Features and Outcome of Hepatobiliary Tuberculosis among Filipino Children: Report of a Six-year Experience

Background@#The features and outcome of hepatobiliary tuberculosis (HBTB) have not been extensively reported in children.@*Objective@#To describe the clinical, biochemical, radiologic, microbiologic and histologic features and outcome of children diagnosed with HBTB. @*Methods@#Data of HBTB patients aged 0-18 years were collected by review of medical records and as they were admitted. Cases were classified as bacteriologically-confirmed (positive AFB smear, TB culture or PCR of bile/liver tissue) or clinically-diagnosed (clinical, histologic and/or radiologic evidence). @*Results@#A total of 36 patients were included (mean age: 13yrs; 64% males): three bacteriologically-confirmed and 33 clinically-diagnosed. Most common signs/symptoms were weight loss (69%), fever (67%), hepatomegaly (61%) and jaundice (53%). Of the total, 68% had hypoalbuminemia, 50% increased transaminases and 47% prolonged prothrombin time. Fifteen (42%) patients were AFB positive on various microbiologic specimens. Most common imaging finding was hepatic calcification (64%). Of 11 patients with liver biopsy, seven (64%) had chronic/ granulomatous inflammation. All 36 were managed medically. Eight were lost to follow up, six died, and 22 (61%) are alive, nine with complete resolution of liver disease. @*Conclusion@#Hepatobiliary tuberculosis presents with non-specific clinical and biochemical findings. Several investigations are necessary to confirm the diagnosis. Overall response to anti-TB treatment is satisfactory with possible resolution of liver disease.

Factors Affecting Discordance between Sputum Smear and Culture Conversion Rates In Newly Diagnosed Pulmonary Tuberculosis: A Retrospective Study in Developing Country.

Aims: To assess the performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs among newly diagnosed smear positive pulmonary TB patients. Study Design: This study was conducted prospectively among newly diagnosed smear positive pulmonary TB patients. Place and Duration of Study: Queen Savang Vadhana Memorial Hospital and Chonburi Regional Hospital, Chonburi province, Thailand during April 2010 and July 2012. Methodology: Sputum AFB smear, culture and drug susceptibility test were performed at the time of diagnosis, the second and the fifth month of treatment. Baseline characteristic, clinical and laboratory parameters, treatment regimens and adverse events were recorded. Descriptive statistics and multiple logistic regression analysis were applied as appropriate. The performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs was done using culture as the gold standard. Results: Of 297 eligible pulmonary TB cases, majorities were male (72.4%) with median age of 39 years, illiterate to low educated (52.6%) and earning low income (77.5%). Cough was the most common symptom (91.2%) and cavity was present in 31.1%. At the second month, 17.0% of patients had discordance between sputum AFB smear and culture. High bacilli load (adjusted OR=2.38, CI=1.09-5.18), and hearing alteration (adjusted OR=10.98, CI=1.79-67.28) were significant predictors. Hypoalbuminemia was significantly more severe in patients with false positive AFB smear (P=.04). Sensitivity and specificity for AFB smear were 44.7% and 89.6% at the second month and 57.1% and 97.5% at the fifth month, respectively. MDR-TB was diagnosed in 1.0% and success rate was 77.1%. Conclusions: Baseline AFB smear ≥ 2+ and hypoalbuminemia as well as adverse events during intensive phase are strongly recommended as the criteria to prioritize culture and DST for new smear positive pulmonary TB patients with positive AFB smear at the second and the third month of treatment in developing countries.

Antimicrobial resistance in Campylobacter spp isolated from broiler flocks / Avaliação de resultados do Teste Direto para Mycobacterium tuberculosis (MTD) e da cultura para micobacterias em amostras de urina

Tuberculosis remains a public health problem in Turkey. Rapid detection of Mycobacterium tuberculosis plays a key role in control of infection. In this article, the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) was evaluated for detection of M. tuberculosis in urine samples. The performance of the MTD was very good and appropriate for routine laboratory diagnosis.

