Diagnosis Of Pulmonary Tuberculosis Research Articles

Construction of ceRNA regulatory networks for active pulmonary tuberculosis

Delayed diagnosis in patients with pulmonary tuberculosis (PTB) often leads to serious public health problems. High throughput sequencing was used to determine the expression levels of lncRNAs, mRNAs, and miRNAs in the lesions and adjacent health lung tissues of patients with PTB. Their differential expression profiles between the two groups were compared, and 146 DElncRs, 447 DEmRs, and 29 DEmiRs were obtained between lesions and adjacent health tissues in patients with PTB. Enrichment analysis for mRNAs showed that they were mainly involved in Th1, Th2, and Th17 cell differentiation. The lncRNAs, mRNAs with target relationship with miRNAs were predicted respectively, and correlation analysis was performed. The ceRNA regulatory network was obtained by comparing with the differentially expressed transcripts (DElncRs, DEmRs, DEmiRs), then 2 lncRNAs mediated ceRNA networks were established. The expression of genes within the network was verified by quantitative real-time PCR (qRT-PCR). Flow cytometric analysis revealed that the proportion of Th1 cells and Th17 cells was lower in PTB than in controls, while the proportion of Th2 cells increased. Our results provide rich transcriptome data for a deeper investigation of PTB. The ceRNA regulatory network we obtained may be instructive for the diagnosis and treatment of PTB.

Diagnosis of Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using Gastric Aspirate in Children with Pneumonic Consolidation

Background: In Bangladesh, there is increased evidence of TB-associated pneumonia in children are currently missed or diagnosed too late resulting in deterioration of condition. The objective of this study was to detect the frequency of pulmonary TB in children presented with pneumonic consolidation by Xpert MTB/RIF assay using gastric aspirate. Materials & Methods: This was a prospective observational study. Admitted children from 6 months to 14 years old from January to December 2020 with clinical features consistent with pneumonia and radiographically confirmed consolidations were enrolled in this study. MT and Xpert MTB/RIF assay using gastric aspirates were done in all cases. Data regarding frequency of TB, clinical features and lab findings of enrolled patients were collected and analyzed. Results: Total 7/60 (11.67%) enrolled patients, were confirmed as Pulmonary Tuberculosis by Gene Xpert using gastric aspirates. The most common clinical signs were fever and cough in all (100%) patients. Others had chest pain 23(38.33%), breathing difficulty 21(35%), vomiting 17(28.33%). Younger children less than 5 years (P=.045), contact with TB patient (P= .001), long duration of fever (P = .001), presence of severe acute malnutrition (P = .001) high ESR (P= .009), positive MT (P=.017) were associated with positive rate of Xpert MTB/RIF assay in children. Conclusions: Xpert MTB/RIF assay can assist in fast diagnosing childhood pulmonary TB especially in patients with fever more than one week, malnutrition and having contact with TB patient. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 65-70

Performance of the BD MAX MDR-TB assay in a clinical setting and its impact on the clinical course of patients with pulmonary tuberculosis: a retrospective before-after study.

Missing isoniazid (INH) resistance during tuberculosis (TB) diagnosis can worsen the outcomes of INH-resistant TB. The BD MAX MDR-TB assay (BD MAX) facilitates the rapid detection of TB and INH and rifampin (RIF) resistance; however, data related to its performance in clinical setting remain limited. Moreover, its effect on treatment outcomes has not yet been studied. We compared the performance of BD MAX for the detection of INH/RIF resistances to that of the line probe assay (LPA) in patients with pulmonary TB (PTB), using the results of a phenotypic drug sensitivity test as a reference standard. The treatment outcomes of patients who used BD MAX were compared with those of patients who did not. Of the 83 patients included in the study, the BD MAX was used for an initial PTB diagnosis in 39 patients. The sensitivity of BD MAX for detecting PTB was 79.5%. The sensitivity and specificity of BD MAX for INH resistance were both 100%, whereas these were 50.0% and 95.8%, respectively, for RIF resistance. The sensitivity and specificity of BD MAX were comparable to those of LPA. The BD MAX group had a shorter time interval from specimen request to the initiation of anti-TB drugs (2.0 days vs. 5.5 days, p=0.001). BD MAX showed comparable performance to conventional tests for detecting PTB and INH/RIF resistances. The implementation of BD MAX as a diagnostic tool for PTB resulted in a shorter turnaround time for the initiation of PTB treatment.

