Diagnosis Of Pulmonary Tuberculosis Research Articles

Diagnostic Accuracy of the Artificial Intelligence Methods in Medical Imaging for Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis.

Tuberculosis (TB) remains one of the leading causes of death among infectious diseases worldwide. Early screening and diagnosis of pulmonary tuberculosis (PTB) is crucial in TB control, and tend to benefit from artificial intelligence. Here, we aimed to evaluate the diagnostic efficacy of a variety of artificial intelligence methods in medical imaging for PTB. We searched MEDLINE and Embase with the OVID platform to identify trials published update to November 2022 that evaluated the effectiveness of artificial-intelligence-based software in medical imaging of patients with PTB. After data extraction, the quality of studies was assessed using quality assessment of diagnostic accuracy studies 2 (QUADAS-2). Pooled sensitivity and specificity were estimated using a bivariate random-effects model. In total, 3987 references were initially identified and 61 studies were finally included, covering a wide range of 124,959 individuals. The pooled sensitivity and the specificity were 91% (95% confidence interval (CI), 89-93%) and 65% (54-75%), respectively, in clinical trials, and 94% (89-96%) and 95% (91-97%), respectively, in model-development studies. These findings have demonstrated that artificial-intelligence-based software could serve as an accurate tool to diagnose PTB in medical imaging. However, standardized reporting guidance regarding AI-specific trials and multicenter clinical trials is urgently needed to truly transform this cutting-edge technology into clinical practice.

The impact of diabetes mellitus on outcomes of adult tuberculosis patients: а сross-sectional study

Background. Both diabetes mellitus (DM) and tuberculosis (TB) are major public health problems and among the leading causes of morbidity and mortality worldwide. The TB-DM coexistence is known to complicate TB care, control and prevention. Globally, 10.4 million TB cases exists, of them 10% are linked to DM. People with DM are at four to five times higher risk of getting infected with tuberculosis and evidence show poor TB treatment outcomes. This study purposed to evaluate the impact of diabetes mellitus on treatment outcomes in patients with active tuberculosis. Materials and methods. A cross-sectional study was conducted in a tertiary health care center in Tirana, Albania. We analyzed the medical records of 140 patients hospitalized during in 2018–2019 with a diagnosis of pulmonary tuberculosis. Study subjects were adult tuberculosis patients hospitalized in our hospital and undergoing antituberculosis treatment. Data from study subjects were obtained by interview method using semistructured questionnaire consisting of socio-demographic and clinical parameters. To determine DM risk factors, one variable and multivariable logistic regression analysis was done with 95% confidence interval and p-value< 0.05 considered significant. Results. Out of 140 patients, the prevalence of DM was found to be 9.3% (n= 13) with average glucose values X= 145 mg/dl (min 120— max 175 mg/dl), SD= 30. No significant differences were found between sex, residence, type and site of TB. Increasing age (p< 0.02), male sex (p= 0.04), and clinical manifestations like type of TB (p= 0.82), multilobe involvement (p= 0.243), other lung diseases (p= 0.154) are not significantly associated with DM-TB comorbidity. Conclusion. The prevalence of DM among TB patients in this study is high. The expanding burden of diabetes is increasing the risk of contracting tuberculosis and has a strong impact on TB treatment outcomes. The results of our study show that patients with TB-DM were at higher risk of treatment failure and mortality compared to those with TB without diabetes. Bidirectional screening for TB and DM along with planning and implementation of preventive and curative strategies will help early detection and prevent complications of comorbidity.

Host biomarker-based quantitative rapid tests for detection and treatment monitoring of tuberculosis and COVID-19

Diagnostic services for tuberculosis (TB) are not sufficiently accessible in low-resource settings, where most cases occur, which was aggravated by the COVID-19 pandemic. Early diagnosis of pulmonary TB can reduce transmission. Current TB-diagnostics rely on detection of Mycobacterium tuberculosis (Mtb) in sputum requiring costly, time-consuming methods, and trained staff. In this study, quantitative lateral flow (LF) assays were used to measure levels of seven host proteins in sera from pre-COVID-19 TB-patients diagnosed in Europe and latently Mtb-infected individuals (LTBI), and from COVID-19 patients and healthy controls. Analysis of host proteins showed significantly lower levels in LTBI versus TB (AUC:0·94) and discriminated healthy individuals from COVID-19 patients (0·99) and severe COVID-19 from TB. Importantly, these host proteins allowed treatment monitoring of both respiratory diseases. This study demonstrates the potential of non-sputum LF assays as adjunct diagnostics and treatment monitoring for COVID-19 and TB based on quantitative detection of multiple host biomarkers.

