Tuberculosis In Differential Diagnosis Research Articles

Evaluation of the radial endosonographic image of peripheral lung lesions for choosing the bronchobiopsies in the differential diagnosis of tuberculosis, mycobacteriosis and malignancy

Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies. Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.

Case series of complicated bronchopulmonary lophomoniasis. Differential diagnosis of tuberculosis?

Case series of complicated bronchopulmonary lophomoniasis. Differential diagnosis of tuberculosis?

Issues of interdisciplinary interaction during detection and diagnosis of tuberculosis in children and adolescents: a literature review and comments

Interdisciplinary interaction between phthisiatricians and pediatricians on the issues of detection and diagnosis of tuberculosis provides basis for the reduction of duration of the diagnostic process and the early identification of disease progression. The purpose of this review and comments is to systematize the knowledge of pediatricians about the detection and diagnosis of tuberculosis in children and adolescents in primary health care (PHC) facilities to improve the diagnostic process. We have performed an analysis and systematization of the current directive and methodological documents, articles on the detection and diagnosis of tuberculosis in PHC facitlities. The significance of skin immunological tests (Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L and a test with recombinant tuberculosis allergen (RTA)) during mass and selective screening to form groups at high risk for Tuberculosis and detect the disease is emphasized. The doctor’s actions based on the current guiding documents and laws are presented for cases when parents/legal representatives or the patient himself refuses from immunological skin tests. Positions that determine the need for interdisciplinary interaction for pediatricians on the issues of detection, diagnosis and differential diagnosis of tuberculosis are clearly articulated. The pathway to diagnosis begins with the formation of groups at high risk for tuberculosis in PHC facilities and with seeking medical help from a pediatrician in the presence of clinical signs similar to those of tuberculosis. Particular attention is paid to the detection of the disease when patients with clinical symptoms similar to those of tuberculosis seek medical help, and the missed opportunities for its early diagnosis are presented. Predictors allowing pediatricians to suspect tuberculosis and promptly refer a patient to a phthisiatrician to confirm / exclude the disease are provided.

Complement regulatory proteins: Candidate biomarkers in differentiating tuberculosis pleural effusion.

Complement activation is essential for tuberculosis pleural effusion. However, little is known about the value of complement regulatory protein (CD46, CD55, and CD59) in the differential diagnosis of tuberculosis. Ninety-nine patients with exudative pleural effusion admitted to Xiangya Hospital of Central South University from June 1, 2021to November 14, 2022 were enrolled. The expression levels of soluble CD46 (sCD46), soluble CD55 (sCD55), and soluble CD59 (sCD59) in pleural effusion were quantified by enzyme-linked immunosorbent assay, and the receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic and co-diagnostic values. The ADA level is higher in TPE patients than non-TPE patients. It is well-found that TPE patients had lower levels of sCD46, sCD55, and sCD59 compared with non-TPE patients. Moreover, the expression of sCD46, sCD55, and sCD59 in pleural effusion was negatively correlated with ADA. In addition, the diagnostic efficacy of sCD46, sCD55 and sCD59 was comparable to that of ADA, with 0.896, 0.857, 0.858 and 0.893, respectively. Furthermore, combine detection of sCD46, sCD55, sCD59 and ADA could improve the diagnostic accuracy. Complement regulatory factors (CD46, CD55, and CD59) were validated by this project to be promising candidate biomarkers for the diagnosis of TPE with high accuracy. The combination of the CD46, CD55, and CD59 and ADA assay exist a better diagnostic value in TPE.

The Application of Artificial Intelligence in the Diagnosis and Drug Resistance Prediction of Pulmonary Tuberculosis.

With the increasing incidence and mortality of pulmonary tuberculosis, in addition to tough and controversial disease management, time-wasting and resource-limited conventional approaches to the diagnosis and differential diagnosis of tuberculosis are still awkward issues, especially in countries with high tuberculosis burden and backwardness. In the meantime, the climbing proportion of drug-resistant tuberculosis poses a significant hazard to public health. Thus, auxiliary diagnostic tools with higher efficiency and accuracy are urgently required. Artificial intelligence (AI), which is not new but has recently grown in popularity, provides researchers with opportunities and technical underpinnings to develop novel, precise, rapid, and automated implements for pulmonary tuberculosis care, including but not limited to tuberculosis detection. In this review, we aimed to introduce representative AI methods, focusing on deep learning and radiomics, followed by definite descriptions of the state-of-the-art AI models developed using medical images and genetic data to detect pulmonary tuberculosis, distinguish the infection from other pulmonary diseases, and identify drug resistance of tuberculosis, with the purpose of assisting physicians in deciding the appropriate therapeutic schedule in the early stage of the disease. We also enumerated the challenges in maximizing the impact of AI in this field such as generalization and clinical utility of the deep learning models.

