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.

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.

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.

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.

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.

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.

Evaluación de la técnica Xpert® MTB/RIF para la detección de Mycobacterium tuberculosis complex en muestras extra-pulmonares / Evaluation of Xpert® MTB/RIF technique for Mycobacterium tuberculosis complex detection in extra-respiratory specimens

Resumen La tuberculosis (TBC) extra-pulmonar alcanza al 26,2% de los casos totales de TBC en Chile. El cultivo es el método estándar de oro, pero es lento. La técnica Xpert® MTB/RIF permite detectar Mycobacterium tuberculosis complex (MTBc) por RPC en tiempo real en menos de 3 h, sin embargo, ha sido validada sólo para muestras respiratorias. El objetivo de este estudio fue determinar la utilidad de la prueba Xpert® MTB/RIF en la detección de MTBc en muestras extra-pulmonares en comparación con un estándar de oro combinado consistente en un cultivo de micobacterias positivo (medio sólido y líquido) y/o un método molecular validado positivo (q-RPC, Cobas® TaqMan-MTB). Se analizaron 50 muestras extra-pulmonares, de las cuales 25 fueron definidas positivas y 25 negativas para MTBc en base a estándar de oro combinado. Las 25 muestras definidas positivas tuvieron un resultado positivo por Xpert® MTB/RIF; de las 25 muestras definidas negativas, 24 tuvieron un resultado negativo y una de ellas un resultado positivo. Se obtuvo una concordancia global entre Xpert® MTB/RIF y el estándar de oro combinado de 98%. La prueba Xpert® MTB/RIF fue capaz de detectar 12 casos de TBC extra-pulmonar con baciloscopia negativa y 3 casos con cultivo negativo. El método Xpert® MTB/RIF ha demostrado tener una sensibilidad similar al q-RPC para detectar MTBc en muestras extra-pulmonares y permite reducir sustancialmente el tiempo de diagnóstico.

Extra-pulmonary tuberculosis (TB) represents the 26.2% of total TB cases in Chile. Culture is the gold standard method, but the process is extremely slow. Xpert®MTB/RIF technique detects Mycobacterium tuberculosis complex (MTBc) through real time PCR in less than 3 h. However, it has been validated only for respiratory specimens. We aimed to determine the performance of Xpert®MTB/RIF test in detecting MTBc in extra-respiratory specimens compared with a combined gold standard consisting in a positive (liquid and solid) mycobacterial culture and/or a positive validated molecular method (q-RPC, Cobas®TaqMan®-MTB). Fifty extra-respiratory specimens were analyzed, from which 25 were positive and 25 negative for MTBc based on the combined gold standard. The 25 positive specimens had a positive result by Xpert®MTB/RIF; from the 25 negative specimens, 24 had a negative result and one had a positive result. We obtained an overall concordance of 98% between Xpert®MTB/RIF and the combined gold standard. Xpert®MTB/RIF test was able to detect 12 smear-negative specimens and 3 culture-negative specimens, all of them corresponding to extra-pulmonary TB cases. Xpert®MTB/RIF showed similar sensitivity to q-RPC in detecting MTBc in extra-respiratory specimens. This procedure allowed a substantial reduction in the time of diagnosis.

Clinical features of tuberculosis in patients with systemic lupus erythematosus / 实用医学杂志

Objective To describe the characteristics and risk factors for Mycobacterium tuberculosis (TB)infection in patients with systemic lupus erythematosus(SLE).Methods A retrospective analysis was per-formed. Results Among our sample of 784 hospitalized patients,42(5.4%)were diagnosed with TB infection. Seventeen were pulmonary TB,11 were pulmonary and extra-pulmonary TB and 14 were extra-pulmonary TB.hest X-rays showed Abnormal chest imaging was observed in 34 cases,among which,19 were multi-lobar involvements and 9 were single-lobe involvements. Logistic regression multivariate analysis indicated that anemia and the daily mean dose of glucocorticoid(GC)were associated with TB. Conclusions Manifestations of TB in SLE patients were atypical.Anemia and the daily mean dose of GC were associated with TB.

Abdominal Tuberculosis Combined with Abdominal Trauma

Abdominal tuberculosis is a rare disease, about 5% of extra-pulmonary tuberculosis. However, the diagnosis of abdominal tuberculosis is difficult, because of its atypical symptoms and signs, and ambiguous results upon physical examination. When abdominal tuberculosis is combined with abdominal injury, the diagnosis will be especially complex. We present our experience of abdominal tuberculosis associated with abdominal trauma.

