Cartridge-based Nucleic Acid Amplification Test Research Articles

Tuberculous Otitis Media: A Mysterious Ailment

Abstract: Introduction: Tuberculous otitis media (TOM) is an infrequent ailment. As an uncommon form of extra-pulmonary Tuberculosis, it is often underestimated, leading to a delay in diagnosis and start of appropriate treatment. Case Series: We describe 3 cases of TOM diagnosed and treated in our institute. The typical presentation was prolonged ear discharge not responding to culture sensitive antibiotics, hard of hearing, perforation of tympanic membrane, pale whitish granulation tissue. Pure Tone Audiogram (PTA) done to evaluate the hearing loss. The granulation tissue from all the patients sent for Histopathology examination (HPE) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) examination. CBNAAT results were positive in all three patients. HPE reported as chronic inflammatory pathology. PTA revealed sensorineural hearing loss in 2 patients and conductive hearing loss in 1 patient. Treatment with regular ATT 4FDC (Anti Tubercular Treatment- Four Drug Combination) regimen was started as per weight band for 6 months. Each of them was on follow up and symptomatically improving. Discussion: TOM requires recognition in refractory chronic otitis media. Early diagnosis and intervention are essential to prevent complications and optimise outcomes. The delay in initiating therapy may lead to complications such as facial nerve palsy. This case series aims to highlight the clinical presentation, effective diagnostic modalities and treatment of tuberculous otitis media and stresses the importance of awareness among otorhinolaryngologists regarding TOM and its timely management.

Comparison of Xpert MTB RIF (G4) With Xpert MTB (Ultra) in Diagnosis of Mycobacterium Tuberculosis in Clinical Samples

Abstract Background: Tuberculosis (TB) continues to be a major cause of morbidity and mortality worldwide. The main strategy to fight the pandemic is the development of rapid, accurate diagnostic tests, which helps to reduce the time for initiation of therapy. In 2010, WHO recommended the use of Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) (G4), which is a cartridge-based semi-automated nucleic acid amplification test (NAAT) as a primary test with an aim to improve the detection of MTB. Later on, to improve the diagnostic efficacy, the new and improved cartridges called Xpert Ultra were introduced in 2017. Materials and Methods: One thousand and sixty-nine clinical samples were utilized for the study for microscopy, culture, and NAATs (Xpert MTB/RIF G4 and Ultra). The samples were randomly allocated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated while assuming trace results as positive and negative in two separate scenarios. Results: The sensitivity of Xpert MTB/RIF Ultra cartridge was higher (100%) than Xpert MTB/RIF G4 cartridge (95.23%) and the specificity of Ultra cartridge was lower (71.79%) when compared to G4 cartridge (91.63%). However, the specificity of Xpert Ultra cartridge improved by reclassifying the “trace” interpretation as negative (89.1%). The NPV was 100% and 99.09% for Xpert Ultra cartridge and the Xpert G4 cartridge, respectively, and did not change by reclassifying the “trace” interpretation as negative. In contrast, the PPV varied greatly between the two tests, 26.66% for Xpert Ultra cartridge and 66.66% for Xpert G4 cartridge. The PPV of Xpert Ultra cartridge was improved to 48.48% by including “trace” samples in the negative pool. Conclusion: Xpert Ultra and G4 shows good performance as a first line diagnostic test. Caution should be exercised when interpreting ‘trace’ results in a country like India without parallel confirmatory tests like microscopy and culture. Data is limited on this newly incorporated value assigned in the automated report. Conducting further studies on results interpreted as ‘trace’ will help in improving the guidelines and as well as utilisation of such tests.

Performance of CBNAAT on Pleural Biopsies Obtained by Semirigid Thoracoscopy for Diagnosis of Unexplained Pleural Effusion: A Prospective Study from North India.

