Diagnosis Of Pulmonary Tuberculosis Research Articles

Comparison between Light Emitting Diode (LED) Fluorescence Microscopy and Conventional Light Microscopy in the Diagnosis of Pulmonary Tuberculosis

Comparison between Light Emitting Diode (LED) Fluorescence Microscopy and Conventional Light Microscopy in the Diagnosis of Pulmonary Tuberculosis

Sodium Hypochlorite Diagnostic Performance compared to Ziehl-Nelseen method among Presumptive Tuberculosis Patients in Uganda

Background: Tuberculosis remains a major public health problem worldwide. Direct Ziehl Nelseen (ZN) is the conventional Laboratory method for diagnosis of TB. However, there are higher chances of missing TB positive cases due to insufficient sensitivity. This would eventually lead to TB transmission and hence mortality. Objective: To determine sensitivity and specificity of ZN diagnostic technique on concentrated and unconcentrated sputum samples as well as to assess how clinical, socio-demographic, and sample variables affect concentrated sputum ZN positivity. Method and Materials: This cross-sectional investigation was carried out in Mulago Hospital, covering adult TB presumptive patients. Sputum samples from 114 patients were collected and processed by both NaOCl concentration and direct ZN diagnostic techniques. Sensitivity and specificity were calculated and tabulated. Prediction of ZN positivity was assessed using Logistic regression analysis. Results: Out of the total 114 samples, 82 (71.9%) were positive by GeneXpert test (the gold standard), whereas by NaOCl concentration method 79 samples (69.3%) were found positive but with direct ZN method 65 samples (57.0%) were found positive, thus an increase of 14 samples (12.3%) in positivity was noted when used NaOCl concentration method which is highly significant with ρ<0.05 (χ2 =95.38). NaOCl concentration method got a higher sensitivity than direct sputum smear with 97.5% and 80.2% respectively. The specificities were almost the same with NaOCl method 93.9% and direct sputum smear with 90.9%. NaOCl concentration method had a PPV of 0.98 and NPV of 0.94 while direct sputum smear had PPV of 0.95 and NPV of 0.65. Conclusion: NaOCl concentration method was found to be more sensitive than direct ZN though the specificity was almost the same. Clinical, socio-demographic and sample factors’ effect on ZN positivity was not statistically significant (ρ value=0.796). NaOCl concentration method should be adopted for effective diagnosis of pulmonary TB.

A case series of three infants having pulmonary tuberculosis

Progression of primary pulmonary tubercular infection to active disease is not common in infants. Bacterial pneumonia is usually an imposter and its suspicion usually delays a definitive diagnosis of pulmonary tuberculosis and starting antitubercular treatment. Although congenital tuberculosis infection from infective mother is a possibility but most commonly, they acquire postnatal disease by contact with an infectious adult source. We are sharing our experience of three infants referred to our side who were being treated as bronchopneumonia for a period of 15 to 20 days, and subsequently were diagnosed with post primary pulmonary tuberculosis for a period of 1 year.

Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis.

To evaluate the outcomes of bronchial artery embolization (BAE) for the treatment of massive hemoptysis in patients with pulmonary tuberculosis and identify risk factors that influence recurrence. A total of 81 patients with massive hemoptysis who underwent BAE between January 2014 and December 2017 were retrospectively reviewed. All of the patients had either a history of pulmonary tuberculosis or a current diagnosis of pulmonary tuberculosis. Follow-up ranged from 18 to 66 months. Hemoptysis was stopped or markedly decreased, with subsequent clinical improvement in 73 patients, while 11 patients experienced recurrence during the follow-up period. Systemic-pulmonary shunts and clinical failure showed a statistically significant correlation with the recurrence rate. The cumulative non-recurrence rate was 95.3% for 3 months and 81.9% for more than 24 months. Complications were common (12.5%), but self-limiting. BAE is a safe and effective treatment option for the control of massive hemoptysis in pulmonary tuberculosis patients. Systemic-pulmonary shunts and clinical failure are the risk factors for recurrence.

