ABSTRACT
Background: many clinicians wish to employ Mycobacterium tuberculosis [MTB]-specific interferon gamma [IFN-gamma] release assays [IGRAs] as a diagnostic test, for active tuberculosis [TB]. They are alternative or adjunct to the tuberculin skin test [TST] in screening for latent tuberculosis infection [LTBI], but there are scarce data directly comparing the tests performance in high burden settings for the diagnosis of active and/or latent TB in low- and middle- income countries [LMICs]
Objective: to compare the performance of Quanti-FERON-TB-Gold in tube assay [QFG-IT] with the TST for identifying active and LTBI in relatively high TB burden settings
Design: in a cross-sectional study, we compared the TST and QFG-IT assay in a cohort of 210 participants classified into three groups; Group I investigated for LTBI and included 74 health care workers [HCWs] with known close contact to active TB cases, Group II; 83 patients investigated for active TB disease, Group III; 53 apparently healthy, control subjects
Results: Of 210 participants in the 3 groups, 117 [55.7%] had a TST result of >/=10 mm; 42 [20%] of them had indurations >/=15 mm. QFG-IT was positive in 69 [32.9%] of the cohort, in 23 [31.1%] of 74 HCWs investigated for LTBI and in 40 [48.2 %] in patients clinically suspected to be tuberculous; 63 [75.9%] of them proved to have active TB. Among healthy control, 6 [11.3%] were positive, meanwhile 21 [10.0%] from the enrolled cohort had indeterminate QFG-IT results. In patients investigated for active TB, QFG-IT was positive in 16/19 cases [84.2%] of PTB, and in 22/39 cases [56.4%] of EPTB. Sensitivity, specificity, positive and negative predictive values of QFG-IT assay were 65.62%, 80%, 95%, and 28.6%, meanwhile they were 90.57%, 50%, 90.57% and 33.33% for TST, respectively. Positive QFG-IT tests were associated with older age, female gender, BCG vaccination and longer duration of work in health care setting. Overall agreement between the 2 tests was moderate [75.66%, kappa 0.526] and in healthy control was fair 78.13% [kappa 0.201]. Also, there were moderate agreements between the two tests among HCWs investigated for LTBI and patients investigated for active TB [76.17%, kappa 0.570], and [77.49%, kappa 0.511], respectively
Conclusion: we showed moderate agreement between TST and QFG-IT test in diagnosing LTBI and active TB infection in high burden setting. Despite higher specificity of QFG-IT test. TST remains a cost effective test in LMICs with limited budget for use of IGRA tests as screening tool in national control programs. However, QFG-IT in conjunction with TST improves the diagnostic yield, can help identifying at-risk groups and reduce the indication of preventive chemotherapy in high burden settings
ABSTRACT
Infertility has become nowadays not only a medical, bur a Social problem as well. Infertility in female is caused by various factors. Tubal disease is responsible for 25-35% of female infertility. Pelvic inflammatory disease [PID] is the most common cause of tubal disease
Aim of the study: determine the frequency of tuberculosis and C. trachomatis in patients with tubal factor infertility to develop a laboratory strategy for identification of the most common causes of tubal factor infertility [M. tuberculosis and C. trachomatis] in our locality with respect to laparoscopic finding. Patients and Methods: this study was performed on ninety women with primary infertility and abnormal hysterosalpingography as studied group and 30 infertile women [with polycystic ovary as the only cause of infertility] and normal hysterosalpingography as a control group. Mycobacterium tuberculosis IgG and of C. trachomatis IgG antibodies were performed by enzyme linked immunoassay [ELlSA]. Polymerase chain reaction [PCR] was performed .for detection mnpt64 gene of M. Tuberculosis and C. trachomatis plasmid DNA
Results: in patient group, M. Tuberculosis and C. trachomatis IgG antibodies showed positive results in 72 [80%] and 13 patients [81.1%] respectively. In control group they were detected in 23 [76.7%] and 5 [16.6%] respectively. PCR for mpt64 gene of M. tuberculosis was detected in peritoneal fluid of 17 patients [18.89%] af7d and C. trachomatis plasmid DNA were detected 5 patients [5.56%] respectively
Conclusions: tuberculosis is one of the major etiological factors for female infertility in Egypt and the use PCR for nzpt64 gene o f M tuberculosis plays on important role in diagnosis of genital tuberculosis with results comparable with laparoscopy and histopathology. Detection of C. trachomatous 1gG antibodies by ELlSA can play a significant role in detection of C. trachomatis in infertile women
