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.

Monitoring the Outcome of Leprosy Using Leprosy Neuropathy Scale: A Preliminary Study

The disability and progress of leprosy patients is monitored by the WHO disability grading system which has limited sensitivity in leprous neuropathy. This study aims to report the spectrum of leprosy patients at a tertiary care neurology service and compare WHO grading, modified Rankin Scale (mRS) and Leprosy Neuropathy Scale (LNS) in monitoring the treatment outcome. The patients with leprosy diagnosed as per WHO criteria were subjected to medical history and clinical examination. Their disability was graded as per WHO grading scale, modified Rankin scale (mRS) and LNS. These parameters were repeated and compared after six months of multiple drug therapy (MDT). Thirty-eight patients with leprosy, aged 40 (`5-80) years, 33 of whom were males have been evaluated. The duration of symptoms was 24 (91-120) months. Mononeuropathy was present in 14, mononeuropathy multiplex in 24, trophic ulcer in two, claw hand in 11, wrist drop in two, foot drop in four, facial palsy in one, Charcot’s joint in one and lepra reaction in seven patients. Their disability as per WHO grade 1 and 2 was in 19 patients each. After 6 months of MDT, WHO grade improved in two patients, mRS revealed improvement in seven and LNS in nine patients. LNS- a clinical scale, seems more effective and easier to use for monitoring the progress/ outcome of neuropathy in leprosy patients and may complement the WHO grading scale

Auramine-O Staining vs Ziehl Neelsen Staining: Advantages and Disadvantages

Background: Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) is still a major public health concern around the world. Prompt detection of active tuberculosis cases helps in timely therapeutic intervention and reduces community transmission. Despite limited sensitivity, conventional microscopy is still used to diagnose pulmonary tuberculosis in high-burden nations such as India. This study, therefore, was aimed at assessing the diagnostic performance of microscopy by Ziehl Neelsen (ZN) and auramine (AO) staining in the diagnosis of pulmonary tuberculosis. Materials and methods: A prospective comparative study was done on the sputum samples of 2,395 adult patients from November 2018 to May 2020 suspected of having pulmonary tuberculosis visiting the Designated Microscopic Centre of SGT Medical College, Budhera, Gurugram. Each sample was subjected to ZN staining, and AO staining as per NTEP guidelines. Results: Out of the 2,395 samples studied, 161 (6.76%) and 224 (9.35%) were positive by ZN and AO staining methods respectively. Pauci-bacillary cases detected by AO were more than ZN staining. There were 63 more sputum samples detected by AO staining which were missed by ZN microscopy. Conclusion: When compared to conventional ZN staining, the auramine staining technique is more sensitive and takes less time to diagnose pulmonary tuberculosis

Comparison between the Mycob.T scanner system and manual microscopy in detecting acid-fast bacilli in sputum specimens / 上海预防医学

ObjectiveTo compare the efficacy between the Mycob.T scanner system and manual microscopy for detecting acid-fast bacilli in sputum specimens. MethodsBetween January and November 2020， a total of 1 519 sputum samples from suspected primary tuberculosis patients from 5 designated tuberculosis hospitals in Shanghai were examined by Smear and BACTEC MGIT 960 liquid culture （liquid culture） methods. Each specimen was subiected to 2 direct smear slides. One slide was stained by Z-N method and examined with manual microscopic method. Another slide was stained and scanned by the Mycob.T system. The efficacy of manual microscopy and the Mycob.T scanner system for detecting acid-fast bacilli in sputum specimens was compared based on the result of liquid culture. Results of the repetitive scanning by the Mycob.T scanner system and the recheck of the manual microscopy were analyzed. ResultsThe average positive rate by the Mycob.T scanner system was 14.4% （219/1 519） while the average positive rate by manual microscopy was 16.3% （248/1 519）. No significant difference was observed （χ2=2.13， P=0.145）. Based on liquid culture confirmation results， the sensitivity of manual microscopy （60.36%） was higher than that of the Mycob.T scanner system （52.94%）， and the difference is statistically significant （χ2=4.38， P=0.036）. Both methods had high specificity （98.94%）. The concordance of the Mycob.T scanner system and manual microscopy was 95.46%， with the kappa value of 0.826. The results of repeatability test of the Mycob.T scanner system and the recheck results of the manual microscopy showed that the coincidence rate of scanning by the Mycob.T scanner system was 99.5% （436/438）， and the recheck coincidence rate by the manual microscopy was 98.6% （432/438）. ConclusionThe Mycob.T scanner system have high specificity for detecting acid-fast bacilli in sputum samples and good consistency with the results of manual microscopy. Compared with manual microscopic examination， the Mycob.T scanner system can greatly alleviate the work intensity.

