Definitive Diagnosis Of Pulmonary Tuberculosis Research Articles

A case series of three infants having pulmonary tuberculosis

Progression of primary pulmonary tubercular infection to active disease is not common in infants. Bacterial pneumonia is usually an imposter and its suspicion usually delays a definitive diagnosis of pulmonary tuberculosis and starting antitubercular treatment. Although congenital tuberculosis infection from infective mother is a possibility but most commonly, they acquire postnatal disease by contact with an infectious adult source. We are sharing our experience of three infants referred to our side who were being treated as bronchopneumonia for a period of 15 to 20 days, and subsequently were diagnosed with post primary pulmonary tuberculosis for a period of 1 year.

Diagnostic Yield of Fiberoptic Bronchoscopy Washings among Patients of Sputum Smear Negative Pulmonary Tuberculosis

Fiberoptic bronchoscopy with bronchial washing is done for diagnosis of pulmonary tuberculosis among patients who cannot produce sputum spontaneously. Aim: To evaluate the diagnostic yield of Fiberoptic Bronchoscopy for detection of positive cases in cases of Smear negative pulmonary tuberculosis. Study Design: Cross-sectional study. Methodology: All patients (n=80) were advised NPO for 6 hours before carrying out the procedure. It was done using local anesthesia while retrievement of the instilled amount by 25% was considered successful. The bronchial washings were sent for AFB staining in-order to confirm the presence or absence of Mycobacterium Tuberculosis. Bronchial washing smear was considered positive if 1-9 AFB/HPF are seen on direct microscopy. Statistical Analysis: SPSS v.26 analyzed the data. Stratification of diagnostic yield was done with respect to age and gender. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. Results: The diagnostic yield of FOB for detection of positive cases in cases of Smear negative PTB was 57.5%. The highest diagnostic yield was seen in patients in the age group 16-32 and 49-60 years old patients i.e. 37% in both groups. For both genders diagnostic yield for FOB was 50%. However patient’s age and gender were insignificantly associated with diagnostic yield of FOB. Conclusion: It was concluded that FOB can provide a rapid and definitive diagnosis of pulmonary tuberculosis in sputum negative patients. Keywords: Diagnostic Yield, Fiberoptic Bronchoscopy, Smear Negative and Pulmonary Tuberculosis.

Subsequent Antituberculous Treatment May Not Be Mandatory Among Surgically Resected Culture-Negative Pulmonary Granulomas: A Retrospective Nationwide Multicenter Cohort Study.

BackgroundHistologic diagnosis of granuloma is often considered clinically equivalent to a definite diagnosis of pulmonary tuberculosis (TB) in endemic areas. Optimal management of surgically resected granulomatous inflammation in lung with negative mycobacterial culture results, however, remains unclear.MethodsFrom 7 medical institutions in northern, middle, and southern Taiwan between January 2010 and December 2018, patients whose surgically resected pulmonary nodule(s) had histological features suggestive of TB but negative microbiological study results and who received no subsequent anti-TB treatment were identified retrospectively. All patients were followed up for 2 years until death or active TB disease was diagnosed.ResultsA total of 116 patients were enrolled during the study period. Among them, 61 patients (52.6%) were clinically asymptomatic, and 36 (31.0%) patients were immunocompromised. Solitary pulmonary nodule accounted for 44 (39.6%) of all cases. The lung nodules were removed by wedge resection in 95 (81.9%), lobectomy in 17 (14.7%), and segmentectomy in 4 (3.4%) patients. The most common histological feature was granulomatous inflammation (n=116 [100%]), followed by caseous necrosis (n=39 [33.6%]). During follow-up (218.4 patient-years), none of the patients developed active TB.ConclusionsIn patients with surgically resected culture-negative pulmonary granulomas, the incidence rate of subsequent active TB is low. Watchful monitoring along with regular clinical, radiological, and microbiological follow-up, instead of routine anti-TB treatment, may also be a reasonable option.

