Diagnosis Of Pulmonary Tuberculosis Research Articles

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.
 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 tuberculosis (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 > 50 years (p = 0.021), use of herbal medicine (p = 0.036) and monthly income < 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

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 & 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.

Evaluation of the efficacy of urine-based lipoarabinomannan antigen test in the diagnosis of pulmonary tuberculosis

Objective: To analyze the diagnostic efficacy of urinary lipoarabinomannan (LAM) antigen detection method in tuberculosis patients, and to provide an experimental basis for the clinical application of urinary LAM kit in China. Methods: From March to May 2023, 228 patients with lung diseases [134 male, 94 female, age 20-82 (44.8±16.7) years] were prospectively collected in Beijing Chest Hospital, Capital Medical University, including 143 pulmonary tuberculosis patients and 85 non-tuberculosis patients. Urine and sputum samples from patients were collected for traditional etiological detection and urinary LAM antigen detection. The screening results of each positive detection combination were analyzed, and the difference analysis and regression analysis were performed. Results: The detection sensitivity and specificity of the urinary LAM kit were 46.2% (95%CI: 37.9%-54.7%) and 96.5% (95%CI: 89.3%-99.1%), respectively, with an overall coincidence rate of 64.9%. The detection rate of LAM antigen detection and GeneXpert MTB/RIF (Xpert) combined (60.8%, 87/143) was significantly higher than that of Xpert alone (49.7%, 71/143), and the difference was statistically significant (P<0.05). The results of risk factor analysis showed that the risk of negative urinary LAM antigen test results increased significantly as the bacterial load decreased. Conclusions: Urine LAM antigen detection method has a high specificity and can be combined with traditional methods to effectively improve the detection rate. Urinary LAM antigen detection method still has limitations, such as the influence of bacterial load and the inability to distinguish nontuberculosis mycobacteria samples, which needs further experimental verification.

Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru.

Tuberculosis (TB) transmission in healthcare facilities is common in high-incidence countries. Yet, the optimal approach for identifying inpatients who may have TB is unclear. We evaluated the diagnostic accuracy of qXR (Qure.ai, India) computer-aided detection (CAD) software versions 3.0 and 4.0 (v3 and v4) as a triage and screening tool within the FAST (Find cases Actively, Separate safely, and Treat effectively) transmission control strategy. We prospectively enrolled two cohorts of patients admitted to a tertiary hospital in Lima, Peru: one group had cough or TB risk factors (triage) and the other did not report cough or TB risk factors (screening). We evaluated the sensitivity and specificity of qXR for the diagnosis of pulmonary TB using culture and Xpert as primary and secondary reference standards, including stratified analyses based on risk factors. In the triage cohort (n = 387), qXR v4 sensitivity was 0.91 (59/65, 95% CI 0.81-0.97) and specificity was 0.32 (103/322, 95% CI 0.27-0.37) using culture as reference standard. There was no difference in the area under the receiver-operating-characteristic curve (AUC) between qXR v3 and qXR v4 with either a culture or Xpert reference standard. In the screening cohort (n = 191), only one patient had a positive Xpert result, but specificity in this cohort was high (>90%). A high prevalence of radiographic lung abnormalities, most notably opacities (81%), consolidation (62%), or nodules (58%), was detected by qXR on digital CXR images from the triage cohort. qXR had high sensitivity but low specificity as a triage in hospitalized patients with cough or TB risk factors. Screening patients without cough or risk factors in this setting had a low diagnostic yield. These findings further support the need for population and setting-specific thresholds for CAD programs.

Diagnosis of pulmonary tuberculosis with 3D neural network based on multi-scale attention mechanism.

This paper presents a novel multi-scale attention residual network (MAResNet) for diagnosing patients with pulmonary tuberculosis (PTB) by computed tomography (CT) images. First, a three-dimensional (3D) network structure is applied in MAResNet based on the continuity and correlation of nodal features on different slices of CT images. Secondly, MAResNet incorporates the residual module and Convolutional Block Attention Module (CBAM) to reuse the shallow features of CT images and focus on key features to enhance the feature distinguishability of images. In addition, multi-scale inputs can increase the global receptive field of the network, extract the location information of PTB, and capture the local details of nodules. The expression ability of both high-level and low-level semantic information in the network can also be enhanced. The proposed MAResNet shows excellent results, with overall 94% accuracy in PTB classification. MAResNet based on 3D CT images can assist doctors make more accurate diagnosis of PTB and alleviate the burden of manual screening. In the experiment, a called Grad-CAM was employed to enhance the class activation mapping (CAM) technique for analyzing the model's output, which can identify lesions in important parts of the lungs and make transparent decisions.