Gallbladder tuberculosis: A rare case report with review of literature

Gallbladder tuberculosis (TB) is a rare disease, and it might be challenging to distinguish it from gallbladder cancer on clinical history and radiology. It frequently mimics carcinoma in patients who initially appear with a gallbladder mass. Gallbladder TB is only identified after histology of the resected specimen since radiography lacks pathognomic characteristics. Here, we describe a unique case of gallbladder TB that was incidentally identified when a 49-year-old lady was being evaluated for suspected gallbladder cancer. Histology of the gallbladder exhibits necrotizing granulomatous inflammation with the presence of numerous pink-colored, curved, and beaded acid-fast bacilli that were recognized on the Ziehl-Neelsen stain.

Smear-positive pulmonary tuberculosis patients with previously abnormal chest radiographs: missed opportunities for early diagnosis

INTRODUCTION@#It is vital to diagnose and treat pulmonary tuberculosis (PTB) early, in the interests of the patient and public health. At the Singapore Tuberculosis Control Unit (TBCU), it was not uncommon to discover abnormal chest radiographs (CXRs) predating their PTB diagnosis by months to years in the electronic medical records (EMRs) of sputum acid-fast bacilli smear-positive patients. Our study explored this observation.@*METHODS@#The EMRs of sputum smear-positive PTB patients treated at the TBCU from January to July 2014 were viewed for abnormal CXRs preceding their PTB diagnosis. Information in the EMRs pertaining to the indication for the CXRs, radiological reports (including whether the possibility of PTB was stated) and action taken was captured.@*RESULTS@#Of the 254 sputum smear-positive patients, 108 had previous CXRs in their EMRs, of whom 39 (36.1%) had previous CXRs compatible with PTB. Most of these were performed in tertiary institutions and for reasons unrelated to PTB. No action was taken in response to these CXRs in 24 (61.5%) patients. 27 (69.2%) patients had abnormal CXRs dating back more than six months, with 12 (30.8%) dating back more than 30 months before the PTB diagnosis. Patients aged ≥ 55 years were significantly more likely to have previous CXRs that were compatible with PTB.@*CONCLUSION@#PTB patients may be asymptomatic or have chronic indolent disease and remain undiagnosed for years. There is a need for vigilance within our healthcare system to seize opportunities for early diagnosis and treatment to prevent the spread of this infectious disease in Singapore.

A Review on Placental Tuberculosis

Vein of GALEN aneurysmal malformation (VGAM) is a rare congenital disease caused by arteriovenous shunts between the choroidal arteries and the porencephalic ectatic vein. The diagnosis is often made in utero or during infancy, endovascular treatment remains the most suitable therapeutic means in a well-equipped environment. Here we report here the case of a patient complaining of headache for 1 year, and whose brain CT imaging showed the presence of Galen veinaneurysm with associated non-communicating hydrocephalus. In the absence of the appropriate technical platform, the placement of a ventriculoperitoneal shunt relieved our patient’s symptoms

Correlation between cytomorphology and acid fast bacilli positivity in tubercular lymphadenopathy in far Western Nepal: a hospital based study

Background: Tuberculous lymphadenitis is the most common manifestation of extrapulmonary tuberculosis. Fine needle aspiration cytology (FNAC) is a valuable tool in diagnosis of tubercular lymphadenitis. The present study aims to determine the prevalence of different cytomorphological patterns in fine needle aspiration cytology of tubercular lymph nodes and their correlation with Acid Fast Bacilli (AFB) positivity on Ziehi-Neelsen (ZN) Staining.Methods: Fine needle aspiration cytology of 274 cases diagnosed as tubercular lymphadenitis over a period of a year were reviewed. Cytomorphological patterns were categorized into three patterns. Pattern I: Epithelioid granuloma without necrosis, Pattern II: Epithelioid granuloma with caseous necrosis and Pattern III: Caseous necrosis only. Fischer Exact test was applied to correlate cytomorphological pattern and AFB positivity.Results: Tuberculous lymphadenitis was most frequent in age group 21-30 years (24.81%). Cervical lymph nodes were the most frequent lymph nodes involved (84.67%). Pattern I was the most common cytomorphological pattern observed (49.3%). Overall AFB positivity was 28.10%. Maximum AFB positivity was seen in pattern III (73.3%).Conclusions: FNAC is the simple, cost effective and minimally invasive tool to diagnose tuberculous lymphadenitis. Study of both cytomorphological pattern and ZN staining for AFB can improve the diagnostic accuracy.