BIAKAN METODE TETRAZOLIUM MICROPLATE ASSAY TERKAIT DAHAK PASIEN TERDUGA TUBERKULOSIS PARU

The definitive diagnosis of pulmonary tuberculosis is the discovery of Mycobacterium tuberculosis from sputum culture, but theconventional culture methods using Ogawa media require between 3−10 weeks detection time. Therefore it is needed a prompt diagnostictools to shorten the detection time. Tetrazolium microplate assay (TEMA) that used tetrazolium bromide as a growth indicator also usemitochondrial dehydrogenate enzymes in the mitochondria of living M. tuberculosis may reduce yellow tetrazolium bromide into purpleformazan crystals. The aim of this study was to know the validity and speed of time detection of M. tuberculosis growth by analyzingit. This study was carried out from November 2012 up to February 2013, which obtained 105 subjects conducted in the Departmentof Clinical Pathology at Dr. Hasan Sadikin Hospital with a cross sectional study design. The subjects consisting of sputum sample frompatients who suspected pulmonary TB which is examined for culture of M. tuberculosis with TEMA method using Ogawa media. Statisticalanalysis was used a 2í—2 table to test the validity and Mann Whitney test for the differences in growth detection time. The validity testof TEMA method got the sensitivity of 90.4% and specificity of 96.2%. The detection time of M. tuberculosis growth in TEMA methodswas found fastest in the third day while from the Ogawa media cultur was found on the 13th day with the M. tuberculosis growth mediausing TEMA methods detected in 12 days. While for those cultured on Ogawa's media the mean duration is 22 days (p<0.001). Basedon this study, can be concluded the examination of M. tuberculosis culture from sputum patient suffer of pulmonary TB with with TEMAmethod has given high validity and faster in the time detection for the diagnosis of pulmonary TB.

Radiographic Manifestations of Tuberculosis in HIV Positive Patients: Correlation with CD4 Positive Tcell Count

Background: Observations on Tuberculosis HIV co-infection in addition to epidemiologic molecular studies have recently provided strong evidence for the state of immune system as the major determinant of the TB imaging spectrum. However, the presence of any correlation between radiographic findings and the degree of suppression in HIV positive patients still remains controversial. The present study aimed to investigate the TB radiographic manifestation in HIV positive patients and its relationship to the CD4 positive cell count. Methods: Chest radiography of 15 HIV positive patients with a definite diagnosis of pulmonary Tuberculosis in Masih Daneshvari hospital, between 2013 - 2014, were retrospectively reviewed. Radiographic findings and severity were categorized as typical (upper lobe infiltration/cavity) and atypical (middle/lower lobe opacity, adenopathy, pleural effusion and normal X-ray). Demographics and CD4 positive cell count were also recorded. Data analysis was performed using SPSS version 23 (frequency and mean for descriptive quantitative variables and Logistic regression analysis for correlation, P < 0.05). Results: Of a total 15 patients (86.7% men and 13.3% women), 78.6% had CD4 positive counts below 350 (mean SD; 229.15 199.45). The most common radiographic findings in descending order of frequency were adenopathy (53.3%), pleural effusion (26.7%) and cavitation (6.7%) with an overall atypical presentation of 93.3%. This study failed to reveal any statistically significant correlation between CD4 positive cell count and radiographic manifestation as well as severity. Conclusions: In CD4 positive cell count below 500, the dominant radiographic pattern of Tuberculosis is atypical presentation. At this level of immunity, CD 4 positive T cell dysfunction may play a deterministic role in TB radiographic manifestation.

Chronic obstructive pulmonary disease in treated pulmonary tuberculous patients

Abstract Background/Aim To detect the prevalence of chronic obstructive pulmonary disease (COPD) as a sequel of treated pulmonary tuberculosis (PTB). Materials and methods A total of 50 adults, 28 men and 22 women, with a definite diagnosis of PTB and complete antituberculous therapy, with subsequent presentation of exertional dyspnea and/or cough, and expectorations for which no other alternative cause was found, were included in our study. All the patients underwent full history taking, full clinical examination, chest radiography, erythrocyte sedimentation rate, prebronchodilator and postbronchodilator forced vital capacity (FVC%), and forced expiratory volume (FEV1%) in the first second of FEV1/FVC%. Results Pulmonary function testing showed 22 patients (44%) with irreversible obstructive pattern denoting chronic obstructive pulmonary disease (COPD), seven patients had restrictive ventilatory defect, and three patients had mixed obstructive and restrictive pattern. Of those 22 patients with irreversible obstructive pattern (COPD), 11 patients (50%) had mild obstruction, nine patients (40.9%) had moderate obstruction, and two patients (9.1%) had severe obstruction. There is a positive correlation between dyspnea and post-tuberculous COPD patients, and a negative correlation between cough and post-tuberculous COPD patients. There is no correlation between the duration since the completion of antituberculous therapy and development of COPD. Conclusion COPD can be a sequel of PTB and should be overlooked, especially in those patients complaining of dyspnea even in the absence of any history of smoking. Post-tuberculous COPD as a cause of COPD in nonsmokers should be now more recognized in countries where the prevalence of PTB is still high.

