Acid-fast Smear Research Articles

Diagnostic efficacy of endobronchial ultrasound-guided transbronchoscopic lung biopsy for identifying tuberculous nodules

BackgroundMicrobiological diagnosis of pulmonary tuberculosis (PTB) is hampered by a low pathogen burden, low compliance and unreliable sputum sampling. Although endobronchial ultrasound-guided transbronchoscopic lung biopsy (EBUS-TBLB) has been found to be useful for the assessment of intrapulmonary nodules in adults, few data are available for the clinical diagnosis of pulmonary tuberculosis. Here, we evaluated EBUS-TBLB as a diagnostic procedure in adult patients with radiologically suspected intrapulmonary tuberculous nodules.MethodsThis was a retrospective analysis of patients admitted with pulmonary nodules between January 2022 and January 2023 at Hangzhou Red Cross Hospital. All patients underwent EBUS-TBLB, and lung biopsy samples were obtained during hospitalization. All samples were tested for Mycobacterium tuberculosis using acid‒fast smears, Bactec MGIT 960, Xpert MTB/RIF, next-generation sequencing (NGS), and DNA (TB‒DNA) and RNA (TB‒RNA). The concordance between different diagnostic methods and clinical diagnosis was analysed via kappa concordance analysis. The diagnostic efficacy of different diagnostic methods for PTB was analysed via ROC curve.ResultsA total of 107 patients were included in this study. Among them, 86 patients were diagnosed by EBUS-TBLB, and the overall diagnostic rate was 80.37%. In addition, 102 enrolled patients had benign lesions, and only 5 were diagnosed with lung tumours. Univariate analysis revealed that the diagnostic rate of EBUS-TBLB in pulmonary nodules was related to the location of the probe. The consistency analysis and ROC curve analysis revealed that NGS had the highest concordance with the clinical diagnosis results (agreement = 78.50%, κ = 0.558) and had the highest diagnostic efficacy for PTB (AUC = 0.778). In addition, Xpert MTB/RIF + NGS had the highest concordance with the clinical diagnosis results (agreement = 84.11%, κ = 0.667) and had the highest efficacy in the diagnosis of PTB (AUC = 0.826).ConclusionEBUS-TBLB is a sensitive and safe method for the diagnosis of pathological pulmonary nodules. Xpert MTB/RIF combined with NGS had the highest diagnostic efficacy and can be used in the initial diagnosis of PTB.

Think beyond TB lymphadenitis - Kikuchi fujimoto lymphadenitis

Kikuchi-Fujimoto disease (KFD) is an extremely unusual lymphadenopathy that typically affects females between the ages of 20 and 40, but the aetiology is still unclear. A 28-year-old female presented with right-sided cervical lymph nodes, but there was no history of fever, anorexia, or loss of appetite. Ultrasonography of the patient's neck revealed bilateral cervical lymphadenopathy. Both the acid-fast bacilli smear and GeneXpert tests returned negative results. Histopathology revealed the presence of lymphocytes and histiocytes mixed with karyorrhectic debris. Immunohistochemistry markers support the diagnosis of Kikuchi-Fujimoto lymphadenitis. This case demonstrates that early recognition of KFD reduces unnecessary evaluations and treatments and patient suffering. KFD is a self-limiting disease that requires a systematic approach for a diagnosis; once the diagnosis is made and confirmed by techniques such as immunohistochemistry, symptomatic treatment alone would suffice in the majority of cases. The commonest presentation is an acute or subacute febrile illness associated with cervical lymphadenopathy.

Screening of Tuberculosis Infection through Acid-Fast Bacilli Tests among Waste Workers in Gresik, Indonesia

