Diagnosis Of Extrapulmonary Tuberculosis Research Articles

Diagnostic utility of interferon-gamma release assay in extrapulmonary tuberculosis

Early diagnosis of extrapulmonary tuberculosis (EP-TB) is essential. However, diagnosis of EP-TB is difficult. We evaluated the diagnostic utility of an interferon-gamma release assay (IGRA) in diagnosing active EP-TB among suspected patients in Korea. We retrospectively reviewed the clinical records of all patients with suspected EP-TB at Gangnam Severance Hospital in Seoul, Korea. Of the 418 patients with suspected EP-TB, 324 had active EP-TB. The tuberculosis (TB) group had a higher percentage of positive IGRAs (70.2%, 33/47) than the non-TB group (33.3%, 3/9) (P=0.034). The IGRA sensitivity and specificity were 70.2% (63.7–74.8%) and 66.7% (32.9–90.6%), respectively. The sensitivity and specificity of IGRAs in patients with TB lymphadenitis were 81.8% (61.4–90.4%) and 80.0% (35.1–98.9%), but 38.5% (31.2–45.7%) and 50.0% (2.7–97.3%) in patients with TB pleurisy. The diagnostic performance of IGRAs may vary depending on the site of EP-TB involvement. IGRA was potentially valuable for diagnosis of active EP-TB in TB lymphadenopathy.

Clinical utility of anti-lipoarabinomannan antibodies testing for the diagnosis of tuberculous arthritis.

Diagnosis of extrapulmonary tuberculosis (TB) is often challenging. In this work we discuss the utility of an assay for Lipoarabinomannan (LAM) antibody detection in synovial fluid. LAM is one of the three major groups of lipopolysaccharides within the Mycobacterium tuberculosis (MTB) cell wall. An ELISA based test was used to investigate the presence of antibodies against LAM in an immunocompetent patient with knee arthritis. The symptoms resolved after isoniazid treatment. LAM positivity has been used as a diagnostic tool for TB in different settings, including veterinary field. The test could be of some value to diagnose tuberculous arthritis in selected patients when gold standard test returned negative although further investigations are welcome.

To Assess the Burden of and Trends in Extra Pulmonary Tuberculosis at a Tertiary Care Hospital in India

Introduction: Extra pulmonary form of tuberculosis is an important public health disease which cannot be ignored because of its low transmissibility. Data on the exact burden of the disease in developing countries is scarce. Aim: To assess the burden of the disease in a tertiary care hospital of India. To study the clinical trends in the disease, and the utility of various diagnostic modalities for its diagnosis. To identify the Mycobacterial species and perform drug susceptibility test. Materials and Methods: A cross sectional study was carried out for a period of two years. A total of one hundred and forty seven samples were tested for extrapulmonary tuberculosis using a combination of bacteriological, cytological, histological and biochemical techniques to achieve proper diagnosis of the disease. Results: Young adults and females predominated in the study group and positive cases. Original Research Article Fatima et al.; BJMMR, 8(6): 495-502, 2015; Article no.BJMMR.2015.472 496 Microbiologically, 26% of the specimens were positive. Eighteen percent of them were found to be culture positive for M. tuberculosis. Smear by Ziehl Neelsen stain was positive in 9%. A combination of culture media both solid and liquid maximized the yield of Mycobacteria. Lymph node tuberculosis was found to be the predominant type followed by others. Fifteen percent of the strains were found to be resistant to the first line drugs used in treatment of tuberculosis. Cytology and biochemical findings were found to be less specific in diagnosis of extrapulmonary tuberculosis. Conclusion: Extrapulmonary form of tuberculosis is seen in significant number of the suspects. Hence, attention should be paid towards its proper and early diagnosis followed by rational management, as if neglected may lead to associated complications and sequalae.

Diagnosis and treatment of extrapulmonary tuberculosis.

Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment.

Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need.

