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Background and Aims: The host immune system plays an important role in the pathogenesis and defense mechanism of Mycobacterium tuberculosis (Mtb). This study aimed to explore the different changes in the immune system between smear-negative pulmonary tuberculosis (PTB) and smear-positive PTB patients. Materials and Methods: A total of 85 active PTB patients and 50 healthy adults were enrolled. The participants were divided into smear-negative PTB, smear-positive PTB, and control groups. Chest computed tomography (CT) and lymphocyte subgroup counts in peripheral blood were measured in all participants. Results: There were higher numbers of CD4 + T-cells, NK cells, and pulmonary cavities in the smear-positive PTB group, whereas the numbers of B-ells were significantly increased in the smear-negative PTB group. Conclusions: Smear-negative PTB showed fewer pulmonary cavities, mild inflammatory response, lower numbers of immune cells, and higher numbers of B- cells.
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Objective:To analyze the relevant factors of bacteriological diagnosis rate in pulmonary tuberculosis in Zhejiang Province, and to provide basis for the control of tuberculosis.Methods:The results of etiology detection of pulmonary tuberculosis in Zhejiang Province from 2015 to 2020 were collected from the China Tuberculosis Information Management System. Positive detection of etiology of pulmonary tuberculosis cases was analyzed. Joinpoint regression model was constructed to evaluate the annual trend of the positive rate of etiology, and linear regression model was used to analyze the influence of new diagnostic technology on the positive detection rate of etiology in smear-negative pulmonary tuberculosis cases.Results:From 2015 to 2020, the positive rate of etiology of pulmonary tuberculosis in Zhejiang Province increased from 38.66%(10 588/27 385) to 64.12%(14 275/22 262), with an average annual growth rate of 8.80%. All of the 11 prefecture cities in Zhejiang Province showed an increasing trend of the positive rate of etiology. The average annual growth rates in Wenzhou City and Lishui City were 10.27% and 11.21%, respectively, and the positive rates of etiology in Jinhua City and Lishui City were 70.13%(2 007/2 862) and 73.34%(707/964) in 2020, respectively. From 2015 to 2020, smear-negative cases accounted for 61.66%(92 935/150 733) in Zhejiang Province, and the further detection rate by culture and molecular test increased from 0.13%(22/16 650) to 84.74%(11 384/13 434). The positive rate of bacteriological tests in smear-negative pulmonary tuberculosis patients increased from 0.04%(6/16 650) to 41.28%(5 546/13 434). If the culture and molecular detection rate increased to 100.00%, the linear regression model predicted positive rate of etiology could increase to 44.20%. Thus, the positive rate of etiology of pulmonary tuberculosis in Zhejiang Province would reach 66.00%. Up to 2020, 95.56%(86/90) and 92.22%(83/90) of tuberculosis designated hospitals were equipped with molecular and liquid diagnostic equipments, respectively, and the detection positive rates of molecular and liquid diagnostics in the etiology positive pulmonary tuberculosis cases were 71.24%(10 169/14 275) and 53.44%(7 629/14 275), respectively.Conclusions:The implementation and promotion of the new diagnostic techniques for tuberculosis, especially the molecular diagnostic techniques, could significantly improve the positive rate of etiology of pulmonary tuberculosis etiology. Methods and strategies of etiological diagnosis of tuberculosis should be paid more attention in prevention and control of tuberculosis.