Highlights: 1. This study was the first in Gresik, Indonesia, to conduct mass screening of tuberculosis among waste workers, comprising various demographic profiles.2. Although the tuberculosis screening of the waste workers showed negative results, mass examination using an acid-fast bacilli smear remains crucial to detect latent infections and prevent transmissions. Abstract Tuberculosis is a major source of illness and mortality worldwide. Therefore, tuberculosis screening is important to increase the number of active case-finding in a community. Bacteriological examinations can be used to initiate community-based active case-finding. Waste workers face a high risk of contracting Mycobacterium tuberculosis due to their constant exposure to waste. This study aimed to conduct bacteriological examinations to identify tuberculosis infections among waste workers in Gresik, Indonesia, who were considered a high-risk group. An analytical observational study was carried out throughout September 2023 in the Ngipik subdistrict, Gresik, East Java, Indonesia. The primary study was conducted using a cross-sectional design using interviews, measurements, and sputum examinations for all samples. The screening involved a total of 72 waste workers who had daily contact with various types of sewage and waste, including medical waste. The data were analyzed descriptively because of the constant variable. Following the analysis, the data were presented using a table and a figure. According to the acid-fast bacilli examinations, all of the samples yielded negative results. Nevertheless, this study concludes that it is imperative to carry out mass tuberculosis screening in various settings, specifically among those with a high risk. Mass screening can uncover the potential of latent tuberculosis and, thus, reduce its transmission.

Navigating a complex case of Mycobacterium xenopi in a patient with blue rubber bleb nevus syndrome

Introduction: Blue rubber bleb nevus syndrome is a rare disorder of venous malformations, with around 200 cases reported. We present a case of Mycobacterium xenopi infection in a patient with blue rubber bleb nevus syndrome. Case Description: A 40-year-old female with blue rubber bleb nevus syndrome, asthma, and bronchiectasis came to the pulmonology clinic with shortness of breath and a cough. She was recently admitted for a bronchiectasis exacerbation but continued to have a worsening productive cough and fevers. The most recent CT scan of the chest showed interval stable right upper lobe fibrocavitary disease, demonstrating gradual progression over two years. She had occasional positive cultures for Mycobacterium Avium Complex and M. xenopi one year previously, assumed to be a colonizer and not treated. Most recent hospital cultures were negative for bacteria and an acid-fast bacilli smear. She was sent to the emergency department for bronchiectasis exacerbation and returned to the clinic six weeks later with two sputum cultures growing M. xenopi. It was decided to treat M. xenopi as this was likely the cause of her cavitary lung lesion and frequent infections. Azithromycin, rifampin, and sulfamethoxazole/trimethoprim were initiated. Intravenous amikacin was added later on. She finally had a right partial lung resection done after one year at an outside hospital. She was on and off antibiotics for M. xenopi for approximately three years with negative repeat cultures for non-tuberculous mycobacteria. Conclusion: Due to the high mortality of M. xenopi infections (which can be as high as 69%), treatment of at least twelve months is recommended. To our knowledge, this is the first reported case of M. xenopi in a patient with blue rubber bleb nevus syndrome.

Laboratory tests and analysis of drug resistance in non-tuberculous mycobacteria

BackgroundThis study analyzed the laboratory diagnosis results and drug resistance of patients infected with non-tuberculous mycobacterium (NTM). MethodsWe collected information on patients with positive indicators of NTM infection at the Henan Provincial Chest Hospital from 2020 to 2022. Acid-fast smear, mycobacterium culture, QB-SPOT assay, GeneXpert MTB/RIF assay, immunoglobulin E test, tuberculosis antibody test, and microplate method for drug sensitivity test were analyzed using strain identification as the gold standard. ResultsThe 242 cases of NTM infection were predominantly detected with slow-growing mycobacteria (a detection rate of 87.19%), among which Mycobacterium intracellulare (66.53%), Mycobacterium avium (15.70%), and Mycobacterium chelonei/abscessus complex (11.16%) ranked the top three in terms of the isolation rate. Males patients accounted for a higher proportion (58.26%) than females (41.74%), and the majority of them were over 60 years (50.83%). Among laboratory tests for patients with NTM infection, mycobacterium culture showed a highest detected rate (87.20%) among laboratory tests. The results of the drug sensitivity test demonstrated that the resistance rate of NTM was generally high. Moreover, the Mycobacterium avium complex with the highest isolation rate showed 100% resistant to doxycycline and minocycline, but exhibited relatively high sensitivity to moxifloxacin (a resistance rate of 7.89%) and rifabutin (a resistance rate of 13.16%). The Mycobacterium chelonei/abscessus complex was 100% resistant to doxycycline and relatively sensitive to cefoxitin (29.17%) and clarithromycin (37.50%). ConclusionThe NTM species isolated by the Henan Provincial Chest Hospital is dominated by Mycobacterium intracellulare and the highest positive rate is detected by mycobacterium culture among laboratory tests. NTM infection generally exhibits a high rate of drug resistance. Accordingly, the accurate diagnosis of NTM diseases requires enhanced drug sensitivity testing to provide patients with targeted combination drug treatment.