Exudative pleural effusions are commonly encountered in clinical practice, but in about one-fourth of cases, etiology remains elusive after initial evaluation. Medical thoracoscopy with semirigid thoracoscope is a minimally invasive procedure with high diagnostic yield for diagnosing pleural diseases, especially these undiagnosed exudative pleural effusions. In tubercular endemic areas, often, these effusions turn out to be tubercular, but the diagnosis of tubercular pleural effusion is quite challenging due to the paucibacillary nature of the disease. Although culture is the gold standard, it is time-consuming. Cartridge-based nucleic acid amplification test (CBNAAT) is a novel rapid diagnostic test for tuberculosis (TB) and has been recommended as the initial diagnostic test in patients suspected of having extrapulmonary TB (EPTB). We conducted a prospective observational study of 50 patients with undiagnosed pleural effusion admitted to our tertiary care hospital. The primary aim of the study is to evaluate the diagnostic performance of CBNAAT on thoracoscopic guided pleural biopsy and compare it with conventional diagnostic techniques like histopathology and conventional culture. Of 50 undiagnosed pleural effusions, TB (50%) was the most common etiology. The overall diagnostic yield of semirigid thoracoscopy in this study was 74%. Our study showed that CBNAAT of pleural biopsies had a sensitivity of 36% only but a specificity of 100%. The sensitivity of CBNAAT was not far superior to the conventional culture. Tuberculosis (TB) is a common cause of undiagnosed pleural effusion in our set-up. CBNAAT testing of pleural biopsy, though, is a poor rule-out test for pleural TB, but it may aid in the early diagnosis of such patients.

Predictors for Concurrent Diabetes in Tuberculosis Patients. Perspectives from Two Mining Districts of Eastern Tribal State Jharkhand, in India.

Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play? One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant. Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%). Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes.

Comparative Evaluation of Cartridge-based Nucleic Acid Amplification Test Smear Microscopy and Conventional Culture Techniques in Laboratory Diagnosis of Tuberculosis

Comparative Evaluation of Cartridge-based Nucleic Acid Amplification Test Smear Microscopy and Conventional Culture Techniques in Laboratory Diagnosis of Tuberculosis

Urinary lipoarabinomannan in individuals with sputum-negative pulmonary tuberculosis.

Tuberculosis (TB) is a major global cause of ill health. Sputum microscopy for confirmation of presumptive pulmonary TB (PTB) has a reportedly low sensitivity of 22-43 per cent for single smear and up to 60 per cent under optimal conditions. National TB Elimination Programme in India recommends the use of cartridge-based nucleic acid amplification test (CBNAAT) and culture for microbiological confirmation in presumptive PTB individuals with sputum smear negative test. The use of lateral flow urine lipoarabinomannan (LF-LAM) is usually recommended for the diagnosis of TB in HIV-positive individuals with low CD4 counts or those who are seriously ill. The objective of this study was to detect urinary LAM using cage nanotechnology that does not require a physiologic or immunologic consequence of HIV infection for LAM quantification in human urine in 50 HIV-seronegative sputum smear-negative PTB individuals. To study the diagnostic value of urinary LAM in sputum smear negative PTB individuals, a cage based nanotechnology ELISA technique was used for urinary LAM in three different groups of participants. Fifty smears negative PTB clinically diagnosed, 15 smear positive PTB and 15 post TB sequel individuals. Sputum was tested by smear, CBNAAT, and culture along with urine LAM before treatment. The results were interpreted by ROC curve in comparison to the standard tests like CBNAAT and culture. The mean urinary LAM value was 0.84 ng/ml in 37 culture-positive [Mycobacterium tuberculosis (M.tb)] and 0.49 ng/ml in 13 culture-negative (M.tb) smear-negative individuals with PTB, respectively. In 47 smear-negative PTB cases with microbiologically confirmed TB by CBNAAT, the mean urinary LAM was 0.76 ng/ml. The mean urinary LAM in post-TB sequel individuals was 0.47 ng/ml. As per the receiver operating characteristic curve, cut-off value of urinary LAM in individuals with smear-negative PTB microbiologically confirmed by: (i) CBNAAT was 0.695 ng/ml and (ii) culture was 0.615 ng/ml. The findings of this study suggest that individuals with smear-negative PTB and a urinary LAM value of >0.615 ng/ml were most likely to have microbiological confirmed TB while those with a LAM value <0.615 ng/ml >0.478 ng/ml are less likely and those with a value <0.478 ng/ml are unlikely to have microbiological confirmed TB.