During the last decade, remarkable progress has been made in the diagnostics of pulmonary tuberculosis; however, diagnostic challenges in extra-pulmonary tuberculosis (EPTB) remain to be addressed. Diagnosis of EPTB is difficult due to the pauci-bacillary nature of disease, the variable clinical presentation, and need for invasive procedures to secure appropriate sample, and lack of laboratory facilities in the resource-limited settings. A more accurate test to diagnose various forms of EPTB, which can easily be incorporated in the routine TB control programme, would contribute significantly towards improving EPTB case-detection and thus reducing the morbidity and mortality. In this overview, we describe the status of current conventional and newer methods available for laboratory diagnosis of EPTB and discuss the challenges in their implementation in the resource-limited settings, and suggestion for better EPTB diagnostic algorithms, which can be incorporated in the routine TB control programmes.

Evaluation of the BACTEC MGIT 960 TB with Solid Media for Recovery of Mycobacteria from Extrapulmonary Specimens in South Tunisia

The slow growth of M. tuberculosis complex is a major challenge for TB diagnosis, hence the importance of using media to obtain quick results. We compared the system MGIT960 to solid media: LJ and Coletsos in the diagnosis of extrapulmonary tuberculosis. A total of 634 extrapulmonary samples were processed for direct AFB smear examination, and culture on MGIT960 and solid media. 98 strains were isolated by the three media (15.4%). The mycobacterial recovery rate was 93.8%, 77.5% and 70.4% respectively for MGIT960, LJ and Coletsos media. The mean turnaround time for mycobacterial growth for MGIT960 was 18.5 ± 7.6 days. It was respectively 44.8 ± 19.3 and 42.8 ± 19 days for LJ and Coletsos media. Unlike most studies, the MGIT960 contamination rate (1.7%) was lower than that of solid media (2.2% for LJ and 2.5% for Coletsos). The MGIT 960 offers several advantages: speed, sensitivity and ease of use.

Accuracy of the Xpert® MTB/RIF assay for the diagnosis of extra-pulmonary tuberculosis in South Korea.

The Xpert(®) MTB/RIF assay has been endorsed by the World Health Organization for the detection of pulmonary and extra-pulmonary tuberculosis (EPTB). To determine the accuracy of the Xpert assay in diagnosing EPTB in South Korea, a country with an intermediate TB burden. We retrospectively reviewed the medical records of 1429 patients in whom the Xpert assay using EPTB specimens was requested between 1 January 2011 and 31 October 2013 in a tertiary referral hospital in South Korea. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of EPTB and detection of rifampicin (RMP) resistance were calculated. Using culture as gold standard, the sensitivity, specificity, PPV and NPV of the assay were respectively 67.7%, 98.1%, 60% and 98.6%. Using a composite reference standard, the sensitivity, specificity, PPV and NPV were respectively 49.3%, 100%, 100% and 95.1%. The sensitivity, specificity, PPV and NPV for the detection of RMP resistance among specimens with positive results for Mycobacterium tuberculosis were respectively 80%, 100%, 100% and 97.7%. The Xpert assay showed acceptable sensitivity in certain groups and excellent specificity in diagnosing EPTB and detecting RMP resistance in an intermediate TB burden country.

Accuracy of the Xpert MTB/RIF assay for diagnosis of extrapulmonary and pulmonary tuberculosis when testing non-respiratory samples: a systematic review

Although the evidence base regarding the use of the Xpert MTB/RIF assay for diagnosis of pulmonary tuberculosis (TB) when testing respiratory samples is well established, the evidence base for its diagnostic accuracy for extrapulmonary and sputum-scarce pulmonary TB when testing non-respiratory samples is less clearly defined.

Utility of Line Probe Assay for diagnosis of extrapulmonary tuberculosis

IntroductionIn 2008, the World Health Organization (WHO) approved a rapid molecular test known as Line Probe Assay (LiPA) for the diagnosis of multidrug-resistant tuberculosis (MDR-TB) in pulmonary specimens. Due to lack of available data, its use in extra-pulmonary tuberculosis (EPTB) specimens has not been determined yet. Recommendations for the use of Xpert MTB/RIF in EPTB have been issued, but alternative rapid molecular tests for EPTB diagnosis need to be evaluated. MethodLiPA (GenoType® MTBDRplus 2.0 Hain Lifescience) was performed on 97 specimens of extrapulmonary origin at the clinical laboratory at Aga Khan University (Dec 2012–Jan 2014). The results were compared with TB cultures in solid and liquid medium. Results97 specimens were tested simultaneously for culture and LiPA, including pleural fluid (35), CSF (22), pus (17), tissue (10) and urine (3). Concentrated smear was positive for 7 while 14 were culture positive for MTB. All 7/7 smear-positive specimens were LiPA positive, while 6/7 were culture positive. Amongst the smear-negative specimens, 8/90 were culture positive and 9/90 were LiPA positive. The overall sensitivity and specificity of LiPA for the detection of MTB in the EPTB specimens was 71.4% (95% CI 41.9–91.4) and 92.8% (95% CI 84.9–97.3), respectively. The highest sensitivity (100%) was seen in urine as 2 of 3 which were culture positive were also LiPA positive. Pus samples showed sensitivity of 85.7% and specificity of 70%. ConclusionThe study shows that LiPA has good overall sensitivity and specificity compared with culture. Although the number of samples was very small, the applicability appears to be most useful in urine and pus specimens and should be explored further as a diagnostic tool in these cases.

