Bacteriological Confirmation Research Articles

HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study

BackgroundChildren under age five years, particularly those living with HIV (CLHIV), are at risk for rapid progression of tuberculosis (TB). We aimed to describe TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV compared to children without HIV in Cameroon and Kenya.MethodsThis sub-analysis of a cluster-randomized trial evaluating the integration of pediatric TB services from May 2019 to March 2021 enrolled children age < 5 years with TB. We estimated the HIV infection rate with 95% confidence interval (CI). We compared TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV and children without HIV. Finally, we investigated whether HIV infection was associated with a shorter time to TB diagnosis (≤ 3 months from symptoms onset) after adjusting for covariates. Univariable and multivariable logistic regression analysis were performed with adjusted odds ratios (AORs) presented as measures of the association of covariates with HIV status and with shorter time to TB diagnosis.ResultsWe enrolled 157 children with TB (mean age was 1.5 years) and 22/157 (14.0% [9.0-20.4%]) were co-infected with HIV. CLHIV were more likely to initially present with acute malnutrition (AOR 3.16 [1.14–8.71], p = 0.027). Most TB diagnoses (140/157, 89%) were made clinically with pulmonary TB being the most common presentation; however, there was weak evidence of more frequent bacteriologic confirmation of TB in CLHIV, 18% vs. 9% (p = 0.067), due to the contribution of lateral-flow urine lipoarabinomannan to the diagnosis. HIV positivity (AOR: 6.10 [1.32–28.17], p = 0.021) was independently associated with a shorter time to TB diagnosis as well as fatigue (AOR: 6.58 [2.28–18.96], p = 0.0005), and existence of a household contact diagnosed with TB (AOR: 5.60 [1.58–19.83], p = 0.0075), whereas older age (AOR: 0.35 [0.15–0.85], p = 0.020 for age 2–5 years), night sweats (AOR: 0.24 [0.10–0.60], p = 0.0022) and acute malnutrition (AOR: 0.36 [0.14–0.92], p = 0.034) were associated with a delayed diagnosis. The case fatality rate was 9% (2/22) in CLHIV and 4% (6/135) in children without HIV, p = 0.31.ConclusionsThese results altogether advocate for better integration of TB services into all pediatric entry points with a special focus on nutrition services, and illustrate the importance of non-sputum-based TB diagnostics especially in CLHIV.Trial registrationNCT03862261, first registration 05/03/2019.

Acute Forms of Pulmonary Tuberculosis

Introduction: Tuberculosis is a cosmopolitan infection disease caused by mycobacteria of the tuberculosis complex. It is a major public health problem. Acute forms of pulmonary tuberculosis are potentially lethal. The objective of this study is to determine the epidemiological, clinical, and evolving profile of patients with acute forms of pulmonary tuberculosis. Material and Methods: We reported a case series conducted at the pneumology department of CHU Mohamed VI in Marrakech. All cases of acute tuberculosis bacteriologically confirmed were included in the study. Results: We collected 33 cases during this period. A male predominance was noted in 61% of cases. A history of pulmonary tuberculosis was noted in 5 cases (15.2%). A field of immunosuppression was found in 8 patients (24.2%) including 6 cases of diabetes and 2 cases of HIV seropositivity. The main symptoms were dyspnea in 18 cases (54.5%), cough in 16 cases (48%) and hemoptysis in 4 cases (12%). The chest X-ray objectified an aspect of miliary in 26 cases (78.7%), an aspect of bronchopneumonia in 4 cases (12%) and caseous pneumonia in 3 patients (9%). In the cases of miliary, the diagnosis was made by a compatible clinical and radiological signs in 20 cases (77%) and by bacteriological confirmation through direct examination of expectorations in 6 cases (23%). As for pneumonia and bronchopneumonia, bacteriological confirmation was obtained through direct examination of expectorations in 5 cases (71.4%) and through molecular biology (GenXpert) in the other cases (28.6%). The anti-bacillary treatment was started urgently, according to the national anti-bacillary program. Corticosteroid therapy at a dose of 1 mg/kg/day; was administered to 10 patients presenting with dyspneic miliaria. Side effects of anti-bacillary treatment were dominated by drug-induced hepatitis in its cytolytic form. 2 patients died (6%) following severe acute respiratory failure associated with pulmonary embolism in 1 case. ........

