A rare case of smear positive tuberculous arthritis

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.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

All Gene Expression of Leukotriene A4 Hydroxylase (LTA4H ) Gene in Extra Pulmonary Tuberculosis Patients and Healthy Control in North Indian Population

Initial diagnosis and timely treatment of Extra Pulmonary Tuberculosis (EPTB) continues to be a challenge in all over World as well as India. First time, this analysis will discover the role of LTA4H gene and may be establishing another candidate that impacts the sensitivity to EPTB in the population of North India. This study will be the first report on LTA4H gene various diagnostic markers, expression of gene may validate as a prognostic factor in (EPTB). The diagnosis (EPTB) poses a special challenge, as it is often missed or misdiagnosed due to its atypical presentations and difficult to isolate M tuberculosis (MTB) due to the small number of organisms present at these sites. Subsequently the outcome of present study will reinforce possible use of LTA4H as biomarkers and the therapeutic utility for (EPTB). This study will be a step to decrease the analytical and therapeutic window to identify another risk factor LTA4H for EPTB. Leukotriene A4 hydroxylase (LTA4H), an enzyme which changes LTA 4 to LTB4, controls the balance amongst the anti-inflammatory lipoxins and pro-inflammatory LTB4, with directly consequences in TB-driven inflammation. In humans and will spawn new ways to protection and enhance the wellbeing status of individuals and population groups. On RT-PCR, Extra Pulmonary Patients had lower expression of LTA4H compared to the controls. Correlation of biomarkers will reveal LTA4H level correlated with age, Gender Smoking, Clinical Parameter Serum Total Protein, BMI Height and TLC, Laboratory Parameter. On ELISA kit and follow as per manufacturer protocol. CEA562Ge 96 Tests Enzyme-linked Immunosorbent Assay Kit For Leukotriene B4 (LTB4) LTB4 Protein level in Extra Pulmonary Patients, (EPTB) (2304.52pg/ml) had lower expression of gene LTB4 compared to the controls (3096.142pg/mls) (P value = 0.0012).

Coinfección de COVID-19 y tuberculosis extrapulmonar / Coinfection of COVID-19 and extrapulmonary tuberculosis

Resumen La pandemia por el coronavirus SARS-CoV-2 continúa causando una significativa morbi-mortalidad global. COVID-19 es una infección respiratoria aguda que puede afectar otros órganos. También la tuberculosis (TB) es una infección endémica que cursa típicamente con compromiso pulmonar y, en menor incidencia, extra-pulmonar. Hay escasa información sobre la coinfección de COVID-19 con TB extrapulmonar. El objetivo de esta comunicación fue presentar información sobre esa asociación en un hospital público de la ciudad de Buenos Aires. Entre marzo 2020 y abril 2021 en nuestro Hospital se diagnosticaron 10 809 casos de COVID-19, 106 de TB y 20 de coinfección de ambas (incidencia 185 casos de TB/100 000 casos de COVID-19), superando más de seis veces su frecuencia media de TB/100 000 habitantes del país (31/100 000). De 20 casos diagnosticados de COVID-19 y TB, cinco presentaron compromiso extrapulmonar por TB (25%). La mediana de edad fue de 30 años (IC25-75, 28-31), tres (60%) eran de sexo femenino. La enfermedad asociada más fre cuentemente vinculada fue la infección por virus de la inmunodeficiencia humana en tres personas (n = 3), bajo peso (n = 2), EPOC (n = 1) y adicción a drogas (n = 1). Tres presentaron compromiso extrapulmonar exclusivo del sistema nervioso central, dos pulmonar y pericárdico. Cuatro pacientes (80%) tuvo evolución favorable.

Abstract The SARS-CoV-2 coronavirus pandemic continues causing significant global morbidity and mortality. COVID-19 is an acute respiratory infection that can affect other organs. Tuberculosis (TB) is also an endemic infection that typically occurs with pulmonary involvement and very infrequently, with extra-pulmonary involvement. There is little information on extrapulmonary TB and COVID-19 coinfection. The objective of this communication was to present information about this association in a public hospital in the city of Buenos Aires. Between March 2020 and April 2021, our Hospital diagnosed 10 809 cases of COVID-19, 106 of TB and 20 of TB-COVID-19 coinfection (incidence 185 cases of TB/100 000 cases of COVID-19), exceeding more than six times the average frequency of TB/100 000 inhabitants of the country (31/100 000). Of these 20 cases diagnosed with COVID-19 and TB, five presented extrapulmonary involvement due to TB (25%). The median age was 30 years (CI25-75, 28-31), three (60%) of them were female. The most frequently associated infection was due to human immunodeficiency virus, (n = 3), underweight (n = 2), COPD (n = 1) and drug addiction (n = 1). Three presented exclusive extrapulmonary in volvement of the central nervous system, two pulmonary and pericardial. Four patients (80%) had a favorable evolution.