Pregnancy in pulmonary alveolar microlithiasis

A 32-year-old nepalese woman presented with dyspnea and dry cough. She had a non-confirmed diagnosis of pulmonary tuberculosis (TB) and completed 6 months of antibacilar treatment 10 years ago. She had no occupational exposure, smoking habits or familiar history of respiratory diseases

ROLE OF FIBEROPTIC BRONCHOSCOPY IN DIAGNOSIS OF SPUTUM NEGATIVE PULMONARY TUBERCULOSIS

Tuberculosis is a disease caused by Mycobacterium tuberculosis. It is a systemic disease, predominantly affecting the lungs. Globally, tuberculosis affects around 10.4 million people per year, and kills around million of them, with the majority of patients presenting with pulmonary disease. One of the key challenges to global tuberculosis control is correct diagnosis. The diagnosis of Pulmonary Tuberculosis can be obtained from microscopy and culture of a number of different sources including expectorated sputum, induced sputum, gastric washings and bronchoscopy. Fiberoptic bronchoscopy (FOB) can provide an early conrmative diagnosis in such patients. Among the bronchoscopic materials, bronchoalveolar lavage (BAL) is the best diagnostic material for the diagnosis of PTB.

267. Delayed Pulmonary Tuberculosis (PTB) Diagnosis During the COVID-19 Pandemic: A Case Series

Abstract Background The COVID-19 pandemic has been associated with underreporting of pulmonary tuberculosis (PTB). Overlapping risk factors, clinical features, and chronicity of post COVID-19 sequelae can lead to attribution of respiratory disease solely to COVID-19 and result in delayed recognition of PTB. Methods Identification of inpatients with both sputum (spu) culture (clt) positive TB and SARS-CoV-2 + PCR was achieved using data extraction tool Slicer Dicer Epic system during 3/2020-1/2022 followed by a retrospective review of electronic medical records. We defined COVID-PTB as a patient (pt) who had positive spu clt for TB ≤ 12 months (mos) following a COVID-19 diagnosis. Results 8 pts had both PTB and COVID-19. Two had PTB > 5 mos prior to, and one had PTB > 12 mos after COVID-19. 3/8 were promptly suspected to have PTB [1 with right upper lobe (RUL) infiltrate; 1 RUL cavitary infiltrate; 1 with miliary nodules and cavities]; in these 3, spu was tested for MTB ≤ 48 hours (h) (hrs) of presentation. 5/8 had COVID-PTB. All 5 had fever and/or respiratory symptoms and ≥ 1 risk factors for TB identified at the time of presentation with COVID-19. Spu was tested for MTB in 48 hs in 1 with RUL cavitary infiltrate, and 5 days after chest CT findings of apical densities and scattered nodules in another. In the remaining 3, spu testing was delayed a median of 36 days (range, 8-133) after initial TB consistent CT findings (LUL opacity and nodular densities in 1; RLL cavitary infiltrate in 1; and clustered RML nodules in 1) and despite immigration from high burden TB countries in all 3; known LTBI in 2; diabetes in 1, and immunosuppressive therapies in 2. Conclusion We observed a delay in sputum collection after COVID-19 diagnosis in the presence of epidemiological risk factors for TB disease and clinical features consistent with PTB. Lack of familiarity with the range radiological TB features, a diagnostic bias towards more typical radiographic (e.g., cavities, miliary patterns) and COVID-19 anchoring bias may have contributed to delayed PTB diagnosis. PTB should be considered, when clinically appropriate, in the setting of COVID-19 or apparent post COVID-19 sequelae. Disclosures All Authors: No reported disclosures.

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.

Influence of COVID-19 for delaying the diagnosis and treatment of pulmonary tuberculosis-Tianjin, China.