Host factors associated with false negative results in an interferon‐γ release assay in adults with active tuberculosis

ObjectiveTo identify host factors associated with false-negative results of interferon-γ release tests in adults with active tuberculosis. MethodsThe clinical data of 943 patients with active tuberculosis diagnosed by acid-fast smear staining, Mycobacterium tuberculosis culture, Mycobacterium tuberculosis PCR and pathological examination at West China Hospital of Sichuan University were retrospectively analysed. According to the results of the interferon γ release test (IGRA), the patients were divided into the IGRA− group and IGRA+ group. Logistic regression was used to analyze the sociodemographic data and clinical characteristics of participants in the IGRA− group and IGRA+ group. ResultsAmong 943 patients with active tuberculosis, 174 (18.5 %) were IGRA negative (false negative), and 769 (81.5 %) were IGRA positive. Multivariate logistic regression analysis identified the following characteristics independently associated with IGRA negativity: age (OR: 1.02; 95 % CI: 1.01 1.03; p = 0.006), anti-tuberculosis treatment >1 month (OR: 1.68; 95 % CI: 1.12 2.52; p = 0.013), HIV infection (OR: 9.48; 95 % CI: 3.23 27.85; p = 0.000), combined with connective tissue diseases (OR: 2.78; 95 % CI: 1.30 5.94; p = 0.008) and low hemoglobin (OR: 0.99; 95 % CI: 0.98 1.00; p = 0.044) was associated with an increased false-negative probability of IGRA. ConclusionAge, anti-tuberculosis therapy >1 month, coinfection with HIV, coassociated connective tissue disease and decreased hemoglobin were identified as risk factors for false-negative results of IGRA. Our results suggest a careful interpretation of IGRA in adults with these characteristics.

Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study

BackgroundTuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area.MethodsWe collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables.ResultsWe included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15–44 years (OR 1.817; 95% CI 1.162–2.840; P < 0.01) and 45–59 years (OR 2.175; 95% CI 1.335–3.543; P < 0.01) had significantly higher incidences of drug resistance than children and the elderly. Patients with a cough of ≥ 2 weeks had a significantly higher chance of drug resistance than those with < 2 weeks or no cough symptoms (OR 2.069; 95% CI 1.234–3.469; P < 0.01). Alcoholism (OR 1.741; 95% CI 1.107–2.736; P < 0.05) and high bacterial counts on sputum acid-fast smears (OR 1.846; 95% CI 1.115–3.058; P < 0.05) were significant in the univariate analysis.ConclusionsSputum smear-positive TB predominated in Yi men (15–44 years) with high smoking, alcoholism, and HIV rates. Extrapulmonary TB, especially abdominal TB, prevailed. Recent drug resistance testing revealed higher rates in 15–59 age group and ≥ 2 weeks cough duration. Alcohol abuse and high sputum AFB counts correlated with drug resistance. Strengthen screening and supervision to curb TB transmission and drug-resistant cases in the region.

The correlation between TLR9 (rs148805533 Del/Ins) gene polymorphisms and susceptibility to pulmonary tuberculosis