Role of CBNAAT in the Diagnosis of Extra-Pulmonary Tuberculosis: Experience from a Tertiary Care Hospital in India

Background. Xpert-MTB/RIF assay or Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) helps in rapid diagnosis of tuberculosis (TB). Methods. Specific samples were collected and carried to Regional Medical Research Centre where these were taken up for CBNAAT and culture in Lowenstein-Jensen media. Appropriate samples were sent to the Designated Microscopy Centre (DMC) of our institute for acid-fast bacilli (AFB) smear examination. Diagnostic measures, such as sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Xpert-MTB/RIF were reported considering mycobacterial culture and a composite reference standard (CRS) as Gold standard. Results. We studied 335 samples. Lymph node fine needle aspirate was the most common sample (32.5%) followed by pleural fluid (29.3%). The overall sensitivity and specificity of Xpert-MTB/RIF was determined to be 26.5% (95% CI [confidence interval] 20.8�.8) and 100% (95% CI 96.8�0), respectively. The sensitivity and specificity of CBNAAT in relation to mycobacterial culture, however, was 78.8% (95% CI 61.1�.0) and 89.1% (95% CI 85�.4), respectively. Both were highest for pus, cerebrospinal fluid and lymph node fine needle aspirate samples. Conclusions. Xpert-MTB/RIF may be useful for samples, like cold abscess and lymph node fine needle aspirate or biopsy specimens. However, its routine use in case of serosal fluids is not recommended because of its lower sensitivity.

ISOLATED PRIMARY TUBERCULOSIS OF VASTUS LATERALIS MUSCLE IN SEVERE OSTEOARTHRITIS PATIENT: A CASE REPORT

Extra pulmonary Tuberculosis involving soft tissues and affecting the joints and surrounding structures (tuberculous arthritis) is well known. However, Tubercular myositis is a rare condition with skeletal muscle involvement without underlying osseous or extra osseous involvement in extremely rare presentation. Due to atypical presentation the diagnosis is often delayed. We report and present a case of isolated tubercular myositis of Vastus lateralis muscle in severe osteo arthritis knee patient without evidence of any primary focus

A clinicopathological study and management of abdominal tuberculosis

 Background: Tuberculosis is a major health problem in developing countries. Inspite of considerable advances, abdominal tuberculosis still continues to be of paramount health issue in India, owing to its vague and non-specific presentation challenging the therapeutic skills of present day surgeon. Surgical intervention was frequently used in the past for diagnosis is not necessary and is reserved for complications like obstruction, perforation, fistula, or a mass which does not resolve with medical therapy.Methods: 30 patients admitted in Department of Surgery satisfying the inclusion criteria from November 2015 to October 2017. Patients were selected on a prospective basis.Results: In this study out of 30 patients, 16 patients were treated conservatively with anti- tubercular therapy (ATT) alone and 14 patients underwent surgical treatment. Out of 14 patients, 5 patients were operated on emergency basis and 9 were operated electively. Of the 5 emergency cases, 2 patients underwent resection anastomosis of small bowel, 1 patient underwent adhesiolysis, and 3 patients with hollow viscus perforation underwent perforation closure with peritoneal drainage.Conclusions: Tuberculosis has become a resurgent global problem with increasing numbers of extrapulmonary manifestations, non-specific features of abdominal tuberculosis result in difficulty in establishing a diagnosis, hence prompt initiation of treatment that can be either medical management or a surgical procedure is important to prevent morbidity and mortality associated with it.