Study of Morphological Patterns of Leprosy in a Rural Setup.

Leprosy is a chronic disease of ancient world and is still afflicting patients in many parts of world mainly Asia and Africa. Leprosy is one of the most dreaded diseases of humankind. We wanted to study the various microscopic patterns and subtypes of Leprosy. We also wanted to study the Bacterial Index in the region of Sawangi, Meghe.METHODS80 skin biopsies after adequate fixation in 10% of formalin, were routinely processed and were stained with H and E, Fite-Faraco stain and Modified Rapid Acid-Fast Bacilli (MRAFB staining) method, were studied microscopically and bacterial index was calculated.RESULTSA total of 80 skin biopsies were obtained from patients of department of dermatology over a period of two years from 2017 to 2019. Among them Lepromatous leprosy were 43 cases, Tuberculoid leprosy were 23 cases, Borderline lepromatous leprosy were 09 cases, Borderline tuberculoid leprosy were 03 cases, histoid leprosy were 01 case and ENL were 01 case. With an age range of 6 - 85 years, majority were in 31-40 years of age group, with male to female ratio of 2.47:1. LL was the most common type of leprosy (53.75%).CONCLUSIONSAccurate diagnosis of leprosy purely on clinical grounds is extremely difficult. Hence, there can be false positive and false negative diagnosis. Since histopathology is confirmatory, with application of Fite-Faraco and MRAFB staining it can also evaluate the bacterial load. Hence in all suspected cases of leprosy, histopathology along with Fite-Faraco and MRAFB staining should compulsorily be done.

Suppurative BCG Lymphadenitis and the Importance of Microbiology Investigations – A Case Report

@#Suppurative BCG lymphadenitis can easily be overlooked, as it mimics other diseases such as tuberculous lymphadenitis. A case of a three-month old female infant who received the BCG vaccination at birth presented with isolated left axillary mass at two months of age. She was initially treated as lymph node abscess but was referred to the hospital due to the increasing size of the swelling. Needle aspiration was done and the microbiology analysis came out positive for acid-fast bacilli. She was planned for syrup isoniazid; however, the management team withheld treatment until they were certain of the identity of the bacteria. The bacteria was confirmed by the molecular method to be Mycobacterium bovis BCG strain. The case report highlights the importance of the microbiology investigations for appropriate management in this case.

Role of flexible fiberoptic bronchoscopy in diagnosis of indefinate pulmonary infiltrates

Background: Respiratory diseases commonly present and are mostly diagnosed by routine clinical assessment and noninvasive investigations. Bronchoscopy a novel diagnostic tool used in diagnosis of various infectious, inflammatory and neoplastic pulmonary diseases by retrieving samples from bronchial, alveolar and interstitial compartments of patients with lung infiltrates. We prospectively assessed diagnostic utility of bronchoscopy in patients who had respiratory symptoms, radiographic infiltrates and sputum smear is negative for acid-fast bacilli (AFB). Despite, recent technical innovations in bronchoscopy, routine FOB is practiced with high yield and cost effectiveness.Methods: A prospective study was performed in which bronchoscopy was performed in 40 patients between August 2018 and January 2019, who had respiratory symptoms, radiographic findings not consistent with any specific diagnostic entity and had sputum smear negative for AFB.Results: Out of total 40 patients, most 30 (75%) patients were from rural areas, more than half 24 (60%) of the patients were males. Out of total 21 (52%) of patients were current smokers. Most common presenting symptoms were cough 22 (55%) and hemoptysis 8 (20%) followed by fever 6 (15%) and weight loss 4 (10%). Tuberculosis was confirmed in 18 (45%) patients. Non tubercular diseases were diagnosed in 22 (55%). Interstitial lung disease (ILD) was diagnosed in 5 (12.5%), lung cancer in 5%, bronhiectasis in 7.5%, pneumonia in 12.5%, lung abscess in 2.5% and non-specific infection in 15%.Conclusions: Diagnostic utility of flexible bronchoscopy is ever growing and has certainly taken a turn from being a luxury to near necessity today. Its association with trivial complications makes it a safe procedure. Hence bronchoscopy should be considered in the evaluation of patients with respiratory symptoms, indefinate radiographic infiltrates and negative sputum AFB test.

