35. What is caseation necrosis? Whether inding of it on autopsy is
speci ic for tuberculosis?
Caseation" (means cheese like) refers to a form of necrosis that, to the
naked eyes appears cheese-like ("caseous"), and is typically (but not
uniquely) a feature of the granulomas of tuberculosis. The caseous look
may also be associated with necrotizing granulomas. The identi ication
of necrosis in granulomas is important because granulomas with
necrosis tend to have infectious causes. Therefore an autopsy inding of
caseous necrosis may not always be suggestive of TB but it may be
suggestive of chronic infectious lung disease with massive pleural
effusion as a complication which may lead to respiratory failure as
cause of death.
36. What is asthenia?
Prolonged infections in the body such as tuberculosis can lead to
asthenia (excessive weakness) due to their debilitating effect on the
muscles and it could be a natural cause of death.
37. What is DOTS? What is the role of patient in treatment of
tuberculosis?
The current internationally accepted therapy by Directly Observed
Treatment, Short-Course (DOTS) for drug-susceptible TB consists of
multiple antibiotics and is lengthy. Adherence and compliance are
critical for optimal ef icacy of these drug regimens. There remains a
more respectful and active role of the patient in disease management.
In exceptional situations, the DOTS approach of facilitating adherence
might not achieve its objectives, since patients need to make
themselves available for treatment and are less likely to do so if they are
imprisoned or suffer medication side-effects.
Some inmates may be afraid to come forward, fearing the
repercussions of a diagnosis of tuberculosis, such as the stigma
tuberculosis brings with it, a transfer to another facility or a delay in
their release. Sometimes inmates may not be allowed to seek care
because of their place in the internal hierarchy among the prisoners.
Other reasons for delay in diagnosis could be
· Not aware of the severity of symptoms
· Not having a previous satisfactory experience with the health
system
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