and pneumococcus sp. and inhibits the growth of tubercle bacillus.... usnea longissimaTUBERCULIN 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
Action: Antiseptic, antispasmodic, rubefacient, anthelmintic, insect repellent. Antimicrobial. Antiscorbutic. Expectorant.
Uses: Used by natives of the Molucca Islands as a lotion for painful stiff joints. Advised by physicians at the turn of the century to combat the tubercle bacillus. Infections of the bronchi. Worms in children. Toothache. Headache.
Preparation. Topically for toothache, bruises, sprains, neuralgia. Cajuput oil BPC: dose, 0.05-0.2ml.
Today it is confined to external use only as an ingredient of stimulating liniments and ointments for aching joints, fibrositis, etc. An ingredient of Olbas oil. ... cajeput
Constituents: sesquiterpene lactones, inulin, resin.
Action: antispasmodic, alterative, stimulating expectorant, diaphoretic, antiseptic, stomachic, anticatarrhal.
“Performs a double action (1) as a bacteriostatic in chronic bronchitis and (2) its biochemical action in alleviating rheumatism.” (Hamdard Foundation, Pakistan).
Helenin inhibits growth of tubercle bacillus. (Ellingwood, 12.4. Apr 18. 126)
Uses: Has a long record for old coughs, especially of tuberculosis. Haemoptysis, whooping cough, croup. Advanced chest diseases to facilitate removal of mucous. Silicosis, pneumoconiosis, emphysema. Chronic catarrh. Night sweats. Leucorrhoea. To strengthen a feeble digestion. Stitches in the side (spleen). Hyperventilation.
Combines well with Yarrow and Marshmallow. Popular combination. Decoction: mix equal parts; Yarrow, Marshmallow root and Elecampane root. 1oz (30g) in 1 pint (500ml) water simmered 20 minutes. Dose: half-1 cup, 2-3 times daily. In the absence of any one ingredient, substitute Wild Cherry bark.
Preparations: Thrice daily.
Powder: quarter to half a teaspoon.
Decoction, root. Quarter to half a teaspoon to each cup of water; simmer gently 10 minutes in a covered vessel. Dose: 1 cup.
Liquid extract BHC Vol 1. (1:1, in 25 per cent ethanol). Dose: 1-2ml. Not used in pregnancy and lactation.
Note: Difficult to maintain chemical stability of the root which may explain why best results have followed pulping or decoction of the fresh root. Dosage of pulp: 2-4 teaspoons. ... elecampane
These people include health workers, contacts of people who have tuberculosis, and immigrants (including children) from countries with a high rate of tuberculosis.
Infants born to immigrants in this category are immunized, without having a tuberculin test, within a few days of birth.
The vaccine is also recommended for children aged 10–14 years for whom the test is negative.... bcg vaccination
The brain and its meninges have a low resistance to infection and a cerebral abscess is liable to follow any penetration of these by microorganisms. The condition is fatal unless relieved by aspiration or surgical drainage.... abscess
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