The COVID-19 pandemic has disrupted the diagnosis, treatment, and care for tuberculosis (TB). Delays in seeking TB care may result in increased community transmission and unfavorable treatment outcomes. We sought to understand the influence of the COVID-19 pandemic on the proportion of patients with TB who delayed seeking the diagnosis and care for TB and explore the reasons for their postponement. We surveyed a representative sample of outpatients treated for pulmonary TB from June to November 2020 using an anonymous standardized questionnaire. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of factors associated with the postponement of TB care. We used routinely collected surveillance data to assess trends of TB reports before and after the emergence of COVID-19 (2017-2019 vs. 2020-2022) in Tianjin, China. Among 358 participants who were diagnosed with pulmonary TB during the COVID-19 response, 61 (17%) postponed seeking TB diagnosis due to COVID-19, with 39 (64%) citing fear as the primary reason. Female sex (aOR:2.0; 95% CI: 1.1-3.7), previous antituberculosis treatment (aOR:3.2; 95%CI: 1.4-7.6), and TB diagnosis during the first-level response (aOR = 3.2, 1.7-6.2) were associated with the postponement. Among all 518 participants receiving antituberculosis treatment, 57 (11%) had postponed their regular healthcare visits due to COVID-19, 175 (34%) received no treatment supervision, and 32 (6%) experienced treatment interruption. Compared to 2017-2019, reported pulmonary TB declined by 36.8% during the first-level response to COVID-19, 23.5% during the second-level response, 14% during the third-level response in 2020, and 4.3% in 2021. The COVID-19 response reduced the number of people who sought and received diagnosis, treatment, and care for TB in Tianjin, China. Integrative programs to ensure access and continuity of TB services should be considered and dual testing for SARS-CoV-2 and M. tuberculosis may facilitate finding cases.

B and T lymphocyte attenuator as a C-reactive protein and IgA associated auxiliary diagnostic marker for pulmonary tuberculosis: a case-control study.

Screening and identification of hematologic molecular indicators of pulmonary tuberculosis (PTB) is crucial for its diagnose and therapy. Therefore, our work aims to detect the diagnostic value of blood marker B and T lymphocyte attenuator (BTLA) in PTB, and provide a certain theoretical basis for the auxiliary diagnosis of PTB. Based on the inclusion criteria, 56 Patients with clinically confirmed pulmonary TB by clinical between January 2020 and December 2021 at our hospital were selected as the research objects of this study. Fifty-two matched healthy population at our hospital was used as the control group. Clinical characteristics were got from clinical laboratory. Real-time polymerase chain reaction (RT-PCR) was used to analyze changes in BTLA along with its ligand in peripheral blood. Changes in BTLA on the surface of different cells were analyzed by flow cytometry. The correlation test was used to determine the associations between BTLA and clinical indicators. Receiver operating characteristic (ROC) curve analysis was used to evaluate the auxiliary diagnostic value in PTB of BTLA expression from different sources. Compared with the control, changes in peripheral blood BTLA in the PTB group were significantly increased (P=0.0187) rather than its ligand. Changes in BTLA on the surface of CD68 and antigen-presenting cell (APC) CD11c were significantly increased in the PTB group (P=0.0004, P<0.0001), while changes in BTLA on the surface of CD4+ T and CD8+ T cells were not significantly different (P=0.0792, P=0.8706). The expression of BTLA+CD11c+ was negatively correlated with the expression of immunoglobulin A (IgA) (r=-0.2934, P=0.0282) and positively related to C-reactive protein (r=0.3277, P=0.0137). ROC curve analysis suggested that the area under the curve (AUC), sensitivity and specificity of BTLA RT-PCR detection were 0.6315, 53.57%, 57.69% while for BTLA+CD11c+ detection were 0.8039, 88.46% and 73.21% and for BTLA+CD68+ detection were 0.6973, 60.71% and 61.54%. BTLA is highly expressed in peripheral blood and specific cell types of patients with PTB and is correlated with specific clinical indicators, which may be an important molecular marker for the auxiliary diagnosis of PTB.

Contribution of Gene Xpert MTB/RIF and epidemiology in the diagnosis of pulmonary tuberculosis in PLWHIV seen at the Ignace Deen National Hospital in Conakry