A tuberculose continua sendo um problema de saúde pública na Turquia. A detecção rápida de Mycobacterium tuberculosis tem um papel importante no controle da infecção. Nesse artigo, avaliou-se o Gen-Probe Amplified Mycobacterium Tuberculosis Test (MTD) para detecção de M. tuberculosis em amostras de urina. O desempenho do MTD foi muito bom e adequado para diagnóstico laboratorial de rotina.

Evaluation of the results of Mycobacterium tuberculosis direct test (MTD) and Mycobacterial culture in urine samples

Tuberculosis remains a public health problem in Turkey. Rapid detection of Mycobacterium tuberculosis plays a key role in control of infection. In this article, the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) was evaluated for detection of M. tuberculosis in urine samples. The performance of the MTD was very good and appropriate for routine laboratory diagnosis.

A tuberculose continua sendo um problema de saúde pública na Turquia. A detecção rápida de Mycobacterium tuberculosis tem um papel importante no controle da infecção. Nesse artigo, avaliou-se o Gen-Probe Amplified Mycobacterium Tuberculosis Test (MTD) para detecção de M. tuberculosis em amostras de urina. O desempenho do MTD foi muito bom e adequado para diagnóstico laboratorial de rotina.

Evaluation of Combination of BACTEC Mycobacteria Growth Indicator Tube 960 System and Ogawa Media for Mycobacterial Culture / 대한진단검사의학회지

BACKGROUND: The combined use of liquid media and solid media is recommended for mycobacterial culture. We evaluated diagnostic performance of combination of BACTEC Mycobacteria Growth Indicator Tube (MGIT; Becton Dickinson, USA) and 2% Ogawa media (Korean Institute of Tuberculosis, Korea) for recovery of mycobacteria. METHODS: In September 2007, 1,764 specimens from 1,059 patients were cultured with MGIT and Ogawa. Acid fast bacilli (AFB) smear was fluorochrome-stained. The isolates were identified into Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) with PCR using Seeplex TB Detection Kit (Seegene, Korea). Recovery rate, time to detection (TTD), contamination rate, mixed growth rate and species distribution were analyzed. RESULTS: Two hundred thirty-five specimens (13.3%) from 165 patients (15.6%) were positive for mycobacterial culture. Recovery rates of mycobacteria from the group using both media, MGIT only, and Ogawa only were 13.3%, 12.1%, and 7.8%, respectively. While MGIT recovered 98.9% of MTB and 79.7% of NTM, Ogawa recovered 65.9% of MTB and 54.1% of NTM. TTDs of total mycobacteria/MTB/NTM in MGIT and Ogawa were 10.6/11.4/9.7 days and 31/29/33 days, respectively. MGIT TTDs of total mycobacteria/MTB/NTM from AFB-positive specimens were significantly shorter than those of AFB-negative specimens; 8.2/9.5/4.4 days vs 11.6/12.7/10.7 days. Contamination and mixed growth rate of MGIT were 9.6% and 3.7%. Primary culture of Ogawa recovered 1 MTB and 1 NTM among the 170 MGIT-contaminated specimens and 38 mycobacteria among 66 specimens that showed mixed cultures of MGIT. CONCLUSIONS: MGIT warrants sensitive and rapid isolation of mycobacteria. However, the combination of MGIT and Ogawa is more desirable to recover mycobacteria in the case of contaminations or mixed cultures.

Clinical Utility of Polymerase Chain Reaction for the Differentiation of Nontuberculous Mycobacteria in Patients with Acid-fast Bacilli Smear-positive Specimens / 결핵및호흡기질환