A comparative study of accuracy between gene Xpert (cartridge-based nucleic acid amplification test) and line probe assay in retreatment cases of sputum-positive pulmonary tuberculosis

Abstract Background: Many studies have compared the efficacy of Gene Xpert (cartridge-based nucleic acid amplification test [CBNAAT]) and line probe assay (LPA) techniques; however, a systematic and meticulous comparison of these two techniques is lacking. Objective: To study the accuracy of GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay and LPA in the detection of MTB complex in smear-positive retreatment cases of pulmonary tuberculosis (TB). Materials and Methods: This diagnostic evaluation study was conducted on 300 retreatment cases of pulmonary TB. The patients who were receiving retreatment were identified by sputum for acid fast Bacilli by Ziehl–Neelsen staining method and were instructed to provide sputum samples for CBNAAT and LPA. These sputum samples were then processed for liquid culture as part of the routine diagnostic procedure. Results: Majority of the patients (52.3%) were of 31–45 years of age. Males (56%) were more than females (44%). Most of the cases were relapse (88%). Ninety-three percent were reactive on sputum culture. Seventy percent had RIF resistance on CBNAAT. Isoniazid and RIF resistance was seen in 69.7% on LPA. 23.3% were sensitive on LPA and 7% had isoniazid resistance. The sensitivity, specificity, positive predictive value, and negative predictive for CBNAAT as compared with LPA were 75%, 100%, 100%, and 22.2%, respectively. Conclusion: Both LPA and CBNAAT are equally effective in detecting MTB in the given sputum sample. However, LPA is preferred over can be very helpful as it can point out the Isoniazid (INH) and Rifampicin (RIF) resistant nature of the bacterium.

Utility of Conventional ZN Staining and Modified Bleach Techniques in Detection of Acid Fast Bacilli from Aspirates of Suspected Cases of Tuberculous Lymphadenitis

Introduction: Tuberculosis (TB) is a significant public health problem in many developing countries, including India. Diagnosing tuberculous lymphadenitis, in particular, poses challenges as it requires the demonstration of Acid-Fast Bacilli (AFB) using the conventional Ziehl-Neelsen (ZN) technique. The Modified Bleach Technique, which involves liquefying the aspirated specimen with sodium hypochlorite followed by centrifugation, has been described to enhance the yield of AFB, improving sensitivity and diagnostic accuracy. Aim: To highlight the role of the bleach concentration method compared to conventional ZN staining in detecting AFB in Fine-Needle Aspiration (FNA) material from clinically suspected cases of tuberculous lymphadenitis. Materials and Methods: A prospective cross-sectional study was conducted at the Department of Pathology, MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India from November 2020 to December 2022. Fine needle aspiration material from 100 cases of clinically suspected tuberculous lymphadenitis was included. In each case, part of the aspirate was processed for ZN staining, while the remaining material was used for modified bleach staining and Cartridge Based Nucleic Acid Amplification Test (CBNAAT). Patient data, including age, sex, duration and site of swelling, nature of aspirate, and cytomorphological diagnosis, were documented. The data was entered into a Microsoft excel spreadsheet and analysed using the Chi-square test, with a p-value&lt;0.05 considered statistically significant. Results: The age range of the study participants was 1-80 years. Out of 100 cases, 13 were excluded due to inadequate material. The most common lymph node site was cervical 69 (79.3%), followed by axillary 8 (9.1%) and supraclavicular 6 (6.89%). Among the 87 cases, reactive lymphadenitis was diagnosed in 36 (41.3%), suppurative lymphadenitis in 12 (13.8%), necrotising granulomatous lymphadenitis in 12 (13.8%), granulomatous lymphadenitis in 15 (17.3%), and necrotising lymphadenitis in 12 (13.8%). Out of the 100 cases included in the study, 32 cases were confirmed as tubercular lymphadenitis by CBNAAT. Among these 32 cases, conventional ZN stain was positive for AFB in only 3 cases (9%), whereas the Modified bleach stain was positive in 16 cases (50%). The results were compared with CBNAAT findings, and the modified bleach technique showed sensitivity (59.4%), specificity (100%), Positive Predictive Value (PPV) (100%), Negative Predictive Value (NPV) (80%), and Accuracy (85%). Conclusion: The Modified bleach method of ZN staining is a simple, safe, inexpensive, and easy-to-perform technique. With the bleach method, AFB was easily visible and detectable in the majority of AFB-positive cases. Additionally, the bleach method preserved the morphology of AFB better. It improves the microscopic detection of AFB, leading to a definitive diagnosis of TB on cytology.

Comparative analysis of CBNAAT (GeneXpert) and Ziehl-Nielsen staining test as diagnostic modalities of tuberculosis.