Timely Pulmonary Tuberculosis Diagnosis Based on the Epidemiological Disease Spectrum: Population-Based Prospective Cohort Study in the Republic of Korea.

Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimizing treatment outcomes. The traditional dichotomous time-divided approach for addressing time delays in diagnosis has limited clinical application because the time delay significantly varies depending on each community in question. We aimed to reevaluate the diagnosis time delay based on the PTB disease spectrum using a novel scoring system that was applied at the national level in the Republic of Korea. The Pulmonary Tuberculosis Spectrum Score (PTBSS) was developed based on previously published proposals related to the disease spectrum, and its validity was assessed by examining both all-cause and PTB-related mortality. In our analysis, we integrated the PTBSS into the Korea Tuberculosis Cohort Registry. We evaluated various time delays, including patient, health care, and overall delays, and their system-associated variables in line with each PTBSS. Furthermore, we reclassified the scores into distinct categories of mild (PTBSS=0-1), moderate (PBTBSS=2-3), and severe (PBTBSS=4-6) using a multivariate regression approach. Among the 14,031 Korean patients with active PTB whose data were analyzed from 2018 to 2020, 37% (n=5191), 38% (n=5328), and 25% (n=3512) were classified as having a mild, moderate, and severe disease status, respectively, according to the PTBSS. This classification can therefore reflect the disease spectrum of PTB by considering the correlation of the score with mortality. The time delay patterns differed according to the PTBSS. In health care delays according to the PTBSS, greater PTB disease progression was associated with a shorter diagnosis period, since the condition is microbiologically easy to diagnose. However, with respect to patient delays, the change in elapsed time showed a U-shaped pattern as PTB progressed. This means that a remarkable patient delay in the real-world setting might occur at both apical ends of the spectrum (ie, in both mild and severe cases of PTB). Independent risk factors for a severe PTB pattern were age (adjusted odds ratio 1.014) and male sex (adjusted odds ratio 1.422), whereas no significant risk factor was found for mild PTB. Timely PTB diagnosis should be accomplished. This can be improved with use of the PTBSS, a simple and intuitive scoring system, which can be more helpful in clinical and public health applications compared to the traditional dichotomous time-only approach.

Chest X-ray evaluation using machine learning to support the early diagnosis of pulmonary TB.

<sec id="st1"><title>BACKGROUND</title>TB is a public health problem, and its diagnosis can be challenging. Among imaging methods, chest X-ray (CXR) is the leading choice for assessing pulmonary TB (PTB). Recent advancements in the field of artificial intelligence have stimulated studies evaluating the performance of machine learning (ML) for medical diagnosis. This study validated a new original Brazilian tool, the XmarTB, applied to CXR images to support the early diagnosis of PTB.</sec><sec id="st2"><title>METHODS</title>An ML model was trained on 3,800 normal images, 3,800 abnormal CXRs without PTB and 1,376 with PTB manifestations from the publicly available TBX11K database.</sec><sec id="st3"><title>RESULTS</title>The binary classification can distinguish between normal and abnormal CXR with a sensitivity of 99.4% and specificity of 99.4%. The XmarTB tool had a sensitivity of 98.1% and a specificity of 99.7% in detecting TB cases among CXRs with abnormal CXRs; sensitivity was 96.7% and specificity 98.7% in detecting TB cases among all samples.</sec><sec id="st4"><title>CONCLUSION</title>This diagnostic tool can accurately and automatically detect abnormal CXRs and satisfactorily differentiate PTB from other pulmonary diseases. This tool holds significant promise in aiding the proactive detection of TB cases, providing rapid and accurate support for early diagnosis.</sec>.