Evaluation of Pulmonary and Extrapulmonary Tuberculosis in Immunocompetent Adults: A Retrospective Case Series Analysis

Objective: It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients. Subjects and Methods: A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. Results: Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000). Conclusion: There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.

Evaluation of the performance of 2 DNA-based methods for the detection of extra-pulmonary tuberculosis in comparison with the conventional culture technique

IntroductionDiagnosing extra-pulmonary tuberculosis continues to be a challenge for both infectious disease specialists and microbiologists. ObjectivesThis prospective study was done to evaluate the performance of two DNA-based methods for the detection of extra-pulmonary tuberculosis in comparison with the conventional culture technique. MethodsAll extra-pulmonary specimens received by the Kuwait National Tuberculosis Reference from October 2011 until August 2013 were included in the study. Smears were stained by Ziehl Neelson (Merck, Germany) followed by inoculation of the specimens into GeneXpert MTB/RIF assay (Cepheid, USA), ProbTec ET PCR (Becton Dickinson) and MGIT 960 (Becton Dickinson). Urine was inoculated into Lowenstein Jensen media (MAST). ResultsA total of 1674 extra-pulmonary specimens (pleural fluid 553, ascetic fluid 194, cerebrospinal fluid [CSF] 85, Urine 67, other sterile body fluids 153, fine needle aspirates [FNA] 301, pus 181, tissue 102, swabs 27 and stool 11) were evaluated. Out of 155 extra-pulmonary specimens that grew Mycobacterium tuberculosis (MTB) by culture, 143 were positive by GeneXpert compared with 128 by ProbTec with a sensitivity of 92% and 83%, respectively. Out of 1517 specimens that did not grow by culture, 52 were detected by GeneXpert while 46 were detected by ProbTec with specificity of 96.5% and 96.9%, respectively. All the 4 smear-negative CSF samples which grew MTB were positive by GeneXpert with a sensitivity of 100% compared with only 2 detected by ProbTec with a sensitivity of 50%. Additionally, all CSF specimens that did not grow by culture were negative by both the molecular methods showing 100% specificity. Of the 3 smear-positive urine specimens that grew by culture, all were positive, and of the 64 samples that did not grow by culture, all were negative by both the molecular methods with a sensitivity and specificity of 100%. For other sterile body fluids the sensitivity and specificity of both the methods were 68% and 99%, respectively. Finally, for FNA, pus and tissue, the sensitivity of GeneXpert was 97% compared with 86% for ProbTec. ConclusionDNA-based technology looks promising for the rapid diagnosis of extra-pulmonary tuberculosis with an overall better performance of GeneXpert over ProbTec.

Diagnóstico genotípico y fenotípico de tuberculosis ósea y miliar en un paciente VIH positivo en Bogotá, Colombia

Tuberculosis is the single most frequent cause of death by an infectious agent worldwide. Diagnosis of extra-pulmonary tuberculosis is not always possible through conventional methods, due to the long time required for cultures and the paucibacillary nature of samples; hence the need of rapid molecular methods. HIV infection increases the risk of tuberculosis, and HIV/tuberculosis coinfection is associated with higher mortality.We describe the case of a 56-year old mestizo male patient suspected of having tuberculosis who consulted the San Ignacio Hospital in Bogotá with a two-month history of a painful ulcerated lesion over the distal third area of the right forearm and in whom HIV coinfection was confirmed.Bone and pulmonary histological examination evidenced multiple granulomas, giant cells and fibrosis. Cultures and IS6110-PCR from lung and bone tissues were positive for Mycobacterium tuberculosis complex. Mycobacterium tuberculosis isolates were sensitive to first line drugs.