Abstract Background: One of the main infectious causes of morbidity and mortality worldwide is Mycobacterium tuberculosis. The Toll-like receptor (TLR) genes’ polymorphisms and mutations have been linked to an increased risk of infection in general. Objectives: This study aimed to investigate the association among TLR9 (rs148805533 Del/Ins), gene polymorphism, and pulmonary tuberculosis (PTB). Materials and Methods: Blood and sputum samples were collected from 70 patients with PTB and 30 healthy as a control group. Patients were diagnosed clinically by the specialized physician, in addition to use the acid-fast smear and culture on Lowenstein–Jensen. In addition, the molecular diagnostics technique was used by Gene Xpert device. The genotyping was carried out by using allele specific-polymerase chain reaction technique, and the TLR9 concentration was estimated by enzyme-linked immunosorbent assay (ELISA) technique. Results: The results of TLR9 polymorphism showed that the Ins/Ins allele, Del/Ins allele, and Del/Del allele genotypes frequencies at the site of (rs148805533) polymorphisms were significantly higher in PTB patients than the control groups (P = 0.05). The Ins/Ins allele genotype was the most frequent in PTB patients. In addition, the insertion allele was the most frequent in PTB patients and control groups. Conclusion: Our results indicated that in a sample of the local Iraqi population, the TLR9 (rs148805533) gene polymorphism may be a significant genetic determinant for PTB susceptibility.

Smoked drug use in patients with TB is associated with higher bacterial burden.

BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10-1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22-4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62-1.87; P = 0.799) was not associated with increased cavitation.CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.

Peritoneal tuberculosis in a woman with ascites and elevated CA 125 who has drug induced liver injury

A 30-year-old woman presented with abdominal pain and ascites. She also complained of reduced appetite and weight loss. She was a nurse who managed patients with tuberculosis (TB) in her entire daily duties. Physical examination revealed significant ascites, no lymphadenopathy or hepatosplenomegaly. Respiratory system examination was normal. Laboratory results showed plasma Ca-125 of 345.87 µ/mL and adenosine deaminase (ADA) of 96 U/L on ascitic fluid. Chest X-ray showed hilar lymphadenopathy. The patient was subjected to antituberculosis treatment, but then suffered from drug induced-liver injury. After modification of TB drug regimens, she subsequently improved. Although the acid-fast smear is the golden standard for the diagnosis of peritoneal TB, history of contact and ADA test should be kept in mind when clinical pictures are non-specific, and bacteria culture was negative. The therapeutic effect of TB treatment was assessed clinically, allowing to identify drug effectiveness and earlier diagnosis of DILI.

GeneXpert and Acid-Fast Bacilli Smear for Diagnosis of Pulmonary Tuberculosis in a Tertiary Care Center of Rural Nepal

Introduction: Mycobacterium tuberculosis is the second most infectious cause of death in adults globally and is major health trouble in Nepal. The diagnosis of pulmonary tuberculosis is mainly carried by acid-fast bacilli smear microscopy, culture on Lowenstein–Jensen media, and GeneXpert MTB/RIF assay. This study aimed to evaluate the GeneXpert MTB/RIF and Acid-Fast Bacilli stain smear used for the diagnosis of pulmonary tuberculosis.&#x0D; Methods: A cross-sectional study was performed at Karnali Academy of Health Sciences, Jumla, from July 2021 to June 2022. Our study population comprised 390 probable cases of pulmonary tuberculosis from the ages of 2 to 92 years. A total of 390 sputum specimens from suspected presumptive tuberculosis sufferers were tested using the direct smear staining technique of Acid-Fast Bacilli stain smear and GeneXpert for the detection of MTB/RIF. The GeneXpert MTB/RIF technique was compared with the Acid-Fast Bacilli stain smear. Patient’s demographic details, sputum AFB smear, and GeneXpert test results were collected and entered in working Performa. Data were analyzed using SPSS 16.0.&#x0D; Results: Out of 390 samples 13.84% were positive for Mycobacterium tuberculosis via GeneXpert MTB/RIF assay while 5.12% were positive through AFB microscopy which was statistically significant (p&lt;.0001). When compared with GeneXpert, taking GeneXpert as the gold standard in the rural setup of Nepal the sensitivity of AFB staining was 37.03%, while its specificity was 90.81%.&#x0D; Conclusions: GeneXpert MTB/RIF is a rapid test that can aid in the timely diagnosis of Mycobacterium tuberculosis, facilitating the timely treatment in the rural area.

