Diagnosis Of Pulmonary Tuberculosis Research Articles

Time to diagnosis and treatment of pulmonary tuberculosis in indigenous peoples: a systematic review

BackgroundTime to diagnosis and treatment is a major factor in determining the likelihood of tuberculosis (TB) transmission and is an important area of intervention to reduce the reservoir of TB infection and prevent disease and mortality. Although Indigenous peoples experience an elevated incidence of TB, prior systematic reviews have not focused on this group. We summarize and report findings related to time to diagnosis and treatment of pulmonary TB (PTB) among Indigenous peoples, globally.MethodsA Systematic review was performed using Ovid and PubMed databases. Articles or abstracts estimating time to diagnosis, or treatment of PTB among Indigenous peoples were included with no restriction on sample size with publication dates restricted up to 2019. Studies that focused on outbreaks, solely extrapulmonary TB alone in non-Indigenous populations were excluded. Literature was assessed using the Hawker checklist. Registration Protocol (PROSPERO): CRD42018102463.ResultsTwenty-four studies were selected after initial assessment of 2021 records. These included Indigenous groups from five of six geographical regions outlined by the World Health Organization (all except the European Region). The range of time to treatment (24–240 days), and patient delay (20 days–2.5 years) were highly variable across studies and, in at least 60% of the studies, longer in Indigenous compared to non-Indigenous peoples. Risk factors associated with longer patient delays included poor awareness of TB, type of health provider first seen, and self-treatment.ConclusionTime to diagnosis and treatment estimates for Indigenous peoples are generally within previously reported ranges from other systematic reviews focusing on the general population. However among literature examined in this systematic review that stratified by Indigenous and non-Indigenous peoples, patient delay and time to treatment were longer compared to non-Indigenous populations in over half of the studies. Studies included were sparse and highlight an overall gap in literature important to interrupting transmission and preventing new TB cases among Indigenous peoples. Although, risk factors unique to Indigenous populations were not identified, further investigation is needed as social determinants of health among studies conducted in medium and high incidence countries may be shared across both population groups.Trial registration N/a.

Evaluation of Purified Protein Derivative Changes Based on Mediastinal Lymph Node Density

Background: The present study evaluated purified protein derivative (PPD) changes based on mediastinal lymph node density. Methods: This cross-sectional observational study was performed on 130 patients who were referred to Valiasr and Amir Al-Momenin Hospitals in Arak, Iran for a CT scan for non-infectious and non-tumor reasons. The gender of the patients was recorded, and they then underwent non-contrast CT, and their mediastinal lymph node density was measured and recorded based on the Hounsfield units. Patients were evaluated for changes in the tuberculin test. The induration diameter obtained from the tuberculin test was recorded for each individual. Data analysis was then carried out using SPSS software ver. 20. Results: There was a positive correlation between mediastinal lymph node density and tuberculin test induration diameter, so larger induration diameter in the tuberculin test results in increasing lymph node density result (r = 0.416, P < 0.001). There was a negative correlation between mediastinal lymph node density and age, i.e., mediastinal lymph node density decreased with increasing age (P < 0.001, r = -0.616). Lymph node density was higher in men than in women (P = 0.022). Conclusions: There is a positive correlation between the mediastinal lymph node density and the tuberculin test induration diameter, and the tuberculin test induration diameter increases with increasing lymph node density. There is a negative correlation between the mediastinal lymph node density and age, i.e., the mediastinal lymph node density decreases with increasing age. Lymph node density was also higher in men than in women. Therefore, the results can help ensure an earlier diagnosis of pulmonary tuberculosis, and measuring the mediastinal lymph node density is recommended.

Performance of microbiological tests for tuberculosis diagnostic according to the type of respiratory specimen: A 10-year retrospective study.