Possible Use of Tuberculous Recombinant Allergen Test in the Differential Diagnosis of Diseases in the Upper Lung Lobes in Adults

The objective of the study: to evaluate the possible use of the subcutaneous test with tuberculous recombinant allergen (TRA) in the differential diagnosis of pulmonary tuberculosis localized in the upper lobes.Subjects and Methods. Data of examinations with subcutaneous TRA and Mantoux tests with 2 units in 648 patients aged 18 to 90 years with various lung pathologies and HIV-negative status and 122 healthy individuals were retrospectively analyzed. Among these subjects, the following diseases were diagnosed: tuberculosis, pneumonia, cancer, post-tuberculosis changes, and sclerotic changes after nonspecific diseases.Results. The sensitivity of TRA test in adults with tuberculous lesions in the upper lobes was 59.87%; the rate of negative responses in those without active tuberculosis was 76.0%; the sensitivity of Mantoux test with 2 units was higher and made 83.6%, but the rate of negative responses in those without tuberculosis was lower – 44.1%. TRA test is most important in the differential diagnosis of tuberculosis and pneumonia in which positive and hyperergic reactions are observed in 59.87 and 13.95% of cases, respectively.The comparative analysis of the rates for tuberculosis and post-tuberculosis changes showed no statistically significant difference in both Mantoux test (83.6 and 78.4%, respectively, p > 0.05) and TRA test (59.87 and 50.77%, respectively, p > 0.05). This indicates that these tests cannot be used to assess the activity of tuberculosis localized in the upper lobes of the lungs in adults.

Pediatric Osteoarticular Tuberculosis as a Diagnostic Dilemma and a Review of Literature.

IntroductionDespite tuberculosis being rampant in the Indian subcontinent, most cases of osteoarticular (OA) tuberculosis (TB) are missed until significant bony destruction has occurred. Initial presentation of extra-pulmonary TB mimics many other disease entities while many diseases mimic TB. This may lead to an incorrect diagnosis and sometimes creates a dilemma in reaching the correct diagnosis. The aim of this study was to evaluate a series of pediatric cases of osteoarticular TB, which posed a diagnostic challenge to us.Material and methodsRetrospective analysis of case records of pediatric OA-TB patients who had presented to two tertiary level centers of urban India between February 2016 and December 2020 was done. There were a total of 69 patients. ObservationsThere were 37 males and 32 females. The age range was from two to 17 years. Forty-four patients showed evidence of disease within the spine (dorsal region followed by lumbar, followed by the cervical spine), 16 showed disease of the extremities, six had disease of the girdle bones, and three showed disease of the short bones of hands or foot. In our series, patients presented to us between 15 days to six months from the onset of symptoms. From our series, six cases with atypical clinical pictures have been selected for presentation purposes. In all six cases, the initial presentation was not that of OA-TB. However, with a high degree of suspicion, differential diagnosis of TB was kept in mind, and the diagnosis was confirmed microbiologically.ConclusionA high degree of suspicion is required to avoid missing the diagnosis of osteoarticular TB. Non-invasive advanced radiological investigations such as MRI and microbiological analysis of biopsy specimens aid in arriving at the correct diagnosis.

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

Magnetic Resonance Imaging Images under Deep Learning in the Identification of Tuberculosis and Pneumonia.

This work aimed to explore the application value of deep learning-based magnetic resonance imaging (MRI) images in the identification of tuberculosis and pneumonia, in order to provide a certain reference basis for clinical identification. In this study, 30 pulmonary tuberculosis patients and 27 pneumonia patients who were hospitalized were selected as the research objects, and they were divided into a pulmonary tuberculosis group and a pneumonia group. MRI examination based on noise reduction algorithms was used to observe and compare the signal-to-noise ratio (SNR) and carrier-to-noise ratio (CNR) of the images. In addition, the apparent diffusion coefficient (ADC) value for the diagnosis efficiency of lung parenchymal lesions was analyzed, and the best b value was selected. The results showed that the MRI image after denoising by the deep convolutional neural network (DCNN) algorithm was clearer, the edges of the lung tissue were regular, the inflammation signal was higher, and the SNR and CNR were better than before, which were 119.79 versus 83.43 and 12.59 versus 7.21, respectively. The accuracy of MRI based on a deep learning algorithm in the diagnosis of pulmonary tuberculosis and pneumonia was significantly improved (96.67% vs. 70%, 100% vs. 62.96%) (P < 0.05). With the increase in b value, the CNR and SNR of MRI images all showed a downward trend (P < 0.05). Therefore, it was found that the shadow of tuberculosis lesions under a specific sequence was higher than that of pneumonia in the process of identifying tuberculosis and pneumonia, which reflected the importance of deep learning MRI images in the differential diagnosis of tuberculosis and pneumonia, thereby providing reference basis for clinical follow-up diagnosis and treatment.