Diagnostic accuracy of clinical diagnostic scoring systems for childhood tuberculosis: a systematic review and meta-analysis protocol

IntroductionDiagnosis of childhood tuberculosis (TB) poses several challenges. Therefore, clinical signs and symptoms, radiological studies, laboratory examinations, point-based scoring systems or diagnostic algorithms have been developed to improve diagnostic yields...

Sensitivity and specificity of CRP and symptom screening as tuberculosis screening tools among HIV-positive and negative outpatients at a primary healthcare facility in Lusaka, Zambia: a prospective cross-sectional study

ObjectivesTo evaluate the performance of point-of-care C-reactive protein (CRP) as a screening tool for tuberculosis (TB) using a threshold of 10 mg/L in both people living with HIV (PLHIV) and...

Antibodies against Histoplasma capsulatum and Aspergillus fumigatus among chronic TB patients in Indonesia: a cross-sectional study.

Chronic pulmonary fungal infections may occur in patients with previous history of pulmonary tuberculosis (TB), and are often clinically misclassified as TB, especially when bacteriological confirmation for Mycobacterium tuberculosis is absent. In this study, we investigated the prevalence of antibody against Histoplasma capsulatum and Aspergillus fumigatus in patients with confirmed and clinically chronic TB. Antibodies against H. capsulatum and A. fumigatus were measured from serum samples using enzyme-linked immunosorbent assay (ELISA). The presence M. tuberculosis in sputum was confirmed using smear microscopy, GeneXpert MTB/RIF assay, or culture. Antibodies against H. capsulatum and A. fumigatus were elevated in 16.9% and 26.9% of bacteriologically confirmed chronic TB patients, and 12.1% and 18.2% in those without bacteriological confirmation, respectively. Approximately one-third of patients who had positive anti-Histoplasma antibody also had elevated levels of antibody against Aspergillus fumigatus (P<.001). Our study highlights the importance of chronic pulmonary fungal infection in post-TB patients with recurrent respiratory symptoms.

Tuberculosis in Poland in 2020.

To evaluate the main features of epidemiology of tuberculosis (TB) in 2020 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2020, data from Statistics Poland on deaths from tuberculosis in 2019, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." In 2020, 3,388 TB cases were reported in Poland. The incidence rate was 8.8 cases per 100,000 with large variability between voivodeships from 5.5 to 13.3 per 100,000. A decrease in the incidence was found in 15 voivodeships, the most significant in Śląskie voivodship (63.9%). The number of all pulmonary tuberculosis cases was 3,237 i.e. 8.4 per 100,000. Pulmonary cases represented 95.5% of all TB cases. In 2020, 151 extrapulmonary TB cases were notified (4.5% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,573 cases (79.5% of all pulmonary TB cases, the incidence rate 6.7 per 100,000). The number of smear-positive pulmonary TB cases was 1,771 i.e. 4.6 per 100,000 (54.7% of all pulmonary TB cases). In 2020, there were 38 cases (15 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.6% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with increasing age from 0.7 per 100,000 among children (0-14 years) to 15.0 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 12.1 per 100,000. There were 39 cases in children up to 14 years of age (1.2% of the total) and 49 cases in adolescents between 15 and 19 years of age - rates 0.7 and 2.7 per 100,000 respectively. In 2020, there were 2,506 cases of tuberculosis in men and 882 in women. The TB incidence in men - 13.5 per 100,000 was 3.0 times higher than among women - 4.5. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 26.8 vs. 4.1 and in age group 55 to 59 years - 28.7 vs. 4.8. In 2020, there were 116 patients of foreign origin among all cases of tuberculosis in Poland (3.4%). In 2019, TB was the cause of death for 456 people (mortality rate - 1.2 per 100,000). TB incidence in Poland in 2020 was 36.7% lower than in 2019. Such significant declines in the incidence have not been observed in the last two decades. As in previous years, there were differences in incidence rates between voivodeships with an unexpectedly sharp decrease in incidence in Silesia (Śląskie voivodeship). The percentage of tuberculosis cases with bacteriological confirmation exceeded 78%, more than in EU/EEA countries (67.3%). The percentage of MDR-TB cases was still lower than the average in EU/EEA countries (1.6% vs. 3.8%). The highest incidence rates were found in Poland in the older age groups (EU/EEAaged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.2%, less than the average in EU/EEA countries (3.8%). The incidence of tuberculosis in men was three times higher than in women in Poland, and six times higher in patients aged 50 to 59. The impact of migration on the TB pattern in Poland has not yet become significant in 2020. The percentage of foreigners among TB patients was 3.4% (33% in EU/EEA countries).