The microbial diagnosis of tuberculosis (TB) remains challenging and relies on multiple microbiological tests performed on different clinical specimens. Polymerase chain reactions (PCRs), introduced in the last decades has had a significant impact on the diagnosis of TB. However, questions remain about the use of PCRs in combination with conventional tests for TB, namely microscopy and culture. We aimed to determine the performance of microscopy, culture and PCR for the diagnosis of pulmonary tuberculosis according to the type of clinical specimen in order to improve the diagnostic yield and to avoid unnecessary, time and labor-intensive tests. We conducted a retrospective study (2008-2018) on analysis (34'429 specimens, 14'358 patients) performed in our diagnostic laboratory located in the Lausanne University Hospital to compare the performance of microbiological tests on sputum, induced sputum, bronchial aspirate and bronchoalveolar lavage (BAL). We analysed the performance using a classical "per specimen" approach and a "per patient" approach for paired specimens collected from the same patient. The overall sensitivities of microscopy, PCR and culture were 0.523 (0.489, 0.557), 0.798 (0.755, 0.836) and 0.988 (0.978, 0.994) and the specificity were 0.994 (0.993, 0.995), 1 (0.999, 1) and 1 (1, 1). Microscopy displayed no significant differences in sensitivity according to the type of sample. The sensitivities of PCR for sputum, induced sputum, bronchial aspirate and BAL were, 0.821 (0.762, 0.871), 0.643 (0.480, 0.784), 0.837 (0.748, 0.904) and 0.759 (0.624, 0.865) respectively and the sensitivity of culture were, 0.993 (0.981, 0.998), 0.980 (0.931, 0.998), 0.965 (0.919, 0.988), and 1 (0.961, 1) respectively. Pairwise comparison of specimens collected from the same patient reported a significantly higher sensitivity of PCR on bronchial aspirate over BAL (p < 0.001) and sputum (p < 0.05) and a significantly higher sensitivity of culture on bronchial aspirate over BAL (p < 0.0001). PCR displayed a higher sensitivity and specificity than microscopy for all respiratory specimens, a rational for a smear-independent PCR-based approach to initiate tuberculosis microbial diagnostic. The diagnosis yield of bronchial aspirate was higher than BAL. Therefore, PCR should be systematically performed also on bronchial aspirates when available.

A Study on Sputum Induction in the Diagnosis of Smear Negative or Sputum -Scarce Presumptive Tuberculosis in HIV Patients in A Tertiary Care Center

Background: HIV infection and TB are two major public health problems in most of the developing countries including India. TB also the most common opportunistic infection seen in HIV infected patients in India 1,2. Tuberculosis is a significant increase in the worldwide incidence of TB which is contributed majorly by HIV infection. AIM: To study the role of Sputum Induction to aid in the diagnosis of Smear Negative or Sputum Scare Presumptive Pulmonary Tuberculosis in adults with HIV. Material &amp; Methods: Prospective hospital based observational study. The present study was conducted in the department of TB &amp; Respiratory medicine, Osmania Medical College, Hyderabad. The subjects of the study were selected among the HIV positive with Presumptive Pulmonary Tuberculosis patients who visited the outpatient department or had been admitted in our hospital who agreed for voluntary participation. A total of 50 Presumptive Pulmonary Tuberculosis with HIV co- infection were taken as sample size. Results: The majority of cases (38 %) were in the age group of 31-40 yrs. Mean age of the study group population is 39.76 ± 9.24. The predominant symptom in the present study was loss of appetite. Out of 50 patients 34% (17 patients) were known Diabetic and 10% (5 patients) were known Hypertensive. Most of the patients in my study are smokers (40%). The mean CD4 count in the present study is 182.68. Majority (72%) of patients in the present study did not have previous history of TB. On General examination majority of the patients had Lymphadenopathy. Out of 45 adequate Induced sputum cases, 89% (40 cases) were Negative for Sputum AFB and whereas 11% (5 cases) were Positive for Sputum AFB. Conclusion: Sputum induction is a safe, simple and valuable procedure to obtain adequate sputum samples in suspected cases of pulmonary tuberculosis and can obviate the need for much sophisticated and invasive procedures like bronchoscopy. Sputum induction improves the diagnostic yield for AFB in patients unable to expectorate adequate sputum sample.

