Abstract
Extra pulmonary Tuberculosis (TB) comprises 15% of the total tuberculosis cases. In cases of suspected extrapulmonary tuberculosis, rapid and accurate laboratory diagnosis is of prime importance, since traditional techniques of detecting acid-fast bacilli have limitations. The major difficulty with mycobacteria in tissue samples is achieving optimal cell lysis. A comparison of two methods, pretreatment of tissue with 4% Sodium Hypochlorite in Bleach concentration method and pretreatment with petroff’s method before culture on Lowenstein Jensen medium, was conducted on 18 extrapulmonary tissue specimens collected from different sites of suspected TB patients to evaluate the use of Bleach concentration method in tissue samples. The aim of this study is to apply this method for demonstration of AFB in tissue samples obtained from extrapulmonary sites and to correlate with Ziehl Neelson staining and LJ culture. A total of 18 tissue samples were studied from clinically suspected cases of Extra pulmonary TB which included endometrial tissue (15), (1) from kidney and (1) from brain. All the samples were processed for conventional ZN staining, bleach concentration method, PCR and AFB culture on LJ media. Out of 18 samples none were suggestive for TB by ZN staining, while 1(5.55%) was positive by PCR, 3(16.66%) were suggestive by bleach concentration method and the same i.e. 3(16.66%) came positive on LJ culture hence confirming the method. However to the best of our knowledge this is the pioneer study applied to the tissue samples and the results of the present study shows improved detection of AFB.
Highlights
Tuberculosis, a leading cause of death, infects more than a third of the world’s population [1]
EPTB has become more common since the advent of human immunodeficiency virus (HIV) infection [3]
Diagnosis of tuberculosis from tissue samples is usually made by histopathological examination (HPE) that depends on the presence of granulomatous inflammation and caseous necrosis
Summary
Tuberculosis, a leading cause of death, infects more than a third of the world’s population [1]. A diagnostic method that is less time-consuming and at the same time has high sensitivity and specificity is desirable [7] Advanced molecular methods such as Polymerase Chain Reaction (PCR), a type of nucleic acid amplification system, have shown very promising results for early and rapid diagnosis of the disease due to its detection limit of one to ten bacilli in various clinical samples. Few studies from different geographical regions of the world have reported that some clinical isolates have either a single copy or no copy of IS6110 which leads to false negative results [10,11,12] Newer molecular techniques, such as polymerase chain reaction (PCR), rapid; are too costly to be routinely used in the settings where most TB cases occur [10]. Further the results were compared by culture on Lowenstein-Jensen (LJ) media and PCR
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