Caracterización de la tuberculosis pulmonar en mayores de 15 años. Hospital de Día "Dr. Efrén Jurado López" / Characterization of pulmonary tuberculosis in over 15 years. "Dr. Efrén Jurado López Day Hospital"

La tuberculosis pulmonar constituye una enfermedad de salud pública en el territorio ecuatoriano en expansión que provoca muerte y sufrimiento para la población. El objetivo del estudio es caracterizar la tuberculosis pulmonar en individuos mayores de 15 años que asisten al Hospital de Día "Dr. Efrén Jurado López" de la ciudad de Guayaquil. Se realizó una investigación cuantitativa, descriptiva, retrospectiva. La muestra de estudio quedó conformada por 58 pacientes de ambos géneros mayores de 15 años, diagnosticados con tuberculosis en todas sus formas, atendidos en el contexto de estudio entre enero 2017 y enero de 2018. En la recolección de la información se aplicó una ficha de observación validada por expertos con previo consentimiento informado de los pacientes estudiados. Como resultados se obtuvo que el 72,4% eran del sexo masculino y el 27,6% femenino. El predominio de diagnóstico presentado fue sintomático TBP BK+ en un 100%. Por otra parte para el diagnóstico por TBP cultivo + fue 87,9% (51/58) y TBP cultivo- de 12,1% (7/58). Por otra parte la TB EP fue de 25,9% (15/58) con predominio en el sexo masculino 80%, las formas de tuberculosis y la comorbilidad asociada al al Virus de Inmunodeficiencia Humana (VIH), se observó una frecuencia de 6,9% (4/58) de personas con TB que tenían VIH, de las cuales el 5,2% correspondían a casos de VIH con tuberculosis extra pulmonar y 1,7% a casos de TBP BK+/VIH. Se debe continuar trabajando en la búsqueda de TB en pacientes sintomáticos respiratorios para un diagnóstico oportuno(AU)

Characterization of pulmonary tuberculosis in teenagers older than 15 years in thedr.Efrénjuradolópez day time hospital. Pulmonary tuberculosis is a public health disease in the expanding Ecuadorian territory that causes death and suffering for the population. The objective of the study is to characterize pulmonary tuberculosis in individuals over 15 years of age attending the "Dr. Efrén Jurado López" Day Hospital in the city of Guayaquil. A quantitative, descriptive, retrospective investigation was carried out. The study sample consisted of 58 patients of both genders over 15 years of age, diagnosed with tuberculosis in all its forms, treated in the context of the study between January 2017 and January 2018. A data sheet was applied in the collection of information observation validated by experts with prior informed consent of the patients studied. As a result, it was obtained that 72.4% were male and 27.6% female. The prevalence of diagnosis presented was symptomatic TBP BK + in 100%. On the other hand for the diagnosis by TBP culture + it was 87.9% (51/58) and TBP culture- of 12.1% (7/58). On the other hand, the TB TB was 25.9% (15/58) with a predominance in the male sex 80%, the forms of tuberculosis and the comorbidity associated with the Human Immunodeficiency Virus (HIV), a frequency of 6 was observed, 9% (4/58) of people with TB who had HIV, of which 5.2% corresponded to HIV cases with extra pulmonary tuberculosis and 1.7% to cases of BK + / HIV TBP. Work should continue in the search for TB in symptomatic respiratory patients for a timely diagnosis(AU)

Tuberculous meningitis masquerading as acute ischemic stroke in young adult

Tubercular meningitis (TBM) constitute 5% of all cases of extra pulmonary tuberculosis but a presentation leading to an ischemic stroke in a young adult is a rare clinical entity. In a case of TB vasculopathy, vasculitis, venous thrombosis and aneurysm may be the underlying events leading to a stroke. Stroke in TBM is seen in the tubercular zone which encompasses internal capsule, thalamus and caudate nucleus. Inflammatory mediators like TNF alpha, Interferon gamma and vascular endothelial growth factor have been implicated in the pathogenesis of arteritis. Imaging modalities like MRI show lesions which are usually bilateral in the territory of the perforating vessels. We report a case of 24 year old Asian male who presented with complaints of headache, projectile vomiting and altered sensorium. On examination his Glasgow Coma Scale (GCS) was 10/15, with left oculomotor and left facial nerve palsy, and hypotonia of all 4 limbs with bilateral plantar reflexes being mute. Contrast MRI of brain showed acute infarct, meningeal enhancement and basal exudates. He was started on Anti-tubercular therapy and steroids, but had a poor clinical outcome, due to his late presentation.