Introduction: Tuberculosis and HIV are real public health problems in the world and mainly in Africa. The current challenge is to be able to diagnose TB in all PLWHA, hence the interest in evaluating the effectiveness of GeneXpert MTB/RIF in the diagnosis of pulmonary TB. Method: This is a prospective cross-sectional and descriptive study of HIV-positive patients who came for consultation during the survey period which lasted six months, from 1 February to 7 August 2021, at the Ignace Deen National Hospital in Conakry and at the Gamal Abdel Nasser University in Conakry. Data were collected and analysed using Epi-info version 7.0, Pack Office 2013 (Word, Excel and Power point). Results: Out of 402 patients received, we recorded 112 positive cases, i.e. 28% and 290 negative cases, i.e. 72%. Fluorescence microscopy gave 16% and Ziehl-Neelsen microscopy gave 14% with sensitivities of 90%, 47% and 43% respectively. 104 sample patients were sensitive to Rifampicin, i.e. 92.86% against 08 cases of resistance, i.e. 7.14%. The male sex is more represented with 53% against 47% for the female sex. All the communes of Conakry were concerned, but the communes of Matoto and Ratoma were the most represented, respectively 31% and 23%. Patients from outside Conakry had a rate of 21%, the communes of Matam 11% and Dixinn 9%. Patients from the Commune of Kaloum were the least represented with 5%. Almost all socio-professional groups are affected. Commercial agents are the most represented with 31%, followed by workers with 22%, housewives with 15%, drivers with 10%, administrative agents with 9%, pupils/students with 7% and security agents with 6%. Also all age groups are affected by HIV-TB co-infection but with the highest prevalence in the 21 to 40 age group with 56% followed by the 41 to 60 age group with 30%. The age groups least affected are those under 20 and over 60 years of age, respectively 9% and 5%. Conclusion: The present study confirms a significantly higher validity of GeneXpert MTB/RIF than microscopy in the detection of TB and its place in the prediction of multidrug resistance. Its systematic use coupled with microscopy would allow better control of tuberculosis in HIV-infected individuals.

Contribution of Gene Xpert MTB/RIF and epidemiology in the diagnosis of pulmonary tuberculosis in PLWHIV seen at the Ignace Deen National Hospital in Conakry

Contribution of Gene Xpert MTB/RIF and epidemiology in the diagnosis of pulmonary tuberculosis in PLWHIV seen at the Ignace Deen National Hospital in Conakry

New estimation of the prevalence of chronic pulmonary aspergillosis (CPA) related to pulmonary TB – a revised burden for India

BackgroundChronic pulmonary aspergillosis (CPA) may be confused with, or a coinfection of, pulmonary tuberculosis (PTB), or may manifest itself after completion of antituberculous therapy (ATT). MethodsLiterature searches were conducted on PubMed. The selected studies stated the timing of CPA diagnosis with respect to PTB. The key assumptions for estimating the annual incidence, annual deaths, and 5-year-period prevalence related to CPA were: of the clinically diagnosed PTB patients , 19% of those HIV-negative had CPA and 7% of HIV-positive patients had CPA; the percentage of patients presenting in the first year after PTB diagnosis or developing CPA as ATT finished was 10%; the annual rate of development of CPA from 2–5 years after PTB diagnosis was 1.5%; and the mortality of CPA was 20% in year 1 and 7.5% thereafter to year 5. FindingsIn India, the annual incidence of CPA arising in PTB patients in 2019 was estimated to be 363 601 cases (range 254 521 - 472 682) and 42 766 deaths (range 29 936–55 595) — 10.5% of total PTB deaths. The 5-year-period prevalence of CPA was estimated at 1 575 716 , with an additional 100 715 deaths' total range of deaths 100 436– 186 525) annually. InterpretationThe revised estimation indicates a substantial unmet need for better diagnosis of CPA as part of a complex PTB-related respiratory morbidity burden.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.

Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

Tuberculosis (TB) is one of the common infections in the world, especially in developing countries like India. Therefore, early diagnosis is important. This study was undertaken to compare the yield of sputum, induction with bronchoalveolar lavage (BAL) in smear-negative suspected pulmonary TB patients in a tertiary care hospital in Agra. Fifty patients were included in the study. In all patients, induced sputum, fibreoptic bronchoscopy and BAL fluid were subjected to diagnostic testing. On acid-fast smear examination, induced sputum and BAL fluid tested positive in 27/50 and 25/50 patients, respectively with a sensitivity of 83.3% and 90% respectively (p<0.0001). On comparing sputum induction versus BAL on culture, 30 patients were positive by sputum induction and 27 patients were positive on BAL fluid, with the sensitivity of 85.7% and 77.1%, respectively. The results showed that the sputum induction showed a significantly higher yield than that of BAL fluid (p=0.0013). Sputum induction offers an alternative approach in the diagnosis of smear-negative suspected pulmonary TB patients and would enhance sensitivity for the diagnosis of TB.

Deep learning-based harmonization of CT reconstruction kernels towards improved clinical task performance.