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@#Abstract: Objective To investigate the diagnostic value of joint detection of Mycobacterium tuberculosis rifampicin resistance gene (Xpert MTB/RIF), Mycobacterium tuberculosis ribonucleic acid (TB-RNA) and Mycobacterium tuberculosis deoxyribonucleic acid (TB-DNA) in bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis. Methods A total of 806 patients with suspected smear-negative pulmonary tuberculosis admitted to our hospital from May 2020 to July 2022 were selected, 506 patients diagnosed as bacterial negative pulmonary tuberculosis by clinical, X-ray and sputum samples were classified as bacterial negative pulmonary tuberculosis group, and the other 300 patients with non-tuberculous pulmonary disease were classified as non-tuberculous pulmonary disease group. XpertMTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid of all patients were detected. With clinical, X-ray and sputum specimen examination of mycobacterium tuberculosis as the gold standard, the diagnostic efficacy of alveolar lavage solution Xpert MTB/RIF, TB-RNA and TB-DNA alone and in combination was analyzed. Results The positive detection rates of Xpert MTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid of the smear-negative pulmonary tuberculosis group and the non-tuberculosis pulmonary disease group were 69.96% (354/506) and 2.67% (8/300), 61.46% (311/506) and 5.00% (15/300), and 63.64% (322/506) and 8.00% (24/300), respectively. The rates in the smear-negative pulmonary tuberculosis group were higher than those in the non-tuberculosis lung disease group, and the differences were statistically significant (χ2=342.005, 246.930, 235.687, P<0.01). Compared with the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Xpert MTB/RIF in the diagnosis of smear-negative pulmonary tuberculosis were 69.96%, 97.33%, 80.15%, 97.79% and 65.77%, respectively; those values of TB-RNA were 61.46%, 95.00%, 73.95%, 95.40% and 59.38%, respectively; those values of TB-DNA were 63.64%, 92.00%, 74.19%, 93.06% and 60.00%, respectively; those values of combined diagnosis with Xpert MTB/RIF, TB-RNA and TB-DNA were 61.26%, 100.00%, 75.68%, 100.00% and 60.48%, respectively; the specificity and positive predictive value of combined detection were higher than those of single detection (P<0.05). Conclusions The joint detection of Xpert MTB/RIF, TB-RNA and TB-DNA in bronchoalveolar lavage fluid can improve the diagnostic efficacy of smear-negative pulmonary tuberculosis and is worthy of clinical promotion and application.
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Introduction: India has the highest burden of TB cases inthe world, majority of them are pulmonary tuberculosis.The method of choice for diagnosis of PTB is microscopicexamination of AFB by sputum smear. However, 30 to 50%of patients with pulmonary tuberculosis can have negativesputum report or may not produce sputum. Flexible fibreopticbronchoscopy can provide excellent material for diagnosis forpatients with suspected sputum smear negative pulmonarytuberculosis. Study aimed to evaluate the role of fiberoptic bronchoscopy in sputum smear negative pulmonorytuberculosis.Material and methods: Forty suspected cases of pulmonaryTB with clinical and radiological evidence of tb and sputumsmear negative on 2 occasions were selected for thisprospective nonrandomised observational study. Detailedexamination of the bronchial tree was done and specimensincluding bronchial aspirate and lavage was collected andsend for investigations. Post bronchoscopy sputum (PBS) wasalso collected and sent for smear microscopy.Results: In our study of 40 patients, tuberculosis wasconfirmed in 13 (32.50%) by smear examination of AFB inBroncho alveolar fluid and by post bronchoscopy sputumsmear examination in 3/40 (7.5%) cases. A definitive diagnosisof tuberculosis was possible in 23 (57.5%) of the 40 patientsby AFB culture by BACTEC MGIT960.Conclusion: Fibreoptic bronchoscopy with post bronchoscopysputum,BAL and BAL AFB culture is a useful tool fordiagnosis and can thereby prompt treatment of sputum smearnegative pulmonary tuberculosis patients.
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Objective To investigate the application value of Xpert mycobacterium tuberculosis/rifampicin (GeneXpertMTB/RIF) and Hain techniques for the diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance. Methods A total of 254 patients with suspected pulmonary tuberculosis treated in our hospital from March 2018 to June 2019 were enrolled. GeneXpertMTB/RIF, Hain techniques, Roche culture and drug susceptibility testing were performed. Taking Roche culture results as a gold standard, the efficacy of GeneXpertMTB/RIF and Hain techniques in detecting sputum smear-negative pulmonary tuberculosis was analyzed by ROC curve. Based on the results of drug susceptibility testing, the efficacy of GeneXpertMTB/RIF and Hain techniques in detecting rifampicin resistance was analyzed. Results The sensitivity, specificity and accuracy of GeneXpertMTB/RIF in the diagnosis of sputum smear negative pulmonary tuberculosis were 82.18%, 86.93% and 83.52%, respectively. The sensitivity, specificity and accuracy of Hain technique in the diagnosis of sputum smear negative pulmonary tuberculosis were 67.33%, 77.12% and 73.23%, respectively. The sensitivity, specificity and accuracy of GeneXpertMTB/RIF in evaluating rifampicin resistance were 73.33%, 98.84% and 95.05%, respectively. The sensitivity, specificity and accuracy of Hain technique in evaluating rifampicin resistance were 86.67%, 82.56% and 83.17%, respectively. Conclusion Compared with Hain technology, GeneXpertMTB/RIF had better clinical value for diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance. This study demonstrates that GeneXpertMTB/RIF technique has a good application value in the rapid diagnosis and treatment of sputum smear negative pulmonary tuberculosis.