Advocating the Use of Loop-mediated Isothermal Amplification Assay to Improve the Rates of Diagnosis of Pulmonary Tuberculosis in Resource-constraint Settings

Advocating the Use of Loop-mediated Isothermal Amplification Assay to Improve the Rates of Diagnosis of Pulmonary Tuberculosis in Resource-constraint Settings

Xpert MTB/RIF Ultra Assay Using Stool: an Effective Solution for Bacilli Identification from Adult Pulmonary Tuberculosis Suspects without Expectorated Sputum.

This study evaluated the diagnostic performance of stool-based Xpert MTB/RIF Ultra assay (Xpert-Ultra, Cepheid, USA) against other tests using respiratory tract specimens (RTS) and stool for diagnosing adult pulmonary tuberculosis. A prospective study on patients with presumptive pulmonary tuberculosis was conducted in Beijing Chest Hospital from June to November 2021. The smear test, MGIT960 liquid culture, and Xpert MTB/RIF (Xpert, Cepheid, USA) were performed simultaneously on RTS, and smear, culture Xpert, and Xpert-Ultra were performed simultaneously using stool. Patients were grouped based on the outcomes of RTS examination and other tests. In total, 130 eligible patients were enrolled that included 96 pulmonary tuberculosis and 34 non-TB patients. The sensitivity of smear, culture, Xpert, and Xpert-Ultra using stool was 10.96%, 23.28%, 60.27%, and 79.45%, respectively. The specificities of Xpert and Xpert-Ultra using RTS and stool were all 100% (34/34). Notably, all five confirmed cases detected by bronchoalveolar lavage fluid (BALF) examination yielded Xpert-Ultra positive outcomes with the stool specimens. Xpert-Ultra assay on stool sample harbors comparable sensitivity with Xpert on RTS. Thus, the Xpert-Ultra testing on stool specimens could be a very promising and practical strategy to improve pulmonary tuberculosis (PTB) diagnosis, especially among patients who could not expectorate sputum. IMPORTANCE This study is aimed at assessing the value of Xpert MTB/RIF Ultra (Xpert-Ultra) in PTB on stool in adult in low HIV settings and Xpert-Ultra assay on stool sample harboring comparable sensitivity with Xpert MTB/RIF on respiratory tract specimens. Although the yield in stool samples by Xpert-Ultra is lower than RTS, it may be useful in detecting disease in presumptive TB patients who cannot expectorate sputum and are not open to BALF collection. In addition, Xpert-Ultra with a "trace call" on stool in adult was highly supportive of PTB.

Features of detection of latent tuberculosis infection and tuberculosis in children from household contacts within a household (clinical case)

Aim: to demonstrate the features of detection and diagnosis of latent tuberculosis infection and pulmonary tuberculosis in children from household contacts based on own clinical observation.
 Materials and methods. A clinical case of own observation of pulmonary tuberculosis and latent tuberculosis infection in children from household contacts who were treated in the paediatric department of the clinical base of the Phthysiatry and Pulmonology Department of Zaporizhzhia State Medical and Pharmaceutical University on Public Non-Profit Enterprise of the “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology” of Zaporizhzhia Regional Council.
 Results. Children from household contacts were examined at ages: 8 months, 2, 3, 5 and 7 years, after their mother was diagnosed with tuberculosis (TB). All children showed an increase in tuberculin skin test, at the X-ray of the thoracic cavity organs (TCO) no changes were detected in any child. Taking into account the age of the children and their constant residence with the index patient, a decision was made to conduct an additional examination using CT scan of the TCO. Thus, three children were diagnosed with pulmonary tuberculosis – primary tuberculosis complex, and two were infected. After receiving the results of the culture test in the gastric lavage, the youngest child was found MBT, which was resistant to first-line drugs, namely isoniazid and rifampicin, which required a treatment regimen adjustment. It should be noted that the youngest girl, who was not vaccinated, had the most widespread process in the lungs compared to other children.
 Conclusions. Monitoring and screening of children who have been in contact with the index patient within the household maximises the detection of additional cases of latent tuberculosis infection and pulmonary TB. The most at-risk groups are those who not vaccinated with BCG vaccine and children under 5 years of age. Early detection and timely prescription of anti-TB therapy is the key not only to effective treatment, but also to preventing the transmission of TB infection.