Scientific platform, development and implementation of effective immunodiagnosis of tuberculosis infection in the Russian Federation

The review presents scientific information about modern approaches to immunodiagnosis of tuberculosis infection in the Russian Federation, which allows to control the spread of infection and prevent the development of the disease in individuals infected with Mycobacterium tuberculosis (MTB). The results of Russian and foreign studies have shown a low total sensitivity of the Mantoux tuberculin skin test, which indicates a low predictive value of the test for the diagnosis of tuberculosis infection. The article presents the results of preclinical and clinical studies of a new diagnostic test for the detection of tuberculosis infection using Diaskintest. The results substantiate the purpose of Diaskintest for the diagnosis of tuberculosis infection, assessment of the process activity; differential diagnosis of tuberculosis; differential diagnosis of post-vaccination and infectious immune response (delayed-type hypersensitivity); monitoring the effectiveness of treatment. The article presents the results information on the screening of tuberculosis infection in the Russian Federation using Diaskintest, its significance, efficacy, and safety. The results of scientific studies carried out in recent years to assess the effectiveness of immunodiagnostics in the Russian Federation give reason to believe that the introduction of a modern screening method for diagnosing tuberculosis infection using Diaskintest can significantly improve the quality of doctors work on the early detection of various manifestations of tuberculosis infection and significantly reduce the states material costs for combating with tuberculosis.

Protein and Microbial Biomarkers in Sputum Discern Acute and Latent Tuberculosis in Investigation of Pastoral Ethiopian Cohort.

Differential diagnosis of tuberculosis (TB) and latent TB infection (LTBI) remains a public health priority in high TB burden countries. Pulmonary TB is diagnosed by sputum smear microscopy, chest X-rays, and PCR tests for distinct Mycobacterium tuberculosis (Mtb) genes. Clinical tests to diagnose LTBI rely on immune cell stimulation in blood plasma with TB-specific antigens followed by measurements of interferon-γ concentrations. The latter is an important cytokine for cellular immune responses against Mtb in infected lung tissues. Sputum smear microscopy and chest X-rays are not sufficiently sensitive while both PCR and interferon-γ release assays are expensive. Alternative biomarkers for the development of diagnostic tests to discern TB disease states are desirable. This study’s objective was to discover sputum diagnostic biomarker candidates from the analysis of samples from 161 human subjects including TB patients, individuals with LTBI, negative community controls (NCC) from the province South Omo, a pastoral region in Ethiopia. We analyzed 16S rRNA gene-based bacterial taxonomies and proteomic profiles. The sputum microbiota did not reveal statistically significant differences in α-diversity comparing the cohorts. The genus Mycobacterium, representing Mtb, was only identified for the TB group which also featured reduced abundance of the genus Rothia in comparison with the LTBI and NCC groups. Rothia is a respiratory tract commensal and may be sensitive to the inflammatory milieu generated by infection with Mtb. Proteomic data supported innate immune responses against the pathogen in subjects with pulmonary TB. Ferritin, an iron storage protein released by damaged host cells, was markedly increased in abundance in TB sputum compared to the LTBI and NCC groups, along with the α-1-acid glycoproteins ORM1 and ORM2. These proteins are acute phase reactants and inhibit excessive neutrophil activation. Proteomic data highlight the effector roles of neutrophils in the anti-Mtb response which was not observed for LTBI cases. Less abundant in the sputum of the LTBI group, compared to the NCC group, were two immunomodulatory proteins, mitochondrial TSPO and the extracellular ribonuclease T2. If validated, these proteins are of interest as new biomarkers for diagnosis of LTBI.