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Background: Tuberculosis is the ninth leading cause of death worldwide. India contributes to about one fifth of global TB burden. It is very important to diagnose early and treat tuberculosis to cut down transmission of tuberculosis.Methods: Author conducted a retrospective study in Department of Pulmonary Medicine SLN Medical College, Koraput, Odisha to analyze the utility and yield of CBNAAT. Study period was from April 2018 to March 2019. Inclusion criteria was all patients whose samples were subjected to CBNAAT were included in our study. Sputum samples from pulmonary tuberculosis patients, and extra pulmonary samples (pleural fluid, ascitic fluid, CSF, synovial fluid and gastric lavage etc. were included in our study population. Exclusion criteria was patients who were under anti tubercular therapy for pulmonary, extra pulmonary and MDR TB were excluded from this study. Data were collected from Pulmonary Medicine Department, ART center, DOTS center and CBNAAT center. Total number of samples tested for CBNAAT, different sample collection sites, age and sex distribution of patients, HIV status of all patients, result of smear microscopy for AFB and CBNAAT and Rifampicin resistance status were analyzed.The detail statistical analysis was done in tabulation form.Results: A total of 2621 samples were tested in CBNAAT during the study period. Mean age of the study population was 38.03 years. 1881 tested were negative and 740 samples were positive for CBNAAT. Of these 2621 samples, 2526 were pulmonary samples (sputum, pleural fluid samples) and 95 were extra pulmonary samples. Author found rifampicin resistance rate of 0.54% (4/740)) in pulmonary tuberculosis cases. There was no rifampicin resistance detected in extra pulmonary samples. CBNAAT could identify 536 cases (23.2%) that were smear negative. Author found TB- HIV co-infection rate of 6.22%.Conclusions: CBNAAT is an important diagnostic modality especially in sputum negative patients for early diagnosis and treatment. In our study it detected Mycobacterium tuberculosis in 23.2% of patients with negative smear for microscopy. Rifampicin resistance rate detected was very low compared to other studies.
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Background: Tuberculosis is a chronic, communicable, infectious disease caused by mycobacterium tuberculosis bacilli usually affecting lungs primarily resulting in pulmonary tuberculosis. Objective: The objective of this study was to evaluate the Revised National Tuberculosis Control Program (RNTCP) through the assessment of case detection performance of the patients registered for treatment under RNTCP in tuberculosis units (TUs). Materials and Methods: The present record-based, observational cross-sectional study was carried out under district tuberculosis centre, Satara, involving all the 10 TUs. District tuberculosis centre is located in the campus of District Hospital, Satara. The functioning of RNTCP under district tuberculosis centre at the level of TUs was studied from 2012 to 2014. Fifty slides of sputum smear positive and 50 slides of sputum smear negative for tuberculosis were selected randomly. Results: Tuberculosis suspect rate was found consistently increasing from 2012 to 2014 in majority of TUs except Umbraj TU. Sputum positive rate was also consistently low in Umbraj TU. Sputum positive smear rate was higher in Bel-Air TU consistently from 2012 followed by Satara TU. Annualized new smear-positive case detection rate was higher in Satara and Bel-Air TUs in 2012; however, it was within the range of 68–83% in 2012 which rose to 86.9% in 2013 at Koregaon and 89.5% at Wai TU in 2014. Conclusion: Tuberculosis suspect rate is consistently low at both Umbraj and Bel-Air TU. Sputum smear-positive rate is consistently higher at Satara and Bel-Air TU.
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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.
