Diagnosis Of Extrapulmonary Tuberculosis Research Articles

Adenosine Deaminase Detection in Serum of Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis patients at Dr. Ramelan Hospital Surabaya

Diagnosis of active tuberculosis (TB) is the first step to determine the next treatment management of patient care. The success of the treatment will not be achieved without the determined accurate diagnosis rapidly. The definitive diagnosis of tuberculosis includes the presence of Mycobacterium tuberculosis through smear staining or histopathological examination or culture method or molecular methods, however some of the methods have limitations for TB diagnosis, especially on extrapulmonary tuberculosis (EPTB). In EPTB, culture method is time consuming till 6-8 weeks, where as it requires a rapid diagnosis, while tissue biopsy to obtain histopathological images is an invasive procedure. Likewise, the constrains on determining diagnosis of pulmonary TB (PTB) especially child TB and EPTB. In certain condition, the detected ADA level exceeds the detection limit as well as in TB disease with an active process. To study the meaning detection of Serum Adenosis Deaminase in serum of patients as an indicator in diagnosing of active disease process in Pulmonary and Extra Pulmonary Tuberculosis. This study was an observational study with a cross sectional study method, carried out in 8 months, by taking serum of blood samples from patients diagnosed with PTB and EPTB. The sample examination, then measuring the ADA serum levels using the ELISA method in Dr Ramelan Hospital Surabaya Indonesia, and cofirmed MTBC in blood samples using standard PCR of gyrB gene region in the Tuberculosis Laboratory, Tropical Disease Institute, Airlangga University, Surabaya, Indonesia. In totally 176 serum samples form PTB and EPTB patients, at January 2020 until December 2020, there were no significant results between serum Adenosine Deaminase (ADA) levels in diagnosing Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis at Dr. Ramelan Hospital Surabaya. So, in this study, ADA serum levels could have the potential role in the diagnosis of pulmonary tuberculosis and EPTB, otherwise this study revealed that ADA serum activity is not a useful test for differentiating tuberculosis from other respiratory diseases, and could be an additional test especially for disease active progressive or recovery.

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

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

An Overview of Extra Pulmonary Tuberculosis in Smear Negative Cases and their Analysis

Mycobacterium tuberculosis (MTB), a bacterium which causes the tuberculosis disease, is one of the most trounce disease in the country. It mainly affects the lungs and other parts of the body. Currently smear-positive cases are further confirmed through chest radiography for PTB. These cases are further subjected for short course chemotherapy (SCC), followed by first line primary drugs, a scheme undertaken by National Tuberculosis Programme to overcome PTB infection. However, the identification of infection through smear-negative results are challenging as the cases may become positive over the time and progresses to cause the Extra Pulmonary Tuberculosis (EPTB). Such infections are asymptomatic and referred to as latent infection, where, MTBremains stable for many years at a specific site and later activates. Worldwide about 10-25% of latent infections progress to an active disease and if undiagnosed, the mortality rate may reach up to 50%. Twenty five percent of EPTB infection differs from organ to organ of the body. However, in such cases, diagnosis may be elusive and is usually delayed. The proper identification of infection that strongly focuses on the infection of either i.e., TB or EPTB is the need of the hour. The diagnosis of EPTB will be elusive, necessitating a high index of suspicion over TB or EPTB. However, smear-negative cases may be positive for EPTB infection, where the suspects are to be further subjected for molecular methods of EPTB detection and confirmation.

Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Introduction: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of the time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis.
 Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy.
 Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed.
 Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values. 
 Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy.

