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Letter To Editor
2 (
1
); 49-49
doi:
10.4103/0974-2727.66702

Steroids: A Promising Drug for Abdominal Tuberculosis?

Immunodeficiencies Unit, Hospital 12 Octubre, Carretera Andalucia km 5,400, Madrid, Spain
Address for correspondence: Dr. Luis Ignacio González-Granado, E-mail: nachgonzalez@gmail.com
Licence
This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0
Disclaimer:
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.

Sir,

I am grateful for the excellent contribution of Dasgupta A et al.[1] to the study of abdominal tuberculosis, but I would like to make one comment. The authors show that vasculitis is a major mechanism of disease in abdominal involvement of tuberculosis. It has been previously demonstrated that steroids added to the general anti-tuberculous regimen could decrease mortality in these patients.[2,3] In pericardial and meningeal involvement, steroids have demonstrated a better outcome, since vasculitis represents a pathogenic contribution to the injury caused by Mycobacterium tuberculosis. Adjunctive prednisolone in the treatment of effusive tuberculous pericarditis has proven efficacy in HIV patients with a reduction of death risk (relative risk 0.5) [2] Treatment with dexamethasone was associated with a reduced risk of death in tuberculous meningitis (relative risk, 0.69) although it was not associated with a significant reduction in the proportion of severe sequelae.[3]

These preliminary evidence should encourage starting randomized controlled trials to definitely support the use of steroids in abdominal tuberculosis. This novel approach could even help to decrease the need of surgery as perforation and bowel obstruction could be avoided.

REFERENCES

  1. , , . Abdominal tuberculosis: A histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. J Lab Physicians. 2009;1:56-61.
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  2. , , , , , . Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart. 2000;84:183-8.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004;351:1741-51.
    [Google Scholar]

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