The role of invasive methods in errors in the differential diagnosis of tuberculosis of the lungs and pleura: clinical examples

BACKGROUND. Differential diagnosis between non-specific diseases of the lungs and pleura and tuberculosis (TB) of these organs is an urgent problem. According to a number of authors, the frequency of false diagnosis of TB is 34-40 %. Difficulties in the differential diagnosis of pulmonary TB (pleura) and non-specific diseases of the lungs and pleura arise in most cases with exudative and caseous inflammation of the lung tissue. The use of various types of surgical interventions, both diagnostic and therapeutic, provides a greater range of conducting various laboratory tests, especially when this issue may be related to the differential diagnosis of TB. Thus, during surgical intervention, it is possible to obtain biopsy material, which can be sent for pathological, molecular genetic and bacteriological research.
 MATERIALS AND METHODS. Two clinical cases are presented, in which, due to suspicion of specific inflammation in the lungs and pleura, we used all the above-mentioned methods of laboratory diagnosis of resection biopsy material during surgical interventions.
 CONCLUSIONS. This approach provides objective morphological and biological detection of Mycobacterium tuberculosis, and also makes it possible to determine the sensitivity to 1st and 2nd line antituberculosis drugs, which ultimately helps to establish the correct diagnosis and prescribe an effective treatment scheme.

Studi Kasus Penerapan Latihan Batuk Efektif Terhadap Perubahan Pola Napas Pasien Tuberkulosis Paru

Complaints of shortness of breath are one of the symptoms that arise in patients with Pulmonary Tuberculosis. This condition certainly requires proper nursing handling, namely through airway management nursing actions. The purpose of this study was to identify the application of airway management to changes in breathing patterns in Mr.S with pulmonary tuberculosis. The method used in research is a descriptive method with a case study approach. The respondent in this case study research was Mr.S with a medical diagnosis of pulmonary tuberculosis who was undergoing treatment in the Az-Zahra treatment room of RSU Dewi Sartika Kendari City. This case study was conducted from February 15, 2022 to February 22, 2022. The focus of the study is clients who experience impaired oxygenation needs characterized by shortness of breath and breathing frequency above 20x / minute, the instrument used is the format of assessment to nursing evaluation. The method of data collection starts from interviews and physical examinations. The results of the study found that Mr. S had difficulty removing his phlegm and the frequency of breathing was 28x / minute, the nursing diagnosis at Mr. S was that airway clearance was not effective related to secretions in the airway. The nursing intervention carried out is airway management which is carried out for 4 days according to the planned intervention. At the end of the evaluation, airway clearance was not effective in patients with resolved pulmonary tuberculosis, marked by a change in breathing frequency to 20x / minute. It is hoped that health workers can apply nursing care to pulmonary tuberculosis clients who experience oxygenation problems more optimally in order to improve the quality of hospital services

The value of metagenomic next-generation sequencing for the diagnosis of pulmonary tuberculosis using bronchoalveolar lavage fluid.

The aim of this study was to compare metagenomic next-generation sequencing (mNGS) with other methods, including Xpert MTB/RIF, Mycobacterium tuberculosis (MTB) culture, and acid-fast bacillus (AFB) staining in the diagnosis of pulmonary tuberculosis (PTB) using bronchoalveolar lavage fluid (BALF). The data of 186 patients with suspected PTB were retrospectively collected from January 2020 to May 2021 at Tongji Hospital. BALF samples were collected from all patients and analyzed using AFB staining, MTB culture, Xpert MTB/RIF, and mNGS. Of the 186 patients, 38 patients were ultimately diagnosed as PTB. Metagenomic next-generation sequencing exhibited a sensitivity of 78.95%, which was higher than AFB staining (27.59%) and MTB culture (44.12%) but similar to Xpert MTB/RIF (72.73%). Utilization of combined methods demonstrates improvement for PTB diagnosis. In support of this, the area under the receiver operating characteristic curve for the combination of mNGS and MTB culture (0.933, 95% CI: 0.871, 0.995) was larger than those of mNGS, Xpert MTB/RIF, MTB culture, and the combination of Xpert MTB/RIF and MTB culture. The sensitivity of mNGS in the diagnosis of PTB using BALF specimen is similar to Xpert MTB/RIF.Metagenomic next-generation sequencing in combination with MTB culture may further improve the diagnosis of pulmonary tuberculosis.