Profile of tuberculosis cases attending a directly observed treatment short-course centre in North Kerala

Background: Tuberculosis (TB) is a worldwide public health problem. India has the highest TB burden in the world. India accounted for a quarter of global incident TB cases, 24% of multi drug resistance (MDR) TB cases and highest TB mortality rate in 2017. Thus it is important to understand the profile of TB patients. The objective of the study was to assess the profile of TB cases attending a directly observed treatment short-course (DOTS) center in North Kerala.Methods: A retrospective record based, descriptive study was done in the DOTS center of Government Medical College Kannur, in North Kerala, to assess the profile of TB patients who attended the centre from January 2015 to July 2018. Details of 548 patients were collected from the record maintained at DOTS center. Data was entered in Microsoft Excel and analysed using Epi info7 software.Results: The age group of 21-60 years was most affected. 68.53% of the patients were males. 45.62% of patients had extra-pulmonary TB (EPTB). Among the pulmonary TB patients, 74.27% tested positive for acid fast bacilli. Among cases of EPTB, most common type was TB lymphadenitis (40.8%) followed by tuberculous pleural effusion (22.4%). 87.59% of TB patients were started on category I treatment under DOTS.Conclusions: In our study, affected population was mostly males and those in productive age group. This is the group that has maximum chances of exposure to TB patients. 45.62% patients had EPTB. Total number of cases is on the rise each year, with maximum cases in 2018.

Role of cartridge-based nucleic acid amplification test to diagnose tuberculosis at tertiary care teaching hospital in Rajasthan, India

Background: Tuberculosis is one of the top 10 causes of death worldwide as per the Global TB report 2017, the estimated incidence of TB in India was approximately 28,00,000 cases accounting for about a quarter of the world’s TB cases (10 million). It is of utmost important to diagnose early and treat it to reduce disease transmission. GeneXpert MTB/RIF, an automated cartridge-based molecular technique detects Mycobacterium Tuberculosis and rifampicin resistance within two hours, has been recommended by WHO for rapid diagnosis of TB.Methods: Author conducted a retrospective study in the Department of TB and Chest, of tertiary care center at Jhalawar Medical College (JMC), Jhalawar to evaluate and analyze the role of CBNAAT to diagnose tuberculosis from 1st January 2018 to 31st December 2018. Author included all patients who came to department of TB and Chest of JMC, Jhalawar either new/ relapsed/ defaulters/ referred cases from ART/ ICTC center, Pediatric Department; Gynaecology and Obstetrics Department, peripheral Government Health Care Facilities and Private Hospitals of Jhalawar District catering about 15.5 lac population were subjected to both ZN staining/ Fluorescent microscopy and CBNAAT in the study period.Results: A total of 3078 samples (pulmonary 2739+EP 339) were tested for ZN staining / Fluorescent microscopy and CBNAAT during the study period. Mean age of the study population was 36.5±10.3 years. 1873 tested were negative and 1205 samples were positive for CBNAAT. Of these 1205 positive samples, 1174 were sputum/ BAL samples and 31 were extra pulmonary samples. Authors found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases, 3 rifampicin resistance cases were detected in extra pulmonary samples. CBNAAT could identify 255 cases (14.01%) that were smear negative. Author found TB-HIV coinfection rate of 18.75%.Conclusions: Author found CBNAAT to be an important diagnostic modality especially in smear negative patients for early diagnosis and treatment. Author could detect Mycobacterium Tuberculosis in 14.01% of patients with negative smear microscopy for AFB. In PLHIV, CBNAAT detected Mycobacterium Tuberculosis in 18.75% (12/64) of patients. Author found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases.

The Current Status of TB in Children of Bangladesh

Objective: In this study our main goal is to evaluate the currentstatus on TB in children of Bangladesh.Method: This cross-sectional study was conducted at thesecondary level hospital in the 250 Bed General Hospital, Feni,Bangladesh from Jan 2016 to Jan 2017 among selected 100children between 1 to 10 years. Data was collected inpreformed data collection sheet by interviewing the patient’sattendants during the study.Results: In this experiment (62%) were male and (38%) werefemale. 6% patients previously diagnosed with TB. Also, 62%had extrapulmonary TB whereas 38% had pulmonary TB.Conclusion: In this study we found that extra pulmonarytuberculosis was more than PTB. Extra precautionary stepsshould be taken to control TB among children in Bangladesh;Further study is needed for better outcome.