Role of Bronchoalveolar Lavage (BAL) Gene Xpert in Diagnosis of PTB in Sputum Smear Negative Patients

The aim of this study was to assess the diagnostic efficacy of Xpert MTB/RIF assay in bronchoalveolar lavage (BAL) in the diagnosis of pulmonary tuberculosis in sputum-smear negative patients. This observational case series study was conducted in a tertiary base institute of Bangladesh from July 2017 to June 2019. All patients with suspected pulmonary tuberculosis who were sputum-smear negative, irrespective of age and gender were included in this study. BAL fluid thus obtained and examined the smear for acid fast bacilli (AFB) and Xpert MTB/RIF assay. The sensitivity, specificity and accuracy values were calculated for smear AFB and Xpert MTB/RIF assay. Xpert MTB/RIF was identified 33 (36.7%) of 90 patients on bronchoalveolar lavage fluid in the final analysis. AFB Fluid culture was positive in 28 (31.2%) cases. The sensitivity and specificity of Xpert MTB/RIF assay was 85.7%, and 85.5% respectively. The positive likelihood ratio was 5.90, and the negative likelihood ratio was 0.167. The accuracy was 85.56%. Xpert MTB/RIF on BAL fluid can be recommended as a fruitful diagnostic tool for mycobacterium pulmonary tuberculosis especially in sputum smear negative, and culture negative patients.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 60-66

Detection of Mycobacterium tuberculosis Complex in Sputum Samples Using Droplet Digital PCR Targeting mpt64.

Tuberculosis (TB) is one of the top 10 causes of death worldwide. It is challenging to find methods of diagnosis of active pulmonary TB that are sensitive enough to detect cases for proper treatment before unintentional transmission. Droplet digital PCR (ddPCR) is a highly sensitive method to detect genetic material of pathogens, but it has rarely been used for diagnosis of TB. This study compared the sensitivity of ddPCR with that of GeneXpert and AFB smear microscopy in 180 leftover sputum samples from patients suspected of having TB on the basis of clinical symptoms and radiography. Absolute quantification of copy numbers of MTB-specific genes was possible using ddPCR targeting the mpt64 gene. Among the 180 samples, 41.1% were diagnosed as having TB using ddPCR. The sensitivities of AFB smear microscopy, GeneXpert and ddPCR were 41.9%, 82.4% and 100%, respectively. AFB smear microscopy and GeneXpert both had a specificity of 100%, and the specificity of ddPCR was 95.3%. The accuracy of ddPCR (97.2%) is higher than that of GeneXpert (92.7%). This robust ddPCR system could potentially be used as a method for early diagnosis of TB.

Barriers and gaps in tuberculosis care and treatment in Iran: A multi-center qualitative study

IntroductionPatients with Tuberculosis (TB) still have barriers in accessing high quality care and treatment services. In this qualitative study, we investigated barriers in accessing TB health services including confirmatory diagnosis, treatment adherence and recurrence of pulmonary TB using patients, physicians, and policy makers point of view. Materials and methodsIn this qualitative research from November to March 2021, 3 policy makers from the Ministry of Health, 12 provincial TB experts and physicians from the TB control program and 33 patients diagnosed with TB from 4 provinces were enrolled for a semi-structured in-depth interview. All interviews were audio recorded and then transcribed. Framework analysis was done by MAXQDA 2018 software to identify key themes. ResultsSeveral barriers reported for TB care and treatment: Poor knowledge of patents about TB symptoms, failure to screen for TB among at-risk patients by physicians, similar symptoms between TB and other lung diseases, low sensitivity of TB diagnostic tests, incomplete case finding and contact-tracing, stigma related to TB, and patients poor adherence due to long TB treatment. In addition, COVID-19 pandemic disrupted TB services and decreased detection, care and treatment services for TB patients. ConclusionOur findings highlight the need for interventions to increase public and healthcare providers awareness about TB symptoms, using more sensitive diagnostic tests, and interventions to reduce stigma, and improve case finding and contact tracing effort. Improving patients’ adherence required better monitoring and shorter effective treatment regimes.