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.

Diagnostic Accuracy of Xpert® Mtb / Rif Compared to Microscopy-Based Methods for Diagnosing Tuberculous Lymphadenitis from Fine Needle Aspirates at the Port Moresby General Hospital, Papua New Guinea

@#Data on the accuracy of Xpert® MTB/RIF (Xpert) assay in detecting TB in lymph node aspirates in Papua New Guinea (PNG) is scanty. This study evaluated Xpert performance in diagnosing tuberculous lymphadenitis (TBLN) using lymph node needle aspirates at the Port Moresby General Hospital (PMGH). The objective of the study was to compare Xpert accuracy to acid fast bacilli (AFB) microscopy, cytomorphology, a composite reference test (CRS) and culture. A total of 107 eligible subjects were recruited out of 1080 clinic attendees. Results showed Xpert detected significantly more cases of TBLN than AFB microscopy (66 vs 35; p=0.001). Compared to AFB microscopy Xpert had a sensitivity of 45.4% (95% CI 33.1-58.1), specificity of 87.8% (95% CI 73.8-95.9), positive predictive value (PPV) of 85.7% (95% CI 71.6-93.4) and negative predictive value (NPV) of 50.0%% (95% CI 43.8-56.1). There was no difference between Xpert and cytomorphology (66 vs 60; p=0.5). Compared to cytomorphology Xpert had a sensitivity of 71.6% (95% CI 58.5-82.5), specificity of 51.1% (95% CI 35.7-66.3), PPV of 66.1% (95% CI 58.2-73.2) and NPV of 57.5% (95% CI 45.2-68.9). There was no difference between Xpert and CRS (66 vs 71; p=0.6). Compared to CRS Xpert had a sensitivity of 76.0% (95% CI 64.4- 85.3), specificity of 66.6% (95% CI 49.0-81.4), PPV of 81.8% (95% CI 73.5-87.9) and NPV of 58.4% (95% CI 46.7-69.4). Culture was completed on 24 subjects with positive isolates in 14 giving a culture yield of 58.3%. Of the 24 subjects, Xpert was positive in 21 subjects. There was no difference between Xpert and culture (21 vs 14; p=0.8). Compared to culture Xpert had a sensitivity of 100.0% (95% CI 76.8-100.0), specificity of 30.0% (95% CI 6.6-65.2), PPV of 66.6% (95% CI 57.1-75) and NPV of 100.0%. The results suggest Xpert is more sensitive than AFB microscopy but comparable to cytomorphology and CRS for TBLN diagnosis in the PNG context. Xpert can be used for diagnosing TBLN at PMGH

Ascitic And Pleural Fluid Being Positive For Acid Fast Bacilli By Ziehl– Neelsen Stain : A Rare Case Report.

The incidence of extrapulmonary tuberculosis is rising globally due to the increased prevalence of HIV infection. Hence a high clinical suspicion and supportive diagnostics is necessary for the diagnosis . The incidence of Acid fast bacilli being positive by ZN stain is very low, but in our patient who prented with easy fatigability, fever and abdominal distension of 5 months duration found to have both pleural and ascitic fluid positive for the organism.the patient was started with anti-tuberculosis treatment and is improving.

