Diagnosis Of Tuberculosis In Patients Research Articles

Xpert MTB/RIF Ultra in the auxiliary diagnosis of tuberculosis among people living with human immunodeficiency virus.

Clinical diagnosis of tuberculosis (TB) in people living with the human immunodeficiency virus (HIV) poses a challenge. The Xpert MTB/RIF Ultra (Ultra) has displayed greater sensitivity at diagnosing tuberculosis and rifampicin resistance compared to the Xpert MTB/RIF (Xpert). However, whether Ultra is able to facilitate an auxiliary diagnosis of TB in patients with an HIV-TB co-infection remains unclear. Accordingly, the current study evaluated the use of Ultra in patients with an HIV-TB co-infection by summarizing relevant studies. The sensitivity and specificity of Ultra and Xpert at diagnosing patients with an HIV-TB co-infection have been summarized and compared. The performance of Ultra in diagnosing extrapulmonary tuberculosis was also summarized. Although a large-cohort, multi-center study needs to be conducted to assess Ultra's ability to detect TB in AIDS patients in the future, the current evidence supports the use of Ultra for the assessment of patients with an HIV-TB co-infection.

ВИЯВЛЕННЯ СПЕЦИФІЧНИХ АНТИТІЛ З ВИКОРИСТАННЯМ ЗЛИТОГО ПРОТЕЇНУ MPT83-MPT63 ПРИ ДЕСТРУКТИВНОМУ ТУБЕРКУЛЬОЗІ ЛЕГЕНЬ

Introduction. The development of effective test systems for tuberculosis (TB) diagnosis and the study of factors influencing their sensitivity and specificity constitute urgent tasks given the unstable epidemiological situation with TB in Ukraine and the world. The study aimed to determine the clinical and laboratory features of pulmonary TB that may affect the sensitivity of IgG TB antibody detection in human serum by the immuno-enzyme test system “IB-Chem Anti-Mycobacterium tuberculosis”, which was developed at the Palladin Institute of Biochemistry of the NAS of Ukraine and uses recombinant fusion protein MPT83-MPT63 as an antigen. Methods. Sera of 62 patients with chemoresistant pulmonary TB were tested for TB antibodies using an indirect enzyme-linked immunosorbent assay. Dependence of the obtained results on clinical symptoms and signs of pulmonary TB, the frequency of different types of antibiotic resistance, cellular and biochemical parameters of blood were analysed. Results. The sensitivity of the immuno-enzyme test system “IB-Chem Anti-Mycobacterium tuberculosis” for detecting human IgG TB antibodies using recombinant fusion protein MPT83-MPT63 was found to constitute 71.0%; it reached 81.3% in patients with destructive pulmonary TB. Conclusion. The developed test system should primarily be used for the TB diagnosis in patients with destructive changes in the lungs where the diagnostic efficiency of this test system reaches high indicators.

Impact of the COVID-19 pandemic on laboratory diagnosis of tuberculosis in southern Brazil

Background and objectives: to understand the impact of the COVID-19 pandemic on tuberculosis (TB) diagnosis in different settings is essential to guide the establishment of appropriate TB control strategies. This study aimed to assess the influence of COVID-19 pandemic in laboratory diagnosis of TB in patients tested and diagnosed for TB. Methods: a data survey was carried out in the database of laboratories that perform TB diagnosis for the public health system in Rio Grande city (Rio Grande do Sul, Brazil). Results: there was a decrease of 1,368 to 735 (reduction of 46.3%) in the number of patients tested for TB in public diagnostic services in 2019 and 2020, respectively, and a decrease of 197 to 119 (reduction of 39.6%) in the number of new TB cases diagnosed. In contrast, the positivity rate was 14.4% in 2019 and 16.2% in 2020. Moreover, it was observed that the laboratory that performs the diagnostic service for Primary Health Care was the most affected, when compared to Tertiary Health Care. Conclusion: as a consequence of measures to control the spread of SARS-CoV-2, there was a reduction in TB testing and in the detection of new cases, especially in Primary Health Care, where patients with less need for hospitalization are received.

A three-methylation-driven gene-based deep learning model for tuberculosis diagnosis in patients with and without human immunodeficiency virus co-infection.

