Diagnostic Procedures, Diagnoses, and Treatment Outcomes of Patients with Presumptive Tuberculosis Pleural Effusion in Uzbekistan.

Fazlkhan Abdugapparov,Nestani Tukvadze,Jamshid Gadoev,Anvar Riskiyev,Mariana Buziashvili,Andrei Dadu,Nargiza Parpieva,Sherali Massavirov,Arax Hovhannesyan,Ruzanna Grigoryan

doi:10.3390/ijerph18115769

Abstract

Tuberculosis (TB) pleural effusion (TPE) is the second most common manifestation of extrapulmonary TB (EPTB), which remains a great diagnostic challenge worldwide. In Uzbekistan, there has been no formal evaluation of the actual practices of diagnosing and treating TPE. Our cohort study therefore aimed to describe the frequency and types of different diagnostic procedures of TPE during 2017–2018 and assess the association of baseline characteristics and establish diagnostic methods with TB treatment outcomes. In total, 187 patients with presumptive TPE were assessed, and 149 had a confirmed diagnosis of TPE (other diagnoses included cancer n = 8, pneumonia n = 17, and 13 cases were unspecified). TB was bacteriologically confirmed in 22 (14.8%), cytologically confirmed in 64 (43.0%), and histologically confirmed in 16 (10.7%) patients. Hepatitis was the only co-morbidity significantly associated with unsuccessful treatment outcomes (RR 4.8; 95%CI: 1.44–15.98, p value 0.011). Multivariable regression analysis showed that drug-resistant TB was independently associated with unsuccessful TB treatment outcome. (RR 3.83; 95%CI: 1.05–14.02, p value 0.04). Multidisciplinary approaches are required to maximize the diagnostic accuracy of TPE and minimize the chances of misdiagnosis. TPE patients with co-infections and those with drug resistance should be more closely monitored to try and ensure successful TB treatment outcomes.

Highlights

Our findings demonstrate that overall, all the diagnostic procedures including bacteriological, cytological, and histological examination of pleural fluid for confirmation of TB pleural effusion (TPE) are commonly used in Uzbekistan and there is no one, standardized approach to diagnosing the TPE
The Xpert Mycobacterium tuberculosis (MTB)/RIF assay has long been known to be a reliable diagnostic test for extrapulmonary TB (EPTB), it was not endorsed as an initial diagnostic test for TPE until updated guidelines in 2020; this could probably be attributed to the presence of polymerase chain reaction inhibitors in pleural fluid and a low bacillary load [9,14,19,20]
Multidisciplinary approaches are required to maximize diagnostic accuracy and minimize the chances of misdiagnosis, which in turn will lead to better TB-specific treatment outcomes

Summary

Introduction

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains one of the top ten causes of death around the world and a leading cause of death from infectious disease. According to World Health Organization (WHO) estimates, 10 million people developed. TB and 1.4 million died from the disease in 2019 [1]. While MTB can affect almost all organs and tissues, pulmonary disease accounts for the majority of TB cases. Other forms of TB are categorized as extrapulmonary TB (EPTB) and, while less common than pulmonary

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Discussion

Conclusion