English

Extrapulmonary tuberculosis is an important clinical problem particularly in developing countries. The aim of this study was to assess two different samples (blood and fluid) for the diagnosis of extra-pulmonary tuberculosis (abdominal tuberculosis and tuberculous lymphadenitis). The study subjects were recruited from WadMedani Teaching Hospital during 2009-2013. Seventy five ascetic fluid and blood samples were collected from each suspected patient with abdominal tuberculosis and twenty five lymphatic aspirates and blood samples were collected from each suspected tuberculous lymphadenitis patient. DNA was extracted using DNPTM kit (CinnaGenInc) and polymerase chain reaction (PCR) was done using IS6110 gene for both samples. In abdominal tuberculosis, 20/75 (27%) were positive for tuberculosis when ascetic fluid was used and 9/75 (12%) in case of blood samples. The comparison between ascetic fluid and blood samples, showed that, there was a significant difference in both results, P-value < 0.05. In tuberculous lymphadenitis, 13/25 (52%) and 3/25 (12%) were positive to tuberculosis when lymph aspirate and blood were used respectively. This study concluded that the best sample for diagnosis of abdominal TB and lymphadenitis is ascetic fluid and LN aspirate. This study recommends that ascetic fluid and lymph aspirate samples are recommended to be used in molecular diagnostic test. Key words: Extra-pulmonary tuberculosis, molecular diagnosis, acetic fluid, lymph aspirate samples.

Differences between pediatric extra-pulmonary and pulmonary tuberculosis: a warning sign for the future.

BackgroundTuberculosis (TB) remains a major global health problem. The childhood tuberculosis has some unique features different which makes the diagnosis more complicated. Here we described the epidemiologic, clinical and microbiologic features of children with extra pulmonary and pulmonary TB.MethodsThe data of the patients <14 years with active TB were collected and compared in pulmonary (PTB) and extrapulmonary TB (EXPTB) patients.ResultsA total of 128 cases was included. Forty-two cases occurred in children were < 5 years of age; 41 cases between 6–10 years and 45 cases > 10 years. PTB was present in 75,0% of the cases, and EXPTB was present in 25% of cases. There was no significant difference between the EXPTB and PTB by means of distribution of age groups (p=0,201). The rate of patients free of constitutional symptoms were significantly higher in EXPTB compared to PTB(p=0,000). There was no significant difference between EXPTB and PTB by means of sources detection(p=0,069).ConclusionTB is still a major public health problem. EXPTB has an insidious and silent onset without any constitutional symptoms, and both microbiological confirmation and the source by an adult are not frequently found. Moreover, detection of the adult source is mandatory for controlling the TB disease in children

TRC4 Gene Based Pcr Assay in Diagnosis Of Extrapulmonary Tuberculosis

Diagnosis of Extra-pulmonary tuberculosis (EPTB) is challenging due to atypical presentation and various inadequacies of diagnostic tools. This study aimed to evaluate polymerase chain reaction (PCR) assay by using TRC4 primers in comparison with the IS6110 primers to detect Mycobacterium tuberculosis from extra pulmonary samples. This study was done in Microbiology and Immunology Department of BSMMU from 162 extra-pulmonary samples sent for laboratory investigation of M. tuberculosis during the period of March 2013 to February 2014. All patients were subjected to AFB smear by Z-N staining, culture in L-J media and PCR by two primes IS6110 and TRC4. Among EPTB cases 24 (25.26%) were positive by AFB smear and/or mycobacterial culture and 73(76.84%) cases were positive by PCR test. PCR showed significantly higher detection rate of EPTB cases than that of AFB smear and L-J medium culture (p &lt;0.005). Only IS6110 and only TRC4 were positive in 4.1% and 12.5% cases respectively. The sensitivity of PCR using TRC4 primers was higher (85.71%) than IS6110 primers (80.95%). Repetitive elements TRC4 can be an ideal target for PCR assays to identify M. tuberculosis; in strains carrying no copies or single copy of 156110 and can play a significant role in diagnose the EPTB cases.&#x0D; JCMCTA 2014 ; 25 (1): 12-17