Improved diagnostic tests for tuberculosis (TB) among people with human immunodeficiency virus (HIV) are urgently required. We hypothesized that methylation-driven genes (MDGs) of host blood could be used to diagnose patients co-infected with HIV/TB. In this study, we identified three MDGs among patients with HIV monoinfection and those with HIV/TB co-infection using the R package MethylMix. We then developed a deep learning model by screening these three MDGs, which distinguished HIV/TB co-infection from HIV monoinfection with a sensitivity of 95.2% and a specificity of 88.3%. On the two independent data sets, the sensitivity and specificity were 80%-92.8% and 72.7%-87.5%, respectively. Besides, our deep learning model accurately classified TB (sensitivity, 75.0%-100%; specificity, 91.3%-98.1%) and other respiratory disorders (sensitivity, 72.7%-75.0%; specificity, 70.9%-72.7%). This study will contribute to improve molecular diagnosis for HIV/TB co-infection.

Usefulness of gastric aspirate for the diagnosis of smear-negative pulmonary tuberculosis

IntroductionGastric aspirate can be useful for the diagnosis of pulmonary tuberculosis (TB) in patients with smear-negative pulmonary TB or without sputum production. The gastric aspirate smear technique has low sensitivity, and a previous report demonstrated that no patient was diagnosed by only gastric aspirate analysis. However, some patients with TB have been negative on sputum examination but positive on gastric aspirate examination, and the incidence of such cases is uncertain. Therefore, this study investigated the usefulness of gastric aspirate in the diagnosis of pulmonary TB. MethodsTo analyze the diagnostic accuracy of gastric aspirate examination, the data of 513 patients with negative sputum smears or a lack of sputum production, including 203 patients with pulmonary TB (39.6%) and 93 patients with nontuberculous mycobacteriosis who underwent gastric aspiration at Fukujuji Hospital from January 2016 to March 2021, were collected retrospectively. ResultsThe accuracy rates of gastric aspirate examination for the diagnosis of pulmonary TB were as follows: 21.2% sensitivity and 91.9% specificity for smear positivity, 55.8% sensitivity and 99.6% specificity for nucleic acid amplification test positivity, and 71.4% sensitivity and 100% specificity for culture positivity. Twenty-three patients (11.2%) were diagnosed by gastric aspirate examination alone. Among the 356 patients who underwent three repeated sputum examinations in addition to gastric aspirate examination, the cumulative diagnostic rate for the 3 mycobacterial examinations plus gastric aspirate examination was higher than that for only three sputum examinations. ConclusionsGastric aspirate is useful for the diagnosis of TB in patients with smear-negative pulmonary TB or without sputum production.

Magnitude and determinants of delay in diagnosis of tuberculosis patients in Ethiopia: a systematic review and meta-analysis: 2020

BackgroundTuberculosis (TB) remains a main public health concern in the world resulting in significant morbidity and mortality as well as in Ethiopia. In Ethiopia, there are various primary studies with inconsistent findings. Delay in the diagnosis of TB is determined by different factors like the type of TB, marital status, TB-HIV co-infection, employment status, place of residence, educational status, type of first visited a health facility, and gender of the patient. This review will produce pooled evidence on delay in diagnosis and associated factors among TB that might have huge public health impacts, like unfavorable treatment outcomes, increase transmission of the disease in the community for better intervention.MethodsThe presence of systematic reviews and meta-analysis on similar topics was checked and the topic was registered on PROSPERO to prevent duplication with the registration number of (CRD42020158963). Both published and unpublished studies conducted in Ethiopia from 2002 to April 1 2020 were searched thoroughly using electronic databases. Data were analyzed using STATA version 14. Heterogeneity was checked by using I2 and Cochrane Q test. In the presence of heterogeneity, a random effect model was employed to estimate the pooled magnitude and determinants of diagnosis delay of TB. Publication bias was checked by using the graphical funnel plot and Egger’s statistical test.ResultThe Pooled magnitude of tuberculosis diagnosis delay in Ethiopia was 45.42% [95%CI 34.44, 56.40]. Residing in urban, having educational status and patients with positive serostatus were protective against TB diagnostic delay while having extra-pulmonary TB and not being married were risk factors for delaying TB diagnosis.ConclusionTB diagnosis delays in Ethiopia are significantly high. Sociodemographic and institutional factors were significantly contributing to the delay. Therefore, national TB control programs need to identify and address gaps, barriers, and weaknesses along the entire patient care cascade, to improve appropriately.