Lateral flow urine lipoarabinomannan assay for extrapulmonary tuberculosis diagnosis in adults who are HIV-positive

BackgroundThe diagnosis of extrapulmonary tuberculosis (EPTB) in patients with HIV remains a challenge for clinicians. The World Health Organization recommends the detection of lipoarabinomannan (LAM) for diagnosing pulmonary tuberculosis in patients with HIV. A new generation of urine LAM tests (FujiLAM®) is available. However, studies regarding its accuracy are limited. ObjectiveThis study aimed to evaluate the accuracy of urine LAM tests using FujiLAM® for diagnosing EPTB in patients with HIV. MethodsA cross-sectional study using urine samples of patients at Cipto Mangunkusumo Hospital, Indonesia, was performed from January 2020 to December 2020. Fresh urine was applied to the FujiLAM®. Patients were grouped into definitive, probable, and non-TB groups. The diagnostic accuracy of the urine LAM test was compared with other Mycobacterium tuberculosis specimen gold standard tests. ResultsAmong 62 patients, 16 patients (25.8%) had definitive diagnosis of EPTB. Among those with definitive TB, an urine LAM test yielded a sensitivity of 75% (95% confidence interval [CI]: 47.62-92.73%) and specificity of 73.91% (95% CI: 87-85.73%). Meanwhile, compared with all diagnostic tests (definite + probable TB), FujiLAM® had a sensitivity value of 61% (95% CI 43.36-76.86%) and a specificity value of 92.31% (95% CI 74.87-99.05%). ConclusionThe FujiLAM® test is a feasible method for diagnosing EPTB in patients with HIV.

Utility of PCR in the Diagnosis of Tubercular Lymphadenitis on Fine Needle Aspirates

Background
 Extra-pulmonary tuberculosis is a diagnostic and therapeutic challenge. Diagnosing tubercular lymphadenitis includes identification of epithelioid granulomas, positive Acid Fast Bacilli detected with Ziehl Neelsen’s stain. The disadvantage is the time taken for formation of granulomas. With the advent of RT-PCR, the diagnosis of tubercular lymphadenitis can be made with ease [1].
 Aims and objectives: To utilize PCR and mycobacterial culture on samples obtained from Fine needle aspiration of lymph nodes in order to aid in early diagnosis of extra-pulmonary tuberculosis.
 Materials and methods: Observational descriptive prospective study; Patients with lymphadenopathy >1 cm, above the age of 2 years were included ; FNA was performed, material was used for routine cytological studies (PAP, MGG and Ziehl Neelsen-stained slides), PCR and culture (wherever possible); Comparative values of PCR and culture were utilized for statistical analysis
 Results: Out of 80 cases studied, M. Tuberculosis by PCR was detected on 36 cases (45%); PCR and culture demonstrated MTB in 42.55% of the cases. 9 cases (11.25%) of reactive lymphadenitis were found to be of tubercular etiology on PCR analysis. The Chi-squared test was highly significant. PCR has been found to have a sensitivity, specificity, PPV and NPV of 100%, 92.59%, 90.91% and 100%, respectively. Positive RT-PCR was more common in cases with chronic granulomatous inflammation when compared against reactive lymphoid hyperplasia with a chronic inflammatory infiltrate.
 Conclusion: From this study, we conclude that RT-PCR is a useful ancillary technique to conclusively identify Mycobacterium tuberculosis in samples obtained from fine needle aspiration of lymph nodes.

Role of CBNAAT in the Diagnosis of Extra-Pulmonary Tuberculosis: Experience from a Tertiary Care Hospital in India

Role of CBNAAT in the Diagnosis of Extra-Pulmonary Tuberculosis: Experience from a Tertiary Care Hospital in India

Rapid Molecular Diagnosis of Extra-Pulmonary Tuberculosis by Xpert/RIF Ultra

Rapid detection of Mycobacterium tuberculosis complex and determination of drug resistance are essential for early diagnosis and treatment of tuberculosis (TB). Xpert MTB/RIF Ultra (Xpert Ultra), a molecular test that can simultaneously identify M. tuberculosis complex and resistance to rifampicin directly on clinical samples, is currently used. Xpert Ultra represents a helpful tool for rapid pulmonary TB diagnosis, especially in patients with paucibacillary infection. The aim of this review is to provide an overview of the diagnostic performance of Xpert Ultra in detection of extra-pulmonary tuberculosis.