Diagnóstico de tuberculosis extra pulmonar: análisis sistemático de la literatura y serie de casos en la región cervicofacial / Diagnosis of extra-pulmonary tuberculosis: Systematic analysis of literature and study of seven cases in the cervicofacial region

Resumen: La tuberculosis tiene múltiples formas clínicas y puede afectar a casi cualquier parte del cuerpo humano. Antes de encontrarse su tratamiento farmacológico, la mitad de afectados fallecía antes de los dos años. Es una enfermedad antigua con una estrategia mundial para erradicarla con un éxito parcial. Actualmente en México existe un aumento del número de casos convencionales y extrapulmonares. Dichos sitios que no-pulmonares son a nivel del tracto gastrointestinal, sistema nervioso central, piel, linfa, cavidad oral, articulación temporomandibular, así como ganglios en región cervical. Cuando se presenta extrapulmonar su diagnóstico es complicado por la variedad de presentaciones y múltiples diagnósticos diferenciales a descartar. Existen diferentes pruebas diagnósticas, algunas que inclusive pueden dar un falso negativo. Su diagnóstico estándar es mediante cultivo de micobacterias. Se presentan un análisis sistemático de la literatura, y se discute cuatro casos clínicos con manifestaciones cervicofaciales de tuberculosis, mostrando el protocolo que se uso para corroborar el diagnóstico y descartar otras patologías.

Abstract: Tuberculosis assumes several clinical forms and can affect almost any part of the human body. Before pharmacological treatment was discovered, half of afflicted subjects died before two years. Tuberculosis can be considered an ancient disease and worldwide strategy to eradicate it has only met with partial success. Presently in Mexico there has been an increase in number of conventional and extra-pulmonary tuberculosis cases. Non pulmonary sites can be found in the gastro-intestinal tract, central nervous system, skin, lymphs, mouth, temporomandibular articulation as well as ganglia at the cervical region. Diagnosis of extra-pulmonary tuberculosis is complicated, this is due to the variety of presentations and multiple differential diagnoses that need to be discarded. There are different diagnostic tests, some of them might even give a false negative. Standard diagnosis is achieved through mycobacterial culture. A systematic analysis of the literature is presented in this study; four clinical cases with tuberculosis cervical-facial manifestations are studied, describing protocol used to corroborate diagnosis and discard other conditions.

Breast Tuberculosis - Experience of Cases in a Tertiary Care Institute.

Aim: The study was conducted with an aim to suspect and diagnose “breast tuberculosis (TB)” cases early to avoid unnecessary delay in their treatment. Materials and Methods: For this purpose, the cases of breast complaints presenting in the Department of Surgery were clinically examined, investigated with fine-needle aspiration cytology (FNAC) or biopsy along with other relevant investigations. FNAC or biopsy positive for breast TB cases were further investigated by chest X-ray and/or sputum acid-fast bacilli for any evidence of pulmonary TB. Results: A total of 9 cases of breast TB were collected. Out of these 9 cases, 7 cases were adult females in the age group of 24-40 years. Cases 1, 2, 5, 6, and 9 were non-lactating, while Cases 3 and 7 were lactating. Case 4 was a 12-year-old girl and Case 8 was 25-year-old male. All the cases were involving the right breast except Case 5, which was involving both breasts, and Case 6, which was involving left breast. Case 5 was also having active pulmonary TB. Case 7 was showing Ziehl-Neelsen staining positive for AFB in breast tissue sample. We treated all cases with first-line four drugs (HRZE) for initial 2 months and two drugs (HR) for another 4 months except in Cases 1 and 5 where the continuation phase was extended to 6 months. Conclusion: Histopathological diagnosis is a more reliable and accurate as compared to the bacteriological diagnosis of tubercular mastitis. Four drugs therapy for 6 months is adequate. The majority of the cases will heal without major surgery, and mastectomy should be reserved for extensive breast destruction and unresponsive cases.

Tubercular Testicular Abscess in a Young Male-Rare Presentation of a Common Disease.

Genitourinary tuberculosis is rare manifestation of extra pulmonary tuberculosis which itself is an fairly uncommon manifestation of a common global disease. Of these rare manifestations, we present a still rarer case of testicular tubercular abscess. We highlight the importance of testicular tuberculosis as a differential diagnosis of testicular mass / abscess and use of histopathology in clinching the diagnosis.

Paradoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis / 고신대학교의과대학학술지

A paradoxical response is not uncommon in non-HIV-infected patients, particularly those with extra-pulmonary tuberculosis. It is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion during anti-tuberculosis therapy. The paradoxical response has been attributed to host immunologic reactions, such as a delayed hypersensitivity or a response to mycobacterial antigens. In most reports of paradoxical response, these responses occurred in the same location as a previous lesion. In this patient with pulmonary tuberculosis, cervical lymph node enlargement occurred as a paradoxical response after the completion of anti-tuberculosis treatment. Although the new lesion developed in another location, it could be considered as a paradoxical response based on the negative culture result of acid fast bacilli from the new lesion and drug sensitivity result from initial bronchoalveolar lavage specimen. Therefore we were able to decide on the termination of unnecessary anti-tuberculous treatment. Based on our case, we can conclude that paradoxical response can occur after the termination of anti-tuberculosis therapy even in new site.