ТЕХНОЛОГИИ GX ДЛЯ БЫСТРОЙ ДИАГНОСТИКИ ТУБЕРКУЛЕЗА В УЧРЕЖДЕНИЯХ ОБЩЕЙ ЛЕЧЕБНОЙ СЕТИ

Introduction. There is still a high percentage of tuberculosis detection by the number of complaints to the general medical network. Differential diagnosis is often performed in pulmonology departments using a standard diagnostic minimum. Reducing the time of diagnosis of tuberculosis is possible with the introduction of molecular genetic methods in the standards of primary examination. Aim. The aim is to determine the possibility of improving the detection of pulmonary tuberculosis using molecular genetic methods by the example of GeneXpert MTB/RIF cartridge technology in the pulmonology department of the general treatment network of healthcare. Material and methods. GeneXpert MTB/ RIF cartridge technology (MGM) was used in 159 patients with high risks of tuberculosis, characteristic changes on the X-ray image in addition to the standard study for the search for M. tuberculosis in biological material (sputum or bronchoalveolar fluid). Аccording to verified diagnoses, two groups were formed: 1st - tuberculosis (n = 119), second - pneumonia (n = 40). Statistical processing was carried out using the IBM SPSS Statistics 22.0 statistical software package. Results and discussions. In the differential diagnosis of tuberculosis in patients of the pulmonology department, there is a commonality of criteria for age (p=0.066), gender (p=0.249), unemployment (p=0.452), HIV infection (p=0.115), drug addiction (p=0.066), hepatitis (p=0.076). Positive results were on smear microscopy with sputum staining by Ziehel- Neelsen 18.9%, bronchoalveolar fluid 31%. The method of GeneXpert MTB/RIF cartridge technology showed a high sensitivity of 100% and specificity of 99% in all cases of a verified diagnosis of «tuberculosis» using culture methods. Conclusion. In patients with pneumonia who have risk factors for tuberculosis, when the GeneXpert MTB/RIF cartridge technology for M. tuberculosis search is included in the standard diagnostic minimum in the general medical network, the effectiveness of tuberculosis detection increases while reducing the time of diagnosis

P502 Different presentation of tuberculosis associated with anti-TNF therapy among patients with Inflammatory Bowel Disease in endemic area: observation from China

Abstract Background Anti-tumor necrosis factor (TNF) therapy increased the risk of tuberculosis(TB), and the characteristic clinical feature of western patients with inflammatory bowel disease (IBD) receiving anti-TNF therapy were predominantly extrapulmonary TB. We aimed to analyze the clinical features of patients with IBD who in TB-endemic area (China) that developed active tuberculosis after receiving anti-TNF therapy. Methods Patients from 9 hospital in 7 provinces developed active TB after the initial treatment with infliximab. Demographics, interval between the time at the first dose of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis were analyzed in our study. The diagnosis of active TB and LTBI were made based on comprehensive evaluation including TB skin test (TST), interferon gamma releasing assay (IGRA), X-ray test and computed tomography (CT). Results Totally 43 patients developed active TB during infliximab therapy. Among 43 patients, 6 patients had a past TB history and 11 patients were confirmed as LTBI before infliximab treatment. Six patients with LTBI received anti-TB prophylaxis as the same time as anti-TNF treatment. The mean time between initiation of infliximab therapy and active tuberculosis diagnosis in patients with LTBI was significantly shorter than patients without LTBI (216.9±83.2 days versus 410.9±220.3 days, p=0.042). Among 43 active TB patients, 29 patients (29/43, 67.4%) had isolated pulmonary tuberculosis and 11 patients (11/43, 25.6%) had pulmonary TB concomitantly with other organ involvement. Conclusion IBD patients with LTBI develop TB earlier than those without LTBI during anti-TNF treatment, and history of treatment and anti-TB prophylaxis didn’t fully prevent active TB. The most common disease site is lung in China, most of cases were diagnosed by imaging. Chinese physicians should be aware of the potential for TB development during anti-TNF therapy, especially pulmonary tuberculosis.