As centuries and millennia passed, tuberculosis remains the major health threat for millions of people. Due to this resurgence of tuberculosis, scientists around the globe have intensified their research efforts to curb down the transmission of this disease and that is the reason which led to the development of new and efficient diagnostic tools, one such being the rapid cartridge-based nucleic acid amplification test which can give the real-time results and that too in a short period of time. These diagnostic tools which are based on the latest technologies help in paving the way to eliminate tuberculosis by early detection method and further prevent the transmission. In this study, we did a comparative analysis of the effectiveness of CBNAAT technique in the early detection of Mycobacterium tuberculosis over the conventional method of Ziehl-Nielsen microscopy as diagnostic modalities. Comparative analysis of CBNAAT (GeneXpert) and Ziehl-Nielsen staining test was done as diagnostic modalities using standard protocols. Out of total 300 samples, 153 were female, 146 were male, while one was transgender. For all these samples, the positivity rates were 48% for the CBNAAT technique and 21.3% for ZN staining method, respectively. For extrapulmonary samples, positivity rates were 49.1% and 11.86% for CBNAAT and ZN microscopy, respectively, while the same for pulmonary samples was 47.7% and 23.6%, respectively. ZN microscopy and CBNAAT are both initial tests for the detection of Mycobacterium tuberculosis, but the introduction of CBNAAT is a boon for peripheral sites. The higher positivity rate of CBNAAT over ZN staining is the icing on the cake with the ability to detect even those cases that could be missed by the latter.

Dual bombard by Cytomegalovirus and Mycobacterium tuberculosis in a renal transplantee

Abstract In the first year following an organ transplant, more than 80% of patients encounter a minimum of one occurrence of infection. Here, we report a case of coinfection of the Cytomegalovirus (CMV) and Mycobacterium tuberculosis (MTB) in a kidney transplantee. Computed tomography chest (CT chest) showed bilateral ground-glass opacities. By Cytomegalovirus DNA polymerase chain reaction, 9360 copies were detected in plasma. Cartridge-based nucleic acid amplification test from bronchial washings tested positive for MTB with very low-level resistance to rifampicin. He was started on category-I antitubercular therapy without rifampicin and intravenous valganciclovir. The clinical status of the patient improved after 1 month of treatment.

Bacillus Calmette-Guérin Adenitis: An Intriguing Series of Four Cases

Bacille Calmette-Guérin (BCG) vaccine is part of the immunisation schedule in India. It is a live-attenuated vaccine with very few adverse reactions, one of which is BCG adenitis. The intriguing fact is that there has been a sudden upsurge in the number of BCG adenitis cases (two males and two female children), with four reported cases within three months (March 2023-June 2023). There were two male and two female children, aged between 2-8 months. All of them presented with left axillary swelling, and all but one had low grade fever only in the initial days. They all had a healed BCG vaccination scar on their left arm. Fine Needle Aspiration Cytology (FNAC) showed multiple epithelioid granulomas and, in some cases, frank caseation necrosis with the demonstration of tubercle bacilli using either Ziehl-Neelsen (Z-N) stain or Cartridge-based Nucleic Acid Amplification Test (CBNAAT). These cases mostly benefited from pus aspiration from the swelling site, with no definite role for oral antibiotics. Proper training of nursing or paramedical staff regarding vaccination technique and dosage, proper maternal and child healthcare, early detection of these cases with a high index of suspicion, as well as adequate knowledge of the treating doctors and parents/caregivers, may help in prompt management of these cases in future occurrences.

Case Series of Primary Breast Tuberculosis Presenting as a Lump: A Diagnostic Challenge

Tuberculosis of the breast is rare, even in countries where the disease is endemic. Breast tuberculosis usually occurs secondary to infection elsewhere. Less commonly, it may be the primary site with no demonstrable focus elsewhere. It is mainly encountered in immunosuppressed individuals, those with a history of trauma and suppurative mastitis. It commonly presents as a lump in the breast, but other presentations such as breast abscess, dull aching pain, nipple discharge, etc., have been reported. Multiparous and lactating women in their second to fourth decade are commonly affected. Studies have shown that microbiological diagnosis is limited to a few cases, and histopathology is the mainstay in diagnosing cases of breast tuberculosis. In the present case series, two cases (44-year-old and 40-year-old females) presented with a painless, ill-defined lump in the left breast. Another case (33- year-old female) presented with a lump in the left breast with dull aching pain. Constitutional symptoms were absent in all of the present case series patients. Microbiological positivity in the form of Cartridge-based Nucleic Acid Amplification Test (CBNAAT) positivity was seen in only one of the patients. Biopsy of all these cases showed non caseating granuloma. All the patients had primary breast tuberculosis with no other organ involvement. All the patients were started on standard antitubercular therapy with a fixed drug combination, following an initial delay due to the non caseating nature of the granuloma. All of them responded well to the therapy. The present case series compared the characteristics and delved deeply into the current data and research on breast tuberculosis to understand the same.