Utility of cartridge based nucleic acid amplification test in the diagnosis of extra pulmonary tuberculosis

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.

Pattern of tuberculosis among tribal population of Central India with special reference to cartridge based nucleic acid amplification test as diagnostic tool: a descriptive study at tertiary care hospital

Background: Tuberculosis (TB) kills close to half a million Indians every year. Lack of reliable rapid diagnostic techniques for TB hampers timely diagnosis and leads to continued disease transmission, causing significant morbidity and mortality. The potential of newly recommended CBNAAT in TB and MDR-TB detection has been underutilized in our area due to lack of awareness regarding the same. Hence we utilized this rapid, logistically simplified test to study the pattern of tuberculosis among tribal population of Central India.Methods: Descriptive study of suspected TB patients in tertiary care centre from March 2016 to March 2019. Appropriate specimens from suspected TB patients were collected and subjected to CBNAAT and AFB smear to study the pattern of TB and Rifampicin- Resistant(RR) TB  in our area.Results: CBNAAT detected overall 27% MTB cases; 27.72 % Pulmonary-TB cases as against smear positivity rate of 20.73% whereas 12.74% Extra-pulmonary-TB (EPTB) cases as against smear positivity rate of 1.59%.Overall 94.91% were RiF Sensitive( RS-TB) and 4.58% were RR-TB. Of the 57 (4.16%) HIV-TB coinfected cases; 96.49% were RS-TB and 5.26% were RR-TB. Co-infected patients have high incidence of EPTB(21.05%) involvement  with RR-TB 3.50%. Among EPTB cases; lymph node aspirate and pus provided highest CBNAAT positive cases and almost 90.62% EPTB specimens were RS-TB .Conclusions: Availability of new diagnostic services has increased early identification of TB and RR-TB. Awareness among physicians regarding diagnostic utility of CBNAAT should be further increased as early identification of possible MDR cases is key to reducing community transmission and treatment initiation, particularly in high-burden, resource-limited settings.

Diagnostic Accuracy of Xpert MTB Compared to Smear Microscopy in Pulmonary vs Extrapulmonary Tuberculosis

Introduction: Mycobacterium tuberculosis is the mostsignificant infectious disease causing death worldwide.Inability to rapidly diagnose and treat the affected patientsleads to increased morbidity and mortality, developmentof secondary resistance. There is sparse data which showthe accuracy of diagnosis of tuberculosis by Gene Xpert inpatients. There is limited data on the usefulness of XpertMTB in the diagnosis of extrapulmonary TB. Study aimedto evaluate the diagnostic accuracy of XpertMTB comparedto smear microscopy in pulmonary and extra pulmonarytuberculosis.Material and methods: Prospective observational studyconducted from May 2017 to July 2017. The study wasconducted in Department of medicine, Department ofpulmonology at R.L.Jalappa hospital and research centre,Kolar. 139 tubercular suspects who were not human immunedeficiency virus (HIV) positive were included in the study.Result: Out of 139 patients 72 were males and 67 were females.99 pulmonary samples and 40extrapulmonary samples wereobtained. 93 pulmonary samples and 24 extrapulmonarysamples were culture positive. Smear microscopy has lowersensitivity in diagnosing pulmonary TB (46.2%) as well asextrapulmonary TB(16.6%).Conclusion: The Xpert MTB is a rapid, sensitive and areliable diagnostic test for TB than smear microscopy in bothpulmonary as well as extra pulmonary TB. The diagnosisof extrapulmonary TB should not solely depend on theresults of Xpert MTB and should be subjected to culture ofMycobacterium.