Risk factors associated with delays in seeking treatment and diagnosis of tuberculosis patients at DOTS center of a tertiary care institute in Himachal Pradesh

Background: Delays in diagnosis of tuberculosis (TB) is still a problem at all levels of health care. Understanding the etiology of these delays is essential for all stakeholders involved in TB control. This study was done to find the delays related to health-care seeking behavior, diagnosis, and major contributors to such delays among newly diagnosed patients of TB. Methods: This cross-sectional study was conducted from August 1, 2018, to July 2019 among the patients of TB diagnosed at Indira Gandhi Medical College, Shimla. A consecutive sample of 105 patients was enrolled for the study. Newly diagnosed cases aged 18 years and above were included in the study. Prevalence ratio with 95% confidence interval was calculated for risk factors associated with the identified delays. Results: At the patient level around 55% reported a delay of more than 14 days in seeking care with a median delay of 45 days (interquartile range [IQR] of 30–60 days). Nearly 67% patients were found to have a diagnostic delay of more than 7 days at the health-care provider level (Median 30 days; IQR 12.5–54.7 days). Delayed initiation of treatment after 7 days of diagnosis was found in 6.6% cases (Median 10 days; IQR 8–15 days) and all of these were patients of extra pulmonary TB. Delay was significantly associated (P = 0.01) with patients who travelled <5 km to reach the health facility. Conclusion: Inter-sectoral coordination, refresher trainings of health-care providers, patient education and capacity building for diagnostics at peripheral institutions can reduce delay in diagnosis and treatment of TB.

Effect of adjusted cut-offs of interferon-γ release assays on diagnosis of tuberculosis in patients with fever of unknown origin

BackgroundTuberculosis (TB) is a leading cause of fever of unknown origin (FUO). In recent years, interferon-γ release assays (IGRAs) have been widely utilized and the cut-off values given by the manufacturers are set in countries where rates of TB are not as high. MethodsA prospective cohort study was conducted in a Chinese general hospital to evaluate the diagnostic performance of T-SPOT.TB (T-SPOT) and QuantiFERON-TB Gold (QFT) in detecting active TB (ATB) in a high TB endemic area. Test results were compared with the culture and clinically confirmed diagnosis. Further, we explored an alternative method of interpreting IGRAs by increasing the cut-off values. ResultsThe sensitivity and specificity of T-SPOT in detecting ATB were 85.3% (95% CI 81.6–94.0%) and 71.8% (95% CI 67.3–76.0%), respectively. The sensitivity and specificity of QFT were 72.3% (95% CI 62.8–80.1%) and 77.0% (95% CI 72.7–80.8%), respectively. Receiver operating characteristic analysis was used for evaluation of different cut-off values. When the cut-off values were adjusted as 125 spot-forming cells (SFCs)/ 2.5*105 cells for T-SPOT and 4.0 IU/ml for QFT, the specificity could be improved to > 90.0% (90.3% and 94.1%, respectively), and the sensitivity were 43.1% and 41.6%, respectively. The new adjusted cut-off values were validated in another independent validation cohort. ConclusionThe adjusted cut-off values of the two assays considerably improved the diagnostic value when applied to FUO patients in clinical settings.

Possibilities of specific immunological tests in patients with TB/HIV coinfection

The objective of the study: to study the possibilities of skin tests with tuberculosis recombinant allergen (TRA) in the diagnosis of tuberculosis in HIV-positive patients in the region with a high prevalence of tuberculosis.Subjects and Methods. Medical files of 85 patients were retrospectively analyzed, all the patients suffered from TB/HIV coinfection and underwent the skin test with TRA.Results. The skin test with TRA was found to be significantly valuable for the diagnosis of tuberculosis in patients with TB/HIV coinfection. The correlation between the intensity of response to the TRA test and CD4+ count was detected (p = 0.011). The lowest values were observed for CD4+ counts below 100 cells/μL. The direct correlation between the intensity of response to TRA and the stage of HIV infection was proved. No effect of the form of tuberculosis, the phase of the tuberculosis disease, or drug sensitivity on the intensity of response to TRA was found. Among tuberculosis patients with bacterial excretion (n = 48), 68.8% of patients responded positively to the TRA test, and in those with no bacterial excretion, the positive reaction was observed in 81.1%.

