ABSTRACT
Background: Tuberculosis is one of the top 10 cause of death globally. Extra-pulmonary tuberculosis is an important clinical problem. Extra-pulmonary tuberculosis range from 30%-53% in India. Diagnosis of extra-pulmonary tuberculosis is still challenging despite many investigations. World Health Organization recommends Gene-Xpert Mycobacterium Tuberculosis/Rifampicin (Cartridge Based Nucleic Acid Amplification Test-CBNAAT) over conventional tests for diagnosis of extra-pulmonary tuberculosis which permits rapid tuberculosis diagnosis through detection of the genetic sequence of DNA of mycobacterium tuberculosis and simultaneous identification of a majority of the mutations that confirm Rifampicin resistance which is highly predictive of multi-drug resistant tuberculosis.Methods: Study was carried out over a period of one year. Patients with suggestive of extra-pulmonary tuberculosis were included in study. Diagnosis of extra-pulmonary tuberculosis carried out by clinical, radiological, biochemical analysis, cytological, bacteriological confirmation. Based on mycobacterium tuberculosis result, the study population were divided into ‘Mycobacterium Tuberculosis detected’ and ‘Mycobacterium Tuberculosis not detected’ groups. Mycobacterium Tuberculosis detected group was further divided into ‘Rifampicin resistant’ and ‘Rifampicin sensitive’.Results: Total 220 patients were included. Among extra-pulmonary tuberculosis, there were 83.64% were pleural fluid. 65.91% patients where be <45 years of age. Mostly patients were from rural areas and illiterate. Diabetes Mellitus found as the most common co-morbidities. CB-NAAT was able to detect mycobacterium tuberculosis in 35% (77) extra-pulmonary samples, out of which 6 were rifampicin resistant. Out of 184 samples of pleural fluid, 53 were rifampicin sensitive and 4 were found rifampicin resistant.Conclusions: CB-NAAT has to be endorsed in every health care centres as the test gives rapid result and also detection of rifampicin resistance which is the major concern for every clinician.
ABSTRACT
Introduction: TB is one of the top 10 causes of death globally. PTB is most common presentation. Lymph node TB is the most common type of EPTB constitutes about 35% cases followed by pleural effusion(20%), bone and joint(10%), genitourinary TB(9%), TB Meningitis(5%), abdominal tuberculosis(3%), other(10%). WHO also recommends Gene Xpert MTB/RIF over conventional tests which permits rapid TB diagnosis through detection of the genetic sequence of DNAof mycobacterium TB and simultaneous identification of a majority of the mutations that confirm Rifampicin resistance which is highly predictive of MDR-TB. Methodology: Study was carried out over a period of one year in a tertiary care centre. Patients with suggestive of pleural effusion were included in study. Pleural fluid was drawn using standard protocol and sent for CBNAAT test and bacteriological examination. Based on MTB result, the study population were divided into 'MTB detected' and 'MTB not detected' groups. MTB detected group was further divided into 'Rif' Resistant and 'Rif' sensitive group. All the collected information was filled in predesigned proforma in excel sheet for final analysis. Chi squire test or suitable formula was applied to know the significance of our study. Results: 203 patients were included with a male to female ratio of 2.98:1. 65.91% patients were below 45 years of age. Mostly patients were from rural areas and illiterate. 38.64% had different type of substance abuse habit. DM (29.03%) found as the most common co-morbidities. CBNAAT test was able to detect MTB in 76 (37.44%) extra-pulmonary samples, 70 were Rifampicin sensitive and 6 were 'Rifampicin' resistant.