Expert consensus on imaging diagnostic criteria for pulmonary tuberculosis associated with acquired immunodeficiency syndrome

Abstract Acquired immunodeficiency syndrome (AIDS)-associated pulmonary tuberculosis is one of the most common opportunistic infections in patients with AIDS and an important cause of death. Pulmonary tuberculosis associated with AIDS occurs in patients with low immunity, and its clinical manifestations are often atypical. Therefore, diagnosis of AIDS-associated pulmonary tuberculosis is difficult, and imaging plays a vital role. To standardize examinations and improve the level of imaging diagnosis, a group of experts in infection, inflammation, radiology, tuberculosis, and statistics have come together and published imaging diagnostic criteria for AIDS-related pulmonary tuberculosis with consideration of the methodological requirements for evidence-based guidelines and standards. Patients with clinical signs and symptoms of pulmonary infection who test positive for human immunodeficiency virus need to undergo further radiographic or computed tomography examination of the chest. AIDS-related pulmonary tuberculosis is suspected when there are pulmonary lesions and/or hilar and mediastinal lymph node enlargement. An imaging diagnosis of AIDS-related pulmonary tuberculosis is based on one of the following findings: mediastinal or hilar lymphadenectasis in multiple areas, diffuse miliary nodules randomly distributed in both lungs, multi-form, multi-lobular, and multi-segmental lesions dominated by exudative lesions, or pleural effusion. Further laboratory or pathological examinations are performed in suspected patients and those with an imaging diagnosis; if one of these additional examinations is positive, the diagnosis of AIDS-related tuberculosis is confirmed.

Tuberculosis diagnostic practices among private medical practitioners of modern medicine in South India – A cross-sectional study

Abstract Background: India has the highest tuberculosis (TB) burden in the world and account for nearly one-fourth of the global burden of TB. Although the Indian government provides a basic national health service, an increasingly large number of health-care interactions in India are with the physicians in the private sector. Objective: The objective is to study the TB diagnostic practices among private medical practitioners and to determine the association of diagnostic practices with socio-demographic factors, the Revised National Tuberculosis Control Programme (RNTCP) training status, and professional/academic qualification of private medical practitioners. Materials and Methods: The current study was a cross-sectional study conducted in the urban areas of Nalgonda district between October 2015 and September 2017. The study included all medical general practitioners (GP) and all specialists practicing internal medicine, chest medicine, and pediatrics, registered with the Indian Medical Association (IMA) branches and had a private practice in the study area. The study included 101 private medical practitioners from three IMA branches. The data on diagnostic practices of TB and RNTCP training status were collected by an interview using a pretested semi-structured questionnaire. The data analysis was done using Statistical Package for Social Sciences (SPSS) 19th version. Results: The majority of study participants in this study were GP, while specialists constituted a smaller portion. Most of these private medical practitioners opted sputum smear examination as their second preferred investigation after a chest X-ray. For the diagnosis of pulmonary TB, majority of the private practitioners preferred both sputum smears examination and chest X-ray. The private medical practitioners who had received the RNTCP training were employing sputum smear microscopy as a diagnostic tool and were also aware about notification of TB. Conclusions: Overreliance on chest X-ray as the investigation of choice to diagnose pulmonary TB and for follow-up. Training in RNTCP has a positive impact on practicing standard diagnostic practices, treatment, and referral practices on private medical practitioners.