Comparative study of different diagnostic methods for detection of mycobacteria in clinically suspected patients of extrapulmonary tuberculosis at IGIMS, Patna

Background: Tuberculosis is a global problem and incidence of extra pulmonary tuberculosis is increasing day by day. Diagnosis of extra pulmonary tuberculosis is a little bit difficult than pulmonary tuberculosis. Aim and Objective: The aim of this study is to compare different diagnostic methods like ZN staining, LED-FM and GeneXpert assay for detection of Mycobacterium tuberculosis in extrapulmonary tuberculosis (EPTB) cases in respect to their sensitivity, specificity, PPV and NPV respectively. Methodology: This prospective study was carried out in the Department of Microbiology, IGIMS, Patna, Bihar. Samples from 210 suspected extrapulmonary cases were collected and processed for ZN-stain, LED-FM, GeneXpert assay and MGIT culture. Taking the MGIT culture result as Gold standard, result of ZN-stain, LED-FM and GeneXpert were compared. Result: Out of 210 samples, detection rate of ZN staining, LED-FM, GeneXpert assay and MGIT culture were 10.47%, 14.28 %, 30.47% and 36.66% respectively. The sensitivity, specificity, PPV and NPV of ZN staining and LED-FM were 28.27 %, 100%, 100%, 70.74% and 39.96%, 100%, 100%, 73.88% respectively. The sensitivity, specificity, PPV and NPV of GeneXpert were 59.74%, 86.46%, 71.87% and 78.76% respectively.

Recurrent Bilateral Pleural and Pericardial Effusions due to Tuberculosis in a Child With Doose Syndrome: A Case Report

Tuberculosis (TB) is one of the 10 causes of death worldwide. According to the World Health Organization (WHO) in the 2020 Global Tuberculosis Report, 12% of all infected people correspond to children. Other reports have been published with collected data regarding extra pulmonary TB showing that it reaches 16% of incident cases in United States of America. Pleural TB is common among adolescents and is less frequent in children. Pericardial effusion due to TB is a rare manifestation of extra pulmonary TB, and the diagnosis can be hard to reach. In this paper, we describe the manifestations, diagnosis and management of children with extra pulmonary disease, specifically the simultaneous presence of two sites of TB and the approach in children with Doose syndrome. A 9-year-old male patient with an extensive medical record was admitted with unspecific lower respiratory infection symptoms. The diagnosis was reached with the GeneXpert test after 1 month of evaluation and readmission for massive pleural effusion. He required tube drainage twice and specific management with rifampicin, isoniazid, pyrazinamide and ethambutol. In this case, the symptoms were nonspecific which delayed the diagnosis. The purpose of this case is to emphasize the importance of suspicion and early diagnosis of extra pulmonary TB known as the “great mimicker”. Int J Clin Pediatr. 2022;11(1):14-19 doi: https://doi.org/10.14740/ijcp456

Combination of Xpert® MTB/RIF and DetermineTM TB-LAM Ag improves the diagnosis of extrapulmonary tuberculosis at Jimma University Medical Center, Oromia, Ethiopia.