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Objective To investigate the diagnostic value of enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection in smear negative pulmonary tuberculosis. Methods From August 2015 to August 2016 ,68 cases of smear negative pulmonary tuberculosis ,admitted in the hospital ,were enrolled in the study.Enzyme-linked immunosorbent assay and bronchoalveolar lavage fluid tuberculosis Xpert detection were used in the study.The results of enzyme-linked immunosorbent assay and tuberculosi sXpert detection were compared with sputum culture results ,and their diagnostic values for smear negative pulmonary tuberculosis were analyzed.Results The clinical manifestations of pulmonary tuberculosis were mainly nocturnal sweating ,fever ,cough and expectoration.The results of X-ray and CT examinations showed that the lesions were mostly patchy or in cloudy opacity.The diagnostic accuracy of the combined ex-amination for different types of pulmonary tuberculosis was significantly higher than single detection of en-zyme-linked immunosorbent assay or tuberculosis Xpert detection ,and the difference was statistically signifi-cant (P＜ 0.05).The sensitivity of enzyme-linked immunosorbent assay was 88.46%,the specificity was 69.05%,and the accuracy was 76.47%;the sensitivity of tuberculosis Xpert detection was 80.77%,the speci-ficity was 52.38%,and the accuracy was 63.23%;the sensitivity of the combined detection was 92.30%,the specificity was 78.57%,and the accuracy was 83.82%;the sensitivity ,the specificity and the accuracy of the combined detection for diagnosis of smear negative pulmonary tuberculosis were significantly increased ,and the difference was statistically significant (P＜0.05).Conclusion The enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection has important value in the diagnosis of smear negative pulmonary tuberculosis.It is a simple ,rapid and effective method of examination.
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Objective To compare the detection rate of Xpert MTB/RIF test and sputum smear and culture method, and to investigate the value of the detection of the smear negative pulmonary tuberculosis.Methods 69 patients with tuberculosis diagnosed in Tianjin Haihe Hospital from July 2014 to July 2015 were examined by fiberoptic bronchoscopy ( and check of tubercle bacillus in sputum smear negative three times ) .With final diagnosis of pulmonary tuberculosis patients the number of statistical smear, culture method and Xpert MTB/RIF test their tuberculosis detection rate.Results A total of 69 patients with sputum smear negative patients with final diagnosis of 54 cases of pulmonary tuberculosis, confirmed 54 cases of tubercle bacillus in sputum smear negative pulmonary tuberculosis patients, Xpert MTB/RIF test was positive in 33 cases accounted for 61.11%(33/54).Among the 35 cases, 17 patients with Xpert MTB/RIF positive, can improve the detection rate of bacterial negative tuberculosis 31.48%(17/54), 19 cases of patients with negative smear positive, 16 cases of Xpert MTB/RIF positive, and the culture method was 84.21%(16/19).BALFXpert MTB/RIF test of tuberculosis found in 61.11%(33/54), the culture method of tuberculosis found 35.19%(19/54).The report is more than 50%, also has reached to 80%, and the selection has a great relationship.Xpert method and culture method, the difference was statistically significant (P<0.05).The positive rate of Xpert test was positive in 2 cases of positive MTB/RIF in the patients with positive smear positive 100%.Conclusion It is a simple, rapid and accurate method to do Xpert MTB/RIF test for BALF, and it can improve the smear negative tuberculosis patients found rate of 48.75%.The positive rate of the sputum smear negative is 59.62%(14+17/35+17), which is better than that of sputum smear and culture.
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Background and objectives: The objective of the present study is to evaluate the yield of AFB by direct sputum smear examination with Bronchial Washings and Post Bronchoscopy sputum smear examination. Materials and methods: This prospective study was conducted on 100 patients with suspected pulmonary TB October 2015 – September 2017 at S.V.S Medical College, Mahabubnagar. Results: Out of 100 clinically suspected, sputum smear negative cases, 38 cases were diagnosed as active pulmonary tuberculosis. Bronchial washings for AFB smear was positive in 32/100 (32%) of cases and post bronchoscopic sputum smear was positive in 16/100 (16%) of cases. Both bronchial washings and post bronchoscopic sputum smear for AFB was positive in 10 (10%) of cases. 4/16 additional cases are diagnosed by post bronchoscopic sputum smear over the bronchial washings. Total yield of bronchoscopy in the diagnosis of sputum negative Pulmonary Tuberculosis was A.N.V. Koteshwar Rao, L. Bhaskar, K. Vamshi, Pradyut Waghray. Yield of AFB by direct sputum smear examination with bronchial washings and post bronchoscopy sputum smear examination. IAIM, 2017; 4(11): 113-116. Page 114 38.00% of which bronchial washing smear samples are superior in the diagnosis and is contributed to 32% . Conclusion: It has shown that additional yield of 38% more than direct sputum smear examination, which helps to initiate early treatment of tuberculosis.