To develop a deep learning-based harmonization framework, assessing whether it can improve performance of radiomics models given different kernels in different clinical tasks and additionally generalize to mitigate the effects of new/unobserved kernels on radiomics features. Patient data with 2 reconstruction kernels and phantom data with 22 reconstruction kernels were included. Eighty-five patients were studied for lymph node metastasis (LNM) prediction, and 164 patients for differential diagnosis between lung cancer (LC) and pulmonary tuberculosis (TB). Two convolutional neural network (CNN) models were developed to convert images (i) from B70f to B30f (CNNa) and (ii) from B30f to B70f (CNNb). Model performance between the two kernels was evaluated using AUC and compared with other well-known harmonization methods. Patient-normalized feature difference (PNFD) was used to identify the incompatible kernels (i.e., kernel with median PNFD > 1) with baseline (B30f/B70f), and measure the ability of the CNN models to convert the non-comparable kernels. For LC versus pulmonary TB diagnosis, AUCs of CNNa vs. others were 0.85 vs. 0.54-0.74 (p = 0.0001-0.0003), and for CNNb vs. others: 0.87 vs. 0.54-0.86 (p = 0.0001-0.55). For LNM prediction, AUCs of CNNa vs. others were 0.68 vs. 0.56-0.61 (p = 0.10-0.39), and for CNNb vs. others: 0.78 vs. 0.70-0.73 (p = 0.07-0.40). After CNN harmonization, 17 of 20 (85%) of investigated unknown kernels produced comparable radiomics feature values relative to baseline (median PNFD from 1.10-2.31 to 0.23-1.13). The CNN harmonization effectively improved performance of radiomics models between reconstruction kernels in different clinical tasks, and reduced feature differences between unknown kernels vs. baseline. • The soft (B30f) and sharp (B70f) kernels strongly affect radiomics reproducibility and generalizability. • The convolutional neural network (CNN) harmonization methods performed better than location-scale (ComBat and centering-scaling) and matrix factorization harmonization methods (based on singular value decomposition (SVD) and independent component analysis (ICA)) in both clinical tasks. • The CNN harmonization methods improve feature reproducibility not only between specific kernels (B30f and B70f) from the same scanner, but also between unobserved kernels from different scanners of different vendors.

Matrix Metalloproteinases in Pathogenesis of Ventilation Disorders of the Respiratory System in Patients with Chronic Pulmonary Tuberculosis

The imbalance in matrix metalloproteinase (MMP)/inhibitors system leads to degradation of extracellular matrix of connective tissue and pathological remodeling forming the morphological basis for respiratory dysfunction.The objective: to study the relationship between parameters of MMP/inhibitors system in blood and parameters of ventilation and gas exchange disorders in patients with chronic pulmonary tuberculosis (PTB).Subjects and Methods. Patients with the verified diagnosis of tuberculoma (n = 45) and fibrous-cavernous pulmonary tuberculosis (n = 85) were examined. All patients underwent computed tomography of the chest and assessment of respiratory function. Serum concentrations of MMP-1, -3, -8, -9 and their inhibitors TIMP-1 and α2-macroglobulin (MG) were tested by ELISA (R&amp;D Systems, Minneapolis, MN, USA). Statistica 7.0 and an ANCOVA model were used for statistical analysis which considered the diagnosis and smoking status as factors, and the respiratory function parameters were considered as covariates.Results. In pulmonary tuberculosis patients, the concentrations of MMP-9 and MMP-8 in the blood correlated with extension of lung parenchyma lesions when compared to tuberculomas and fibro-cavernous tuberculosis, MMP-9 and TIMP-1 with changes in lung volumes (R2 = 0.60 and 0.80; p = 0.001), and MMP-8 correlated with functional disorders of gas exchange (R2 = 0.60 and 0.80; p = 0.001). Changes in MMP-1, MMP-3, and α2-MG (R2 = 0.60 and 0.80; p = 0.45) did not correlate with extension of lung parenchymal lesions and decreased lung function.

Contribution of bronchoscopic lavage to the diagnosis of smear negative pulmonary tuberculosis

Objectives: Sputum acid-fact bacilli (AFB) and Xpert examinations are the most commonly used methods in early diagnosis for pulmonary tuberculosis. It becomes difficult for the clinician to initiate treatment in patients with negative sputum smear and Xpert examinations at the stage of diagnosis. Waiting for culture results for diagnosis causes delay in treatment and increases the risk of disease transmission. We aimed to investigate the contribution of bronchoscopic lavage (BL) obtained with flexible fiberoptic bronchoscopy (FOB) to the diagnosis of tuberculosis. Methods: The BL results of 36 patients hospitalized in the tuberculosis clinic who were clinically suspected of tuberculosis, but whose sputum AFB and Xpert results were negative, and whose bronchoscopic lavages were taken by FOB, were retrospectively evaluated. Results: BL Xpert examination was the method that made the most contribution to the diagnosis with a rate of 27.7%. BL smear AFB results did not contribute to the diagnosis statistically. Sputum and BL tuberculosis culture results were found to be close to each other. In total, the diagnosis of 50% of the patients was confirmed. Conclusions: Performing Xpert examinations on bronchoscopic materials of patients with negative sputum examinations significantly increase the rate of early diagnosis.