LARYNGEAL TUBERCULOSIS – A NEGLECTED DISEASE THAT CAN MIMIC LARYNGEAL CARCINOMA

Laryngeal tuberculosis is a form of extra-pulmonary tuberculosis that occurs in only 1% of all tuberculosis cases, with the mortality rate of less than 2%. It can be a complication of pulmonary or some other form of extra-pulmonary tuberculosis (via bronchogenic, haematogenic or lymphagenic spread of bacilli), or the larynx can be the only organ affected after the direct invasion of Mycobacterium tuberculosis. Clinical, laryngoscopic and radiological findings of laryngeal tuberculosis tend to mimic laryngeal cancer, delaying the appropriate treatment. In this paper, we present a case of the laryngeal and pulmonary tuberculosis which was primarily diagnosed and almost treated as laryngeal carcinoma. An 84 years old Caucasian male presented with a 3-months history of hoarseness, odynophagia, dysphagia, cough with expectoration and weight loss. After the laryngoscopy and biopsy of the laryngeal ulceration, a squamous cell carcinoma was suspected. However, chest X-ray and CT scan detected pulmonary infiltrates, while the positive sputum smear for acid-fast bacilli was obtained and the sputum cultures grew Mycobacterium tuberculosis. Detailed histopathological analysis of the biopsies was in accordance with tuberculosis, and no signs of timorous tissue were found. After the end of the proposed antituberculous treatment, the patient reported no symptoms of the diseases, laryngoscopic findings showed no signs of neoplastic tissue, and CT findings showed partial radiological regression. Distinguishing laryngeal carcinoma and tuberculosis can be very challenging, even after obtaining histopathological material. Nevertheless, biopsies should be taken from all suspicious lesions and at multiple sites and Ziehl-Neelson staining of sputum and bioptic tissue is necessary. Otorhinolaryngologists should always consider tuberculosis in differential diagnosis of laryngeal lesions, especially nowadays when the incidence of laryngeal tuberculosis is increasing in developing countries.

Rapid Discrimination of Tuberculosis and Sarcoidosis by Next-Generation Sequencing

Background: Tuberculosis (TB) is caused by the infection of Mycobacterium tuberculosis (MTB) and shares highly similar clinical, radiological, and histopathological characteristics with sarcoidosis (SA). Correctly distinguishing SA from TB is still one of the clinical challenges. Methods: This study enrolled 44 TB patients and 47 SA patients that were clinically diagnosed by chest radiography, pathological examination, routine smear microscopy, and culture. The MTB genome was captured and sequenced directly from tissue specimens by operation or biopsy and evaluated the feasibility of next-generation sequencing (NGS) for the MTB genome in the differential diagnosis of TB from SA. Findings: Following the depth > 10× and coverage > 15% filter of the sequencing data, TB patients were well identified by the NGS approach directly in using of operation or biopsy specimens without clinical pretreatment. The sensitivity, specificity, and concordance of NGS diagnostic method was 81.8% (36/44), 95.7% (45/47) and 89.0% (81/91), respectively (Kappa value = 0.78, 95%CI = 0.65-0.91 P-value = 0.00). Interpretation: Our study established an improved method of rapid strategy in distinguishing patients with TB, and have a potential benefit in clinical implications. Funding Statement: This work was supported by the Shanghai Science and Technology SMEs Technology Innovation Fund (1702H117500), the Jiaxing Leading Talent Entrepreneurship Project, and the Technology innovation projects of Jiaxing. Declaration of Interests: The authors declare no potential conflicts of interest. Ethics Approval Statement: This study was conducted according to the principles of the World Medical Association Declaration of Helsinki. The study was approved specifically by the Internal Review Board of the Affiliated Zhongshan Hospital, Fudan University. All participants were informed and consent to participate in this retrospective study (IRB approval No. B2017-122).

Immunological skin tests in differential diagnostics disseminated processes in the lungs