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Objective To investigate the changing patterns of serum IL-6, IL-10, IL-23 and osteopontin in patients with smear-negative pulmonary tuberculosis before and after treatment and their clinical implication.Methods A total of 43 patients with smear-negative pulmonary tuberculosis and 40 healthy controls were included in this study. Enzyme-linked immunosorbent assay (ELISA) was conducted to measure the levels of serum IL-6, IL-10, IL-23 and osteopontin in healthy individuals and patients before and after anti-tuberculosis treatment for 2, 4 and 6 months.Results The levels of serum IL-6, IL-10, IL-23 and osteopontin in patients with smear-negative pulmonary tuberculosis were signiifcantly higher than those in control group (P0.05). The levels of serum IL-6 and IL-23 gradually decreased after treatment, and restored to normal at six months. There was no signiifcant difference compared with those in control group (P>0.05). Conclusions Serum IL-6, IL-10, IL-23 and osteopontin levels in patients with smear-negative pulmonary tuberculosis can be used as sensitive indicators for assessment of tuberculosis disease activity and therapeutic effect of anti-tuberculosis drugs.
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<p><b>OBJECTIVE</b>To compare the performance of MTBDRplus V2 and Xpert MTB/RIF for detecting smear negative pulmonary tuberculosis (PTB).</p><p><b>METHODS</b>Clinical PTB suspects were enrolled consecutively in Anhui Chest Hospital and Xi'an Chest Hospital from January to December in 2014. The sputum samples of smear negative PTB suspects were collected and decontaminated. The sediment was used to conduct MTBDRplus V2, Xpert MTB/RIF and drug susceptibility test (DST). All the samples with discrepant drug susceptibility result between molecular methods and phenotypic method were confirmed by DNA sequencing.</p><p><b>RESULTS</b>A total of 1973 cases were enrolled in this study. The detection rates of Mycobacterium tuberculosis complex (MTBC) by MTBDRplus V2 and Xpert MTB/RIF were 27.67% and 27.98%, respectively. When setting MGIT culture result as a gold standard, the sensitivity and specificity of MTBDRplus V2 were 86.74% and 93.84%, and the sensitivity and specificity of Xpert MTB/RIF were 86.55% and 93.43%, respectively. For the detection of the resistance to rifampin, the sensitivity and specificity of MTBDRplus V2 were 94.34% and 96.62%, and the sensitivity and specificity of Xpert MTB/RIF were 88.68% and 95.96%, respectively. For the detection of the resistance to isoniazid, the sensitivity and specificity of MTBDRplus V2 were 77.38% and 98.02%, respectively.</p><p><b>CONCLUSION</b>MTBDRplus V2 and Xpert MTB/RIF can be used to detect MTBC in smear negative samples with satisfactory performance.</p>
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Humanos , Antituberculosos , Farmacología , Técnicas Bacteriológicas , Métodos , Farmacorresistencia Bacteriana , Isoniazida , Farmacología , Mycobacterium tuberculosis , Sensibilidad y Especificidad , Tuberculosis Pulmonar , Diagnóstico , MicrobiologíaRESUMEN
Background: The diagnosis of Pulmonary Tuberculosis is largely dependent of the positive result of the sputum smear by ZN staining. But in many cases, although active tuberculosis is present, due to many reasons, sputum smear may yield a negative result. With a late culture result, no reliable serological test available to enable an early diagnosis, role of induced sputum and bronchoscopy has been tried with excellent results. Methods: 50 fresh smear negative cases between the ages of 16-65 years, clinically and radiologically suspected of Pulmonary Tuberculosis were subjected to induced sputum and bronchoscopy after detailed history and thorough clinical examination as done. Clinical symptoms were noted, 2 sputum smears (spot and early morning) and chest x-rays were taken for all patients. Results: Males between 24 – 44 years were seen to be predominant patients. The most common symptom appeared to be cough in 80% followed by fever in 60% of the cases. 76% of patients had unilateral lesions and 24% with bilateral lesions. 84% of the sputum negative patents were identified as active tuberculosis cases. Conclusion: Induced sputum and fiber optic bronchoscopy with bronchial aspirate and post bronchoscopic sputum can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria. There is minimum patient discomfort, reduced complications and relatively good yield which makes these procedures justifiable in the diagnosis of fresh smear negative pulmonary tuberculosis.