Frequency and Determinants of Delay in Diagnosis of Pulmonary Tuberculosis

Delays in diagnosis of TB can lead to more severe illnesses, complications, and higher rates of morbidity and mortality. Objective: To identify the frequency and reasons of delay in diagnosis of pulmonary tuberculosis. Methods: The study was conducted at the TB & Chest ward of Jinnah Hospital, Lahore. Well-systemized questionnaire was being used to collect the data. A sample of n=150 was recruited through convenient sampling. Results: Out of total 150 applicants, 101(65.6%) were male and 49(31.8%) were female. Out of total 150 respondents, 51(33.1%) responded yes they have medical knowledge and 99(64.3%) responded no, 106(68.8%) responded yes they take self-treatment and 44(28.6%) responded no, 92 (59.7%) responded yes they take anti TB treatment and 58(37.7%) responded no, 45(29.2%) responded positively to question about health facility near home and 105(68.2%) responded no, 103(66.9%) responded yes they were satisfied with health care system and 47(30.5%) responded no, 61(39.6%) responded yes they have knowledge regarding TB and 89(57.8%) responded no, 71(46.1%) responded yes they had previous history of TB and 79(51.3%) responded no, and 77(50%) responded yes they have fear in expressing TB among society and 73(47.4%) responded no they have no fear in expressing TB among society. Conclusions: The study concluded that the most significant part of the delay in diagnosing TB is associated with the time between the first medical visit and diagnosis, which often leads to misdiagnosis. The authors recommend frequent health education and support programs for high-risk patients.

Active Case Finding Using Mobile Chest Radiography among Homeless People with Pulmonary Tuberculosis in Osaka City, Japan, 2013-2019.

Mobile digital chest radiography (CR) is a commonly used method for pulmonary tuberculosis (PTB) screening among homeless people in Nishinari District, Osaka City, Japan. We investigated mobile CR screening (MCS) to calculate the case-finding rate of culture-confirmed PTB among homeless examinees in Nishinari District from 2013 to 2019. PTB was defined as a sputum culture-confirmed case. Examinees with culture-confirmed PTB >90 days after MCS were defined as having no progression to active tuberculosis when undergoing MCS. We collected participants' information, including their name, date of birth, age, sex, date of MCS, CR classification (whether the abnormal CR result required further investigation), date of PTB diagnosis, and sputum smear results. Of 10,111 homeless people, 175 (1.7%) with abnormal CR results underwent further investigation at medical facilities. Of those with abnormal CR results, 22 (0.22%) were diagnosed with culture-positive PTB within 90 days of MCS. Of 22 PTB cases with culture-positive results, 13 (59.1%) were smear-positive. We found that MCS contributed to the detection of PTBs with a lower smear-positive rate among patients with PTB analyzed by MCS compared with all culture-confirmed PTB cases in Nishinari District.

Concordance between microscopic and molecular detection of Mycobacterium tuberculosis in hospitalized patients with suspected pulmonary tuberculosis in Peltier General Hospital, Djibouti

Background: Tuberculosis (TB) remains a significant public health issue, and Djibouti is still one of the nations with a high TB burden, with a forecasted incidence rate of 224 cases per 100,000 people in 2020. Objectives: To compare the Ziehl-Neelsen (ZN) stain direct smear microscopy with the GeneXpert (Xpert MTB/RIF assay) as the gold standard for diagnosing patients with suspected pulmonary tuberculosis (PTB). Material and method: A health facility-based cross-sectional study was conducted on hospitalized patients at Peltier General Hospital from March to July 2022. A total of 153 samples (including bronchoalveolar lavage (BAL) and sputum) collected from presumptive TB patients were tested. Results: Out of the 153 samples analyzed by GeneXpert and ZN smear microscopy, 29 (19.0%) were detected by GeneXpert and 23 (15.0%) were positive by ZN smear microscopy. ZN smear microscopy had sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) that were 79.31%, 100%, 100%, and 95.38%, respectively. Conclusion: This study concluded that ZN smear had a slightly poor sensitivity for determining the presence of PTB; consequently, we continue to advise GeneXpert testing whenever it is possible to prevent prolonged morbidity in those affected and to prevent the direct as well as indirect expenses of missing the diagnosis of smear-negative PTB.