Private Sector Involvement in Tuberculosis Control in An Urban City of Western India– A Cross-Sectional Study

Background: In India, TB diagnosis and treatment practices among Private Practitioners (PPs) vary widely and are not properly regulated by the national TB program. Despite their irrational and inequitable practises, PPs remain an important and preferred primary care provider for many people. The study was done to with the objectives to describe different diagnosis and treatment practices of Tuberculosis among private practitioners and their involvement in National Tuberculosis Elimination Program (NTEP). Material and Methods: A cross sectional study was performed among 303 PPs during October 2020 to March 2021 by using stratified random sampling to select private practitioners based on their speciality. Results: Most preferred investigation was Chest X ray (45.2%) followed by sputum smear microscopy (29.7%). Only 71.3% PPs practiced the correct regimen for new cases of Pulmonary TB according to NTEP. More than half of the PPs had TB training (59.7%). Majority of the PPs (90.1%) were involved in NTEP mainly by referral of TB patients to local government centres for treatment purpose. Conclusion: Preferred investigation for diagnosis of pulmonary TB was chest X-ray followed by sputum examination among PPs. The treatment regimen and duration of treatment varies among PPs as per their clinical judgement and practice.

Comparing diagnostic accuracy: Xpert MTB/RIF Ultra vs. Xpert MTB/RIF for diagnosis of pulmonary tuberculosis

IntroductionWith the development of Xpert MTB/RIF (Xpert) and its latest version Xpert MTB/RIF Ultra (Ultra), diagnosis of tuberculosis has improved dramatically. Only few have compared the Ultra to Xpert, especially in varied geographic locations. The ability of Ultra to detect tuberculosis in pulmonary samples was thus compared in the current study to the Xpert for the quick identification of MTBC and resistance to rifampicin (RR) in sputum samples. MethodologyAdults and adolescents (>10 years) with suspicion of pulmonary tuberculosis were enrolled for the study. All the samples were subjected to smear microscopy, liquid culture and molecular methods Xpert MTB/RIF as well as Xpert Ultra in parallel. ResultsA total of 143 sputum samples were cultured in liquid media, with 52 of them proved to be culture positive. Using culture as the “reference standard,” the Xpert Ultra detected MTBC in 45 samples, with sensitivity and specificity of 86.5% (74.2%–94.4%) and 89.9% (81.0%–95.5%), respectively. While the sensitivity and specificity, of Xpert was found to be 76.9% (63.2%–87.5%) and 93.7% (85.8%–97.9%) respectively. Xpert Ultra also detected 78.8% smear negative culture positive samples in comparison to Xpert MTB/RIF which detected 63.6% smear negative samples. ConclusionXpert Ultra can offer a valid TB diagnosis in a fraction of the time it takes to perform a culture and has higher sensitivity than Xpert MTB/RIF. This is especially true for paucibacillary samples with negative sputum smear.

GAMBARAN PEMERIKSAAN TES CEPAT MOLEKULER (TCM) GENEXPERT PADA PASIEN DI RUMAH SAKIT UMUM DAERAH PALEMBANG BARI

Background: Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. The diagnosis of pulmonary TB is made based on the clinical picture, physical examination, radiological picture, laboratory examination, and tuberculin test. The pulmonary TB diagnosis currently used routinely in laboratories including hospitals and health centers is bacteriological diagnosis using the rapid molecular test (TCM) technique, while microscopic examination is used as a follow-up examination (monitoring) in patients receiving treatment. TCM examination is a molecular detection method based on nested real-time PCR. The use of TCM is a priority for TB testing because it has several advantages, including: it can diagnose TB and resistance to rifampicin quickly, accurately with high sensitivity, and results can be known in approximately 2 hours.&#x0D; Objectives: The aim of this study is to see the description of TCM examinations in patients at Palembang BARI Regional Hospital based on gender and age groups. Method: This research was conducted at the Palembang BARI Regional General Hospital Laboratory Installation. The samples taken were from patients at the Palembang BARI Regional General Hospital and not referrals from other health service facilities. 50 samples were taken and grouped based on TCM results, gender and age. Result: In grouping based on TCM results, the highest result was negative. In gender grouping, more male patients underwent TCM examinations. In the age grouping, the elderly are more likely to undergo TCM examinations. Conclusion: There are several factors that cause a person to become infected with TB, namely social status, smoking, and having the habit of drinking alcohol.

Bronchoscopic strategies to improve diagnostic yield in pulmonary tuberculosis patients.