Validity of FNAC for the Diagnosis of Leprosy

Early and accurate diagnosis of leprosy is crucial because delay may lead to some permanent disability and sequelae. Histopathological examination of skin and nerves and slit skin smears examination to assess the bacillary load, have been the major tools used in the laboratory diagnosis, classification and follow up of patients with leprosy. Histopathological evaluation is not feasible in many leprosy endemic areas. Fine needle aspiration cytology (FNAC) is a simpler tool compared to histopathology for the evaluation of the cytomorphology of skin lesions. Aims of this study are to evaluate the role of cytology in diagnosing leprosy patients, to study the cytomorphology of leprosy lesions in fine needle aspirates and to compare the diagnostic value of FNAC with that of standard histopathological diagnosis. Sensitivity of FNAC in diagnosing leprosy was observed to be BT (87.5%); LL (80%); TT and BL (66.67%) in the descending order. Specificity of FNAC in diagnosing leprosy was in the following order BL (96.29%); followed by LL (96%); TT (92.59%) and BT (85.71%). Positive predictive value was observed to be BT-87.5%; LL-80%; BL-66.67% and TT-50%. Fairly good correlation was observed between clinical, histological and cytomorphological features in the aspirates taken from the skin lesions. A reasonably good sensitivity, specificity, positive and negative predictive values were obtained in all types of leprosy except for mid borderline spectrum. FNAC is a simple, easy, cost effective, relatively non invasive procedure which provides faster results than biopsy. Drawbacks include- “dry taps”, bloody smears and lack of cellular infiltrate in case of macular lesions.

Performance of LED fluorescence microscopy for the detection of acid-fast bacilli from respiratory samples in peripheral laboratories in Argentina / Rendimiento de la microscopía de fluorescencia LED para la detección de bacilos ácido-alcohol resistentes en muestras respiratorias en laboratorios periféricos de Argentina

ABSTRACT Introduction: Light-emitting diode fluorescence microscopy (LED-FM) has been endorsed by the World Health Organization (WHO) for tuberculosis diagnosis, but its accuracy in HIV-infected patients remains controversial, and only some few studies have explored procedural factors that may affect its performance. Objective: To evaluate the performance of LED-FM for tuberculosis diagnosis in patients with and without HIV infection using a newer, less expensive LED lamp. Materials and methods: We compared the performance of LED-FM and Ziehl-Neelsen (ZN) microscopy on respiratory specimen smears from tuberculosis (TB) suspects and patients on treatment examined by different technicians blinded for HIV-status and for the result of the comparative test. We analyzed the effect of concentrating specimens prior to microscopy using different examination schemes and user-appraisal of the LED device. Results: Of the 6,968 diagnostic specimens collected, 869 (12.5%) had positive Mycobacterium tuberculosis cultures. LED-FM was 11.4% more sensitive than ZN (p<0.01). Among HIV-positive TB patients, sensitivity differences between LED-FM and ZN (20.6%) doubled the figure obtained in HIV-negative patients or in those with unknown HIV status (9.3%). After stratifying by direct and concentrated slides, the superiority of LED-FM remained. High specificity values were obtained both with LED-FM (99.9%) and ZN (99.9%).The second reading of a sample of slides showed a significantly higher positive detection yield using 200x magnification (49.4 %) than 400x magnification (33.8%) (p<0.05). The LED-device had a very good acceptance among the technicians. Conclusion: LED-FM better performance compared with ZN in HIV-infected patients and user-appraisal support the rapid roll-out of LED-FM. Screening at 200x magnification was essential to achieve LED-FM increased sensitivity.

RESUMEN Introducción. La microscopía de fluorescencia con lámpara LED (MF-LED) ha sido recomendada por la Organización Mundial de la Salud (OMS) para el diagnóstico de la tuberculosis, pero su precisión en pacientes con HIV continúa siendo controversial y en pocos estudios se han explorado los factores metodológicos que pueden afectar su utilidad. Objetivo. Evaluar el rendimiento de la MF-LED en el diagnóstico de la tuberculosis en pacientes con HIV y sin él mediante un novedoso dispositivo LED. Materiales y métodos. Se comparó el rendimiento de la MF-LED y la microscopía en frotis de muestras respiratorias con tinción de Ziehl-Neelsen (M-ZN) examinados por técnicos cegados en cuanto al estado de HIV y el resultado de la prueba comparativa. Se analizó el efecto de concentrar muestras antes de la microscopía, usar diferentes esquemas de observación y la valoración con el dispositivo LED. Resultados. De las 6.968 muestras recolectadas, 869 (12,5 %) resultaron con cultivo positivo para Mycobacterium tuberculosis. La MF-LED fue 11,4 % más sensible que la M-ZN (p<0,01). Entre los pacientes con tuberculosis positivos para HIV, la diferencia de sensibilidad entre la MF-LED y la M-ZN (20,6 %) duplicó la cifra obtenida en pacientes negativos para HIV o con estatus desconocido (9,3 %). Al estratificar los frotis en directos y concentrados, se mantuvo la superioridad de la MF-LED. Las especificidades de la MF-LED (99,9 %) y la M-ZN (99,9 %) resultaron elevadas. La lectura de una muestra de frotis mostró una positividad significativamente mayor con un aumento de 200X (49,4 %) que con uno de 400X (33,8 %) (p<0,05). El dispositivo LED tuvo una buena aceptación entre los técnicos. Conclusión. Debido al mejor desempeño de la MF-LED comparada con la M-ZN en pacientes con HIV y su fácil utilización, se recomienda su adopción. La utilización del aumento de 200X fue esencial para el incremento de la sensibilidad de la MF-LED.