Role of Serum CA 125 Level in the Diagnosis of Pulmonary Tuberculosis

Background: Pulmonary tuberculosis (PTB) persists as a great public health problem in Bangladesh. Although many diagnostic tools are invented but the diagnosis continues to rely on smear microscopy, culture and chest radiography. Other non-conventional approaches include detection of immunological response and the search for biochemical markers. Cancer Antigen 125 (CA-125) was considered a promising one and have been reported in few instances. Methods: This study was a hospital based cross-sectional analytical study conducted at department of Medicine in Rangpur Medical college Hospital, Bangladesh for 24-months following approval of the protocol. Total 100 people with pulmonary tuberculosis either smear positive or smear negative gene X pert positive were selected and analysed in this study. Written informed consent were taken from all subjects. After taking written consent from each patient, detailed clinical history, physical examination and relevant investigations including serum CA 125 level were done for every patient. Reflection of CA 125 positivity were calculated on the basis of smear positive and smear negative gene X pert MTB/RIF positive pulmonary tuberculosis. Collected data were noted down in separate case record form. After removing consistency and compilation, final data analysis was done in the statistical program Statistical Package for Social Science (SPSS) version 23.0.P-value of <0.05 was considered to indicate statistical significance. Results: Of total 100 patients, mean age was 36.68 ± 12.57 SD (years) with slight male predominance with Male female ratio was 2.13:1. Overall elevated CA-125 was found in 88% cases with mean value 90.82 ± 74.28 IU/mL. Mean level of CA- 125 among sputum smear positive cases 74.69±49.51 IU/mL (37-153 IU/mL). Among 50 smear negative gene Xpert positive cases, 24% had serum CA-125 level <35 IU/mL (19.73±11.86 IU/mL) and rest 76% had e”35 IU/mL (134.51±86.74 IU/mL). Smear negative & gene Xpert positive cases has statistically significant higher level of CA-125 cases in comparison to smear positive cases (P-value <0.05). Conclusion: More than two thirds of the pulmonary tuberculosis patients had higher level CA-125 and smear negative-Xpert positive cases had significantly higher level than smear positive cases. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 206

Xpert MTB/RIF Assay for the Diagnosis of Pulmonary Tuberculosis Based on Bronchoalveolar Lavage Fluid: A Systematic Review and Meta-analysis

Abstract Currently, tuberculosis (TB) is the second most lethal disease in the world caused by a single infectious pathogen. Rapid diagnosis of TB is of great importance for its treatment and management. Xpert MTB/RIF is a novel rapid diagnostic assay for the diagnosis of pulmonary TB (PTB). Use of the Xpert assay based on bronchoalveolar lavage fluid (BALF) samples is indicated when TB is suspected and sputum smears or cultures are negative. The aim of this meta-analysis was to systematically evaluate the diagnostic performance of the Xpert assay based on BALF samples for the diagnosis of PTB. A systematic review of previously published articles was performed, and relevant data were extracted. Meta-DiSc 1.4 and Stata 12.0 were used to analyze the data. When Mycobacterium tuberculosis cultures were used as the criterion standard, the combined sensitivity of BALF-based Xpert was 0.89 (95% CI, 0.87–0.91), the specificity was 0.87 (95% CI, 0.85-0.88), the positive likelihood ratio was 8.28 (95% CI, 5.39–12.71), the negative likelihood ratio was 0.14 (95% CI, 0.10–0.19) and the diagnostic ratio was 84.08 (95% CI, 42.00–168.31). When composite reference standard was used as the criterion standard, the above observations were 0.69 (95% CI, 0.67–0.72), 0.98 (95% CI, 0.97–0.98), 41.40 (95% CI, 14.56–117.71), 0.28 (95% CI, 0.21–0.37) and 190.47 (95% CI, 50.56–717.54), respectively. The area under the summary receiver operating characteristic curve was close to 1 for both. Overall, the Xpert MTB/RIF assay based on BALF samples showed high sensitivity and specificity for the diagnosis of PTB and seems to be a reliable rapid detection method.

Evaluation of immunodominant peptides of in vivo expressed mycobacterial antigens in an ELISA-based diagnostic assay for pulmonary tuberculosis.

