[Evaluation of mycobacterial microscopy and culture results of Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital: A 3-year analysis]. / Süreyyapasa Gögüs Hastaliklari ve Gögüs Cerrahisi Egitim ve Arastirma Hastanesi mikobakteri mikroskopi ve kültür sonuçlarinin degerlendirilmesi: Üç yillik analiz.

INTRODUCTION: Effective diagnosis of tuberculosis is of great importance for transmission control and treatment success. The purpose of this study is to evaluate microscopic examination results of Ehrlich-Ziehl Neelsen (EZN) and Auramine-Rhodamine staining methods and automated BACTEC MGIT 960™ system and Löwenstein-Jensen (L-J) culture results of various clinical samples in the light of recent data from the world and Turkey. MATERIALS AND METHODS: Specimens that were sent from various clinics to Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital Microbiology Laboratory from January 2012 to December 2015 were evaluated retrospectively. RESULT: From a total of 62456 samples; 60923 (97.5%) were pulmonary and 1533 (2.5%) were non-pulmonary samples, especially pleura. 2853 (4.6%) Acid-resistant bacilli (ARB) positivity was detected and mycobacterial culture positivity was in total 12.2%. 7076 (93%) and 535 (7%) mycobacteria other than tuberculosis (MOTT) strains were isolated. In 356 specimens the cultures were negative in despite the positive ARB results. Considering mycobacterial culture as the gold standard; the sensitivity, specificity, positive and negative predictive values of ARB microscopy were 32.8%, 99.4%, 87.5% and 91.4%, respectively. The contamination rates in total were within acceptable limits being 2.7% for L-J and 3.8% for MGIT. CONCLUSIONS: Analysis of our data indicated that the sensitivity of microscopy is low and it should be evaluated together with the mycobacterial culture to rule out tuberculosis infection. With the use of fluorescent staining and also L-J and MGIT broth together for routine culture since 2013; ARB false negativity rate was observed to fall to 51.7% from 74.1% compared to the years. The follow-up of data such as the sensitivity of microscopy, culture positivity, false-positivity and false-negativity rates and contamination values is of great importance in terms of assessing compliance with laboratory quality standards and contributing to the surveillance studies.

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.

AIMS: Patients with suspected tuberculosis without pulmonary lesions and with intrathoracic lymphadenopathy often pose a diagnostic challenge. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isoleted intrathoracic lymphadenopathy due to tuberculosis (TB). MATERIALS AND METHODS: Cases with tuberculous lymphadenitis (TBLA) as the final diagnosis were analysed among patients in whom EBUS-TBNA had been performed. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, pathological findings, and microbiological results were recorded. All patients received 6-month antituberculous treatment, followed-up regularly and recovered both on clinical and radiological basis. RESULTS: Forty-four patients were included. EBUS-TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4%) patients. In 2 patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7%) patients. One of the patients (2.2%) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50%) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation s improved the diagnostic yield from 72.7% to 95.4%. CONCLUSION: EBUS-TBNA is a safe and effective first line investigation for evaluating isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of EBUS-TBNA.

Non-tuberculous mycobacteria infection: 75 cases.