A clinical profile of sputum positive pulmonary tuberculosis among elderly patients

The Pulmonary Tuberculosis has been known to mankind to cause increased morbidity and mortality especially in elderly. There is delay in diagnosis of pulmonary tuberculosis which led to increased mortality. Hence, this study looks into the pattern of presentations of the pulmonary tuberculosis and the radiological features that these patients demonstrate, which may help in early diagnosis and effective management.A cross-sectional, descriptive study was conducted on seventy patients above 60 years of age, who attended the outpatient department or those who were admitted in the geriatric ward of BLDE DU, Shri B. M. Patil Medical College, Hospital and Research Centre with symptoms suggestive of pulmonary tuberculosis over a period of twenty-four months irrespective of sex. The patients who tested sputum positive by ZN Stain for Mycobacterium Tuberculosis irrespective of primary diagnosis, defaulters and reactivation of pulmonary tuberculosis were included in the study group. In our study male predominance was seen with 48% of elderly in age group of 60-65 years. Majority (67%) of patients had typical features like fever, cough, evening rise of temperature while 32% had atypical symptoms like decreased appetite, increased thirst, weight loss and breathlessness. The common comorbid was Hypertension (10%). The most common radiological feature was miliary mottling (21%), while there was 11% mortality reported.This study being carried on elderly with sputum positive have given insight on the various pattern of clinical presentations and radiological features in elderly. Importance of sputum examination cannot be undermined in elderly and high degree of suspicion will help reach the diagnosis.

Value analysis of next-generation sequencing combined with Xpert in early precise diagnosis of pulmonary tuberculosis

The current study aims to investigate the value of combination of NGS with Xpert MTB/RIF in the diagnosis of early pulmonary tuberculosis (PTB). A total of 85 patients with suspected PTB were analyzed retrospectively. The positive detection rates of PTB by Xpert MTB/RIF, TBseq Ultra, TB-DNA, and TB-RNA were significantly higher than those by acid-fast staining. Xpert MTB/RIF, TBseq Ultra, TB-DNA, and TB-RNA possessed higher sensitivity and accuracy than acid-fast stained smears. Kappa agreement analysis showed good agreement between Xpert MTB/RIF and TBseq Ultra. Combined diagnosis improves the detection sensitivity compared with a single diagnostic method. ROC curve analysis showed that Xpert MTB/RIF combined with TBseq Ultra showed the highest area under the curve (0.886). In conclusion, the combined diagnosis of TBseq Ultra and Xpert MTB/RIF harbors the characteristics of short cycle, high specificity and accuracy, which demonstrated a promising application value in the early diagnosis of PTB.

Cutaneous and Pulmonary Tuberculosis—Diagnostic and Therapeutic Difficulties in a Patient with Autoimmunity

Cutaneous tuberculosis (CTB) is a very rare disease and accounts for only 1-2% of cases of extrapulmonary tuberculosis (EPTB). Due to the variety of its clinical manifestations, the uncharacteristic appearance of its lesions, resembling other dermatoses in the early stages, and the limited experience of clinicians due to the rarity of CTB, diagnosis is very difficult. Particularly noteworthy is the fact that most cases of EPTB, including skin tuberculosis (TB), can be a manifestation of systemic involvement. In this paper, we present a case of an immunocompromised patient who was diagnosed with CTB almost a year after the first dermatological lesions were located on the lower extremities. At the same time, due to respiratory symptoms, a diagnosis of pulmonary TB (PTB) was made, and radiological and microbiological confirmations were obtained.