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Objective To evaluate the diagnostic value of Tuberculosis Infection in T Cell Test(T‐SPOT .TB) for smear negative pulmonary tuberculosis .Methods Separately used T‐SPOT .TB ,TB‐DNA ,TB‐DOT the three diagnostic methods for tuberculosis , separately detected with each method ,112 smear negative pulmonary tuberculosis ,and 60 non tuberculosis regarded as control group .Results The sensitivity of T‐SPOT .TB ,TB‐DNA ,TB‐DOT in proper sequence were 88 .3% ,25 .9% ,58 .9% .Contrasted to TB‐DNA and TB‐DOT ,the differences were statistically significant(X2 =86 .6 ,P<0 .01 ;X2 =23 .3 ,P<0 .01);the specificity of T‐SPOT .TB was 96 .7% ,significantly higher than TB‐DOT (78 .3% ) ,the differences were statistically significant(X2 = 9 .22 ,P<0 .05) .Conclusion T‐SPOT .TB has obvious advantages in sensitivity and specificity for smear negative pulmonary tuberculosis .It can be one auxiliary tool for smear negative pulmonary tuberculosis early diagnosis ,provided with the value of fast and accurate .
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Objective To establish a diagnostic scoring system for diabetic patients with smear-negative pulmonary tuberculosis , and then to improve the rapidity and accuracy of clinical diagnosis and save medical expenses. Methods A case-control study was applied. 150 diabetic patients with smear-positive pulmonary tuberculosis who on initial treatment were assigned to a study group; 150 patients with lung infection were recruited as a study group. The data on general status, symptoms, chest X-ray manifestation, and laboratory examinations was collected. Univariate logistic regression analysis was used to gain significant indexes for multiple logistic regression analysis. β-coefficients derived from the independent predictors in our logistic regression model was applied to develop a scoring system. Results Toxic symptoms of tuberculosis, cough, upper lung, cavity, multiple lung field , and PPD positive entered into the final multipie logistic regression model , and the scoring system was accordingly established. The patient with a score of more than 11 had higher probability of TB , while those with a score of smaller than 11 were not likely to have TB. Conclusion The scoring system can be used as a predictive tool in diagnosis of diabetes mellitus complicated by smear-negative pulmonary tuberculosis , helping diagnose active tuberculosis rapidly.
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PURPOSE: We investigated the value of an interferon-gamma release assay (IGRA) for the diagnosis of active pulmonary tuberculosis (PTB) among sputum smear negative PTB suspects in an environment with intermediate burden of PTB and high Bacillus Calmette-Guerin (BCG) vaccination rate. MATERIALS AND METHODS: We retrospectively reviewed IGRA, medical records, chest PA and CT scan of PTB suspects seen at Gangnam Severance Hospital, Seoul, Korea from Oct. 2007 to Apr. 2013. "Active PTB" was diagnosed when 1) M. tuberculosis culture positive, 2) confirmation by pathologic examination; or 3) clinical findings compatible with TB. RESULTS: Of 224 sputum smear negative PTB suspects, 94 were confirmed as having active PTB. There were no statistically significant differences in the diagnostic yield of IGRA between immunocompromised and immunocompetent sputum smear negative PTB suspects. IGRA did show superior sensitivity [81.9%, 95% confidence interval (CI); 74.13-89.70%] in the diagnosis of sputum smear negative PTB when compared with chest high-resolution computed tomography (HRCT), tuberculin skin test (TST), and chest X-ray (p<0.001). Also, IGRA showed highest negative predictive value (82.7%, 95% CI; 75.16-90.15%) when compared with HRCT, TST and chest X-ray (p=0.023). However, combining the results of IGRA with those of HRCT, TST, or both did not increase any diagnostic parameters. CONCLUSION: Failure to increase diagnostic yields by combination with other diagnostic modalities suggests that additional enforcement with IGRA may be insufficient to exclude other diagnoses in sputum smear negative PTB suspects and to screen active PTB in an environment with intermediate TB prevalence and a high BCG vaccination rate.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos de Liberación de Interferón gamma/métodos , Estudios Retrospectivos , Esputo/microbiología , Tuberculosis Pulmonar/sangreRESUMEN
