The use of polymerase chain reaction for early diagnosis of tuberculosis in Mycobacterium tuberculosis culture

Early diagnosis plays a vital role in controlling tuberculosis. The conventional methodology is slow, with results taking several weeks, in addition to having low sensitivity, especially in clinical paucibacillary samples. The objective of this study was to evaluate the use of polymerase chain reaction (PCR) on solid medium culture for a rapid diagnosis of tuberculosis, mainly in cases of negative sputum smears. Forty sputum samples were collected from inpatients with tuberculosis treated for less than 2 days. Bacilloscopy, PCR for sputum, culture on Lõwestein-Jensen (LJ) solid medium, and daily PCR from culture were performed on each sample. DNA extracted from the BCG vaccine, which contains attenuated bacillus Calmette-Guérin, was used as the positive control. Smear microscopy showed 68.6 percent sensitivity, 80 percent specificity, 96 percent positive predictive value, and 26.7 percent negative predictive value, with culture on LJ medium as the gold standard. Culture at day 28 showed 74.3 percent sensitivity and 100 percent specificity. PCR of DNA extracted from sputum amplified a 1027-bp fragment of the 16s RNA gene, showing 22.9 percent sensitivity and 60 percent specificity. PCR performed with DNA extracted from daily culture showed that, from the 17th to the 40th day, the sensitivity (85.7 percent) and specificity (60 percent) were constant. We conclude that a 17-day culture is a good choice for rapid diagnosis and to interfere with the transmission chain of tuberculosis.

Histoplasmose em região de palato duro simulando lesão causada por Leishmania / Histoplasmosis in the region of the hard palate simulating a lesion caused by Leishmania

Os autores relatam um caso de histoplasmose em indivíduo com suspeita clínica de leishmaniose mucosa. A infecção por Leishmania foi descartada, pela negatividade do teste de Montenegro e ausência do parasita. O diagnóstico de histoplasmose foi confirmado pelo encontro do fungo na lesão e o seu isolamento em Ágar-Sabouraud. O tratamento do paciente com anfotericina B resultou na remissão da lesão.

A case of histoplasmosis at the oral cavity simulating mucocutaneous leishmaniasis is reported. The initial suspicion of leishmaniasis was not confirmed due to lack of amastigotes and no reactivity of the Montenegro's skin test. Diagnosis of histoplasmosis was done by Grocott's stained smears and isolation of Histoplasma capsulatum in Sabouraud's-agar slants. Treatment with Amphoterecin B led to complete remission of the lesion.