Tuberculosis with isolated atelectasis: a case report

Introduction Tuberculosis is a significant health issue in developing countries, with the World Health Organization reporting over 10 million cases worldwide in 2014. While methods exist for rapid investigation of Mycobacterium tuberculosis, radiological imaging may lead to an earlier suspicion, such as presence of cavitation. In this case report, a patient with only radiological finding being atelectasis will be presented. Case Presentation An 18 years old female patient with no specific medical background history had been evaluated at an outpatient clinic with complaints of cough and exertional dyspnea. After a fluoroquinolone treatment for 7 days given for a pericardiac density in chest radiography, patient was admitted due to limited clinical response. A chest tomography was performed while the patient was under wide spectrum antibiotics and atelectasis in right lower lobe was observed. Repeated Acid-Fast Bacilli smears and sputum samples were found negative and bronchoscopy sampling did not show any findings of obstruction. Mycobacterium tuberculosis complex DNA was later detected in the lavage samples for which antituberculosis treatment was initiated with a regimen of isoniazid 5 mg/kg, pyrazinamide 25 mg/kg, ethambutol 15 mg/kg, and rifampin 10mg/kg. Discussion The diagnosis of tuberculosis, in this case, was probably masked during the AFB smear testing due to a treatment regimen of fluoroquinolone. The general radiological definition of tuberculosis primarily consists of older studies, with the expected presentation being a combination of cavitation and infiltration. Normal lung imaging results had also been described for tuberculosis regarding chest radiography, and studies have reported the presence of atelectasis in patients with tuberculosis, as seen in tomography case series; however, the isolation of atelectasis had not been specified in the studies. Conclusion Pulmonary tuberculosis may present itself with a myriad of radiological findings. This presentation often complicates the diagnostic process; however, differential diagnosis can be achieved via a combination of clinical symptoms and rapid culture sampling.

The diagnostic performance of endobronchial ultrasound with Xpert MTB/RIF Ultra in smear-negative pulmonary tuberculosis

ObjectiveThis study investigated the diagnostic performance of endobronchial ultrasound with Xpert MTB/RIF Ultra (Ultra) for detecting smear-negative pulmonary tuberculosis (TB).Methods143 patients suspected of sputum smear-negative pulmonary tuberculosis were enrolled in this study in Shanghai Pulmonary Hospital, China. These patients underwent endobronchial ultrasound with a guide sheath (EBUS-GS) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) based on their chest CT manifestations. We assessed the sensitivity and specificity of tissue specimens with Ultra in the TB group and non-TB group. Culture and clinical diagnosis were used as gold-standard for TB.ResultsAmong these 143 patients, 11 patients were culture-positive TB, 85 patients were diagnosed with culture-negative TB and 47 were with the non-TB diseases. Direct testing with microscopy (Acid-Fast Bacilli smear, AFB), liquid culture, pathology, Xpert MTB/RIF(Xpert) test and Ultra had a sensitivity of 8.3%, 11.5%, 42.7%, 64.6%, and 78.1% individually among all the TB patients. Ultra had a higher sensitivity than Xpert (P = 0.011). But Ultra had a specificity of 59.6% (95% CI 44.3–73.3), lower than that of Xpert (89.4%, 95% CI 76.1–96.0, P = 0.001). Ultra had the same sensitivity on specimens from EBUS-TBNA and EBUS-GS (P = 0.975). Ultra’s positive predictive value and negative predictive value were 79.8% and 57.1% respectively.ConclusionsTissue specimens from interventional bronchoscopy combined with Ultra provide a sensitive method for diagnosing smear-negative pulmonary tuberculosis, but its specificity was lower than Xpert.

Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

Tuberculosis (TB) is one of the common infections in the world, especially in developing countries like India. Therefore, early diagnosis is important. This study was undertaken to compare the yield of sputum, induction with bronchoalveolar lavage (BAL) in smear-negative suspected pulmonary TB patients in a tertiary care hospital in Agra. Fifty patients were included in the study. In all patients, induced sputum, fibreoptic bronchoscopy and BAL fluid were subjected to diagnostic testing. On acid-fast smear examination, induced sputum and BAL fluid tested positive in 27/50 and 25/50 patients, respectively with a sensitivity of 83.3% and 90% respectively (p<0.0001). On comparing sputum induction versus BAL on culture, 30 patients were positive by sputum induction and 27 patients were positive on BAL fluid, with the sensitivity of 85.7% and 77.1%, respectively. The results showed that the sputum induction showed a significantly higher yield than that of BAL fluid (p=0.0013). Sputum induction offers an alternative approach in the diagnosis of smear-negative suspected pulmonary TB patients and would enhance sensitivity for the diagnosis of TB.