INTRODUCTION: Non-tuberculosis mycobacterium is especially seen in AIDS and non-immunosuppressant patients. This study was designed to evaluate data relating to non-tuberculosis mycobacterium content in patients' sputum for the clinical importance. PATIENTS AND METHODS: During 2009-2010 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital clinics, 75 patients [30 women (40%) and 45 men (69%); mean age (SD): 48.7 (15.9) years] with non-tuberculosis mycobacterium were determined by the rapid test and NAP test in Mycobacteria Growth Indicator Tube (MGIT), which had atypical growth in 51.864 Lowenstein-Jensen. Identification was done with Hsp65PCRREA methods in 32 (43%) cases. Treatment management, radiology, bacteriology, co-morbidity, treatment outcomes were evaluated from medical records, calling patients and from tuberculosis dispensaries. RESULTS: In 9 (28%) patients Mycobacterium abscessus, in 8 (25%) patients Mycobacterium avium complex (MAC), in 5 (16%) patients Mycobacterium kansasii was found with identification Hsp65PCRREA methods. In 18 (24%) of 75 cases with American Thoracic Society definition and treatment criteria, treatment was administered using major and minor drugs. Standard tuberculosis treatment was administered in 25 (33%) of the 75 cases. In 8 of 25 (32%) cases identification of non-tuberculosis mycobacterium was evident. In 32 of 75 cases follow up was performed with no treatment. One positive atypical growth culture was identified in 23 (72%) of 32 patients. Treatment was administered in 43 cases while 25 (58%) of 43 were cured, 3 (7%) of 43 were default and 3 (7%) died. Drug resistance was the outcome in 36 cases. While 31 (86%) had any drug resistance, 27 (75%) had HR drug resistance. Past history of tuberculosis treatment was evident in 20 (40%) cases. Respiratory and non-respiratory diseases were identified equally in 18 (38%) cases. Radiological consolidation in 28 (65%), and cavity in 16 (37%) cases were determined. CONCLUSION: In order to carry out the right treatment and epidemiologic evaluation, it is important to identify non-tuberculosis mycobacterium by culture methods.

Comparison of bronchoscopic washing and gastric lavage in the diagnosis of smear-negative pulmonary tuberculosis.

OBJECTIVE: To evaluate the diagnostic contribution and utility of bacteriologic surveys using bronchoscopic washing and gastric lavage in cases of radiologically suspected tuberculosis with no detectable acid-fast bacilli (AFB) in the sputum. MATERIAL AND METHODS: This prospective study performed bronchoscopic lavage following gastric washing in suspected pulmonary tuberculosis patients. The presence of AFB was determined via direct microscopy and materials were cultured in Löwenstein-Jensen medium. RESULTS: Thirty-eight consecutive patients were enrolled in the study (30 males and 8 females; mean age, 33.8 +/- 10.9 years). Three patients could not give sputum. In 23 of 35 cases (66%), sputum cultures (SC) were positive. In 17 cases (49%), gastric lavage cultures (GLC) were positive. Eighteen cases (55%) had positive bronchoscopic washing cultures (BWC). No statistically significant difference was observed when SC positivity was compared to GLC and BWC, and no difference was observed when the GLC results were compared with BWC. Tuberculosis was confirmed in 30 of 38 (79%) patients when SC and GLC were evaluated together, in 33 of 38 patients (87%) when SC and BWC were evaluated together, and in 36 of 38 (95%) when SC, GLC, and BWC were evaluated together (P = 0.016, P = 0.002, and P = 0.0001, respectively). The increase in positive cultures was statistically significant when gastric lavage was evaluated together with bronchoscopic washing (P = 0.004). CONCLUSION: Adding gastric lavage and bronchial washing to sputum culture could increase culture positivity for M tuberculosis bacilli in suspected pulmonary tuberculosis patients with AFB-negative sputum smears.

Diagnostic value of repeated sputum examinations in pulmonary tuberculosis: how many sputum specimens are adequate?

The aim of this study was to assess the value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis (PTB). We analyzed sputum smear and culture results of patients diagnosed with culture-proven PTB during 2002. In 1027 patients, the diagnosis was established by detection of Mycobacterium tuberculosis bacilli in sputum samples. The number of sputum specimens submitted to laboratory was one in 634 cases, two in 167 cases, three in 186 cases and more than three in 48 cases. 760 (74%) cases had positive smear examination result. The first sputum smear examination was positive in 82.3% of smear positive cases. Either the first or the second sputum was diagnostic in 94.9% of these cases. Smear examination of third sputum revealed 4.2% additional diagnostic yield. In 863 (84%) cases, culture examination of the first sputum was positive. The second and the third sputum culture examinations revealed additional diagnostic yield of 11% and 4.5%, respectively. Percent 95 of culture-proven cases were diagnosed with the first two sputum cultures. In conclusion the majority of PTB cases can be diagnosed with the examination of two sputum specimens. Three or more sputum specimens submitted obtain a small additional diagnostic yield.