Utility of Oral Swab in the Diagnosis of Pulmonary Tuberculosis

Utility of Oral Swab in the Diagnosis of Pulmonary Tuberculosis

Drug Resistance Tests for Mycobacterium Tuberculosis and Compatibility between Tests; From Past to Today

Objective: The gold standard for pulmonary tuberculosis diagnosis is the demonstration of Mycobacterium tuberculosis bacilli. Drug susceptibility test results of the bacilli obtained are crucial in tuberculosis treatment management. The various tests used to determine drug susceptibility must yield the same result. In the present study, we aimed to evaluate the compatibility of drug susceptibility test results obtained by Löwenstein-Jensen (L-J) and BACTEC 460TB methods from the past to the present. Material and Methods: Sputum results from 79 patients suspected of multidrug-resistant pulmonary tuberculosis (MDR-TB) clinically, radiologically, and bacteriologically were evaluated for isoniazid, rifampicin, ethambutol, and streptomycin between June 1997 and June 1998. Culture and drug sensitivity tests on the L-J medium were conducted at the Heybeliada Chest Diseases and Thoracic Surgery Center bacteriology laboratory, while culture and drug sensitivity tests with the BACTEC 460 TB system were performed at another center. The results were assessed for compatibility using the Kappa (κ) test, a tool for comparing two independent parameters. Results: All drug sensitivity tests for isoniazid, rifampicin, ethambutol, and streptomycin were collectively evaluated. It was determined that 263 (83.3%) of 316 drug sensitivity tests yielded concordant results, while 53 (16.7%) produced discordant results. The drug sensitivity tests using L-J and BACTEC 460TB methods indicated compatibility only for streptomycin (κ = 0.715). In contrast, they yielded different results for isoniazid (κ = 0.585), ethambutol (κ = 0.552), and rifampicin (κ = 0.507). Streptomycin exhibited compatibility, while isoniazid, ethambutol, and rifampicin showed incompatibility between the L-J and BACTEC 460TB methods. Conclusion: Drug sensitivity tests are pivotal in tuberculosis treatment management. While literature suggests compatibility between L-J and BACTEC 460TB methods, our study revealed incompatibility. Evaluation of drug sensitivities may lead to confusing results. Current practices involving studies in the same laboratory and genetic testing contribute to faster and more accurate outcomes in managing drug-resistant tuberculosis. Genetic tests and reference laboratories remain crucial for antituberculosis drug sensitivity, emphasizing their continued importance.

TB or not TB? Diagnostic Sensitivity, Specifity and Interobserver Agreement in the Radiological Diagnosis of Pulmonary Tuberculosis in Children.

The differentiation between latent tuberculosis infection (LTBI) and tuberculosis (TB) relies on radiological changes. Confirming the diagnosis remains a challenge because typical findings are often missing in children. This study evaluates diagnostic sensitivity, specifity and interobserver agreement on the radiological diagnosis of TB by chest-x-rays in accordance to professional specialization and work experience. Chest x-rays of 120 children with proven tuberculosis infection were independently evaluated by general radiologists, paediatric radiologists and paediatric pulmonologists. Results were compared to a reference diagnosis created by group of experienced paediatric radiologists and paediatric pulmonologists. Primary endpoints were diagnostic sensitivity and specificity and interobserver variability defined as Krippendorfs alpha of thesel groups compared to the reference diagnosis. Of the 120 chest x-rays 33 (27,5%) were diagnosed as TB by the reference standard . Paediatric pulmonologist had the highest diagnostic sensitivity (90%) but were less specific (71%) whereas general radiologist were less sensitive (68%) but more secific (95%). The best diagnostic accuracy was achieved by pediatric radiologists with a diagnostic sensitivity of 77% and specificity 95% respectively. We demonstrated significant interobserver variability and relevant differences in sensitivity and specificity in the radiological diagnosis of TB between the groups. Paediatric radiologists showed the best diagnostic performance. As the diagnosis of pulmonary TB has significant therapeutic consequences for children they should be routinely involved in the diagnostic process.