Frequency of pulmonary tuberculosis in cirrhotic patients with resistant chest infection

ABSTRACT

24 cirrhotic patients with resistant chest infection were selected for this study. Full clinical assessment, liver function tests, abdominal ultrasonography, and tuberculin skin test were done for all patients. Also, bacteriological examination of sputum for acid fast bacilli [AFB] by direct stained film and cultured on Lowenstein-Jensen [L-J] medium for mycobacteria PCR to search for mycobacterium tuberculosis complex DNA using primer set for DNA segment of the IS 6110 was performed for all cases. The prevalence of tuberculosis among the 24 patients was 29.2% by one or more employed technique. Direct microscopy alone showed 2 positive cases [8.3%] for AFB, and L-J cultures were positive in 5 cases [20.8%] whereas PCR revealed 5 [20.8%] patients, 2 of them were negative by direct microscopy and L-J culture. The sensitivity and specificity of direct stained film were 40% and 100% respectively. Whereas the sensitivity and specificity of PCR in diagnosing tuberculosis were 100% and 89.5%. There were significant difference between tuberculous and non tuberculous patients as regard prolonged fever and elevated enzymes whereas no significant difference as regard other studied parameters. In pulmonary tuberculosis is not uncommon cause of resistant chest infection in cirrhotic patients and should be considered as an important cause of such resistance. PCR is rapid, sensitive, specific and valuable tool for diagnosing pulmonary tuberculosis especially in immunocompromised patients