Non-sputum-based biomarker assay is urgently required as per WHO's target product pipeline for diagnosis of tuberculosis. Therefore, the current study was designed to evaluate the utility of previously identified proteins, encoded by in vivo expressed mycobacterial transcripts in pulmonary tuberculosis, as diagnostic targets for a serodiagnostic assay. A total of 300 subjects were recruited including smear+, smear- pulmonary tuberculosis (PTB) patients, sarcoidosis patients, lung cancer patients and healthy controls. Proteins encoded by eight in vivo expressed transcripts selected from previous study including those encoded by two topmost expressed and six RD transcripts (Rv0986, Rv0971, Rv1965, Rv1971, Rv2351c, Rv2657c, Rv2674, Rv3121) were analyzed for B-cell epitopes by peptide arrays/bioinformatics. Enzyme-linked immunosorbent assay was used to evaluate the antibody response against the selected peptides in sera from PTB and controls. Overall 12 peptides were selected for serodiagnosis. All the peptides were initially screened for their antibody response. The peptide with highest sensitivity and specificity was further assessed for its serodiagnostic ability in all the study subjects. The mean absorbance values for antibody response to selected peptide were significantly higher (p<0.001) in PTB patients as compared to healthy controls; however, the sensitivity for diagnosis of PTB was 31% for smear+ and 20% for smear- PTB patients. Thus, the peptides encoded by in vivo expressed transcripts elicited a significant antibody response, but are not suitable candidates for serodiagnosis of PTB.

Burden of Pulmonary Rifampicin-Resistant Tuberculosis in Kajiado, Kenya: An Observational Study.

Rifampicin resistance (RR) is a major challenge in the clinical management of tuberculosis (TB), but data on its prevalence are still sparse in many countries. Our study aimed at estimating the prevalence of RR-TB in Kajiado County, Kenya. Secondary objectives were to estimate the incidence of pulmonary TB in adults and the rate of HIV-TB coinfection. We conducted an observational study in the context of the ATI-TB Project, carried out in Kajiado. The project was based on an active-case-finding campaign implemented with the aid of village chiefs, traditional healers and community health volunteers. Diagnosis relied on Xpert MTB/RIF, including a mobile machine that could be used to cover areas where testing would otherwise be difficult. In sum, 3840 adults were screened for active TB during the campaign. RR cases among all TB diagnoses were 4.6%. The annual incidence of pulmonary TB among adults was 521 cases per 100,000 population. The rate of HIV coinfection was 22.2% among pulmonary TB diagnoses. The prevalence of RR-TB was four times that what could be inferred from official notifications in Kajiado, and higher than overall prevalence in Kenya. In addition, our estimate of incidence of pulmonary TB in adults in Kajiado significantly differed from cases notified in the same area. In contrast, the rate of HIV coinfection was in line with national and regional data. TB diagnostic capability must be strengthened in Kajiado to improve patients' management and public health interventions.

A prospective observational multicentric clinical trial to evaluate microscopic examination of acid-fast bacilli in sputum by artificial intelligence-based microscopy system.

Microscopy-based tuberculosis (TB) diagnosis i.e., Ziehl-Neelsen (ZN) stained smear screening still remains the primary diagnostic method in resource poor and high TB burden countries, however itrequires considerable experience and is bound to human errors. In remote areas, wherever expert microscopist is not available, timely diagnosis at initial level is not possible. Artificial intelligence (AI)-based microscopy may be a solution to this problem. A prospective observational multi-centric clinical trial to evaluate microscopic examination of acid-fast bacilli (AFB) in sputum by the AI based system was done in three hospitals in Northern India. Sputum samples from 400 clinically suspected cases of pulmonary tuberculosis were collected from three centres. Ziehl-Neelsen staining of smears was done. All the smears were observed by 3 microscopist and the AI based microscopy system. AI based microscopy was found to have a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 89.25%, 92.15%, 75.45%, 96.94%, 91.53% respectively. AI based sputum microscopy has an acceptable degree of accuracy, PPV, NPV, specificity and sensitivity and thus may be used as a screening tool for the diagnosis of pulmonary tuberculosis.