ABSTRACT
TB arthritis is a very rare extrapulmonary presentation in an immunocompetent host. It is usually the result of direct hematogenous spread from the primary focus. Our patient presented with pain and swelling of the right knee for 6 months. The blood investigations and CT chest revealed findings consistent with active tuberculosis. Synovial fluid was positive for acid-fast bacilli (AFB) which is a very rare finding. Cartridge-based nucleic acid amplification test (CBNAAT) revealed Mycobacterium tuberculosis and sensitivity to rifampicin. Establishing the diagnosis of Mycobacterium tuberculosis beyond doubt is very important, and early initiation of antitubercular treatment (ATT) is important as delay in treatment may lead to irreversible damage to the joint and restriction of joint mobility.
ABSTRACT
Background & objectives: High transmissibility of the SARS-CoV-2 has significant implications on healthcare workers’ safety, preservation, handling, transportation and disposal of the deceased bodies. The objective of this study was to detect SARS-CoV-2 antigen in nasopharyngeal samples and its implications in handling and care of COVID-19 deceased bodies. Methods: A study was conducted at a dedicated COVID-19 centre on deceased individuals from April to December 2020. Rapid antigen test (RAT) and reverse transcription (RT)-PCR was compared on all the SARS-CoV-2 positive cadavers recruited in the study. Results: A total of 115 deceased individuals were included in the study. Of these, 79 (68.7%) were male and 36 (31.3%) were female and majority were in the age group of 51-60 yr [31 (27%)]. SARS-CoV-2 antigen test was positive in 32 (27.8%) and negative in 83 (72.1%) individuals. The mean time interval between deaths to the sample collection was 13.2 h with interquartile range of eight to 20 h. Reverse transcription (RT)-PCR was used as the reference test and 24 (20.9%) cases were true positive; 93.6 per cent [95% confidence interval (CI) 88.8-98.4%] sensitivity, 45.2 per cent (95% CI 35.5-55%) specificity, 60.2 per cent (95% CI 50.6-69.8%) positive predictive value and 88.8 per cent (95% CI 82.7-95%) negative predictive value of antigen test was computed. Interpretation & conclusions: SARS-CoV-2 antigen test was positive beyond 19 h in COVID-19 deceased individuals. Antigen test was found to be highly sensitive in the deceased. Patients, suspected of having died due to COVID-19, can be screened by this method. As infectiousness of the virus in the deceased bodies cannot be directly concluded from either the antigen or RT-PCR test, yet possible transmission cannot be completely ruled out. Strict infection control measures need to be followed during the handling and clearance of COVID-19 cadavers.
ABSTRACT
Background: COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. After a December 2019 outbreak in China, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus. Currently, WHO recommends detection of unique sequences of virus RNA by rRT-PCR. ICMR also recommends use of CBNAAT using Cepheid Xpert Xpress SARS-CoV2. The aim of this study is to determine the prevalence of SARS-CoV-2 detected through CBNAAT.Material & Methods:This retrospective study was conducted from July 2020 to December 2021 at VRDL, GMC, Amritsar. The study group consisted of all the patients presenting with symptoms of Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) who presented to hospital. The data was collected and subjected to statistical analysis.Results:During the present study, a total of 1,259 samples were analyzed for SARS-CoV-2 by CBNAAT from July 2020 to December 2021. Out of total 1,259 cases which were included in the study, 327 cases (25.97%) were found to be SARS-CoV-2 positive while 870 cases (69.10%) were SARS-CoV-2 negative and 62 cases were found to be inconclusive. 62 inconclusive samples were further tested by RT-PCR. Out of which, 15 were RT-PCR positive and 47 were RT-PCR negative.Conclusions:The COVID-19 pandemic has put forward unprecedented challenge to the public health system across countries to prepare themselves for this current crisis which included isolation, contact tracing, quarantine and enforcement of a nation wide lockdown starting 25th March, 2020.
ABSTRACT
Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.
ABSTRACT
Authors wish to report a major discordance between Xpert MTB/RIF Ultra Trace positivity (GeneXpert, Cepheid) and follow up by liquid culture.