Tuberculous Cold Parietal Abscesses in Immunocompetent Subjects

Tuberculosis of the chest wall is a rare extrapulmonary localization, affecting mostly the immunocompromised and rarely the immunocompetent. Clinically, it presents as an abscessed collection or a tissue mass making the diagnosis difficult, especially in the absence of other signs, hence the interest of a bacteriological and/or histological confirmation. Extensive surgery accompanied by anti-bacillary chemotherapy is the treatment of choice.

The experience in tuberculous spondylitis treatment taking into account the susceptibility of mycobacteria tuberculosis to antibacterial medicines

Objective — to increase the effectiveness of treatment of patients with tuberculous spondylitis (TS), to improve the etiological diagnosis and operative treatment of patients with TS. Materials and methods. The data of 60 patients with active TS of the thoracic and lumbar vertebrae, operated in the osteoartikular tuberculosis department of Kharkiv Regional Antituberculosis Dispensary No. 1 and Traumatology and Orthopedics department of Kharkiv Municipal Clinical Emergency Care Hospital named after A.I. Meshchaninov in the period 2014—2019. Patients were divided into the main and control groups (n = 30). The main group includes patients with TS operated with the use of a telescopic titanium cage for ventral interbody spondylodesis after necrosequestrectomy. The group II (control group) included patients treated with using traditional approaches to TS treatment. Results and discussion. Bacteriological confirmation of the diagnosis was obtained in 40.0 % of patients of the control group, of which 20.0 % of mycobacterium tuberculosis (MBT) were isolated only by culture, 13.3 % only by bacterioscopy, and in 6.7 % of cases positive results were obtained using two methods.In patients of the control group, the largest number of positive results was obtained from the contents of abscesses — in 30.0 % of patients, with pus on tampons and secretions from fistulas — in 6.7 % (p &lt; 0.01), from operative material (granulations and caseous masses) — in 16.7 %. Among the patients of the control group, bacteriological confirmation was obtained in 10 (33.3 %) patients.Diagnostic puncture biopsy of vertebral bodies, used in 17 diagnostic patients, made it possible to diagnose cancer metastasis in the vertebral body in one (5.9 %) case, in three (17.6 %) — primary tumors of the spine, in 9 (52.9 %) patients — tuberculosis and 4 (23.6 %) — non-specific osteomyelitis of the spine. This study was performed by the method of diagnostic percutaneous trepanobiopsy of the vertebral bodies with the help of electronic-optical converter through the posterior access through the root of the affected vertebral arch.The long-term results of TS treatment were studied in 26 patients of the main group (86.7 %) and in 25 patients of the control group (83.3 %) in the period from 1 to 10 years. Long-term results of treatment were evaluated using a generally accepted scoring scale. Conclusions. The new method of TS treatment in the main group compared to traditional standards of surgical interventions in the control group allowed: 1) to avoid the progression of TS, the development of complications of the disease (p &lt; 0.05) and complications related to the transplant (fractures, displacement of the autograft, cage) (p &lt; 0.05), in the early postoperative period; 2) significantly increase the effectiveness of treatment due to an increase in excellent results (46.7 and 26.7 %, respectively) and a decrease in satisfactory (13.3 and 23.3 %) and unsatisfactory (0.0 and 10.0 %; p &lt; 0.05) of the results in the remote terms of obser­vation; 3) significantly shorten the inpatient stage of treatment ((96 ± 12) and (190 ± 21) bed-days; p &lt; 0.001).