Clinical, radiological, and laboratory predictors of a positive urine lipoarabinomannan test in sputum-scarce and sputum-negative patients with HIV-associated tuberculosis in two Johannesburg hospitals.

BackgroundTuberculosis (TB) is a major cause of mortality in persons living with HIV (PLWH). Sputum-based diagnosis of TB in patients with low CD4 counts is hampered by paucibacillary disease and consequent sputum scarcity or negative sputum results. Urine lipoarabinomannan (LAM) has shown promise in the point-of-care detection of TB in this patient subset but lacks sensitivity, and its exact role in a diagnostic algorithm for TB in South Africa remains to be clarified.ObjectivesThe objective of this study was to better define the patient profile and the TB characteristics associated with a positive urine LAM (LAM+ve) test.MethodThis multicentre retrospective record review examined the clinical, radiological, and laboratory characteristics of hospitalised PLWH receiving urine LAM testing with sputum-scarce and/or negative sputum GeneXpert ® (mycobacterium tuberculosis/resistance to rifampicin [MTB/RIF]) results.ResultsMore than a third of patients, 121/342 (35%), were LAM+ve. The positive yield was greater in the sputum-scarce than the sputum-negative group, 66/156 (42%) versus 55/186 (30%), P = 0.0141, respectively. Patients who were LAM+ve were more likely to be confused (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2–3.7, P = 0.0045), have a higher median heart rate (P = 0.0135) and an elevated quick sepsis-related organ failure assessment score (≥ 2), OR = 3.5, 95% CI = 1.6–7.6, P = 0.0014. A LAM+ve test was significantly associated with disseminated TB (dTB), P < 0.0001, TB-related immune reconstitution inflammatory syndrome (IRIS), P = 0.0035, and abdominal TB, P < 0.0001. Laboratory predictors of a LAM+ve status included renal dysfunction, P = 0.044, severe anaemia, P = 0.0116, and an elevated C-reactive protein, P = 0.0131. Of the 12 PLWH with disseminated non-TB mycobacteria cultured from the blood and/or bone marrow, n = 9 (75%) had a LAM+ve result (OR = 5.8, 95% CI = 1.6–20.8, P = 0.0053).ConclusionUrine LAM testing of hospitalised PLWH with suspected active TB had significant diagnostic utility in those that were sputum-scarce or sputum-negative. A LAM+ve result was associated with dTB, clinical and laboratory markers of severe illness, and TB-IRIS. Disseminated non-tuberculous mycobacterial infection of hospitalised PLWH may also yield urine LAM+ve results, and mycobacterial cultures must be checked in those non-responsive to conventional TB treatment. Selective use of the LAM test in the critically ill is likely to maximise the diagnostic yield, improve the test’s predictive value, and reduce the time to TB diagnosis and initiation of treatment.

Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China

BackgroundTuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay.MethodsData was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM.ResultsOf 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days.ConclusionsOur study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.

Detection and differential diagnosis of tuberculosis in patients of the pulmonary department with community-acquired pneumonia and chronic obstructive pulmonary disease

The purpose of the present work was to study the problem of tuberculosis detection in patients with chronic obstructive pulmonary disease (COPD) in the anamnesis and the role of Mantoux test and Diaskintest in diagnosing tuberculosis in patients hospitalized in the pulmonary department of the multidisciplinary emergency hospital. Materials. According to the results of analysis of 122 medical records of inpatient patients (form 003/u) hospitalized are divided into 2 groups: 1 st – patients admitted to hospital with the diagnosis of community-acquired pneumonia (CAP), 2 nd – patients with acute COPD, CAP at the follow-up of which was diagnosed in 73% of cases. Results. The age of patients with acute COPD was found to be 48.0 ± 1.9 and 69.9 ± 2.7 years respectively (z = –1.44; p = 0.149). Acute onset, duration and intensity of coughing, and pronounced shortness of breath were observed in patients with COPD in the clinical picture, but a CAP was detected in the follow-up survey. Coughing, fever, leukocytosis and accelerated sedimentation rate were more common symptoms in patients without COPD. Tuberculosis was detected in 10.7% of patients in the pulmonary department, while DNA of mycobacteria tuberculosis in the epithelial lining fluid was found in 30.8% of cases. Positive results of simultaneous immunodiagnostics (Mantoux test and Diaskin-test) were recorded in 76.9% of cases. Conclusion. Patients with COPD exacerbation, as well as patients with CAP, are a potential risk group for tuberculosis, need additional examination in the pulmonology department of the hospital according to the CAP standard to exclude or early diagnosis of pulmonary tuberculosis. If 2 diagnostic tests are used simultaneously (Mantoux test with 2 tuberculin units and Diaskintest), the accuracy and timeliness of tuberculosis diagnosis increases, including in case of exacerbation of COPD.