Positive Profile of Acid-fast bacilli in Patients with Clinical Diagnosis of Pulmonary Tuberculosis at the Semarang Public Health Center

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Until now, tuberculosis is still a public health problem in the world. Tuberculosis is a dangerous infectious disease, the healing process also takes a long time. Acid-fast bacilli examination is an examination to determine the presence or absence of Mycobacterium tuberculosis bacteria. The factors that influence Tuberculosis patients are age, gender, education and occupation. The purpose is to knowing the description of AFB positivity in patients with clinical diagnosis of pulmonary tuberculosis at Balkesmas Semarang in 2020. This research was an observational study with descriptive research criteria through a retrospective approach. Results from 656 patients with clinical diagnosis of tuberculosis who underwent acid-fast bacilli examination, 220 patients (33.5%) were found positive and acid-fast bacilli were negative (64.5%). The results of the examination of acid-fast bacilli were positive with a scanty positivity degree of 3 patients (1.4%), acid-fast bacilli (+1) were 71 patients (32.3%), (+2) were 83 patients (37.7%), (+3) as many as 63 patients (28.6%). Based on the category of age 0-14 years as many as 1 patient (0.5%), 15-34 years as many as 78 patients (35.5%), 35-54 years as many as 96 patients (43.6%), 55-74 years as many as 44 patients (20%), 75 years as many as 1 patient (0.5%). Based on gender, there were 123 patients (56%) male and 97 female patients (44%). Conclusion the results of the examination of acid-fast bacilli were positive with a scanty positivity rate of 3 patients (1.4%), acid-fast bacilli (+1) 71 patients (32.3%), (+2) 83 patients (37.7%), (+3) 63 patients (28.5%). Based on gender with positive acid-fast bacilli, there were 123 male patients (56%) while female 97 patients (44%). Age with the most positive acid-fast bacilli results in the range 0–14 years 1 patient (0.5%), 15–34 years 78 patients (35.5%), 35-54 years 96 patients (43.6%), 55 –74 years.

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

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

Peritoneal and Pulmonary Tuberculosis in a Postpartum Female with Elevated Cancer Antigen 125 and Ascites

Peritoneal tuberculosis is a rare form of extrapulmonary tuberculosis and presents a challenging diagnosis because of its nonspecific clinical manifestations. Peritoneal TB mimics other pathologies, including abdominal carcinomatosis, especially when the patient presents with ascites and an elevated cancer antigen (CA)-125 levels. Case Presentation. A postpartum 20-year-old Hispanic female recently discharged after transverse cesarean surgery, presented to the ER with fever, chills, edema, abdominal distension, nausea, and vomiting. The patient was febrile, tachycardic, and hypotensive. Chest X-ray demonstrated alveolar and interstitial consolidations; chest CT revealed tree-in-bud opacities in the right lower lobe, suggestive of atypical (TB)/fungal infection. CT of the abdomen and pelvis demonstrated ascites, omental thickening, peritoneal thickening, and mesenteric adenopathy, suggestive of carcinomatosis. She was admitted with a presumed diagnosis of sepsis secondary to pneumonia and started empirically on broad-spectrum antibiotics without clinical improvement. A battery of oncology markers was ordered and revealed a mildly elevated cancer antigen (CA)-125. Diagnostic paracentesis showed lymphocytic predominance with positive mycobacteria PCR, elevated adenosine deaminase (ADA), and no malignant cells. Subsequently, the sputum acid-fast bacilli (AFB) stain returned positive for tuberculosis, confirming the diagnosis of pulmonary tuberculosis. A peritoneal biopsy was obtained and demonstrated caseating granulomas consistent with peritoneal tuberculosis. The patient was started on standard antituberculosis therapy with clinical improvement. This case highlights the need for a high-level of suspicion for peritoneal tuberculosis in a patient with pulmonary tuberculosis who presents with intra-abdominal ascites, omental thickening, peritoneal thickening, and mesenteric lymphadenopathy, despite the presence of an elevated CA-125 level.