In cases where pulmonary tuberculosis (PTB) is not microbiologically diagnosed via sputum specimens, bronchoscopy has been the conventional method to enhance diagnostic rates. Although the additional benefit of bronchoscopy in diagnosing PTB is well-known, its overall effectiveness remains suboptimal. This review introduces several strategies for improving PTB diagnosis via bronchoscopy. First, it discusses how bronchoalveolar lavage or an increased number of bronchial washings can increase specimen abundance. Second, it explores how thin or ultrathin bronchoscopes can achieve specimen acquisition closer to TB lesions. Third, it highlights the importance of conducting more sensitive TB-polymerase chain reaction tests on bronchoscopic specimens, including the Xpert MTB/RIF assay and the Xpert MTB/RIF Ultra assay. Finally, it surveys the implementation of endobronchial ultrasound with a guide sheath for tuberculomas, collection of post-bronchoscopy sputum, and reduced use of lidocaine for local anesthesia. A strategic combination of these approaches may enhance the diagnostic rates in PTB patients undergoing bronchoscopy.

Retracted: Application Value of SAT-TB Combined with Acid-Fast Staining in the Diagnosis and Treatment of Pulmonary Tuberculosis.

[This retracts the article DOI: 10.1155/2020/3620425.].

Late Diagnosis and Treatment of Pulmonary Tuberculosis in Ziguinchor, Southern Region of Senegal

Background: Untreated smear-positive pulmonary tuberculosis constitutes the main source of transmission of the disease in the community. Aims: The aim of our study was to determine the diagnosis delays of smear-positive pulmonary tuberculosis in adults and to identify the factors associated with the diagnosis delay in Ziguinchor, Senegal. Methodology: This is a prospective descriptive and analytical study carried out from January 1, 2019 to December 31, 2022, in cases of pulmonary tuberculosis whose diagnosis was confirmed by the identification of AFB in sputum after Ziehl Nielsen staining and/or detection of Mycobacterium tuberculosis by Genexpert. Delay was defined as a diagnosis confirmed after 36 days. Logistic regression was performed to determine factors associated with diagnosis delay. Results: A total of 141 patients were included. They had an average age of 40 years ± 16 years, (16 years - 86 years). The peak age group was 16-30 years (34.04%). The sex ratio (M/F) was 1.8. The main characteristics of the patients were: a low level of education (34.8%), work in the informal sector (70.2%) and smoking (25.5%). More than half of the patients (78.44%) had their home less than 5 km from the anti-tuberculosis dispensing center. The patients’ initial symptoms were dominated by cough (90.0%), fever (78%) and weight loss (59.6%). The traditional healer was the first source of care in 40.4%, followed by the health post (37.7%), the health center (16%) and regional hospitals (5.8%). HIV serology was positive in 13.5% of cases. The average time between the beginning of symptoms and the tuberculosis diagnosis was 36± 9.22 days (15 - 58 days). The median time to treatment initiation was 1.8± 1.6 days (1 - 6 days). A diagnosis delay was noted in 53.19%. In multivariate analysis with linear regression, age &gt; 50 years (p = 0.021), use of herbal medicine (p = 0.036) and monthly income &lt; 58 USD (p = 0.039) were the factors associated with late diagnosis of tuberculosis. Conclusion: The diagnostic delay in smear-positive tuberculosis cases is significant in our context.  To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills of caregivers in the health posts and involve after training the traditional healers in the screening and sensitizing process of the population

Utility of rapid on-site evaluation during bronchoscopy in the diagnosis of pulmonary tuberculosis.