ЭТИОЛОГИЧЕСКАЯ ВЕРИФИКАЦИЯ МИКОБАКТЕРИОЗА ЛЕГКИХ ПРИ ИССЛЕДОВАНИИ ОПЕРАЦИОННОГО МАТЕРИАЛА У ПАЦИЕНТОВ С ДИАГНОЗОМ А16.0 – РЕАЛЬНАЯ ПРАКТИКА

Objective: to evaluate effectiveness of etiological verification of pulmonary mycobacteriosis (PM) in patients with diagnosed “pulmonary TB without bacteriological or histological confirmation” (А16.0) as per ICD-10 and species diversity of nontuberculous mycobacteria (NTM) in resection samples from the studied cohort. Materials and methods.We analyzed test results from 28 patients with initially diagnosed “pulmonary TB without bacteriological or histological confirmation” (А16.0) as per ICD-10 and verified PM according to resection sample studies. The microbiological study (at least two sputum samples, one bronchobiopsy sample, and one resection sample) included luminescent microscopy (LUM), extraction of M. tuberculosis DNA or NTM DNA by polymerase chain reaction (PCR), culture growth on liquid media in the ВАСТЕС MGIT 960 system, identification of mycobacteria by molecular genetic methods: real-time PCR for M. tuberculosis DNA detection (Syntol, Russia) and DNA-strip technology (GenoType Mycobacterium CM/AS Hain Lifescience). Results. The analysis of referral diagnoses established that in more than half of patients with diagnosed “pulmonary TB without bacteriological or histological confirmation” (А16.0) changes in the lungs had been referred to tuberculoma (64.3%) or infiltrative TB (21.4%); 28.6% of patients had received TB treatment as per chemotherapy regimen no. 3, and 17.8% of patients – broad-spectrum antibiotics. TB treatment duration varied from 4 to 28 months. Atypical lung resections were performed in most cases (75%). NTM DNA detection in resection samples was the most informative method of etiological verification of PMB (100% of cases). NTM culture growth was observed in 17.9% of cases. Only slowly-growing NTM were represented in the studied cohort as etiologically significant. Conclusion. The diagnosis verification is based on data obtained by microbiological and/or histological, cytological studies. Studies of resection samples from TB suspects significantly improve diagnostic effectiveness.

Clinico-Epidemiological Profile and Diagnostic Procedures of Tuberculosis in Children: A Retrospective Study from OPD of Tertiary Care Center in Bangladesh