Assessment of diagnostic value of different methods (culture, PCR and biopsy) for the diagnosis of tuberculosis in patients with bronchial anthracosis

Introduction: Although several studies have shown the relationship between tuberculosis (TB) and anthracosis, few studies have investigated the diagnostic value of various methods of diagnosis of TB in these patients. Objectives: This study was conducted to investigate the diagnostic value of different methods including smear, culture and polymerase chain reaction (PCR) of bronchoalveolar lavage (BAL) sample and bronchial biopsy specimens in the diagnosis of TB in patients with bronchial anthracosis. Patients and Methods: This descriptive cross-sectional study was performed on 67 patients referring for bronchoscopy, and bronchial anthracosis was an incidental finding. The BAL sample and patients’ bronchial biopsies were examined for TB infection. Results: The most affected areas by anthracosis were the right and the left upper lobes. The BAL smear and its culture were positive in 12 (20%) and 10 patients (17%), respectively. The PCR of BAL sample was positive in 37%. Non-specific chronic inflammation followed by bronchial anthracosis was the most common pathologic findings. According to pathological examinations, nine patients (13%) had TB. Sensitivity and specificity of the PCR versus culture were 90% and 70%, respectively, with a diagnostic accuracy of 74%. Sensitivity, specificity and diagnostic accuracy of the pathologic examination of biopsy specimen were 33%, 85% and 74%, respectively. Conclusion: Findings of this study showed that nearly one fifth of patients with bronchial anthracosis suffer from TB simultaneously. In these patients, PCR of the BAL and pathologic examination of the biopsy specimen had the same diagnostic accuracy, but the sensitivity of PCR was three times higher. However, application of PCR and pathologic examination does not seem to have more diagnostic advantages than BAL culture for the diagnosis of TB, although the results by PCR may help to diagnose the disease sooner.

Диагностика туберкулеза у больных с терминальной стадией хронической болезни почек

Диагностика туберкулеза у больных с терминальной стадией хронической болезни почек

Evaluation of the Agreement Between the Tissue Sample and Bronchoalveolar Lavage (BAL) Fluid in the Diagnosis of Tuberculosis in Patients with Anthracosis

Background: Black dust deposited in the lungs is called anthracosis. By damaging bronchial mucosa, anthracosis can affect the mucociliary cleaning function. Initial reports indicate that there is a relationship between anthracosis and pulmonary tuberculosis. Due to obstructive effects of anthracosis on distal airways and disruption in a proper sampling of bronchoalveolar lavage (BAL), other diagnostic methods are necessary for estimating the tuberculosis prevalence in these patients. The aims of this study was to evaluate tissue samples adjacent to an anthracotic plaque for acid-fast bacilli smear and culture. Methods: his is a cross-sectional analysis study on 100 patients referred to Shahid Sadoughi Hospital who required bronchoscopy and anthracotic plaque based on bronchoscopy results. Bronchial fluid lavage, two biopsy samples for culture, and a smear of Mycobacterium tuberculosis from the surrounding of these plaques were prepared. Data analyses were carried out using SPSS (version 18). Results: One-hundred patients og the age range 46-91years were studied. The patients with tuberculosis diagnosis based on the smear of BAL and bronchial tissue samples and culture of BAL and bronchial tissue samples were 7%, 13%, 6% and 8% respectively. The presence of granuloma in histopathology was seen in 15 patients infected with tuberculosis. (κ &gt; 0.04, p-value &lt;0.05). In patients with positive tuberculosis, culture of bronchoalveolar lavage was superior to other methods. Conclusions: Diagnostic value of BAL method and tissue biopsy in anthracosis patients with tuberculosis did not show a statistically significant difference. As compared with other methods, BAL culture was more positive. Therefore, tissue biopsy is not a good alternative to BAL.