Introduction：The diagnostic value of rapid on-site evaluation (ROSE) in bronchoscopy for lung tumors has been widely researched. However, the diagnostic efficacy of ROSE for pulmonary tuberculosis has not been extensively assessed yet. This study aimed to examine the value of ROSE in diagnosing pulmonary tuberculosis during bronchoscopy, and the relationship between ROSE cytology patterns and acid-fast bacilli (AFB) smears and mycobacterial cultures. Methods：A retrospective study was conducted at a single respiratory endoscopy centre, including 418 patients under clinical or radiological suspicion of having pulmonary tuberculosis who underwent bronchoscopy. In addition to the use of ROSE and definitive cytology, material obtained by aspiration/lavage or brushing was sent for AFB smear and mycobacterial culture. If histopathological examination was required, endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB) and transbronchial needle aspiration (TBNA) were performed at the discretion of the clinician. A composite reference standard (CRS) was used as the diagnostic gold standard for this study. The diagnosis obtained by ROSE was compared with the final diagnosis. Results：Of the 418 patients studied, 282 (67.5%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 238 (84.4%); Non-tuberculosis (Non-TB) ，in 44 (15.6%). In 238 pulmonary tuberculosis patients, ROSE cytology showed granulomas without necrosis were observed in 107 cases, granulomas and necrosis in 51 cases, caseous necrosis only in 25 cases, and non-specific inflammation in 55 cases. For the diagnosis of tuberculosis according to CRS, ROSE showed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 76.9%, 68.2%, 92.9% and 35.3%, respectively. The positivity rate for bacterial detection by acid-fast staining and culture at bronchoscopy was 51.7%. The cytological pattern showed a higher detection rate for bacteria in cases of necrosis. Discussion：The application of rapid on-site evaluation (ROSE) during bronchoscopy is a straightforward procedure that delivers an immediate and precise assessment regarding the adequacy of collected samples, enabling a preliminary diagnosis of pulmonary tuberculosis. ROSE has exhibited a higher sensitivity in detecting pulmonary tuberculosis compared to microbiological examinations. In addition, the cytological presentation of ROSE tends to show a higher positivity rate for microbiological testing in caseous necrosis. Therefore, samples with these characteristics should be prioritised for microbiological examination after on-site evaluation.

Discovering novel biomarkers for diagnosis and treatment monitoring of active pulmonary tuberculosis by ion metabolism analysis

Tuberculosis (TB) is a highly lethal infectious disease that poses a global threat. Timely and accurate biomarker for TB diagnosis and treatment monitoring remains a pressing need. Ions, the crucial trace element for humans, may be potential targets for TB diagnosis and the forecasting of TB development. To explore the potential of ions as biomarkers, we measured and compared the levels of various ions in whole blood and plasma samples from healthy control (HC), pulmonary TB patients (TB), cured pulmonary TB patients (RxTB), and other non-TB pneumonia patients (PN) by using ultra-high performance liquid chromatography-tandem mass spectrometry. Our study demonstrated that Cu (AUC = 0.670), Pb (AUC = 0.660), and Zn (AUC = 0.701) in whole blood exhibited promising diagnostic performance for TB. Then we used a neural network (NNET) for TB prediction, the AUC values used to differentiate definite TB from HC or PN in plasma were 0.867 and 0.864, respectively. The AUC values used to differentiate definite TB from HC or PN in whole blood were 0.818 and 0.660, respectively. Our correlation analysis showed that Zn (r= 0.356, p=0.001) and Cu (r= 0.361, p=0.0004) in plasma are most closely related to disease severity. Additionally, six ions (Cu, Sb, V, Mn, Fe, Sr) in plasma and whole blood were altered following anti-TB therapy. These results showed that ions could be diagnostic biomarkers for TB. Furthermore, the level of particular ions can forecast the degree of lung damage and the success of the TB treatment. In conclusion, this study highlights the possibility of using ions from blood samples to enable rapid tuberculosis diagnosis.

Carbon 13 urea breath test as a novel technique in the diagnosis of pulmonary tuberculosis

BackgroundThe Urea Breath Test (UBT) is the golden standard of investigation for Helicobacter pylori. Tuberculosis is common and endemic in Iraq, with limited investigations. This study was conducted to determine the safety and importance of UBT as a method for the diagnosis of active pulmonary tuberculosis. Material and methodA prospective, case-control study trial was conducted to determine the safety of 75 mg of inhaled C13-urea in 50 healthy participants. Then, in national TB, Over the course of a one-year study at a medical city in Baghdad, 50 participants with confirmed active pulmonary tuberculosis were enrolled. The safety of inhaled C13-urea was assessed by physical examination and spirometry. The C13-urea was administered by using a jet nebulizer, followed by the collection of exhaled breath at 15 and 30 min’ post-inhalation. A double-beam infrared spectrophotometer examined the isotopic ratio of (C13) CO2 to (C12) CO2. ResultsThe lung function test, which included forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), did not show any changes that were clinically significant when healthy people and people with pulmonary tuberculosis (PTB) were compared to their baseline values. Additionally, there was no recorded incidence of adverse events among both healthy individuals and those with pulmonary tuberculosis (PTB). After 15 min of the nebulization process, the delta over baseline (DOB) means of the control group and PTB patients were −1.2381 ± 1.8392 and 4.8215 ± 5.1889, respectively. After 15 min of the nebulization process, the DOB means of the control group and PTB patients were −1.9628 ± 3.0717 and 3.5686 ± 3.8484, respectively. ConclusionInhaling 13 C-urea seemed safe. DOB values in PTB patients were greater than in controls. Preliminary data suggest that DOB values at 15 min were higher than 30 min. This has potential for diagnosing Mycobacterium tuberculosis.