Detection in Tetrazolium Microplate Assay Culture Methods from Pulmonary Tuberculosis Suspected Sputum

The definitive diagnosis of pulmonary tuberculosis is the discovery of Mycobacterium tuberculosis from sputum culture, but the conventional culture methods using Ogawa media require between 3−10 weeks detection time. Therefore it is needed a prompt diagnostic tools to shorten the detection time. Tetrazolium microplate assay (TEMA) that used tetrazolium bromide as a growth indicator also use mitochondrial dehydrogenate enzymes in the mitochondria of living M. tuberculosis may reduce yellow tetrazolium bromide into purple formazan crystals. The aim of this study was to know the validity and speed of time detection of M. tuberculosis growth by analyzing it. This study was carried out from November 2012 up to February 2013, which obtained 105 subjects conducted in the Department of Clinical Pathology at Dr. Hasan Sadikin Hospital with a cross sectional study design. The subjects consisting of sputum sample from patients who suspected pulmonary TB which is examined for culture of M. tuberculosis with TEMA method using Ogawa media. Statistical analysis was used a 2×2 table to test the validity and Mann Whitney test for the differences in growth detection time. The validity test of TEMA method got the sensitivity of 90.4% and specificity of 96.2%. The detection time of M. tuberculosis growth in TEMA methods was found fastest in the third day while from the Ogawa media cultur was found on the 13th day with the M. tuberculosis growth media using TEMA methods detected in 12 days. While for those cultured on Ogawa’s media the mean duration is 22 days (p<0.001). Based on this study, can be concluded the examination of M. tuberculosis culture from sputum patient suffer of pulmonary TB with with TEMA method has given high validity and faster in the time detection for the diagnosis of pulmonary TB.

Adenosine Deaminase Level as an Indicator for Differentiating Between Active Pulmonary Tuberculosis Infection and Other Pulmonary Infections

Background: In spite of recent advents, and novel improvements in the diagnosis and treatment of pulmonary tuberculosis (TB), definitive diagnosis of pulmonary TB in children is problematic. Therefore, measurement of the serum level of adenosine deaminase (ADA) was later introduced as a helpful marker for the diagnosis of TB. Objectives: The purpose of this study was to determine the usefulness of the ADA testin the diagnosis of pulmonary TB, and compare enzyme activity between patients with pulmonary TB and those with other pulmonary infections. The sampling strategy was randomized, and the design of study was case-control diagnostic descriptive, we used IBM SPSS V-16.0.2 software for analyzing our data. Patients and Methods: This study was performed at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Tehran, IR Iran. In all, 49 children, divided into 3 groups, were examined. Of these, 22 had pulmonary TB, 17 had other pulmonary infections, and the remaining 10 children were normal and were assigned to the control group. Results: Serum ADA levels were higher in the pulmonary TB patients than in the control group (P < 0.05), however, these levels did not differ significantly between TB patients and patients with other pulmonary infections (P = 0.391). Our evaluation revealed that ADA level in TB patients with a positive smear of gastric washing were higher than those in patients with a negative smear (P = 0.006). Conclusions: Similar to the other studies, this study showed higher serum ADA level in pulmonary TB patients than in normal individuals. However, ADA was not found to be a suitable marker for differentiating between pulmonary TB and other pulmonary infections.