Background: Childhood Tuberculosis (TB) is an important cause of mortality and morbidity, which causes a significant TB burden in developing countries. Objectives: The aim of this study was to describe clinical profile and diagnostic procedures used in outpatient department (OPD) of a tertiary care hospital. Methods: It was a retrospective study conducted in OPD of Paediatrics Department, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh. Age range of studied populations, 3 months to 18 years who presented with clinical features of TB and were later diagnosed with tuberculosis according to national guidelines for the management of tuberculosis in children, 2021 were enrolled in this study. A total of 108 diagnosed cases of Tuberculosis between August 2021 and July 2022 were enrolled in this study. Data were collected from OPD records and transferred into MS excel sheet for data processing & analysis. Results: Among 834 suspected patients, 108 patients aged 3 months to 18 years were diagnosed with tuberculosis. The highest number of cases 47 (43.51%) were found in 11 - 18 years age group. Gender distribution of the patient showed 58 (53.70%) were male and 50 (46.29%) were female. Among 108 TB cases, 44 (40.74%) were pulmonary TB and 64 (59.25%) were extrapulmonary Tb. Among 64 extrapulmonary TB cases 38 (59.37%) cases were diagnosed as TB lymphadenitis. Fever 83 (76.85%), weight loss 62 (57.4%), cough 50 (46.29%), lump in neck and axilla 38 (35.18%) were found in most of the cases. A positive Mantoux test was found in 68 (62.96%) patients. Chest x-ray findings showed patchy opacity and consolidation in 46 (42.59%) cases. Suggestive FNAC from lymph node was observed among 35 (32.4%) cases. For bacteriological confirmation sputum gene Xpert and stool xpert ultra were positive among 10 (9.25%) and 23 (21.29%) cases. Conclusion: In this study, extrapulmonary TB (EPTB) cases were more than pulmonary TB (PTB) in children. Diagnosis of tuberculosis was based on clinical suspicion supported by various investigations especially bacteriological detection with stool X pert ultra in children.

Outcome of intramedullary nail coated with antibiotic-impregnated cement in chronic osteomyelitis.

Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular infections, Chr OM is one of the most challenging in terms of treatment. In the present study, we evaluate the outcome of antibiotic cement-coated nails in the treatment of chronic pyogenic osteomyelitis and also discuss the future innovations in field of antibiotic-compatible biomaterials for coating the implants. Twelve cases of Chr OM (5 hematogenous and 7 exogenous following trauma or surgery) were operated by intramedullary nail coated with antibiotic-impregnated bone cement from September 2018 to January 2021. All the cases had bacteriological confirmation of infection by deep curettage and its subsequent culture sensitivity. K nail was used in 10 cases and elastic stable intramedullary nails were used in 2 cases. Out of 12 cases, 8 were male and 4 were female. The average duration of follow-up was 13 months. Infection was controlled in all the cases (two cases required repeat antibiotic-coated nailing), and there was no incidence of relapse in any case. The control of infection was assessed by clinical assessment and laboratory parameters. Antibiotic cement-coated nails are an effective method in local control of infection in Chr OM without any systemic side effect.

Prevalence, associated factors and rifampicin resistance pattern of pulmonary tuberculosis among HIV-positive patients attending antiretroviral treatment clinic at East Gojjam Zone, Ethiopia: An institution-based cross-sectional study

BackgroundDrug-resistant tuberculosis (TB) threatens global TB care and prevention, and it remains a major public health concern in many countries particularly in sub-Saharan countries. Pulmonary TB is the most common serious opportunistic infection on HIV-positive patients and it is the leading cause of death among HIV-positive patients in developing countries. Ethiopia is one of the high TB burden countries with high morbidity and mortality. ObjectiveTo determine the prevalence, associated factors and rifampicin resistance of pulmonary TB among HIV-positive attending antiretroviral treatment clinic at East Gojjam. MethodsHospital-based cross-sectional study was conducted at Debre Markos Referral Hospital, from February to June 2019. A total of 112 HIV-positive TB suspected patients were included using convenient sampling techniques and a bacteriological confirmation test for tuberculosis was performed using Gene-Xpert MTB/RIF assay from a spot sputum sample. Viral load was determined by using a quantitative real-time polymerase chain reaction (RT-PCR) from the blood sample. Socio-demographic and clinical data were collected by face-to-face interview using a semi-structured questionnaire. The data were analyzed by using Statistical Package for Social Sciences (SPSS) software (version 24). ResultOut of the 112 study participants, the prevalence of Pulmonary TB was 11.6 %. Among TB positives 23.1 % were rifampicin resistant. Rifampicin resistance was 100 % among female patients. Having family members treated for pulmonary TB (P = 0.003, [AOR = 4.5; 95 % CI = 3.59–58.8]), cigarette smoking (P = 0.039, [AOR = 2.18; 95 %CI = 1.17–40.5]), being on WHO HIV disease clinical stage II (P = 0.024, [AOR = 1.81; 95 %CI = 1.50–30.99]), and having viral load (1000–9999) RNA copies/ml (P = 0.031, [AOR = 1.54; 95 %CI = 1.32–31.41]) were found to be significantly associated with pulmonary TB. ConclusionThe prevalence of pulmonary TB and rifampicin resistance was high among HIV patients. Having family members treated for Pulmonary TB, history of cigarette smoking, WHO HIV clinical stage, and high viral load were associated risk factors for TB. Therefore, strengthening awareness creation on TB transmission, drug resistance, and treatment adherence are essential. Moreover, early screening and treatment are vital for preventing the transmission and occurrence of drug-resistant TB among study populations.