ABSTRACT
Tuberculosis is one of the major health problems in developing countries like India. Even though lungs are the commonly involved organs in Tuberculosis, extrapulmonary presentations are on the rise nowadays. Among the various types of presentations of extrapulmonary tuberculosis, lymphadenitis is the most common presentation. A spectrum of investigations is available for diagnosis, and molecular methods like CBNAAT and PCR analysis are highly reliable. But their disadvantage is their cost and requirement of trained personnel. FNA is the first line of investigation but is lacking in sensitivity and culture method is time consuming. So, Modified Ziehl Neelsen method with low cost and less time may be considered as an alternative. We wanted to evaluate the sensitivity of the Modified Bleach Ziehl Neelsen method and compare the Modified and Conventional Ziehl Neelsen Method in association with the CBNAAT in the diagnosis of TB lymphadenitis.METHODSDiagnostic validation study was conducted with 30 clinically suspected cases of tuberculosis. FNA was done and aspirated material was spread on 2 slides. Slides were stained with H & E stain and convention Ziehl Neelsen stain. Part of the aspirate material was centrifuged with 5 % sodium hypochlorite. Sediment was smeared on a slide and stained with Ziehl Neelsen stain. Remaining material was subjected to CBNAAT assay.RESULTSCorrelation shows that 9, 6, and 11 out of 30 cases were positive for tuberculosis in Conventional, Modified and CBNAAT methods respectively. Sensitivity was 81.81 %; specificity was 94.74%, positive predictive value was 90% and negative predictive value was 90% for Conventional Ziehl Neelsen Method and 54.55%, 94.73%, 85.71% and 78.26%, respectively for modified bleach method.CONCLUSIONSConventional method is found to be more sensitive than modified method. CBNAAT negative results do not rule out TB. So, they should be correlated with cytology and microbiological studies.
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.
ABSTRACT
Background: Diagnosis of extrapulmonary tuberculosis is difficult. Tuberculous lymphadenitis is one of the most common extrapulmonary manifestation of tuberculosis.1 Cervical group of lymph nodes are commonly involved.2 Fine needle aspiration cytology can be used easily, safely for specimen collection of these cases. The cytology samples can be used for CBNAATX-pert assay for rapid diagnosis of tuberculous lymphadenitis along with fluoroscence microscopy. The aim of the present study was to evaluate proportion of tuberculous lymphadenitis from FNAC specimens of all lymphadenopathy cases, to study diagnostic utility of CBNAATX-pert MTB for diagnosis of tuberculous lymphadenopathy in patients with lymphadenitis and to correlate cytological findings with CBNAATand fluorescence microscopy results.Methods:The present study was included 45 cases of lymphadenopathy. Detailed history and physical examination was done followed by FNAC . Multiple smears were prepared from each aspirate for routine cytological examination and for evaluation by fluroscence microscopy. The cytology findings were correlated with CBNAATand fluoroscence microscopy results.Results:In the present study female preponderence was noted. Maximum number of cases were in 3rd decade. Tuberculous lymphadenitis was the most common cytological diagnosis found in 51.1 % cases, of which 33.3% were positive on CBNAATand 20% cases were positive by fluorescence microscopy.Conclusion:The most common cause of cervical lymphadenopathy is tuberculosis. The present study supports combined use of FNAC and CBNAATfor early diagnosis of tuberculosis.