BACKGROUND: In Korea, polymerase chain reaction (PCR) test for M. tuberculosis has been used for the diagnosis of acid-fast bacilli (AFB) smear-negative tuberculosis in order to increase diagnostic sensitivity. However, there have been no data dealing with the clinical utility of PCR in AFB smear-positive patients to differentiate between M. tuberculosis and nontuberculous mycobacteria. METHOD: We retrospectively analyzed the PCR test results which have been performed in patients who had AFB smear-positive sputum but had ambiguous clinical manifestations of active tuberculosis. PCR test was done using AMPLICORa M. tuberculosis kit. The sensitivity, specificity, and positive and negative predictive values of the PCR test were calculated based on culture and final clinical diagnosis result. RESULTS: Fifty-six consecutive patients (62 PCR tests) were included in the study. Active tuberculosis was diagnosed in 23 patients (41.0%), while 9 patients had NTM infection (16.0%). The sensitivity, specificity, positive- and negative-predictive value of PCR test were 88.8%, 86.8%, 76.1% and 94.3%, respectively, according to the culture result. In comparison, they were 91.3%, 100%, 100%, 94.3%, respectively, according to the final clinical diagnosis. All 15 patients with NTM isolates, including 6 patients who had other lung diseases but expectorated NTM isolate, were negative for PCR test. CONCLUSION: Even though tuberculosis is still prevalent in Korea, PCR test is useful to differentiate between M. tuberculosis and NTM in patients with AFB-smear positive sputum but with ambiguous clinical manifestations of active tuberculosis.

Detection of M. tuberculosis by LCx M. tuberculosis Assay / 대한임상병리학회지

BACKGROUND: Mycobacterial culture is a confirmatory test to detect the Mycobacterium tuberculosis, but it requires considerable time and the diagnosis and treatment may be delayed. The recently developed LCR (ligase chain reaction) is a more rapid and more specific test for the detection of M. tuberculosis. In this study, we compared the LCR results with those of the culture and AFB smear. METHODS: Mycobacterial culture was performed on 3% Ogawa media for 8 weeks. For LCR, we used LCx Mycobacterium tuberculosis assay kit (Abbott Laboratories, North Chicago, Ill.). The specimens for LCR were resuspended to LCx respiratory specimen resuspension buffer, and then separated mycobacterial DNA by ultrasonicator (Abbott LCx Lysor). Then the samples were mixed in amplification vial containing DNA polymerase and DNA ligase and amplified. For the detection, we used LCx analyzer from Abbott laboratories. RESULTS: The sensitivity, specificity, and positive and negative predictive values of the LCx M. tuberculosis assay were 95, 100, 100, 60%, respectively; 90, 100, 100, 42.9%, for culture; and 62.5, 100, 100, 16.7%, for acid-fast staining, respectively. The agreements between culture and LCx, smear and LCx, and culture and AFB smear were 86%, 65% and 60%, respectively. CONCLUSIONS: LCx was confirmed as a more rapid and sensitive test than the culture test and AFB smear.

Detection of Mycobacterium tuberculosis in Urine by Nested Polymerase Chain Reaction / 대한비뇨기과학회지

Today, genitourinary tuberculosis as well as tuberculosis of other organs have decreased in its incidence with development of antituberculosis drugs. However, it is still very frequent in Korea. There are still great deal of difficulties in finding Mycobacterium tuberculosis from urine because of variations in method of taking urine sample and techniques of examination. For these matters, early diagnosis was difficult indeed. For this reason, we performed amplification of Mycobacterial DNA from urine by use of the Polymerase Chain Reaction, and urine AFB smear from Apr., 1993 to Feb., 1994 and achieved following results. l. In order to increase sensitivity and specificity, we performed nest PCR. and primers used each cases were a) INS1 and INS2, which amplify 245-base pair sized DNA, b) Pt3 and Pt6, which amplify 188-base pair. The sequences of primers were INS1 (5'-CGTGAGGGCATCGAGGTGGC-3'), INS2 (5'- GCGTAGGCGTCGGTGACAAA-3'), Pt3(5'-GAACGGCTGATGACCAAACT-3'), and Pt6( 5'-ACGTAGGCGAACCCTGCCCA-3') (Table l). And after 30 cycles of amplification, unique Mycobacterium tuberculosis DNA band was found ( Figure). 2. Total number of confirmed genitourinary tuberculosis were 35 cases, 19 cases were positive in both PCR and AFB smear, other 15 cases were positive only in PCR and in one case, PCR was negative but positive in AFB smear (Table 2).