Evaluation of three alternatives cost-effective culture media for Mycobacterium tuberculosis detection and drug susceptibility determination using the microscopic observation drug susceptibility (MODS) assay

Tuberculosis phenotypic detection assays are commonly used in low-resource countries. Therefore, reliable detection methods are crucial for early diagnosis and treatment. The microscopic observation drug susceptibility (MODS) assay is a culture-based test to detect Mycobacterium tuberculosis and characterize drug resistance in 7–10 days directly from sputum. The use of MODS is limited by the availability of supplies necessary for preparing the enriched culture. In this study, we evaluated three dry culture media that are easier to produce and cheaper than the standard one used in MODS [1]: an unsterilized powder-based mixed (Boldú et al., 2007) [2], a sterile-lyophilized medium, and (Sengstake et al., 2017) [3] an irradiated powder-based mixed. Mycobacterial growth and drug susceptibility were evaluated for rifampin, isoniazid, and pyrazinamide (PZA). The alternative cultures were evaluated using 282 sputum samples with positive acid-fast smears. No significant differences were observed in the positivity test rates. The positivity time showed high correlations (Rho) of 0.925, 0.889, and 0.866 between each of the three alternative media and the standard. Susceptibility testing for MDR and PZA showed an excellent concordance of 1 compared to the reference test. These results demonstrate that dry culture media are appropriate and advantageous for use in MODS in low-resource settings.

Description, validation, and review of a decade of experience with a laboratory-developed PCR test for detection of Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens

Rapid detection of Mycobacterium tuberculosis complex directly from clinical specimens is critical for patient care. Mycobacterial culture requires days to weeks for results and therefore many laboratories employ rapid molecular methods for the diagnosis of tuberculosis. There are two FDA-cleared molecular assays for the detection of M. tuberculosis complex in the United States and both are cleared for testing of respiratory specimens only. The detection of M. tuberculosis complex in extrapulmonary specimens is often done using laboratory-developed PCR methods. In this work, the verification and subsequent validation of test performance over a decade is detailed for a laboratory-developed PCR assay (MTBRP) that detects M. tuberculosis complex from respiratory and non-respiratory specimens. The assay also provides information about potential isoniazid resistance. The performance of the MTBRP PCR assay was compared to the Cepheid Xpert MTB/RIF assay in acid-fast smear positive and smear negative specimens and mycobacterial culture for acid-fast smear positive specimens. The MTBRP assay demonstrated 99% correlation with the Xpert MTB/RIF assay using 499 respiratory specimens. The performance of the MTBRP PCR assay compared with mycobacterial culture for 867 AFB smear positive respiratory and non-respiratory specimens demonstrated a sensitivity of 100% and a specificity of 99.1%. This work provides longitudinal evidence using real-world clinical laboratory conditions and specimens to demonstrate that laboratory-developed PCR assays such as the MTBRP can provide a rapid and sensitive method for detection of pulmonary and extra-pulmonary tuberculosis from a wide-variety of smear positive specimen sources.

PULMONARY CRYPTOCOCCUS: THE GREAT IMPERSONATOR

PULMONARY CRYPTOCOCCUS: THE GREAT IMPERSONATOR

Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Protocol for a Cluster Randomized Controlled Trial.