Role Of Sputum And Bronchoalveolar Lavage CBNAAT In The Diagnosis Of PTB In Smear Negative Patients

AIM. To study the use of sputum and broncho alveolar lavage (BAL) for CBNAAT, as an adjunct in the diagnosis of pulmonary tuberculosis, in sputum AFB smear negative patients. OBJECTIVE. To calculate and compare the yield of sputum Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and BAL CBNAAT in sputum AFB smear negative patients. MATERIALS and METHODS. 50 Patients with respiratory symptoms which are suspected of pulmonary tuberculosis with Chest X-ray showing changes consistent with active pulmonary TB and Sputum negative for AFB on two samples were subsequently subjected to sputum CBNAAT, in which 23 out of 50, came out to be positive (46% yield). The remaining 27 patients were subjected to bronchoscopy and the BAL was sent for CBNAAT, in which 23 patients came out as positive (Yield 85%). CONCLUSION. Sputum CBNAAT and BAL CBNAAT prove to be useful adjuncts in the diagnosis of presumptive PTB patients who are sputum AFB smear negative. BAL CBNAAT has higher yield than sputum CBNAAT.

Chest X-rays and CT Results from Tuberculosis Screening in Healthcare Workers Using Interferon- Gamma Release Assay (IGRA)

Background: To examine the prevalence of tuberculosis (TB) in healthcare workers (HCWs) with positive chest X-ray (CXR) and computed tomography (CT) findings and to ascertain the function of imaging in the diagnosis of TB. Aims &amp; Objectives: This study’s objectives included determining the prevalence of TB based on CXR and CT findings in healthcare professionals with positive IGRA results as well as the function of imaging in the diagnosis and management of pulmonary TB. Materials and Methods: Retrospective investigations were conducted on IGRA positive people among 1976 hospital staff who had been TB-screened using the test. CXR was positive for clustered nodular and/or linear streaky opacities in the upper lung zone. The CT results were categorised. as being active, uncertain, inactive, or typical. The class was regarded as CT-positive if it was active or undetermined. Results: In 195 patients, the IGRA was positive. 190 participants (98.95%) and 90 subjects (46.87%) had CXR and CT, respectively. There were 6 of 190 and 14 of 90 patients with CXR- and CT-positive findings, respectively. 9 and 5 of the 14 CT-positive individuals had active and indeterminate TB results, respectively. All 14 CT-positive participants had negative microbiological reactions for TB. Nine CT-positive people were given empirical anti-TB drugs, and 5 of these 14 subjects tested negative for pulmonary TB on the CXR. Conclusion: CT helped diagnose asymptomatic TB in IGRA-positive HCWs.

Diagnostic Yield of Nucleic Acid Amplification Tests in Oral Samples for Pulmonary Tuberculosis: A Systematic Review and Meta-analysis.

The diagnostic accuracy of oral specimen nucleic acid amplification tests (NAATs) for pulmonary tuberculosis (PTB) remains controversial. We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies that reported the diagnostic yield of NAATs in oral samples for PTB diagnosis. The pooled estimates, including those of sensitivity and specificity, were calculated, and a meta-regression was performed to investigate heterogeneity, which was determined using χ2 and I² tests. A total of 23 articles were included, and the pooled sensitivity, specificity, and area under the curve of NAATs in oral samples for PTB diagnosis were 50% (95% CI, 37%-63%), 97% (95% CI, 93%-99%), and 0.89 (95% CI, 86%-92%; I 2 = 99%; chi-square, 169.61; P < .001), respectively. Our data demonstrated that NAATs using oral samples have a less satisfactory sensitivity and high specificity for PTB diagnosis. However, due to significant heterogeneity, such as heterogeneity in age, the results should be interpreted with caution.

Expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in China (2022 edition)