Evaluation of cepheid GeneXpert MTB/RIF assay for Mycobacterium tuberculosis detection and rifampicin resistance in clinical specimen

Background: Timely diagnosis and treatment of tuberculosis is important to treat the disease and to reduce transmission. The WHO recommends using GeneXpert MTB in developing, high-burden countries.  A study was conducted to evaluate the performance of Xpert assay for the detection of M. tuberculosis and rifampicin resistance in clinical specimen.Methods: About 615 consecutive samples were simultaneously subjected to culture and phenotypic drug susceptibility test for M. tuberculosis and analysis by GeneXpert assay. Confirmed Mycobacterium tuberculosis in a positive culture was used as a reference standard for TB diagnosis.Results: The assay achieved a sensitivity of 96.75% (268/277) and 76.47% (26/34) for smear positive and smear negative pulmonary specimen respectively. In extrapulmonary specimen, the sensitivity was 50% (1/2) and 42.8% (3/7) for smear positive and smear negative specimen respectively. An additional 48 M. tuberculosis were detected by Xpert assay which were smear and culture negative. The Xpert assay identified 100% of the phenotypic rifampicin susceptible isolates and 74.19% of the phenotypic rifampicin resistant isolates. Discordant results were seen in 8 (2.76%) isolates. 6 of these isolates were confirmed to be rifampicin resistant by the reference lab.Conclusions: Present study indicates that Xpert MTB/RIF assay is an effective and rapid tool for the rapid diagnosis of Mycobacterium tuberculosis. The sensitivity is comparable to culture in smear positive specimen but less sensitive than culture for smear negative specimen. In cases with high index of suspicion or discordance for rifampicin results, confirmation should be done by other methods due to false negative results on Xpert assay.

Improved sensitivity of direct microscopy for Mycobacterium tuberculosis in lymph nodes: comparison of fluorescent microscopy and modified bleach method ZN microscopy along with conventional ZN staining method

Background: Extra pulmonary tuberculosis arises as a result of lymphatic spread from a primary focus. Fine needle aspiration cytology has assumed an important role in the evaluation of peripheral lymphadenopathy as a possible minimally invasive alternative to excisional biopsy. In most low-income countries; the only practically available bacteriologic method for diagnosing EPTB is direct smear microscopy for acid fast bacilli from the sample of the lesion. There are various methods of staining and concentration for improving sensitivity of direct microscopy for detection of tubercle bacilli in specimen.Methods: This prospective study was carried out in the Department of Pathology, Subharti Medical College and associated Chattrapati Shivaji Subharti Hospital, Meerut for a period of 2 years from July 2016 - August 2018 in 151 patients with clinical suspicion of TB and significant lymphadenopathy.Results: AFB positivity increased from 40.39% on conventional ZN stain to 48.34% on modified bleach method ZN stain and to 56.29% on Auramine-O fluorescent stain. Taking fluorescent microscopy (Auramine-O) as reference method the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of conventional ZN stain and modified bleach method ZN stain were calculated as 71.8%, 100%, 100%, 73.33%, 84.10% and 85.33%,100%,100% ,84.61% ,92.05%, respectively.Conclusions: The addition of fluorescent microscopy (Auramine-O) and modified bleach method ZN microscopy along with conventional ZN staining method would be an important adjunct to improve the microscopic detection of Mycobacterium tuberculosis in fine-needle aspirates of lymph nodes.

A study on treatment outcome of tuberculosis cases registered under RNTCP in Sonbhadra District: A Medico-Geographical Perspective

Introduction: Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis. It mostly affects the lungs (pulmonary TB) and sometime affect other sites (extra pulmonary TB). The disease is spread when people who are sick with pulmonary TB expel bacteria into the air by coughing. Overall, a relatively small proportion (5–15%) of the estimated 1.7 billion people infected with M. tuberculosis will develop TB disease during their lifetime. Objective: To assess the treatment outcome of tuberculosis patients registered under Revised National Tuberculosis Control Programme (RNTCP) and to find out spatial pattern of tuberculosis patients. Materials and Methods: A retrospective record based study was conducted based on the secondary data pertaining to the patients registered at six different tuberculosis units (TU) and 29 designated microscopic centers (DMC) in Sonbhadra district during the period from 2005 to 2015. Results: Overall 85.8% were new cases and among them 80.0% were as pulmonary cases observed. Sputum conversion rate of new sputum-positive case at 2 or 3 months after treatment was 89.9%. Cure rate for new sputum-positive pulmonary TB cases was 84.9% and out of all smear-positive cases, it was 62.4%. Default among new smear-positive cases was 5.5%. Conclusion: The observed treatment success rate in form of cured and treatment completed (91.5%) reveals that the DOTs as an effective strategy for tuberculosis treatment may be classified as better alternative for area like Sonbhadra.