Symbolic Artificial Intelligence to Diagnose Tuberculosis Using Ontology.

Pulmonary Tuberculosis (PTB) is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. This paper aims to create Symbolic Artificial Intelligence (SAI) system to diagnose PTB using clinical and paraclinical data. Usually, the automatic PTB diagnosis is based on either microbiological tests or lung X-rays. It is challenging to identify PTB accurately due to similarities with other diseases in the lungs. X-ray alone is not sufficient to diagnose PTB. Therefore, it is crucial to implement a system that can diagnose based on all paraclinical data. Thus, we propose in this paper a new PTB ontology that stores all paraclinical tests and clinical symptoms. Our SAI system includes domain ontology and a knowledge base with performance indicators and proposes a solution to diagnose current and future PTB also abnormal patients. Our approach is based on a real database of more than four years from our collaborators at Pondicherry hospital in India.

Diagnosis Model in Smear-Negative Pulmonary Tuberculosis Using Faster R-CNN

Background: One of the most important human organs in the respiratory system is the lung. The main function of the lung is the respiration process, which is responsible for pumping air into the body. The health of the lung organs is very important, because if this organ is disturbed it will affect the health of the rest of the body. One of the diseases that attacks the lungs is Tuberculosis (TB). TB disease can be cured, but if it is delayed in getting treatment it can increase the risk of death. Method: This research developed a Smear Negative Pulmonary Tuberculosis diagnosis model using the Deep Learning method using the Faster R-CNN algorithm. The data used in this research are x-ray images of the lungs at the Jakarta Repository Center - Indonesian Tuberculosis Eradication Center (JRC-PPTI) clinic, totaling 220 datasets. At the preprocessing stage, the images used for training and testing were used with a size of 1280 x 1280 to see the effect on the accuracy of the prediction results of the Faster RCNN model. The test results are in the form of accuracy values that reflect the performance of the Faster RCNN model in classifying normal (without TB) and abnormal (with TB) test data. Results: The research implementation carried out the training process and testing process for 75% of training images, and 25% for testing images. Training images are labeled using the Img label. In the testing stage of the faster RCNN model, the accuracy value was 62.04%, precision was 40.00%, recall was 64.52% and F1-score was 49.38%. Conclusion: From the results of this research it is concluded that the Faster RCNN model test results using the ResNet 50 model have an accuracy value of 62.04%, Precision of 40.00%, Recall of 64.52% and F1-score of 49.38%.

Application of artificial intelligence in diagnosis of pulmonary tuberculosis.

Application of artificial intelligence in diagnosis of pulmonary tuberculosis.

Truenat: Can it be A Game Changer in Extrapulmonary Tuberculosis?

Tuberculosis is a leading health problem worldwide, with India accounting for the majority of cases. Owing to the diverse clinical presentation and paucibacillary nature of extrapulmonary tuberculosis, it is tough to diagnosis by routine microbiological methods. Newer chip/cartridge based nucleic amplification tests (NAATs) like Truenat and Xpert have proved to be game changer in diagnosis of pulmonary tuberculosis. However, role of Truenat in extrapulmonary tuberculosis is still to be evaluated. This study was undertaken to evaluate the diagnostic yield of truant in various extrapulmonary tuberculosis. The study was conducted during 01 June 2021 to 31 July 2022. Of the total 1481 samples received during study, 761 (52%) were extrapulmonary samples. The highest yield of 36% was found in pus aspirate, followed by a 12% yield in pleural fluid. Overall yield of 12% in various extrapulmonary samples is encouraging. Further studies are required for evaluating Truenat role in rapid diagnosis of EPTB and rifampicin resistance detection for better patient care.