Clinical and Radiologic Factors Associated With Detection of Mycobacterium tuberculosis in Children Under 5 Years old Using Invasive and Noninvasive Sample Collection Techniques-Kenya.

Pediatric tuberculosis (TB) remains a critical public health concern, yet bacteriologic confirmation of TB in children is challenging. Clinical, demographic, and radiological factors associated with a positive Mycobacterium tuberculosis specimen in young children (≤5 years) are poorly understood. We conducted a prospective cohort study of young children with presumptive TB and examined clinical, demographic, and radiologic factors associated with invasive and noninvasive specimen collection techniques (gastric aspirate, induced sputum, nasopharyngeal aspirate, stool, and string test); up to 2 samples were taken per child, per technique. We estimated associations between these factors and a positive specimen for each technique using generalized estimating equations (GEEs) and logistic regression. A median (range) of 544 (507-566) samples were obtained for each specimen collection technique from 300 enrolled children; bacteriologic yield was low across all collection techniques (range, 1%-7% from Xpert MTB/RIF or culture), except for lymph node fine needle aspiration (29%) taken for children with cervical lymphadenopathy. Factors associated with positive M. tuberculosis samples across all techniques included prolonged lethargy (median [range] adjusted odds ratio [aOR], 8.1 [3.9-10.1]), history of exposure with a TB case (median [range] aOR, 6.1 [2.9-9.0]), immunologic evidence of M. tuberculosis infection (median [range] aOR, 4.6 [3.7-9.2]), large airway compression (median [range] aOR, 6.7 [4.7-9.5]), and hilar/mediastinal density (median [range] aOR, 2.9 [1.7-3.2]). Identifying factors that lead to a positive M. tuberculosis specimen in very young children can inform clinical management and increase the efficiency of diagnostic testing in children being assessed for TB.

The Simple One-step stool processing method for detection of Pulmonary tuberculosis: A study protocol to assess the robustness, stool storage conditions and sampling strategy for global implementation and scale-up.

The Xpert MTB/RIF Ultra (Xpert-Ultra) assay provides timely results with good sensitivity and acceptable specificity with stool specimens in children for bacteriological confirmation of tuberculosis (TB). This study aims to optimize the Simple One-Step (SOS) stool processing method for testing stool specimens using the Xpert-Ultra in children and adults in selected health facilities in Addis Ababa, Ethiopia. The study is designed to assess the robustness of the SOS stool method, to help fine-tune the practical aspects of performing the test and to provide insights in stool storage conditions and sampling strategies before the method can be implemented and scaled in routine settings in Ethiopia as well as globally. The project "painless optimized diagnosis of TB in Ethiopian children" (PODTEC) will be a cross sectional study where three key experiments will be carried out focusing on 1) sampling strategy to investigate if the Xpert-Ultra M. tuberculosis (MTB) -positivity rate depends on stool consistency, and if sensitivity can be increased by taking more than one stool specimen from the same participant, or doing multiple tests from the same stool specimen, 2) storage conditions to determine how long and at what temperature stool can be stored without losing sensitivity, and 3) optimization of sensitivity and robustness of the SOS stool processing method by varying stool processing steps, stool volume, and storage time and conditions of the stool-sample reagent mixture. Stool specimens will be collected from participants (children and adults) who are either sputum or naso-gastric aspiration (NGA) and/or stool Xpert-Ultra MTB positive depending on the experiment. Stool specimens from these participants, recruited from 22 sites for an ongoing related study, will be utilized for the PODTEC experiments. The sample size is estimated to be 50 participants. We will use EpiData for data entry and Stata for data analysis purposes. The main analyses will include computing the loss or gain in the Xpert-Ultra MTB positivity rate and rates of non-determinate Xpert-Ultra test results per experiment compared to the Xpert-Ultra MTB result of stool processed according to the published standard operating procedures for SOS stool processing. The differences in the MTB positivity rate by regarding testing more than one sample per child, and using different storage, and processing conditions, will be also compared to the baseline (on-site) Xpert-Ultra result.