English

BACKGROUND & OBJECTIVES: Tuberculosis has affected mankind for over 5000 years, and it still continues to be a leading cause of morbidity and mortality. As for any disease of contagious nature, early diagnosis and treatment remains the mainstay of therapy. This holds true for extrapulmonary tuberculosis as well. Therefore, this study was undertaken to compare the Auramine-O staining with Ziehl-Neelsen (ZN) staining and Lowenstein Jensen (L-J) media with Mycobacteria Growth Indicator Tube (MGIT) for diagnosis of extrapulmonary tuberculosis. METHODS: A total of 83 extra-pulmonary samples were processed. All the samples were stained by both ZN and Auramine-O method. The samples were inoculated on L-J media and in MGIT after performing the NALC-NaOH (N-Acetyl-L-cysteine NaOH) procedure according to standard protocol. All the isolates obtained were identified biochemically using standard procedures. RESULTS: ZN staining failed to detect acid-fast bacilli in any of the extra-pulmonary samples, while Auramine -O staining detected 5 of the positive cases. Growth on L-J media was obtained in 4 samples while MGIT was positive in 8 samples. INTERPRETATION & CONCLUSIONS: We found out that Auramine-O staining was better than ZN staining and MGIT was better than L-J media for the extra-pulmonary

The Clinical Utility of Polymerase Chain Reaction and Adenosine Deaminase (ADA), for the Diagnosis of Pleural Tuberculosis: Indian Scenario

Background and Objectives: In spite of higher incidence and prevalence of tuberculosis, the diagnosis of extra-pulmonary tuberculosis (EPTB) in various clinical specimens (such as pleural fluid, ascitic fluids, CSF, lymph node aspirate etc), remains true challenge. Current tools for the diagnosis of tuberculosis in various body fluids are suboptimal. Clinicians underestimate these diseases, and use of insensitive conventional analytical method has contributed to the difficulties in managing patient with extra pulmonary tuberculosis. It is important to develop rapid, sensitive and specific test for early diagnosis of extra pulmonary tuberculosis because of the lack of sensitivity & specificity of the conventional methods as AFB smear by ZN technique and culture on LJ media. Pleural tuberculosis (TB) diagnosis often requires invasive procedures such as pleural biopsy. The study was undertaken to evaluate the combined utility of polymerase chain reaction (PCR) for different gene targets (IS6110, MPB64 and protein antigen b; Pab ) especially in pleural fluid specimens with adenosine deaminase (ADA) levels in the diagnosis of pleurisy. Methods: Total 430 clinical specimens (412 extra-pulmonary and 18 pulmonary tuberculosis) were recruited from the outdoor and indoor Department of National Institute of Tuberculosis and Respiratory Diseases, New Delhi during the 2011-2013 periods. All specimens were further processed for AFB smear, culture on LJ media, ADA level and conventional PCR (IS6110 & MPB 64 and Pab gene targets). Results: The PCR positivity IS6110, MPB64 &Pab gene targets was found to be 90.3% (N=28/31) in smear negative & culture positive (as gold standard) extra pulmonary tuberculosis cases. However the total PCR positivity of Pab (43.9%; 181/412) gene target was found to be significantly low as compared to the IS6110 (65.3%; 269/412; X2=37.058; pc=0.000; Odds ratio 2.401; 95% CI=1.795-3.213) & MPB 64 (63.6%; 262/412; X2=31.245; pc=0.000; Odds ratio 2.229; 95% CI=1.669-2.978) gene targets in extra pulmonary tuberculosis cases. Further we have analyzed the combined utility of PCR with ADA levels among the body fluids (165 pleural fluid, 15 ascitic fluid, 1 lymph node and 1 cerebrospinal fluid; CSF). Our results indicated that the PCR alone can detect total 72.5% (132/182) TB cases, whereas ADA alone can detect 61.5% (112/182; considering cutoff value >40IU/L or confirmed cases of TB on clinic-radiological findings), M.tuberculosis in body fluids. Further data was compared in between single, two and three gene targets considering cut off value ADA >40IU/L levels in body fluids. Our observation showed that the positivity of tuberculosis cases were significantly higher through three gene targets (N=48/83; 57.8%; Mean of ADA >40IU/L =127.3) as compared to single gene target (N=10/83; 12.1%; Mean of ADA >40IU/L =68.2; X2=36.27; pc=0.000; Odds ratio 10.011; 95% CI=4.272-24.008) utilizing conventional PCR technology. No significant difference has been observed in other body fluids. The combined evaluation of both techniques (PCR and ADA) raised 14-15 % additional diagnosis of tuberculosis in body fluids (158/ 182; 86.8%; in pleural fluid= 147/165; 89.1%).Interpretation and Conclusion: Our results suggested that Protein antigen b (Pab) gene target showed less sensitivity as compared to IS6110 & MPB64. This study demonstrated the combined utility of both techniques (multigene target PCR with ADA level), enhanced the sensitivity of diagnosis of tuberculosis in body fluids. The study also confirmed the high diagnostic utility of PCR and ADA methods in diagnosis of tuberculosis in various paucibacillary body fluids in Indian scenario.