Utility of a Clinical Scoring System (Bandim TB Score and Karnofsky Performance Score) to Assess Mycobacterial Burden in Terms of Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) Cycle Threshold Values Among Pulmonary TB Patients.

Tuberculosis (TB) continues to be a global public health problem. Physicians fail to clearly interpret cycle threshold (Ct)values as a measure of mycobacterial burden due to the paucity of literature correlating Ct values with the clinical scoring. This study aims to correlate the clinical scoring parameters (Bandim TB scoreand Karnofsky Performance score (KPS)) with Ct values obtained by Cartridge-Based Nucleic Acid Amplification Test (CBNAAT). The study spanned from November 2019 to October 2021, during which a total of 40 cases were recruited. These cases were identified as pulmonary TB patients based on Ziehl-Neelsen staining for acid-fast bacilli and/or the GeneXpert MTB/RIF assay. Bandim TB scores and KPSs were recorded using standardized questionnaires. There was a strong negative correlation between Bandim TB score and Ct value (mean), and this correlation was statistically significant (rho = -0.82, p < 0.001). There was a moderate positive correlation between KPS and Ct value (mean), and this correlation was statistically significant (rho = 0.57, p < 0.001). No literature has compared Bandim TB score and KPS with the Ct values obtained by CBNAAT for pulmonary TB. Thus, the knowledge on the proper utilization of CBNAAT cycle threshold values and its correlation with clinical scoring parameters will help clinicians in the early identification and prompt initiation of appropriate treatment.

Clinical profile of multi-drug reisitance tuberculosis in adults

on 24 march 1884 etiological agent of tuberculosis was discovered by German doctor Dr. Robert Koch, this discovery led to variety of medical applications in diagnosis and management of pulmonary TB. Among many infectious disease prevalent in India, drug resistant TB is one among the important public health problem. There are many factor which influence occurrences of the drug resistant TB, our study conducted mainly to understand those factors which influences the drug resistant TB i.e clinical profile of drug resistant TB in tertiary hospital VIMS, Ballari. The prospective study was conducted in patients admitted in medical college hospitals affiliated to Vijayanagar Institute of Medical Sciences, Ballari over a period of 2 years from November 2016 to October 2018. All patients with sputum AFB and X-ray suggestive of tuberculosis were sent to CBNAAT (Cartridge-based nucleic acid amplification test) for detection of drug resistance. Clinical and radiological characteristics, and risk factors were recorded and further analysis was made. Out of 150 patients with pulmonary tuberculosis 28 of them were detected with drug resistance tuberculosis. Out of 28 drug resistance tuberculosis patients all 28 patients had resistance to isoniazid and rifampicin (MDR-TB). During the study period, among the drug resistant tuberculosis patients the maximum patients belonged to age group 35 to 48yrs of age and males (n=24, 85.7%) outnumbered females (n=4, 14.3%). Fever (n=26, 92.9%) was common symptom. And next common symptom was cough (n=25, 89.2%), loss of appetite, shortness of breath, hemoptysis, loss of weight, chest pain and wheezing. HIV (39.2%) was the common comorbidities among the study patients, followed by diabetes mellitus (35.7%), HTN (35.7%) and COPD (28.5%). About 71.5% of the cases were smokers and 64.3% had history of alcohol consumption and 14.2% were tobacco chewers in this study. About 57.1 % (n=16) were taken ATT previously and not completed treatment and 4 of them were relapse case. This study had shown that, drug resistance tuberculosis is more common than a rare entity and also shows that drug residence is associated with HIV and drug defaulter. Appropriate adherence with ATT and early diagnosis is main determinant in drug resistance TB.