Towards Shorter, Child-Friendly Regimens for Treatment of Tuberculosis Disease and Infection in Children.

Towards Shorter, Child-Friendly Regimens for Treatment of Tuberculosis Disease and Infection in Children.

Prevalence and Characterization of Campylobacter Species from Chickens Sold at Informal Chicken Markets in Gauteng, South Africa

This study determined the prevalence, characteristics, and risk factors of Campylobacter species contamination of chicken carcasses sold at informal poultry outlets in Gauteng province, South Africa. Within six townships, 151 chicken carcasses were collected from 47 outlets. Carcass swab, cloacal swab, and carcass drip samples were collected from each chicken, along with a matched questionnaire on risk factors regarding Campylobacter contamination. Sample-inoculated Bolton broth (BB) was cultured to isolate Campylobacter species by bacteriological methods. Subsequent confirmation and characterization of Campylobacter were conducted using polymerase chain reaction (PCR). Isolated Campylobacter strains were evaluated for the presence of six virulence genes (ciaB, dnaj, pldA, racR, flaA, and flaB), three toxin genes (cdtA, cdtB, and cdtC), and one antimicrobial resistance gene (tetO). The overall prevalence of Campylobacter was 23.4% (106 of 453), with sample type-specific prevalence being 17.2% (26 of 151), 25.8% (39 of 151), and 27.2% (41 of 151) for the carcass swabs, cloacal swabs, and carcass drip, respectively, following bacteriological isolation and confirmation by PCR. The overall prevalence of Campylobacter species was 93.5% by PCR, which varied significantly (P = 0.000) by sample: 99.2, 98.4, and 82.8% for carcass swabs, cloacal swabs, and carcass drip, respectively, by using PCR to detect Campylobacter in BB. Important risk factors for carcass contamination by Campylobacter included the slaughter of culled breeders and spent chickens, the use of stagnant water, and poor sanitation. Virulence and toxin gene frequencies were higher in C. jejuni-positive (82.5%) than in C. coli-positive (71.4%) BB cultures, but tetracycline resistance gene (tetO) frequency was higher in C. coli (75.9%) than in C. jejuni (48.10%). The observed high frequencies in C. jejuni recovered from street-vended chickens may pose food safety and therapeutic concerns to consumers.

Effect of Laser Bio stimulation and Bone Graft in Treatment of a Large Periapical Lesion – A CBCT Analysis