A study on the clinico-histopathological correlation in hansen’s disease

Introduction: Leprosy, caused by Mycobacterium leprae, is widely prevalent in India and presents with different subtypes. However, there exists a great variation in the interpretation of clinical and histopathological examination of these lesions. The present study was carried to correlate clinical diagnosis of leprosy cases with histopathological diagnosis. Methodology: A retrospective Hospital-based study was conducted in patients of Leprosy, who attended Dermatology Out Patient Department for a period of 18 months. Clinical diagnosis was noted and the biopsies were processed as per standard protocol in the Department of Pathology. The clinical and histopathological concordance was calculated using percentage parity. Results & Conclusion: In a total of 52 cases, 29(55.7%) were males and 23(44.2%) were females. The histopathological diagnoses from our study showed agreement with clinical diagnoses in 27 (57.69%) cases. Clinico-histopathological agreement was noted maximum in LL (80%), followed by BT (57.14%), BL (50 %), BB (50%), TT (46.2 %), and least in IL (42.8 %).

Exames complementares no diagnóstico da tuberculose em bovinos reagentes à tuberculinização comparada / Comparison of complementary diagnostic methods of bovine tuberculosis on skin-test reactive cattle

Objetivou-se com este estudo comparar diferentes métodos complementares de diagnóstico (macroscópico, histopatológico, sorológico e molecular) da tuberculose, em bovinos naturalmente infectados. O trabalho deu-se por meio de amostras colhidas em abate sanitário de 40 bovinos reagentes no teste cervical comparativo (TCC) para tuberculose. A inspeção macroscópica post mortem das carcaças foi acompanhada de colheita de amostras de muco nasal, sangue e tecido (fígado, pulmão e linfonodo mediastínico) para realização do exame de reação em cadeia pela polimerase (PCR), de Enzyme-Linked Immunosorbent Assay (ELISA) e histopatológico com colorações de hematoxilina-eosina (HE) e Ziehl-Neelsen (ZN), respectivamente. Dos 40 bovinos inspecionados no abate, 22 (55%) animais apresentaram algum tipo de lesão macroscópica sugestiva de tuberculose. Nos achados histopatológicos visualizados em HE, 13 (32,5%) carcaças apontaram alterações histológicas, sendo 6 (15%) nos linfonodos mediastínicos, 5 (12,5%) no fígado e 3 (7,5%) no pulmão. Não foi observada a presença de bacilos álcool-ácido resistentes em nenhuma das amostras avaliadas. O ensaio sorológico de ELISA/IDEXX(r) identificou um (2,5%) animal reagente, e o teste de PCR detectou DNA de Mycobacterium bovis em uma (2,5%) amostra. Concluiu-se que entre os exames complementares de diagnóstico avaliados nenhum foi capaz de detectar todos os animais que estavam positivos na tuberculinização, porém a associação de diferentes métodos pode garantir a confiabilidade do diagnóstico.(AU)