Adenosine Deaminase Level as an Indicator for Differentiating Between Active Pulmonary Tuberculosis Infection and Other Pulmonary Infections

Background: In spite of recent advents, and novel improvements in the diagnosis and treatment of pulmonary tuberculosis (TB), definitive diagnosis of pulmonary TB in children is problematic. Therefore, measurement of the serum level of adenosine deaminase (ADA) was later introduced as a helpful marker for the diagnosis of TB. Objectives: The purpose of this study was to determine the usefulness of the ADA testin the diagnosis of pulmonary TB, and compare enzyme activity between patients with pulmonary TB and those with other pulmonary infections. The sampling strategy was randomized, and the design of study was case-control diagnostic descriptive, we used IBM SPSS V-16.0.2 software for analyzing our data. Patients and Methods: This study was performed at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Tehran, IR Iran. In all, 49 children, divided into 3 groups, were examined. Of these, 22 had pulmonary TB, 17 had other pulmonary infections, and the remaining 10 children were normal and were assigned to the control group. Results: Serum ADA levels were higher in the pulmonary TB patients than in the control group (P < 0.05), however, these levels did not differ significantly between TB patients and patients with other pulmonary infections (P = 0.391). Our evaluation revealed that ADA level in TB patients with a positive smear of gastric washing were higher than those in patients with a negative smear (P = 0.006). Conclusions: Similar to the other studies, this study showed higher serum ADA level in pulmonary TB patients than in normal individuals. However, ADA was not found to be a suitable marker for differentiating between pulmonary TB and other pulmonary infections.

Diagnostic yield of post-bronchoscopy sputum smear in pulmonary tuberculosis

The early definitive diagnosis of pulmonary tuberculosis (TB) is important for control of the disease in the community. We performed this study to evaluate the additional gain of post-bronchoscopy sputum in the diagnosis of pulmonary TB. Bronchoscopy and bronchoalveolar lavage were performed for 126 patients suspected of pulmonary TB who either had 3 negative sputum smears for acid-fast bacilli or could not expectorate. After bronchoscopy the patients were asked to give sputum samples for 3 consecutive days. All of the obtained specimens were investigated for Mycobacterium tuberculosis by smear and culture. Pulmonary TB was confirmed in 56 patients. Among all confirmed cases, the sensitivity of bronchoalveolar lavage smear was 57.1% (32 of 56), sensitivity of post-bronchoscopy smear was 76.7% (43 of 56), and the yield of a combination of the 2 methods was 83.9% (47 of 56). Results of post-bronchoscopy sputum smears were not significantly related to sex, age, human immunodeficiency virus (HIV) infection, presence of cavitary lesions on chest X-ray, or the ability to expectorate before bronchoscopy (p > 0.05). Evaluation of post-bronchoscopy sputum smears is helpful for earlier diagnosis of pulmonary TB and is an inexpensive and accessible assay.

Diagnostic usefulness of transbronchial aspiration and bronchial lavage for pulmonary tuberculosis

Fiberoptic bronchoscopy is a well established methods as a useful tool in the diagnosis of pulmonary tuberculosis with smear negative cases. In order to get the early and definite diagnosis of pulmonary tuberculosis, we performed transbronchial aspiration and bronchial lavage by a fiberoptic bronchoscope in 97 patients. All patients (1) were clinically suspected of having active tuberculosis; (2) showed abnormal chest roentgenogram suggesting tuberculosis; (3) showed negative sputum smears of acid-fast bacilli, or had no sputum. The results of the study were summarized as follows: 1) Final diagnosis of study subjects were 90 patients of active pulmonary tuberculosis, and 7 patients of pulmonary atypical mycobacteriosis. 2) Sputum culture of acid-fast bacilli was positive in 22 out of 90 patients with active pulmonary tuberculosis. 3) Smear and culture examination of acid-fast bacilli of transbronchial aspirates were positive in 9 and 28, respectively out of 90 patients. 4) Smear and culture examination of acid-fast bacilli of bronchial lavage were positive in 12 and 39, respectively out of 90 patients. 5) A rapid and definite diagnosis was made in 16 out of 90 patients by transbronchial aspirates or bronchial lavage. 6) Atypical mycobacteria were detected in 7 out of 97 patients by transbronchial aspirates or bronchial lavage. 7) There were no serious complications such as pneumonia and exacerbation of pulmonary tuberculosis. These results suggested that transbronchial aspiration and bronchial lavage were useful procedures for rapid and definite diagnosis of pulmonary tuberculosis.

Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment

Our objectives were to define the incidence and etiology of solitary pulmonary nodules (SPNs) in patients undergoing living donor liver transplantation (LDLT), describe a diagnostic approach to the management of SPNs in LDLT, and define the impact of SPNs on the overall survival of adult LDLT recipients. Nine patients (9/152, 5.9%) were diagnosed with an SPN on the basis of chest radiography findings during the pretransplant survey. All were male. The mean age was 52 years. All the patients had hepatitis B virus-related cirrhosis with hepatocellular carcinoma. All were asymptomatic for the lung lesion. All underwent contrast-enhanced chest computed tomography (CT) to verify the presence and possible etiology of the SPNs. In 3 cases, CT was used to definitely determine that there was no pulmonary nodule; in 2, CT led to a definite diagnosis of pulmonary tuberculosis. In 4, CT led to a definite identification of an SPN but not to an etiological diagnosis. Two patients underwent outright thoracoscopy and biopsy of their SPNs. Biopsy showed cryptococcosis in both patients. One received a therapeutic trial of an antituberculosis treatment, and repeat CT after 1 month showed a regression in the size of the SPN. A diagnosis of tuberculosis was made. One patient had an inconclusive whole body positron emission tomography scan and subsequently underwent thoracoscopy where biopsy showed tuberculosis. A concomitant malignancy, either primary lung cancer or metastasis from the liver tumor, was not identified. All patients were surviving with their original grafts and were lung infection-free. The overall mean posttransplant follow-up was 54 months (range = 33-96 months).

The Value of Fiberoptic Bronchoscopy in Culture-Positive Pulmonary Tuberculosis Patients Whose Pre-Bronchoscopic Sputum Specimens were Negative both for Smear and PCR Analyses

This study assessed the diagnostic rate of pulmonary tuberculosis (PTB) using fiberoptic bronchoscopy (FBS) in patients with suspected PTB, and negative pre-bronchoscopy smear and polymerase-chain reaction (PCR) in sputum. We retrospectively reviewed 201 culture-positive PTB patients that underwent FBS because both smear and PCR results in sputum were negative. The positive rates of smear for acid fast bacilli, PCR for Mycobacterium tuberculosis, the presence of granuloma in transbronchial biopsy (TBB), and culture of M. tuberculosis were analyzed. In addition, the radiographic features, contribution of FBS to rapid and/or definitive diagnosis of PTB, and drug susceptibility results of M. tuberculosis were also reviewed. There were 136 males and 102 patients under the age of 40 years; non-cavitary (156 cases) and minimal disease (119 cases) on radiographs predominated. The positive rates of FBS were: 44% (smear), 62% (PCR), 61% (TBB), and 87% (culture). These rates increased in smear and PCR examinations when taken from wider spread shadows on radiographs. The combination of the various bronchoscopy samples increased the diagnostic rate to 92% when all examinations were combined. Positive culture results depended on FBS procedures in 80 cases. Twenty-one cases showed resistance to at least one of the major anti-tuberculous agents. This analysis revealed high positive rates of PTB from bronchoscopy samples, providing rapid and definitive ability for PTB diagnosis, and details of drug susceptibility. Therefore, FBS is an important diagnostic procedure in patients with suspected PTB whose sputum specimens were negative both for smear and PCR analyses.

Diagnostic validity of an expert tuberculosis commission that assists the diagnosis of bacteriologically negative suspected TB cases in Havana, Cuba