ABSTRACT
Background: The aim was to determine utility of Cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of mycobacterium tuberculosis in children with neurotuberculosis diagnosed on the basis of clinical evaluation, CSF findings and neuroimaging.Methods: A prospective randomized controlled trial was conducted in Pediatric Department of RNT Medical College, Udaipur, Rajasthan, India from July 2017 to June 2018. Total 110 children of age group of 6 months to 18 years with the diagnosis of tubercular meningoencephalitis (TBME) on the basis of clinical evaluation, CSF examination and neuroimaging were included in the study.Results: A total 110 children were enrolled. Maximum number of cases admitted with TBME were among 1-5 years of age group (60.91%). CSF and gastric aspirate were examined by CBNAAT for MTB. 5 (4.55%) children had CBNAAT positivity in CSF. Gastric aspirate was positive among 16 (14.55%) children. None of the patient had CBNAAT positive result both in CSF and gastric aspirate.Conclusions: TBME is a major health problem in children below 5 years. Gene Xpert assay has the potential to significantly improve and escalate the diagnosis of smear-negative body fluid specimens. CBNAAT for mycobacterium tuberculosis was positive in 5 (4.55%) children from CSF and 16 (14.55%) from gastric aspirate. Negative CBNAAT should not prevent any patient with suspected features of TBME from starting anti tubercular treatment (ATT) as sensitivity of this test remains low. Final judgement to start ATT should be based on clinical, biochemical and radiological profile especially in CNS tuberculosis.
ABSTRACT
Background: The genital tract tuberculosis is one of the most common causes of tubal factor infertility. This study was conducted to compare the results of different diagnostic methods used in screening for female genital tuberculosis in suspected cases attending Gynecology OPD at RMC, Ajmer.Methods: This prospective study was conducted in department of obstetrics and gynecology, J. L. N. Medical College, Ajmer, Rajasthan, for studying incidence of genital tuberculosis by various diagnostic methods (viz. AFB smear examination, AFB Lowenstein Jensen culture method, TB-PCR and CBNAAT).Results: Prevalence of genital TB was 5.5% in study population of 200 selected women meting the inclusion criteria. 72% women were in between 20-30 years age group. Oligomenorrhoea (24%) was found to be significant symptom with P value of <0.05. TBPCR and CBNAAT were found to be statistically significant with P value of <0.001 for diagnosing FGTTB.Conclusions: We concluded that genital tuberculosis is paucibacillary disease, TBPCR and CBNAAT appears to be rapid and sensitive diagnostic modality.
ABSTRACT
Drug resistance is a threat to TB control program worldwide. Patient infected with multiple drug resistant strains are less likely to become cured. Management of resistant cases is complex and presents therapeutic limitations. Patients with multidrug resistant strains are more prone to treatment failure, progresses to more chronic forms of the disease and death. In most areas of the world, the routine use of drug susceptibility tests, let alone cultures to diagnose tuberculosis or multidrug resistant tuberculosis is beyond the scope of health care resources. According to Global Tuberculosis Report 2015, about 3.3% of newly diagnosed patients had multidrug resistant tuberculosis and 20% of previously treated Tuberculosis cases were estimated to have Multidrug resistant Tuberculosis (MDR-TB). This present study was conducted in the department of chest and TB, Government medical college, Amritsar, with an aim to study the clinico-radiological profile of patients with multidrug resistant tuberculosis. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 100 diagnosed patients of Multidrug Resistant Tuberculosis. Clinicoradiological profile of these patients was determined. Results: Out of 100 study population, maximum number of patients belonged to the age group of 21-30 years i.e. 26% followed by 22% in the age group of <20 years. Most common symptom was cough with expectoration which was present in 94 (94%) patients. 97 (97%) patients were having previous history of ATT, 3 (3%) patients were not having any previous history of ATT. On radiology unilateral disease was present in 48 (48%) patients, bilateral disease present in 52 (52%) patients. Parenchymal infiltration was present in 79 (79%) patients. Cavitation was present in 23 (23%), Fibrocavitary disease was present in 37 (37%) study subjects. Previous history of ATT had significant association with extent of lesion on chest x- ray (p < 0.05). Conclusion: clinico-radiological characteristics should always be determined where appropriately administered drugs have not achieved necessary drug levels to deal with all the population of mycobacteria, to timely modify and strengthen the national programs, and evaluation of trends in drug resistance pattern.