Diagnosis of extrapulmonary TB - experience with the Xpert® MTB/RIF assay in Kwa-Zulu Natal, South Africa

Diagnosis of extrapulmonary TB - experience with the Xpert® MTB/RIF assay in Kwa-Zulu Natal, South Africa

Extra-pulmonary tuberculosis: differential aspects and role of 16S-rRNA in urine

Early diagnosis of extra-pulmonary tuberculosis (EPTB) is important for successful treatment. All cases of EPTB diagnosed at Ramon y Cajal Hospital, Madrid, Spain, from 1997 to 2008 were analysed and compared with pulmonary tuberculosis (PTB) patients to identify differential parameters that could serve to predict the presence of EPTB at initial presentation. Different microbiological techniques were analysed, including amplification of 16S-rRNA in urine. During the study period, 814 cases of TB were diagnosed at our centre; 330 (40.5%) were EPTB. Concomitant PTB was detected in 45% of EPTB cases. The main clinical forms of EPTB were lymphadenitis (86, 26%), miliary TB (60, 18%), and multifocal TB (43, 13%). Variables independently associated with EPTB were human immunodeficiency virus (HIV) infection (OR 3.6, 95%CI 2.4-5.4), older age (>60 years) (OR 3.7, 95%CI 2.5-5.6) and mortality (OR 2.9, 95%CI 1.3-6.3). 16S-rRNA in urine was performed in 82 EPTB patients (25%), among whom a positive result was obtained in 70%; in the PTB group, a positive result was found in 5 of 28 patients (18%) (P <0.001). HIV infection and older age appear to be the main risk factors associated with EPTB. In this study, mortality was significantly higher in patients with EPTB. A positive 16S-rRNA test result in urine is a useful marker of EPTB.

English

BACKGROUND: In a country like India where tuberculosis is rampant and considered as a major public health problem so much that there are national programs aimed towards this disease. Pulmonary form is the most common form but extrapulmonary form of the disease is accounts for 57.9 % of all cases of tuberculosis, in which abdominal TB accounts for most cases. The diagnosis of extra-pulmonary tuberculosis is often difficult because of its varied clinical manifestations .In the abdomen the disease can affect intestinal tract, lymph nodes, peritoneum and solid viscera. CT provides a comprehensive overview of all the abdominal structures and is the imaging modality of choice for evaluation of such patients. In view of this we studied the role of multi-detector computed tomography in diagnosing abdominal tuberculosis.AIMS: The role of multidetector computed tomography in diagnosing abdominal tuberculosis.METHODS AND MATERIALS:This was a study done between over a period of from between December 2011 to November 2012. The reports of all patients who were referred for abdominal CT were searched for tuberculosis and the data was co-related as to whether the patients had tuberculosis.RESULTS: During this period of study a total of 212 studied, 5 cases were diagnosed as having tuberculosis based on abdominal CT. Ascites which was not attributable to any specific disease as a feature; peritoneal involvement was another common feature. CONCLUSION: Tuberculosis continues to be endemic in the developing world and diagnosis of abdominal tuberculosis is usually very difficult, due to nonspecific symptoms and signs. The developments in imaging modalities like CT help in identifying cases of abdominal tuberculosis and the overall organ involvement and should be used whenever there is a high index of clinical suspicion is high.