The cure rate of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in the world is about 60%, and timely surgical intervention can increase the cure rate to more than 85%. The treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis requires multidisciplinary involvement of tuberculosis department, thoracic surgery department, imaging department, laboratory department and other disciplines to significantly reduce its morbidity and mortality. Although the World Health Organization has defined the role and status of surgery in the treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis, there are significant differences in the cognition and diagnosis and treatment methods of domestic clinicians on multidrug-resistant and rifampicin-resistant pulmonary tuberculosis. Therefore, it is urgent to develop expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis for clinicians to learn from in clinical diagnosis and treatment practice. The Chinese Society for Tuberculosis,Chinese Medical Association organized experts in tuberculosis thoracic surgery to write the first draft of consensus based on the expert suggestion on surgical diagnosis and treatment of multidrug-resistant pulmonary tuberculosis written by the European Office of the World Health Organization in 2014 and the 2019 version of China's multidrug-resistant and rifampicin-resistant pulmonary tuberculosis expert consensus, and combined with China's national situation. This consensus systematically elaborated seven aspects, including surgical indications, contraindications to surgery, conditions and timing of surgery, surgical methods and indications of various surgical procedures, preoperative and postoperative chemotherapy, treatment of surgical complications, and perioperative management of patients with multidrug-resistant and rifampin-resistant pulmonary tuberculosis. After discussion and voting by experts, six recommendations were formed, aiming to provide reference for clinicians in the treatment of multidrug-resistant and rifampin-resistant pulmonary tuberculosis and further improve the standardized diagnosis and treatment level of multidrug-resistant and rifampin-resistant pulmonary tuberculosis in China.

An Analysis of Two Aged Patients with Pulmonary Tuberculosis

What methods would you choose apart from purified protein derivative (PPD) skin test and culture for acid-fasting bacilli (AFB) to make a clinical diagnosis of pulmonary tuberculosis (TB) in an aged patient with possible TB? These are two cases of pulmonary TB, that occurred with persistent low-grade fever, fatigue and anorexia due to a mild toxemia of tuberculosis. A final diagnosis of pulmonary tuberculosis was established on the basis of mild toxemia(low-grade fever), debilitation and characteristic pulmonary CT imaging, free of PPD and interferon-gamma release assay (T-spot). The authors realized that the dosage of anti-tuberculosis drugs should be carefully controlled and the improvement of their overall nutritional status to gain better efficacy is much more needed.

A Comparative study between the two interferon gamma releasing assays in the diagnosis of pulmonary tuberculosis

Objectives: To examine and compare the diagnostic value of Interferon gamma releasing assay (IGRAs) (T- SPOT TB and Qunati FERON Gold in Tube) in the diagnosis of pulmonary tuberculosis.&#x0D; Materials and methods: The study included 40 patients with active pulmonary tuberculosis. They were attendance of Respiratory Health Care Centers in Mosul City for the period from March to December 2013. From each patient a sputum sample was collected and processed for culture on Löwenstein-Jensen (L-J media). Twelve milliliters (ml) of blood from each patients was collected (10 ml collected in heparinised tube for T SPOT TB and 2 ml in QFT-GIT special tubes)&#x0D; Results: From the total 40 patients with positive AFB staining 37 (92.5%) were culture positive. The specificity of both IGRAs were 100% . The sensitivity of T- SPOT TB test was 91.89%, while the QFT-GIT sensitivity was 86.49%. The positive predictive value of both IGRAs was 100%. The negative predictive value of T SPOT TB was 50 %, while that of QFT-GIT was 37.5 %. There was a moderate degree of agreement between the T -SPOT TB and QFT–GIT in (82.5%, k=0.54, 95%CI). The results of the two IGRAs are not affected by BCG vaccination status of TB patients.&#x0D; Conclusions: The IGRAs could provide a supplementary information as part of diagnostic work-up for tuberculosis diagnosis but it is important to note that a negative IGRA does not rule out active TB . Moreover, and of the two IGRAs, QFT GIT is more convenient to adopted for diagnostic use.

Correlation of serum Adenosine Deaminase levels with microbiological parameters in Pulmonary Tuberculosis.