India accounts for 23% of global TB burden. Of these 38% are of Extra Pulmonary Tuberculosis. Lymph node TB is the most common EPTB, pleural effusion is second most common type of EPTB in India. The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. This study aims assessing the comparison of ADA with Gene- Xpert MTB RIF in pleural fluid in the diagnosis of tubercular pleural effusion. Study was a cross-sectional study carried out at the Department of Respiratory Medicine and Department of Internal Medicine, Muzaffarnagar Medical College, and School of Medical Science and Research, Greater Noida, Gautam Budh Nagar, UP from January 2018 to March 2019. Paired and unpaired Student's t-test, Chi square test, P &lt; 0.05 was considered statistically significant; SPSS 18.0 software was used for analysis. The detection of MTB and rifampicin resistance using the Gene-Xpert MTB/RIF with pleural fluid ADA assay was assessed in 66 specimens. With ADA cut off as 40IU/L, 60 cases had an ADA &gt; 40IU/L and 6 cases had ADA &lt; 40IU/L. Pleural fluid Gene-Xpert detected MTb in 22 samples while in 44 samples MTB not detected. All pleural fluid MTb detected by Gene-Xpert were rifampicin sensitive. Gene-Xpert detected 2 tubercular pleural effusion in which ADA level was less than 40. Study shows that there was no statistically significance in diagnostic value between Gene- Xpert and ADA pleural fluid however Gene-Xpert MTB/RIF is useful method for rapid detection of MTB and Rifampicin resistance simultaneously. Estimation of ADA in pleural fluid is rapid inexpensive laboratory investigation where the diagnosis is uncertain. We found no significant connection between CBNAAT positivity and ADA level. In developing country lymphocyte predominant effusions with high ADA levels (&gt; 40 U/L) is better option but definitely combined use of ADA and Gene-Xpert is better than using individually for the diagnosis of Tubercular pleural effusion

A systematic review of clinical, epidemiological and demographic predictors of tuberculosis in children with pneumonia

BackgroundTuberculosis (TB) can present as acute, severe pneumonia in children, but features which distinguish TB from other causes of pneumonia are not well understood. We conducted a systematic review to determine the prevalence and to explore clinical and demographic predictors of TB in children presenting with pneumonia over three decades.MethodsWe searched for peer-reviewed, English language studies published between 1990 and 2020 that included children aged between 1 month and 17 years with pneumonia and prospectively evaluated for TB. There were 895 abstracts and titles screened, and 72 full text articles assessed for eligibility.ResultsThirteen clinical studies, two autopsy studies and one systematic review were included in analyses. Majority of studies were from Africa (12/15) and included children less than five years age. Prevalence of bacteriologically confirmed TB in children with pneumonia ranged from 0.2% to 14.8% (median = 3.7%, interquartile range (IQR) = 5.95) and remained stable over the three decades. TB may be more likely in children with pneumonia if they have a history of close TB contact, HIV infection, malnutrition, age less than one year or failure to respond to empirical antibiotics. However, these features have limited discriminatory value as TB commonly presents as acute severe pneumonia – with a short duration of cough, and clinical and radiographic features indistinguishable from other causes of pneumonia. Approximately half of patients with TB respond to initial empirical antibiotics, presumably due to bacterial co-infection, and follow-up may be critical to detect and treat TB.ConclusionTB should be considered as a potential cause or comorbidity in all children presenting with pneumonia in high burden settings. Clinicians should be alert to the presence of known risk factors for TB and bacteriological confirmation sought whenever possible. Quality data regarding clinical predictors of TB in childhood pneumonia are lacking. Further, prospective research is needed to better understand predictors and prevalence of TB in childhood pneumonia, particularly in TB endemic settings outside of Africa and in older children. Children of all ages with pneumonia should be included in research on improved, point-of-care TB diagnostics to support early case detection and treatment.

500 Mendelian Susceptibility to Mycobacterial Diseases (MSMD) with autosomal dominant Interferon Gama receptor one defect: A clinical diagnostic and treatment challenge for a 13 year old ethiopian girl

A 13 year old female patient had multiple hospital visits since age of 6months. The most striking diagnosis was repeated mycobacterial infections; which were diagnosed at times clinically and at other times with bacteriological confirmation. She had tuberculosis affecting lymph nodes, skin and soft tissue, bone and joints, lungs and epidural and para-spinal regions. She has been treated 4 times with first line, ones with second line anti-Tb drugs and now she still taking anti-TB. She has taken all childhood vaccines, including BCG.

Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children.

Background:Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan.Methods:In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years.Results:A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB.Conclusions:This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.