Clinical Features and Diagnostic Delay of Tuberculosis (TB) in Patients with Acute Myeloid Leukemia. (AML)

Introduction Patients with AML are inmmunocompromised because of the disease itself and the use of chemotherapy, increasing endemic opportunistic infections. The main complication is secondary infectious diseases, which we have to consider TB. In cancer patients infected with TB frequently manifest more atypical. Clinical signs and symptoms include lung disease which is still the most commonly involved site, extra pulmonary tuberculosis is not uncommon. Even that we're in an endemic country we still have some delay in the diagnosis of such disease. Objective To characterize the clinical and factors that contributes to the delay on the diagnosis of tuberculosis in patients with AML. Methods We did a chart review of patients with the diagnosis of TB and AML in the Instituto Nacional de Cancerologia, Mexico City, from January 2014 to July 2019. We analyze the clinical presentation of and the time to diagnosis TB in those patients. Results We analyze a cohort of 5 patients, three male and two female with a median age of 44 years old. The majority of patients were on induction chemotherapy. The main clinical presentation was persistent fever that begins in the nadir of chemotherapy. We observed a median of days for the diagnosis of tuberculosis of 37 days (9-82), the diagnosis was made by histopathology supported by special stains, and were required at least two biopsies for the diagnosis. One patient has pulmonary tuberculosis, one nodal presentation, two have a hepatosplenic presentation, and in the last patient was conclude latent TB. Just in one patient was available the microbiological identification, Mycobaterium bovis. Four patients started the approved treatment in Mexico, intensive phase with rifampicin, pyrazinamide, ethambutol and isoniazid. One patient develop Drug induce liver injury (DILI) so she couldn't continue the first line treatment and have to receive the second line which it is not standardize. After the initiation of the treatment, patients went out of fever and improve their condition. The patients were followed during the maintenance phase with rifampicin, and isoniazid. All of the patients are alive at the moment of the study. Conclusion: Febril neutropenia is a common complication in patients with AML, and in patients with persistent fever, tuberculosis should be include in the differential diagnosis. In México we have limited access to all the diagnostic tools available in our center. Culture is not always a way to identify TB, most of our patients were diagnosed by biopsy, median number of procedures were 3. Patient number 5 was followed by the infectology service after the whole protocol of culturing TB were concluded with no evidence of the disease and they decide to stop the treatment, and they manage the patient as latent TB. The availability of the techniques is the main factor which contributes to the diagnosis delay of TB. After the treatment was started, patients have a significant clinical improvement. Disclosures No relevant conflicts of interest to declare.

A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda

BackgroundThe management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread.MethodA retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.ResultsOf the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).ConclusionThe proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.

DETECTION OF MYCOBACTERIUM TB IN PATIENTS WITH EMPYEMA THORACIS USING NUCLEIC ACID AMPLIFICATION TEST

PURPOSE: To determine the utility of Nucleic Acid Amplification Test (GeneXpert MTB/RIF Assay) in the diagnosis of tuberculosis in patients with Empyema thoracis using empyema fluid METHODS: This is a cross-sectional study among patients admitted in Jose B. Lingad Memorial Regional Hospital under Department of Internal Medicine, diagnosed with empyema thoracis. Samples of empyema fluid after chest tube insertion were collected and then sent to the hospital’s Department of Pathology for empyema fluid analysis and GeneXpert assay. RESULTS: In Table, the utility of GeneXpert assay in detecting tuberculosis among patients with empyema thoracis showed higher sensitivity of 91.7% as well as specificity of 100%. Whereby those who are positive on GeneXpert assay have a very high likelihood (infinity estimate) of having tuberculosis. Meanwhile, those with negative result in GeneXpert assay are 0.08 times higher to negative with tuberculosis. Thus, GeneXpert assay demonstrates a clinically acceptable performance in detecting tuberculosis among empyema thoracis cases. CONCLUSIONS: GeneXpert assay is a clinically acceptable tool in detecting tuberculosis among empyema thoracis cases which yielded high sensitivity of 91.7% and specificity of 100%. CLINICAL IMPLICATIONS: Hence, based on the result of this study the use of GeneXpert assay may be a viable option in diagnosing TB among patients presenting with empyema thoracis where available. The use of empyema fluid AFB smear in the detection of tuberculosis cannot be recommended due to its low sensitivity result.