Accurate diagnosis of pulmonary tuberculosis is largely based on sputum smear microscopy, culture, and GeneXpert MTB/RIF tests; culture being the gold standard. All these diagnostic tests require sputum sample to be positive for Mycobacterium tuberculosis, while many active TB patients often do not present with M. tuberculosis positive sputum. Biochemical markers play an important role in early diagnosis, disease prevention, and drug response in tuberculosis. This study aims to find the association of serum adenosine deaminase (a biomarker) with the various microbiological parameters like sputum smear microscopy, culture and CBNAAT in pulmonary tuberculosis patients. A total of 40 cases were collected from November 2019 to October 2021, and the presumptive cases of pulmonary tuberculosis diagnosed by Ziehl-Neelsen staining for acid fast bacilli and/or CBNAAT were recruited. Serum adenosine deaminase levels were estimated.The following variables were significantly associated (p < 0.05) with serum adenosine deaminase levels: age, sputum smear microscopy findings, time to culture positivity, CBNAAT category and Ct value (Mean).This study does witness few significant correlations between serum adenosine deaminase levels and various microbiological parameters used in diagnosis of TB, which can be further explored and utilised in diagnosis and treatment of pulmonary tuberculosis.

Impact on tuberculosis diagnostic during COVID-19 pandemic in a tertiary care hospital

IntroductionThe aim of this study is to review how did the first three COVID-19 waves affected the diagnostic of tuberculosis and to describe the extra-pulmonary Mycobacterium tuberculosis complex (TB) diagnosis. Materials and methodsA retrospective observational study was done during the first three waves of pandemic to ascertain the impact on TB samples and to recover the extra-pulmonary TB cases we included the first two years of COVID-19. All relevant data was recovered from hospital and Clinical Microbiology records. ResultsPrepandemic period showed an average of 44 samples per week for TB study; during the first three waves this number dropped to 23.1 per week. A reduction of 67.7% of pulmonary TB diagnosis was observed and an increase of 33.3% diagnosis of extra-pulmonary TB was noted when comparing pre-pandemic and pandemic period. DiscussionThe number of declared cases and samples for TB diagnosis dropped during the first three COVID-19 waves due to the overstretched Public Health System which could lead to a delay in diagnosis, treatment and to the spread of TB disease in the general population. Surveillance programs should be reinforced to avoid this.

Colored Cellophane Use in Sputum Smear Microscopic Examination Performance in Pulmonary Tuberculosis Diagnosis

Colored Cellophane Use in Sputum Smear Microscopic Examination Performance in Pulmonary Tuberculosis Diagnosis

Comparison of chlorhexidine 0.7% and modified Petroff's method on sputum decontamination for culture method to detect Mycobacterium tuberculosis

Background: Tuberculosis (TB) is an infectious disease that is the leading cause of death from a single infectious agent worldwide. Culture is still the gold standard for the diagnosis of pulmonary TB. As an important specimen, sputum is often contaminated by normal flora at the time of collection, making the decontamination process an essential step of Mycobacterium tuberculosis culture. Decontamination with chlorhexidine 0.7% is expected to improve the detection of Mycobacterium tuberculosis in the culture method better than Modified Petroff's method. Methods: This research is an experimental study. Sputum was collected from pulmonary TB patients. Each sputum was decontaminated with chlorhexidine 0,7% and others with Modified Petroff's. Decontaminated sputum inoculated on Lowenstein-Jensen media. Samples were incubated, and evaluated the recovery rate of Mycobacterium tuberculosis. Data were analyzed using SPSS version 25.0 for Windows. Results: In total, we collected 16 sputum with 11 (68.75%) direct smear positive, 14 (87.5%) smear positive by chlorhexidine 0.7% method, and 13 (81.25%) by Modified Petroff's method. The number of cultures positive for Mycobacterium tuberculosis by chlorhexidine 0.7% method was 14 (87.5%), of which 11 (68.75%) have specific colony characteristics of Mycobacterium tuberculosis, 3 (18.75%) non-tuberculous mycobacteria, and 1 (6.24%) mixed. In Modified Petroff's, 6 (37.5%) were positive cultures and showed only growth of Mycobacterium tuberculosis. The contamination rate was 1 (6.25%) using chlorhexidine 0.7% and 8 (50%) using Modified Petroff’s method. Conclusion: Chlorhexidine 0.7% has a higher recovery rate in the culture of Mycobacterium tuberculosis compared with Modified Petroff's, showing recovery of non-tuberculous mycobacteria and a lower contamination rate.