CLINICAL PROFILE AND OUTCOME OF PEDIATRIC TUBERCULOSIS IN A TERTIARY CARE SETTING IN CENTRAL INDIA

Objective: To study the clinical profile and outcome of tuberculosis (TB) in children under 14 years of age. Methods: It is a hospital-based cross-sectional study done in a tertiary referral center in Central India from July 2017 to June 2019. After ethical approval, 80 children (under 14 years of age) diagnosed with presumptive TB were enrolled. Those already on TB treatment or prophylaxis for more than 7 days were excluded from the study. Relevant patient details were noted on a predesigned pro forma. Routine first-line investigations for TB were done in all cases. Histopathological and specific radiology tests were done as per the site involved. Microbiological confirmation was done using microscopy, and molecular diagnosis was done by a cartridge-based nucleic acid amplification test (CBNAAT). Results: Overall mortality was 13.8%, and 82% of them were children below 5 years of age. As per WHO criteria, 52.5% and 20% of children below 5 years of age were severely and moderately undernourished, respectively. History of contact was present in 66%; BCG scar in 91.3%; and tuberculin sensitivity test positivity in 56% of cases. Fever, cough, and weight loss were the most common presenting complaints. The majority had extrapulmonary involvement (75%), with neurotuberculosis being the most common and with the highest mortality (70%). Microbiological confirmation was possible in only 8.8% of cases. Conclusion: It is still challenging to diagnose pediatric TB. Though newer diagnostics are now available, clinical suspicion is a valuable tool. The diagnosis of pediatric TB should thus be based on a combination of epidemiological variables, clinical suspicion, and supported by various laboratory investigations.

Diagnostic Utility of Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) on Induced Sputum Versus Gastric Aspirate Samples for the Diagnosis of Paediatric Pulmonary Tuberculosis.

Tuberculosis (TB) in children is neglected, mainly due to a lack of sensitive diagnostic tools. Paediatric TB is now a global priority. More paediatric TB cases are being recorded as a result of the introduction of Xpert® Mycobacterium tuberculosis (MTB)/rifampicin (RIF) (Cepheid Inc., Sunnyvale, USA). This study was undertaken to evaluate the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children. We recruited 70 paediatric patients with probable pulmonary TB and their gastric aspirate (GA), and induced sputum (IS) samples were collected between January 2021 and June 2022 in Saifai, Etawah, Uttar Pradesh, at the Microbiology Department of the Uttar Pradesh University of Medical Sciences (U.P.U.M.S.). All samples were subjected to smear examination, Bacterial Activation ofContinuousTemperature andEnvironmentalControl -MycobacterialGrowthIndicatorTube (BACTEC-MGIT) culture, and Xpert MTB/RIF. The specimens included 70 GAs and 70 IS samples. The total number of specimens were 140 and we collected GA as well as IS from each of the patient enrolled in the study.When compared to microscopy, GeneXpert provides a quicker and earlier detection of paediatric TB. The sensitivity of the cartridge-based nucleic acid amplification test (CBNAAT) against mycobacterial growth indicator tube (MGIT) was 75.0% for GA samples and 63.64% for IS samples. Paediatric TB, owing to its paucibacillary nature and difficulty in the collection of samples, makes the diagnosis difficult by conventional methods. Our study shows that smear and culture yield in GA samples are superior to those of IS samples and the sensitivity of Xpert MTB/RIF assay is also significantly different in GA and IS samples, but a combination of GA and IS yielded the best results.

Hearing assessment and treatment outcome in ENT tuberculosis at a tertiary hospital in India

AimAn attempt has been made to observe the response of anti-Koch’s treatment and the effect of anti-Koch’s treatment on hearing in ENT tuberculosis patients by pure tone audiometry.Material and methodsA prospective observational study was carried out at the Government Medical College Hospital. A total of 200 cases diagnosed with tuberculosis in the head and neck regions were included in the study. Sputum/pus of patients were sent for cartridge-based nucleic acid amplification test (CBNAAT). Hearing assessment was done with PTA1 at the start of the treatment, PTA2 after the intensive phase (IP) at 2 months for newly diagnosed patients and at 3 months for previously treated patients, and PTA3 at the end of the AKT treatment given as per guidelines.ResultsAmong 200 ENT tuberculosis patients, 176 patients were cured with a new case regimen, and one patient was a defaulter. Among 19 patients who were previously treated cases (CAT II regimen), two patients had treatment failure, and the other 17 patients were cured. Four patients diagnosed to have multidrug-resistant tuberculosis (MDR-TB) on the initial drug susceptibility testing (DST) were given 24 months’ treatment according to the recent guidelines of MDR-TB treatment regimen, and the patients were cured. In the present study of 200 patients, in the first PTA, 192 patients had normal hearing; in the second PTA, 106 patients had normal hearing; and in the third PTA, 35 patients had normal hearing. 21.7% of cases who were on aminoglycoside therapy developed significant sensorineural hearing loss in high frequency.ConclusionAnti-Koch’s treatment (AKT) has proven effective in ENT tuberculosis. All patients taking anti-Koch’s treatment should be regularly monitored for hearing loss, adherence to treatment, drug-resistant variants, and local recurrences.