The Provincial Tuberculosis Commission of Havana, Cuba, a multi-speciality committee, assists clinicians in diagnosing bacteriologically negative tuberculosis (TB). At its weekly meetings, clinicians present the files of suspected TB cases for discussion, diagnosis and recommendations. This prospective study assessed the validity of the diagnoses made by the Commission by comparing the diagnoses made with diagnoses ascertained after one year of follow-up. Between October 2002 and December 2003, 126 patients suspected to have TB but who were bacteriologically negative completed diagnostic work at the Commission. Fifty-three (42%) were diagnosed as TB cases. The definite diagnosis of 116 patients (92%) was ascertained after one year of follow-up. Six patients diagnosed by the Commission as TB cases were suffering from other diseases, while one patient diagnosed with pneumonia had a definite diagnosis of pulmonary TB. The diagnostic sensitivity and specificity of the Commission were 98% (95% CI 93-100) and 92% (95% CI 85-98), respectively. The Provincial Tuberculosis Commission of Havana can be considered a valuable tool for the diagnosis of TB in patients suspected of TB but who are bacteriologically negative. A comparable approach, adapted to the local conditions, could prove useful in other epidemiological and healthcare settings.

A long delay from the first symptom to definite diagnosis of pulmonary tuberculosis.

Despite the recent advances in medicine, still many people suffer from long-standing tuberculosis. Delay in the diagnosis may result in further mortality and morbidity. Because of the importance of delay in the diagnosis, we decided to study and evaluate the patient delay and physician delay. A descriptive analytical study was done on 97 patients referred to the National Research Institute of Tuberculosis and Lung Disease in Tehran from September 2002 through March 2003. Those individuals who fulfilled the inclusion criteria underwent a face to face interview. The questionnaires were filled out. The interval between the first appearance of the clinical manifestation and the first visit to the physician was calculated (patient delay). Also, the period between the patient's first visit to the physician and the final diagnosis was worked out. The mean patient delay time was 15 +/- 13 days with a median of 13 days. The mean physician delay time was 93 +/- 72 days with a median of 75 days. The mean total delay time was 108 +/- 71 days with a median of 96 days. The patient delay in our country is at an acceptable level compared with other countries, but our physician delay time has not been shortened during the last eight years. Improving and upgrading the mycobacteriological courses for general physicians and specialists during their academic years should be accompanied by short-term teaching courses after the graduation.

How many sputum specimens are necessary to diagnose pulmonary tuberculosis?

The definitive diagnosis of pulmonary tuberculosis (PTB) relies on identifying or culturing Mycobacterium tuberculosis from respiratory specimens. National guidelines have recommended obtaining 3 sputum specimens from patients with suspected tuberculosis, but there has been little data on the number of specimens actually needed to support a diagnosis. We retrospectively reviewed all patients diagnosed with PTB at a public inner-city hospital and assessed the sensitivity of the acid-fast bacilli (AFB) smear and the number of smears needed to establish the diagnosis. Between January 1, 1997 and October 1, 2000, 425 patients were diagnosed with culture-proven PTB. Acid-fast bacilli (AFB) smears and cultures were performed on 951 respiratory specimens from 425 patients. The overall sensitivity of a positive AFB smear increased from 67% with 1 sputum collected to 71% and 72%, respectively, with the second and third specimens. The sensitivity of smears from 239 HIV-negative patients was 75%, 79%, and 80% with 1, 2, and 3 smears, respectively, collected compared with 57%, 61%, and 62%, respectively, for 142 HIV-positive patients. In summary, 2 respiratory specimens proved adequate in establishing a diagnosis of tuberculosis, and the third specimen added little additional diagnostic value.

Bronchoscopic aspiration and bronchoalveolar lavage in the diagnosis of sputum smear-negative pulmonary tuberculosis

The ability to make a definitive diagnosis in sputum smear-negative pulmonary tuberculosis by bronchoscopic aspiration, bronchoalveolar lavage (BAL), and examination of postbronchoscopy sputum were compared. Thirty-four patients with lesions on chest x-rays suspected of being pulmonary tuberculosis were entered into the study. The diagnosis of pulmonary tuberculosis was subsequently confirmed in 28 patients and the method of arriving at the final diagnosis was analyzed. A positive acid-fast bacilli (AFB) smear result was obtained in 4/28 (14%) of cases by a combination of bronchoscopic techniques and postbronchoscopy sputum examination. Prebronchoscopy sputum culture was positive in 12/28 (43%). Combined with bronchoscopy specimens, a positive AFB culture result was obtained in 26/28 (93%). Sputum examination, bronchoscopic aspiration, and BAL are complementary techniques and together they give a high yield of definitive diagnosis of pulmonary tuberculosis.