The aim of this study was to compare different complementary diagnostic methods (macroscopic, histological, serological and molecular) of tuberculosis in naturally infected cattle. The study was conducted from samples taken from 40 reagents cattle in cervical comparative intradermal tuberculin test (ITT). The macroscopic post mortem inspection of carcasses was followed by the collection of nasal swabs, blood and tissue samples (liver, lung and mediastinal lymph node) for polymerase chain reaction (PCR) test, Enzyme-Linked Immunosorbent Assay (ELISA) and histopathologic test with hematoxylin-eosin (HE) and Ziehl-Neelsen (ZN), respectively. Of the 40 cattle slaughtered, 22 (55%) carcasses had macroscopic lesions suggestive of tuberculosis. The histopathology HE identified 13 (32.5%) carcasses with histological changes: 6 (15%) in the mediastinal lymph nodes, 5 (12.5%) in the liver and 3 (7.5%) in the lung. At ZN, the presence of acid-fast bacilli was not detected in any of the samples tested. The ELISA/IDEXX(r) identified one (2.5%) reagent animal, and the PCR test detected DNA of Mycobacterium bovis in one (2.5%) cow. It is concluded that among the diagnostic methods reviews none was able to detect all animals that were positive in tuberculin test, but the association of different methods can ensure diagnostic accuracy.(AU)

Role of fine needle aspiration cytology in diagnosing leprosy: in a tertiary care hospital.

Background: Leprosy, a chronic inflammatory granulomatous disease chiefly involving skin and peripheral nerves and occasionally other organ systems, caused by Mycobacterium leprae. It has tormented the human civilization through time immemorial. Leprosy remains a significant public health problem worldwide, especially in developing countries like India. The diagnosis of leprosy is not always easy because of long incubation period, over dependence of clinical expertise and a lack of rapid and simple diagnostic tool, patients remain undiagnosed for longer time. Fine needle aspiration (FNAC) technique is an inexpensive, rapid and accurate procedure for diagnosis of leprosy. We conducted a prospective study evaluating the ability of fine needle aspiration cytology in diagnosing and classifying leprosy lesions on Ridley-Jopling scale (R-J scale). The aim of this prospective study was to assess the usefulness of fine needle aspiration cytology in early diagnosis of leprosy, to identify specific cytological characteristics of diagnosis and to correlate the cytological smear findings with histopathology and to evaluate merits of relatively non-invasive procedure of FNAC over more invasive procedure - biopsy. Methods: The study is a hospital based prospective study carried out in the Department of Pathology and Department of Skin, Venereal Diseases, Leprosy, N.S.C.B. Medical College & Hospital, Jabalpur (M.P.) September 2010 to September 2013. Patients with new skin lesions were selected for the study. FNAC was performed and aspirates were evaluated for cytology using Hematoxylin and Eosin staining (H&E staining), Ziehl-Neelsen staining (ZN staining) and punch biopsy was collected. Results: Out of 50 cases, clinical and cytological correlation was seen in 88% tuberculoid leprosy, 93.7% of borderline tuberculoid, 33% of borderline lepromatous leprosy and 66% of lepromatous leprosy. While clinical with histopathological correlation revealed 100% specificity in tuberculoid leprosy, 100% in borderline tuberculoid, 66.6% in borderline lepromatous, 83.3% in lepromatous leprosy and 80% in indeterminate leprosy and 100% in histoid leprosy in our study. The overall cytodiagnostic accuracy has been 92% in present study. Conclusion: Our study demonstrates that the combination of FNAC and ZN staining for Acid Fast Bacilli (AFB) can provide a rapid diagnosis in majority of leprosy suspected cases. FNAC is a safe, simple, rapid, less-invasive, OPD procedure for early diagnosis and classification of leprosy cases.

The effect of different staining reagent and time on acid fast bacilli staining and its quality control significance / 重庆医学

Objective To observe the effect of different staining reagent and time on acid fast bacilli staining and study its quality control measures.Methods We collected 38 cases for positive acid fast bacilli stain.Every wax blocked into 4 pieces,with different staining reagent and time of acid fast staining.Results Using xylene and ethanol staining for 20 minutes,acid fast bacilli was discontinuous and red punctate.Zero cases were positive and the positive rate was 0%.Turpentine dyeing for 1 5 minutes group,acid fast bacilli was clear,bright red,slightly bent branched,and easy to identify.A total of 34 cases were positive and posi-tive rate was 89%.Turpentine dyeing process for 20 minutes,the whole background was red,and was not easy identification.A total of 28 cases were positive and the positive rate was 74%.Turpentine dyeing for 30 minutes,the background was entirely deep red, and was hard to discern the acid fast bacilli.A total of 27 cases were positive and the positive rate was 71%.Conclusion Different staining reagent and time had different positive staining results.Suitable turpentine process was stained for 1 5 minutes for acid fast bacilli.