Pleural tuberculosis in Bhubaneswar, Odisha, during 2016 to 2022

We conducted a retrospective study to evaluate the burden of tuberculosis and rifampicin resistance in patients with pleural effusion in Bhubaneswar, Odisha, during February 2016, to December 2022, using cartridge-based nucleic acid amplification test (CBNAAT, Xpert MTB/RIF). Of the 1370 pleural fluid samples tested at the National Reference Laboratory for tuberculosis, 3.8% (52/1370) were positive for M.tuberculosis. Rifampicin resistance was detected in 3.8% (2/52) samples. The positivity was 5% in 2016, increased to 7.5% in 2020, and was 4.4% in 2022. The positivity varied across age groups, ranging from 1.5% in patients aged >60 years to 6.1% in 15–30 years.

Development and evaluation of PlasmoPod: A cartridge-based nucleic acid amplification test for rapid malaria diagnosis and surveillance.

Malaria surveillance is hampered by the widespread use of diagnostic tests with low sensitivity. Adequate molecular malaria diagnostics are often only available in centralized laboratories. PlasmoPod is a novel cartridge-based nucleic acid amplification test for rapid, sensitive, and quantitative detection of malaria parasites. PlasmoPod is based on reverse-transcription quantitative polymerase chain reaction (RT-qPCR) of the highly abundant Plasmodium spp. 18S ribosomal RNA/DNA biomarker and is run on a portable qPCR instrument which allows diagnosis in less than 30 minutes. Our analytical performance evaluation indicates that a limit-of-detection as low as 0.02 parasites/μL can be achieved and no cross-reactivity with other pathogens common in malaria endemic regions was observed. In a cohort of 102 asymptomatic individuals from Bioko Island with low malaria parasite densities, PlasmoPod accurately detected 83 cases, resulting in an overall detection rate of 81.4%. Notably, there was a strong correlation between the Cq values obtained from the reference RT-qPCR assay and those obtained from PlasmoPod. In an independent cohort, using dried blood spots from malaria symptomatic children living in the Central African Republic, we demonstrated that PlasmoPod outperforms malaria rapid diagnostic tests based on the PfHRP2 and panLDH antigens as well as thick blood smear microscopy. Our data suggest that this 30-minute sample-to-result RT-qPCR procedure is likely to achieve a diagnostic performance comparable to a standard laboratory-based RT-qPCR setup. We believe that the PlasmoPod rapid NAAT could enable widespread accessibility of high-quality and cost-effective molecular malaria surveillance data through decentralization of testing and surveillance activities, especially in elimination settings.

Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult

Background: Antibioma is a loculated collection in the spermatic cord, which is generally a transparent sterile fluid located above the testis in the inguinal region. It is an acquired congenital anomaly that is commonly observed in infants and children. Infected spermatic cord hydrocele has been reported on previously, but to the best of our knowledge, antibioma of spermatic cord hydrocele in adults has not yet been reported. In specific cases of long-standing abscesses, cartridge-based nucleic acid amplification test (CBNAAT) is used as the final diagnostic tool and can determine whether they are of tubercular pathology. Case: Here we are presenting a case of a 72-year-old male patient reporting to the surgery Outpatient Department, with complaints of swelling in the left inguinal region since birth, along with intermittent pain in the swelling for one year. It was diagnosed as antibioma and was confirmed to be of tubercular origin by CBNAAT following surgical exploration. The patient was started on anti-tubercular management as per the National Tuberculosis Elimination Programme protocol. Conclusions: Long standing abscesses are mostly tuberculous. We must look into whether they need urgent attention or can be managed conservatively as a routine procedure.