Ethiopia is one of the high burden countries for extrapulmonary tuberculosis (EPTB); however, the prompt diagnosis of EPTB remains challenging. This study is aimed to evaluate the diagnostic performance of Xpert MTB/RIF and DetermineTM TB-LAM Ag (TB-LAM) for the prompt diagnosis of EPTB in Ethiopia. A total of 147 presumptive EPTB patients, including 23 HIV- positive participants were enrolled. Extra-pulmonary samples were collected from all presumptive EPTB cases and tested for Mycobacterium tuberculosis complex (MTBC) using fluorescent microscopy, Xpert MTB/RIF, and culture. Additionally, urine samples were also collected from 126 participants and were tested by DetermineTM TB-LAM Ag (Alere Inc, Waltham, USA). The Sensitivity and specificity of Xpert and TB- LAM tests were calculated by comparing with a composite reference standard (CRS), which comprises smear microscopy, culture and response to empirical anti-TB treatment. Of 147 patients, 23 (15.6%) were confirmed EPTB cases (culture-positive), 14 (9.5%) were probable EPTB (clinically, radiologically or cytologically positive and received anti-TB treatment with good response), and 110 (74.8%) were classified as "non- TB" cases. Compared to the composite reference standard (CRS), the overall sensitivity and specificity of Xpert MTB/RIF were 43.2% and 100%, respectively with the highest sensitivity for Lymph node aspirate (85.7%) and lower sensitivity for pleural fluid (14.3%) and 100% specificity for all specimen types. The sensitivity and specificity of TB-LAM were 33.3% and 94.4% respectively with the highest sensitivity for HIV co-infected participants (83.3%). The sensitivity of the combination of Xpert MTB/RIF and TB-LAM tests regardless of HIV status was 61.1% whereas the sensitivity was improved to 83.3% for HIV-positive cases. TB-LAM alone has low sensitivity for EPTB diagnosis; however, the combination of TB-LAM and Xpert MTB/RIF improves the diagnosis of EPTB particularly for countries with high EPTB and HIV cases.

Molecular studies on extra-pulmonary tuberculosis among patients attending Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria

In 2010 World Health Organization reported that, one third of the World population had tuberculosis, and it is among the infectious disease with significant morbidity and mortality. Mycobacterium tuberculosis is a successful pathogen that has evolved several mechanisms to manipulate the host immune response. The purpose of this study was to determine the incidence of extra-pulmonary TB in patient that visited DOTs clinic, Aminu Kano Teaching Hospital, Kano Nigeria for treatment. A prospective cross-sectional laboratory based study that involved the use of questionnaire and consent/assent form prior to sample collection. Extra pulmonary tuberculosis samples were tested by MTB/RIF assay using GeneXpert. Descriptive statistics was used to analyzed the data obtained and results were given in charts and tables. Out of 71 samples analyzed along with positive control (H37RV) and molecular grade water as a negative control, 3 (4.2 %) samples had extra-pulmonary TB, among which 2 (2.8 %) were from urine samples and 1 (1.4 %) from acetic fluid. This study shows the existence of extra-pulmonary tuberculosis in the study area; and the tuberculosis was sensitive Mycobacterium tuberculosis. It is therefore important to make screening of patients with sign and symptoms of extra pulmonary tuberculosis using Xpert MTB/RIF assay as regular method for extra pulmonary tuberculosis diagnosis. This will be achieved through enlightenment of the clinicians in our health facilities, our States and local governments should strengthen the laboratory capacity for diagnosis and make the services available and reachable to the patients who need them.

Evaluation of Immunohistochemistry Technique for Diagnosis of Extrapulmonary Tuberculosis in Biopsy Tissue Specimen as Compared to Composite Diagnostic Criteria.

Diagnosis of extrapulmonary tuberculosis (EPTB) has been challenging owing to its paucibacillary nature and diverse clinical manifestations. Immunohistochemistry (IHC) on biopsy specimens has presented a new perspective toward improving tuberculosis diagnosis. MPT64 is a unique antigen that has shown high sensitivity and specificity compared to other conventional techniques in its ability to diagnose tuberculosis as well as differentiate it from nontubercular mycobacteria. In this study, we aimed to analyze the utility of anti-MPT64 in the diagnosis of EPTB. In this cross-sectional study, conducted over a period of 1 year, 52 nonrepetitive samples from 52 participants with a presumptive diagnosis of EPTB were collected and processed. The specimens were subjected to Ziehl-Neelsen staining, GeneXpert, tissue culture by mycobacterium growth indicator tube, H and E staining, and IHC with anti-MPT64. The sensitivity and specificity of anti-MPT64 was computed against a composite diagnostic criterion. Fifty-two consecutive participants satisfying the study criteria were recruited. The mean age of the study population was 37.35 ± 18.71 years. Lymph node specimen accounted for majority of the specimen processed (n = 20, 38.5%). The sensitivity of anti-MPT64 in the diagnosis of EPTB was 68.29%, specificity was 90.90%, positive predictive value was 96.55%, and negative predictive value was 43.47%, when composite criteria were considered standard for diagnosis. Immunohistochemical staining by anti-MPT64 is useful in establishing microbiological diagnosis of EPTB on biopsy specimens.

Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis in children and adolescents.

ABSTRACTThis prospective study describes the use of Gene-Xpert Ultra for the diagnosis of extrapulmonary tuberculosis (EPTB) in children and adolescents, in Rio de Janeiro, Brazil. Eighteen patients were studied; the final diagnosis of EPTB was established in 13 (72%). Gene-Xpert Ultra results showed detection in 10/13 (77%) of EPTB cases (7 of these 10 with trace-positive results). Gene-Xpert Ultra proved to be a promising method for the diagnosis of childhood EPTB.

Routine Ultrasonography for Intensified Tuberculosis Case Finding in High Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) Burdened Countries: A Proposed Frame Work.

Sonography has proven to be valuable diagnostic imaging equipment in the work-up of patients infected with acquired immune deficiency syndrome (AIDS) and tuberculosis (TB) coinfection. An extensive literature search was conducted between 1994 and 2021 for original peer-reviewed articles in the English language on ultrasound application in the diagnosis of extrapulmonary TB (EPTB), ultrasound application in infectious diseases in resource-constrained settings, point-of-care ultrasound in resource-scarce settings among others, across various electronic databases including MEDLINE, PubMed, POPLINE, Scopus and Google Scholar, among others and some gray literature were also retrieved. Emerging themes were identified by their recurrence in literature. Ultrasound imaging is a rapid diagnostic tool and can accurately identify and characterize pathologic findings in patients infected with HIV/AIDS and TB co-infection, such as enlarged lymph nodes, pericarditis, and pleural effusion, among others for prompt patient management. Ultrasonography is cheaper and portable; interfacing software has become more users friendly and image quality significantly improved, making it possible for the provision of imaging services in an increasing number of clinical settings in resource-limited settings where access to diagnostic imaging is scarce. The use of focused assessment with sonography for HIV (FASH) for prompt diagnosis of EPTB in regions with a high incidence of HIV/AIDS and TB co-infection will aid in prompt diagnosis and treatment of patients with undifferentiated TB, thus impacting on morbidity and mortality. The training and deployment of sonographers in endemic regions with a high prevalence of HIV/AIDS and TB co-infection, to diagnose EPTB using FASH protocol is a viable option that is in line with the global drive for intensified case finding and treatment algorithm, with a view to meeting the sustainable development goals target of ending HIV and TB epidemics and achieving universal health coverage.

Tuberculosis – important issues to know

Tuberculosis (TB) is a communicable infectious disease, one of the most frequent infectious causes of morbidity and mortality. Tuberculosis represents an important pu­blic health problem around the world, being present in all countries and in all group ages. Despite being a pre­ven­table and curable disease, 1.5 million people die annually of tuberculosis, being the 13th cause of death and the se­cond infectious killer microorganism after SARS-CoV-2, be­fore HIV/AIDS. TB is most frequently caused by a species of Mycobacterium genus – Mycobacterium tuberculosis, which differentiates from most of the bacteria through its high lipid content of its cellular wall and through an ex­tremely slow multiplication rate, dividing at every 18-24 hours. The diagnosis of pulmonary tuberculosis is made at the territorial dispensary of pneumophthisiology, ac­cor­ding to clinical manifestations, through laboratory in­ves­ti­ga­tions and imaging techniques. The diagnosis of extrapulmonary tuberculosis is made by the specialist doc­tor corresponding to the affected organ. The treatment must be initiated right after the diagnosis, under a strict sur­veil­lance, with a complex of four or five antituberculous drugs, for a period of approximately six months. A worrying issue is represented by the emergence of multiresistant forms to antituberculous drugs, in this case the treatment being longer and more complex, novel research for the dis­co­very of new antituberculous substances being necessary.