Evaluation of Gene Xpert Test of Stool Specimen with that of Induced Sputum as Gold Standard

Background: Globally Tuberculosis (TB) is a major infectious disease. In 2011, there were an estimated 8.7 million new cases with 6% childhood tuberculosis. The majority of the cases occurring in high TB burden countries worldwide. Confirmed diagnosis of childhood TB remains challenging for physicians. MT test and Chest X-ray usually has very little diagnostic value for the diagnosis of pulmonary tuberculosis in children who has symptom criteria suggestive of PTB. Objectives: This study was done to evaluate of Gene Xpert Test of Stool Specimen with that of Induced Sputum as Gold Standard. Methods: The cross-sectional study was conducted in the Department of Pediatrics, Sir Salimullah Medical College &amp; Mitford Hospital from January 2020 to June 2021. A total of 48 subjects of both sexes with the age range from 1 month to 59 months were included in the study. Data were collected over a period of eleven months and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 22. Results: In this study, most of the children 14 (29.2%) lies between 13 months to 24 months. About most of the children 28 (58.33%) were male and 20 (41.67%) children were female. According to the clinical presentation majority of the children present with fever 39(75.0%), followed by cough (72.9%) and weight loss (50%), history of contact was present in 15 (31.3%) children. Chest X-ray of 54% children was suggestive of PTB (as Consolidation, Milliary mottling, patchy opacity etc) 46% showed normal X-ray findings. Gene X-pert of Induced sputum could detect M.Tuberculosis in case of 12.5% children and in 87.5% cases Gene X-pert could not detect M.Tuberculosis in induced sputum. M.Tuberculosis was detected by Stool X-pert in 18% of children who were clinically diagnosed as PTB. In 82% of patient stool X-pert could not detect M.Tuberculosis. Conclusion: Gene Xpert test of stool specimen is a relatively easy test for the diagnosis ........

Performance evaluation of Truenat MTB and Truenat MTB-RIF DX assays in comparison to gene XPERT MTB/RIF ultra for the diagnosis of pulmonary tuberculosis in Uganda

BackgroundThe World Health Organization endorsed Truenat MTB rapid molecular assay in 2020 and recommended additional in-country evaluation studies before uptake. We evaluated the accuracy and operational feasibility of Truenat MTB assay (Truenat) in comparison with GeneXpert Ultra and culture.MethodsIn a cross-sectional study of 250 presumptive TB patients, participants were requested to provide a sputum sample on the day of their visit to the clinic. The sputum sample was homogenized and a portion was tested using GeneXpert Ultra as per the routine standard procedure and the other portion was tested using Truenat assay at the clinic laboratory. The second sample portion was processed for Concentrated Fluorescent smear Microscopy (CFM), LJ, and MGIT cultures. Truenat sensitivity and specificity were compared to GeneXpert Ultra and culture. Test performance characteristics and operational feasibility assessment data through interview of the study laboratory staff were also collected and summarized as proportions and percentages.ResultsOf the 250 participants recruited in the study, the sensitivity and specificity of Truenat was n/N (%, 95%CI); 66/82 (80.5, 70.2–88.4) and 156/159 (98.1, 94.5–99.6) when compared with Ultra, 50/64 (89.3, 66.0-87.4) and 166/180 (92.2, 87.2–95.6) when compared with LJ, 58/71 (81.7,70.7–89.8) and 131/138 (94.9, 89.8–97.9) when compared to MGIT culture and 59/73 (80.8, 69.9–89.1) and 159/169 (94.1,89.3–97.1) when compared to LJ and/or MGIT culture. The sensitivity of Truenat was lower, 14/23 (60.9, 40.6–82.8) among smear-negative compared to 45/50 (90.0, 78.1–96.6) among smear-positive participants but not different by HIV status. There were no special training needs especially among laboratory personnel with previous GeneXpert /molecular test experience, 19/242 (7.8%) error/invalid, and 12 (17,4%) uninterpretable/indeterminate results mainly for rifampicin resistance determination. However, there were 3 (3.5%) of GeneXpert Ultra indeterminate results.ConclusionAmong presumptive TB patients in Uganda, the Truenat assay has high sensitivity and specificity. The Truenat assay has acceptable operational feasibility attributes when compared with the GeneXpert Assay.