Criteria For Diagnosis Of Tuberculosis Research Articles

Utility of cartridge based nucleic acid amplification test in diagnosis of tubercular lymph nodes on fine needle aspiration and its comparison with zeihl-neelsen staining and concentration bleach method

Tuberculosis (TB) is one of the oldest disease known to humanity and among the deadliest epidemics and is in the top 10 causes of death worldwide. The incidence of tuberculosis in India has dramatically increased and contributing to it is Human Immunodeficiency Virus (HIV). Various diagnostic methods are available for detection of tubercular bacilli. Only full proof criteria for diagnosis of TB is to demonstrate the bacilli from affected tissue. This study was planned in extra pulmonary tuberculosis cases to evaluate different staining methods for demonstration of mycobacterium on FNAC material. To evaluate efficacy of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) in the initial cytodiagnosis of Tubercular Lymphadenitis 147 clinically suspected cases of extra pulmonary tuberculosis mainly TB lymphadenitis who attended cytology OPD were selected irrespective of age and sex. FNAC was performed. Slides stained for PAP, ZN and concentration bleach. Material remained in hub was sent for CBNAAT. PAP stained slides were observed for various morphological pattern.Six morphological patterns were observed. Positivity for acid fast bacilli by ZN staining, concentration bleach method and CBNAAT were compared. Detection of acid-fast bacilli by CBNATT was found more as compared to ZN and Concentration bleach method.

Pancreatic Tuberculosis

Tuberculosis of the pancreas is a rare entity, and anecdotal reports describing imaging features of pancreatic tuberculosis have been described in medical literature. The imaging features including computed tomography (CT) and ultrasonography in diagnosed cases of tubercular involvement of the pancreas are described, with an overview of clinical features and laboratory investigations. We analyzed records of 384 patients of diagnosed cases of abdominal tuberculosis for involvement of pancreas and detected 32 patients (8.33%) who had pancreatic involvement. This included 22 men and 10 women with an age range of 19 to 64 years (mean age of 42.5 years), who were detected to have pancreatic tuberculosis from 1999 to 2004 in our institute. We reviewed the clinical, radiologic (ultrasonographic and CT features), and laboratory findings of all patients. The criteria for diagnosis of tuberculosis were based on ascitic fluid adenosine deaminase level in 14 patients, fine-needle aspiration cytology of lymph nodes in 9 patients, and presence of pulmonary tuberculosis on chest radiograph, which was found in 9 patients. On follow-up, 6 months after antituberculous treatment, 25 patients showed response to anti-Koch's treatment, 3 patients had drug-resistant tuberculosis, 2 patients died, and 2 patients were lost to follow-up. The male/female ratio was 2.2:1. The maximum number of patients was in the fourth decade (30-39 years). The duration of symptoms was spanning between 2 and 11 months, with a mean duration of 6 months. The most common symptom was abdominal pain localized to the epigastrium. Sixteen patients were seropositive for HIV-1 infection. Fourteen patients had history of tuberculosis of the lungs, whereas 18 patients had pancreatic and peripancreatic involvement as the primary manifestation. Ultrasonography showed bulky inhomogenous pancreas in 5 patients; solitary or multiple hypoechoic collections were observed in all 7 and 20 patients, respectively. CT findings demonstrated hypodense collections within the pancreas associated with peripancreatic lymphadenopathy in 29 patients. Three patients had a complex pancreatic mass lesion. Pancreatic tuberculosis can present with a variable spectrum of imaging findings. Tuberculosis of the pancreas should be considered as a diagnostic possibility in patients who present with a pancreatic space occupying lesion associated with peripancreatic lymphadenopathy.

Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population.

This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population. Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (< 65 years) and Group B (> or = 65 years). Natural sputum smears and cultures positive for M. tuberculosis (M. TB) in each group were compared with FOB specimens, acid-fast bacilli (AFB) smears and cultures. Data were analyzed by chi-square tests of independence for each year, then compared to determine statistical significance. Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC-approved criteria for diagnosis of tuberculosis. The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only. In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age < 65), the difference in rates for those in Group B (age > or = 65) was statistically significant (P < 0.05). A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.