ABSTRACT
Background: Tuberculosis is one of the most common opportunistic infections among people with HIV infection. Detection of pulmonary tuberculosis by sputum-based techniques includes microscopy and culture. However, in people living with HIV, sputum production is scanty and also the sputum contains less number of bacilli due to fewer cavitations, thereby decreasing the sensitivity and specificity of sputum microscopy as a diagnostic tool. Aim of the study: In this study, we assess the usefulness of CBNAAT in the early detection of pulmonary tuberculosis and its incidence by using CBNAAT in smear-negative HIV patients using mycobacterial culture in Lowenstein Jensen medium as Gold Standard. Materials and methods: The study was conducted in the Department of Cardiothoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital. Data were collected from 150 HIV infected patients who tested sputum smear negative. Sputum samples were then sent for CBNAAT and sputum culture for mycobacteria. Results: Of the 150 patients enrolled, 28(18.66%) of them were detected with MTB by CBNAAT; whereas sputum culture could detect 38(25.33%) of them. Thus, compared to sputum smear, CBNAAT increases TB detection by 18.66% and sputum culture increases by 25.33%. The sensitivity of CBNAAT in our study was 73.68% and the incidence of smear-negative pulmonary TB in the study population by using CBNAAT was 18.66%. Conclusion: CBNAAT is a highly sensitive and diagnostic stool for the diagnosis of pulmonary TB and it is of immense help in the early diagnosis of smear-negative pulmonary TB in HIV infected patients. Therefore, CBNAAT should be used as the initial test in HIV infected patients suspected with pulmonary TB.
ABSTRACT
Objective:To identify factors that discriminate between transient and permanentcongenital hypothyroidism. Methods: Retrospective evaluation of 58 children withcongenital hypothyroidism and eutopic thyroid gland. Gender, gestational age, birth weight,TSH and serum thyroxine levels at diagnosis and L-thyroxine dose at 12 and 24 months ofage were analyzed. Results: Median (IQR) initial TSH levels were 73.3 (276.5) ?IU/mL inpermanent hypothyroidism and 24.24 (52.7) ?U/mL in transient hypothyroidism (P =0.0132).The optimum cut-off value of initial TSH to predict transient hypothyroidism was 90 ?IU/mL.Mean (SD) L-thyroxine doses at 24 months of age were 2.64 (0.98) ?g/kg/day in permanenthypothyroidism and 1.91 (0.65) ?g/kg/day in transient hypothyroidism. Requirement of L-thyroxine dose at 24 months of ?0.94 ?g/kg/day had the highest sensitivity (100%) to predicttransient hypothyroidism. Conclusions:L-thyroxine doses at 24 months can predicttransient hypothyroidism in patients with eutopic thyroid gland earlier than at 36 months.
ABSTRACT
Introduction: Diagnosis of pulmonary tuberculosis in sputum negative patients for acid fast bacilli ischallenging till today. It is a fact that 50-60% patients of pulmonary tuberculosis are sputum negativemicroscopically. Smear microscopy is the easiest, commonest and widely employed tool for confirmatorydiagnosis of pulmonary tuberculosis, but it has low sensitivity and specificity. Sputum culture forMycobacterium tuberculosis bacteria can increase the diagnostic yield by 20-40%, but it takes long duration of2-8 weeks when solid media are used or 10-14 days when radiometric system in liquid media are used. Delayeddiagnosis causes increased rate of disease transmission in the community. The role of newly introducedcartridge based nucleic acid amplification test (CBNAAT) in the revised national TB control program (RNTCP)is highly promising with a higher yield of bacteriological diagnosis in sputum negative pulmonary tuberculosispatients with detection of rifampicin resistance within 2 hours only. Aims and objectives: The current study isto find out efficacy of CBNAAT in diagnosis of new sputum negative pulmonary tuberculosis patients. Thedetection of rifampicin resistance is also done in those patients. Materials and Methods: Sputum samples of100 sputum negative pulmonary tuberculosis patients were sent to District CBNAAT center in sterilized falcontube container. The CBNAAT result were analyzed. Results: Mycobacterium tuberculosis was detected inthirty one patients (31%). Not a single case was detected as resistant to rifampicin. Conclusion: CBNAAT helpsin increased case detection rate in lesser time in new sputum negative pulmonary tuberculosis patients.Rifampicin resistance was not detected in any patient.