Diagnostic yield of CBNAAT in the diagnosis of extrapulmonary tuberculosis: A prospective observational study.

Extrapulmonary Tuberculosis (EPTB) accounts for 15%-53% of all TB cases. In recent years, cartridge-based nucleic acid amplification test (CBNAAT) has emerged as an important diagnostic tool since the diagnostic yield is higher. We conducted this study to evaluate the diagnostic yield of CBNAAT in EPTB. One hundred and four patients with EPTB were included in the study. Samples were subjected to CBNAAT, AFB smear, culture for Mycobacterium tuberculosis and histopathology examination (HPE). Yield of each was estimated as compared to a composite reference standard (CRS). The most common EPTB was lymph node TB (48.1%). CBNAAT was positive in 30.76% of EPTB cases. The highest yield was for bone and joint TB (35.7%), followed by lymph node TB (34%) and abdominal TB (33.3%). Taking CRS as the gold standard, sensitivity of CBNAAT was 32.3%, that of AFB culture was 33.3% and that of HPE was 87.2%. When taken as a single diagnostic tool, HPE had highest sensitivity in diagnosing EPTB when compared to CBNAAT and AFB culture. Use of CBNAAT alone for diagnosis of EPTB may result in missing the diagnosis. A combined modality incorporating CBNAAT, histopathology and AFB culture is the best approach for diagnosis of EPTB.

Diagnosis of Extrapulmonary tuberculosis by cartridge-based nucleic acid amplification test (CBNAAT) and detection of rifampicin resistance on fine-needle aspiration samples: An institution-based study

Diagnosis of Extrapulmonary tuberculosis by cartridge-based nucleic acid amplification test (CBNAAT) and detection of rifampicin resistance on fine-needle aspiration samples: An institution-based study

Role of GeneXpert MTB/RIF assay for the diagnosis of cervical lymph node tuberculosis and rifampicin resistance.

Tuberculosis (TB) of lymph node (TB lymphadenitis) is one of the most common forms of extrapulmonary TB (EPTB) whose diagnosis is critically challenging. Although new diagnostic methods have been developed, especially in patients without a history of TB, the cervical tuberculous lymphadenitis diagnosis is still elusive. This study assessed the applicability of GeneXpert in early diagnosis of EPTB, especially cervical lymphadenopathy. The study was conducted in a tertiary care hospital from January 2018 to December 2020 at the department of microbiology. All the samples of cervical lymph node tissue and lymph node aspirate were followed as per the routine protocol for mycobacterial identification. The sample was divided into two parts: one was used for the new molecular-based GeneXpert MTB/RIF assay and the second one was tested by direct and concentrated acid-fast bacilli microscopy by Z-N staining and culture for the detection of MTB. Among the 145 samples tested, the GeneXpert detected the DNA of MTB in 89 samples (61.37%), whereas the culture test was positive in 42 (28.93%) specimens. GeneXpert also detected 7 rifampicin resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay were 85.71% and 48.54%, respectively. GeneXpert MTB/RIF should be used in conjunction with clinical presentation and other molecular investigation in nonrespiratory specimens.

Tuberculosis: A Head to Toe Radiological Review

Tuberculosis (TB) results from infection by Mycobacterium tuberculosis and can involve any organ or tissue. Early diagnosis of TB is essential for timely initiation of therapy in order to decrease transmission rate and avoid severe morbidity associated with delayed treatment. Although conventional radiography remains the most common initial imaging modality in diagnosis of pulmonary TB, computer tomography (CT) and magnetic resonance imaging (MRI) are modalities of choice with regards to diagnosis of extra-pulmonary TB. The purpose of this paper is to provide a concise review of various imaging manifestations of TB in various organ systems, in order to promote radiologists’ and clinicians’ familiarity with common radiological findings of this important disease.