BackgroundThe health care system in Thailand has struggled to cope with the COVID-19 pandemic, resulting in decreased administration of community-based directly observed therapy (DOT) for tuberculosis (TB). As an alternative to failed DOT, video-observed therapy (VOT) or the Thai asynchronous VOT system, “TH VOT,” was devised. We developed a protocol for a study to test the superiority of VOT over DOT in ensuring treatment compliance.ObjectiveWe aim to compare the mean cumulative compliance days of TB patients and their observers under the VOT program with that of individuals under the DOT program during the intensive phase of TB treatment.MethodsA cluster randomized controlled trial of pulmonary TB patients and their observers will be conducted over a 2-month period. This study will be conducted in the Hat Yai and Meuang Songkhla districts of Songkhla Province, Southern Thailand. A total of 38 observers working at 38 primary care units (PCUs) will be randomized equally into VOT and DOT groups. The TH VOT system will be implemented in 19 PCUs in the VOT group while the other 19 PCUs will continue with the traditional DOT program. Approximately 1-5 TB patients will be under observation, depending on the PCU jurisdiction in which the patients reside. The inclusion criteria for TB patients will be as follows: patients diagnosed with newly active pulmonary TB with a positive acid-fast bacilli sputum smear, aged >18 years, own a smartphone, and are able to use the LINE (Line Corporation) app. The exclusion criteria will be patients with a condition that requires the intervention of a specialist, rifampicin resistance according to a cartridge-based nucleic acid amplification test (GeneXpert MTB/RIF), unable to continue the treatment, and/or alcohol dependence. After the 2-month observation period, all sessions and follow-up clinical outcomes recorded will be retrieved. An intention-to-treat analysis will be performed to assess the compliance of both patients undergoing drug administration and their observers.ResultsThe Human Research Ethics Committee, Faculty of Medicine, Prince of Songkla University approved the trial on February 19, 2021 (approval number 64-03618-9). The trial was funded in May 2021. The recruitment period will be from January 2022 to July 2022. The observation is scheduled to end by September 2022.ConclusionsIf the VOT shows superiority in observational compliance among patients and observers, the existing DOT policy will be replaced with VOT.Trial RegistrationThai Clinical Trials Registry TCTR20210624002; https://www.thaiclinicaltrials.org/show/TCTR20210624002International Registered Report Identifier (IRRID)DERR1-10.2196/38796

Alternative cost-effective media to facilitate MODS culture for diagnostics of tuberculosis

Most culture-based methods for tuberculosis diagnosis remain low-cost options for low- and mid-income countries. The MODS culture is a rapid and low-cost assay to diagnose tuberculosis and determine drug susceptibility. However, its implementation is limited due to the low accessibility to supplies required for the enriched medium. In this study, we evaluate two alternative culture media: A powder-based mixed (PM) and a lyophilized media (LM). Catalase, PANTA, and gamma irradiation were evaluated as additions to PM and LM. The culture performance of the alternative media was compared with the standard MODS medium (MM) using Mycobacterium tuberculosis isolates and positive acid-fast smear sputum samples. Overall, no significant difference was observed in the bacterial growth between PM and LM with MM. However, PANTA and gamma irradiation combined reduced bacterial growth significantly in all media variants. A median positivity day of 6 ± 5 days was observed for sputum samples, regardless of the culture medium. The preliminary results show that the two variants culture media have a similar performance to the standard MODS medium. The powder-based media with PANTA (PM_P) showed a time-to-positivity and sensitivity similar to the standard MODS medium. It is the simplest to prepare and does not require any sterilization process.

Concurrent severe pulmonary tuberculosis with Evans syndrome: a case report with literature review

BackgroundTuberculosis is a bacterial infection involving multiple organs and systems. Its hematological presentation mainly includes anemia and leukocytosis. Evans syndrome is a rare autoimmune disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and neutropenia, with positive results for the direct Coombs test and platelet antibodies. The cooccurrence of tuberculosis and Evans syndrome is rarely reported.Case presentationA 69-year-old female presented with a fever and shortness of breath. Her chest computerized tomography scan showed extensive miliary nodules in the bilateral lung fields. She rapidly developed respiratory failure that required endotracheal intubation and mechanical ventilation. The acid-fast bacilli sputum smear results indicated a grade of 3+. Later on, blood testing revealed hemolytic anemia, a positive direct Coombs test result, and the presence of the platelet antibody IgG. This patient was diagnosed as having disseminated pulmonary tuberculosis and Evans syndrome. She successfully recovered after treatment with antituberculosis drugs and glucocorticoids.ConclusionsTuberculosis can occur together with Evans syndrome. Affected patients should receive both antituberculosis and immunosuppressive drugs.