ABSTRACT
The performance of the nitrate reductase assay (NRA) was compared with the proportion method (PM) on Lowenstein-Jensen medium and the BACTEC MGIT960 assay under routine conditions using 160 clinical isolates of Mycobacterium tuberculosis with a high proportion of resistant strains. The mean time to obtain results was 8.8 days and the overall agreements between NRA and PM and NRA and M960 were 95 percent and 94 percent, respectively. NRA was easy to perform and represents a useful tool for the rapid screening of drug-resistant M. tuberculosis strains in low-resource countries.
Subject(s)
Humans , Antitubercular Agents/pharmacology , Culture Media/pharmacology , Microbial Sensitivity Tests/methods , Mycobacterium tuberculosis/drug effects , Nitrate Reductase/pharmacologyABSTRACT
We describe a case of a male patient, 38 years old, HIV-positive (most recent CD4 count about 259/mm³), with abdominal pain, nausea, vomiting, anorexia, weight loss, and vespertine high fever with chills. His hemogram showed normocytic and normochromic anemia, with a high erythrocyte sedimentation rate (ESR) and gross granulations in the neutrophils. Transaminases were normal. Bone marrow biopsy evidenced a chronic disease anemia pattern and a lack of infectious agents. Abdominal ultrasound examination showed a normal-size spleen, which exhibited heterogeneous parenchyma and multiple small hypoechoic images, together with small ascites, peripancreatic and para-aortic lymphadenopathy. These findings were confirmed by abdominal CT. The liver was normal in size, but had a hyperechoic image, which was not visualized on CT. Histopathological analysis of one of the multiple abdominal lymph nodes obtained by laparoscopic biopsy exhibited a chronic granulomatous inflammatory process, with caseous necrosis. Tissue sections were positive for BAAR (acid-alcohol-resistant bacillus), and the cultures were positive for Mycobacterium tuberculosis. Anti-tuberculosis treatment was begun, and the patient evolved with improvement of his general state, fever remission and weight gain. Splenic tuberculosis is a rare disease, occurring predominantly in patients in late stages of AIDS and/or disseminated tuberculosis. It is a difficult diagnosis, since there are no specific findings. Hence, complementary examinations, such as abdominal ultrasound/ CT, or fine needle aspiration, are usually necessary for investigation and differential diagnosis. Often, lesion regression after anti-tuberculosis regimens can be seen, and splenectomy is restricted to complicated or refractory disease.
Subject(s)
Adult , Humans , Male , AIDS-Related Opportunistic Infections/diagnosis , Antitubercular Agents/therapeutic use , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Lymph Node/diagnosis , Tuberculosis, Splenic/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Mycobacterium tuberculosis/isolation & purification , Treatment Outcome , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Lymph Node/drug therapy , Tuberculosis, Splenic/drug therapyABSTRACT
Introdução: a amplificação de ácido nucleico através da técnica de reaçã em cadeia da polimerase - PCR pode ser útil para o diagnóstico da tuberculose. O objetivo deste trabalho foi padronizar um método molecular para o diagnóstico da TB pulmonar. Material e métodos: iniciadores especificos foram usados para amplificação...