ABSTRACT
Clinical diagnosis of neonatal sepsis is difficult even in the most sophisticated settings. Many technical pitfalls raise questions regarding blood culture reliability in diagnosis of neonatal sepsis. Detection of microbial DNA rather than the microorganisms themselves is a new era has been introduced in diagnostic microbiology that allows effective and rapid diagnosis of many diseases; it is suggested to represent a rapid and sensitive method in diagnosing bacterial sepsis in neonates
Aim of the study: to evaluate the role of Broad Range 16 S rDNA PCR in diagnosis of sepsis in newborn infants and to compare the results of PCR with the conventional blood culture
Patients and Methods: 58 newborn infant with clinically suspected sepsis were included in the present work. Complete blood picture and Creative protein level were done. Concomitant blood culture and 16S rDNA gene PCR amplification were done to all newborn infants included in this study
Results: blood cultures were positive in only 28[48.2%] of case. With the molecular method of broad range 16S rDNA PCR, the detection of bacteria in this study was improved to 38 [65.5%] of these patients. Compared to blood culture, the diagnosis of bacterial sepsis in the newborn by PCR revealed 96.4% sensitivity, 66.6% specificity, 72.9% positive predictive value and 95.2% negative predictive value. Out of 58 newborn infants included in this study 41 patients had suspected early onset sepsis [EOS] [<7days] and 17 patients had suspected late onset sepsis 7 days]. The sensitivity, specificity, PPV, and NPV of PCR for the diagnosis of EOS were similar to those of late-onset sepsis. Of the patients with suspected EOS, 16 [39%] mothers had received antibiotics within 72 hours before delivery and maternal antibiotic drug use did not alter the performance of PCR
Conclusions and Recommendations: the benefit of PCR is its rapid availability of results with a high negative predictive value. As a tool to 'rule out sepsis', PCR can be easily incorporated into the hospital setting for newborn infants admitted to the NJCU for sepsis evaluation PCR seems to perform well in patients either with suspected EOS or late onset sepsis, irrespective of antibiotic drug use in the mother. Future studies are needed to incorporate PCR to provide us with additional valuable information regarding identification of definitive bacterial species and guide the clinical antibiotic selection
ABSTRACT
Autoimmune hepatitis [AIH] in children is a rare chronic progressive liver disorder. It is characterized serologically by high aminotransferase levels, elevated immunoglobulin G [JgG] and the presence of autoantibodies. AIH is divided into two types according to the auto antibody profile. This study aims to assess frequency, clinical manifestations, biochemical features and outcome of AIH in children attending Assuit University Hospitals with acute icteric hepatitis and sero-negative viral markers [anti-HAV JgM, Hbs Ag, anti- HCV AB]
Patients and methods: 34 children with AIH, based on the International Scoring Criteria of Autoimmune Hepatitis, recruited from Assuit University Hospitals, during the period from January 2005 to December 2009. Alf patients received prednisolone 2 mg/kg per day. Follow-up was done for one year
Results: among 34 children diagnosed as AIH, 24 were females [70.5%] with a mean age of 8.7 +/- 3.4 years and JO were males [29.5%] with a mean age of 9.5 +/- 2.8 years at time of presentation. Jaundice represented the most consistent finding in all patients. According to the auto antibody profile, 25 children were classified as type 1 and 9 children were classified as type 2. Corticosteroid therapy was started. Complete remission was observed in 67.6% of patients and partial remission in I 7. 6%. There was no significant statistical difference in clinical and biochemical features of AIH in patients regarding the response to treatment. Mild side effects of the steroid therapy were encountered in 48.2% of patients and disappeared after stoppage of therapy. After complete withdrawal of corticosteroids, 6 patients [20. 7%] developed relapse of the disease
In conclusion: AIH type 1 was the main form of autoimmune hepatitis in children referred to Assiut University Hospitals. Girls more affected than boys. AIH type 1 exhibited a more active ongoing immunologic process. Steroid alone can be used successfully in most cases. Children with AIH type 2 had a higher frequency of relapse after corticosteroid withdrawal. Further studies on bigger number of cases and long-term follow up are recommended