Background: In view of the diagnostic difficulties associated with sputum- negative pulmonary TB (PTB), we aimed at exploring if bronchoalveolar lavage (BAL) samples can be subjected to smear- microscopy and rapid mycobacterial culture (by Mycobacterial Growth Indicator Tube (MGIT) method) to achieve improved diagnosis of this condition. Methods: Patients presenting with clinico-radiological features suggestive of pulmonary tuberculosis and whose sputum smears were negative for acid- fast bacilli (AFB) or who could not expectorate sputum were prospectively enrolled in this study. BAL samples collected from them were subjected to smear- microscopy for AFB and micro-MGIT culture. BAL samples were also inoculated on Lowenstein- Jensen (LJ) slants. Results: A total of 105 patients (74 males) were recruited in the study, with a mean (±SD) age of 51 (± 15) years. The diagnosis of PTB was made in 52 patients on the basis of clinico- radiological presentation, with or without microbiological confirmation. Thirty- four patients (65.4 %) had microbiologically confirmed PTB. Of them, AFB were detected in 12 BAL samples, while culture- positivity was noted in 24 and 27 patients by the LJ and MGIT methods respectively. Intertest agreement between the LJ and MGIT methods was found to be significant (ê= 0.655; p= <0.001). However, the mean time to positivity was significantly lower for the MGIT method than for the LJ method (p= <0.001). Conclusion: Examination of BAL samples by smear- microscopy and micro-MGIT culture can, therefore, provide a rapid and definitive diagnosis of PTB in sputum- negative patients.
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Adolescente , Adulto , Anciano , Lavado Broncoalveolar/análisis , Lavado Broncoalveolar/microbiología , Broncoscopía/métodos , Técnicas de Cultivo , Humanos , Persona de Mediana Edad , Pruebas de Sensibilidad Microbiana/instrumentación , Pruebas de Sensibilidad Microbiana/métodos , Microscopía/métodos , Mycobacterium tuberculosis/crecimiento & desarrollo , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto JovenRESUMEN
The human immunodeficiency virus (HIV) epidemic and dual infection of tuberculosis (TB) and HIV are now altering the role of chest radiography (CR) in TB control. The role has been gaining increasing importance, especially as HIV-associated TB and childhood TB are less likely to show positive smears. However, CR with poor image quality can cause misdiagnoses or require repeated examinations, wasting economic resources and exposing patients to unnecessary radiation. In order to improve the image quality of CR, the Tuberculosis Coalition for Technical Assistance (TBCTA) developed an assessment tool for CR categorized on the basis of six factors as “excellent,” “good,” “fair,” and “poor.” With the aim of disseminating the assessment tool, five-day international training sessions were held in Cambodia and Kenya in 2009. This field report summarizes the international training activities and documents the findings after the trainings.<BR>A total of thirty-four participants from 14 countries were trained and assigned to conduct an assessment upon their return. The results from nine countries showed that the quality of CR ranged from 90% excellent or good in Bangladesh to over 90% fair or poor in Afghanistan. Of 69 health facilities, only 4 apply more than 120kV and above. This is one of the considerable factors behind the sub-optimal quality of CR in these countries.
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Objective: To assess the levels of adenosine deaminase (ADA) in serum in patients with sputum smear negative pulmonary tuberculosis (SNPTB) and to compare it with serum ADA levels in patients with non-tuberculous pulmonary disease - chronic obstructive pulmonary disease (COPD) and with healthy control group and to explore its validity as a diagnostic marker in serum in SNPTB patients.Methods:Three groups of study populations were made. Group I: SNPTB - 142 cases, Group II:non-tubercular pulmonary disease - COPD - 40 cases, Group III: healthy controls - 80 cases. Serum samples were collected and ADA assay was done by the method of Guisti and Galanti. Results: ADA levels (Mean±SD, U/L) in the three groups were as follows: Group I: 42.26±21.22, Group II: 23.31±8.22, Group III: 18.88±6.67. Difference between Group I and Group III was statistically significant (P < 0.0001). The test showed a high specificity 91.25% (95% confidence interval - CI 83.00 - 95.7) and a sensitivity of 83.10% (95% CI 76.08-88.37) in Group I. Positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy in Group I were 94.00%, 69.52%, 9.49, 0.18 and 82.43% respectively.Conclusions: Overall assessment of the use of serum ADA levels as a diagnostic biochemical marker in smear-negative pulmonary tuberculosis patients showed promising results. Studies with a larger population group are required to validate its use as a routine diagnostic test in these cases.