Diseases that manifest as Х-ray syndrome of pulmonary dissemination are one of the most complex differential diagnostic problems in pulmonology and Phthisiology. Literature data on the effectiveness of using a new intradermal test with tuberculosis recombinant allergen (ATR, Diaskintest®) for disseminated processes in the lungs are single and contradictory.The aim. Тo study the diagnostic capabilities of intradermal test with tuberculosis recombinant allergen in disseminated lung processes of various etiologies.Methods. The analysis of archival materials of 204 patients with disseminated lung processes of various etiologies who were admitted to diagnostic departments of the N.S.Pokhvisneva Voronezh regional anti-tuberculosis dispensary in 2011 – 2019 was carried out. There were 85 (41.67%) women and 119 (58.33%) men aged 19 to 87 years. The data of im mu no - logical examination of patients using intradermal Mantoux samples with 2 TE PPD-L and with ATR were studied, and their comparative analysis was performed.Results. In disseminated pulmonary processes in tuberculosis, the proportion of individuals who respond positively to the Mantoux test was greater only in comparison with the group of people with sarcoidosis (p &lt; 0.01) and did not significantly differ from the results in other groups of patients (p &gt; 0.05). At the same time, the proportion of people who respond positively to a test with ATR in tuberculosis was greater than in patients with pneumonia, sarcoidosis (p &lt; 0.01) and, to some extent, with a tumor. In healthy individuals, a lower proportion of positive reactions to ATR was established compared to the Mantoux test (p &lt; 0.01). With active disseminated pulmonary tuberculosis, a hyperergic reaction (11.9%) was observed in the sample with ATR, which was not observed with the Mantoux test. In non-specific processes in the lungs, less often than negative reactions (p &lt; 0.05) were detected on the sample with ATR less often than on the Mantoux test with 2 TE.Conclusion. The ATR sample compared to the Mantoux test indicates that it is appropriate to use it in the differential diagnosis of tuberculosis and non-specific lung diseases in adult patients with radiological dissemination syndrome.

Disseminated Mycobacterium avium complex infection as a differential diagnosis of tuberculosis in HIV patients.

BACKGROUND: Disseminated Mycobacterium avium complex infection (DMAC) has symptoms and microscopic findings similar to those of TB in HIV patients. To inform a clinical algorithm-based differential diagnosis, we aimed to characterise the clinical features of DMAC.METHODS: This was a retrospective cohort study of 192 HIV-positive patients with culture-confirmed mycobacterial infections hospitalised during 1996-2016 at a major HIV/AIDS treatment centre in Taiwan.RESULTS: HIV patients with DMAC (n = 58) had a three times higher 1-year mortality than those with TB (n = 98) (48.3% vs. 16.3%, P < 0.001). DMAC and TB were not distinguishable by the WHO TB screening criteria (fever, cough, night sweats or weight loss). Nevertheless, DMAC was characterised by a lower median CD4 count (5.0 cells/µL vs. 38.5 cells/µL, P < 0.001), lower median body mass index (BMI) (17.7 kg/m² vs. 19.7 kg/m², P = 0.002) and the absence of chest radiographic findings (P < 0.001). Simultaneous presence of CD4 <20 cells/µl, BMI <18.5 kg/m² and negative chest radiographic finding had a 98% specificity for diagnosing DMAC against TB or other types of mycobacterial infections.CONCLUSION: DMAC is an important differential diagnosis of TB in HIV patients. A simple rule based on CD4, BMI and chest radiography may inform the decision to start anti-DMAC treatment in patients with mycobacterial infection.

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.

An ANN model for the differential diagnosis of tuberculosis and sarcoidosis.

Sarcoidosis is often misdiagnosed as tuberculosis and consequently mistreated owing to inherent limitations in histopathological and radiological presentations. It is known that the differential diagnosis of Tuberculosis and Sarcoidosis is often non-trivial and requires expertise and experience from clinicians. Therefore, it is of interest to describe a multilayer neural network model to differentiate pulmonary tuberculosis from Sarcoidosis using signal intensity data from blood transcriptional microarray. Genes that are significantly upregulated in Pulmonary Tuberculosis and Sarcoidosis in comparison with healthy controls were used in the model. The model classified Pulmonary Tuberculosis and Sarcoidosis with 95.8% accuracy. The model also helps to identify gene markers that are differentially upregulated in the two clinical conditions.

A Fault-Based Testing Approach in Safety Critical Medical Systems

The advent of technology has opened unprecedented opportunities in health care delivery system as the demand for intelligent and knowledge-based systems has increased as modern medical practices become more knowledge-intensive. As a result of this, there is greater need to investigate the pervasiveness of software faults in Safety critical medical systems for proper diagnosis. The sheer volume of code in these systems creates significant concerns about the quality of the software. The rate of untimely deaths nowadays is alarming partly due to the medical device used to carry out the diagnosis process. A safety-critical medical (SCM) system is a complex system in which the malfunctioning of software could result in death, injury of the patient or damage to the environment. The malfunctioning of the software could be as a result of the inadequacy in software testing due to test suit problem or oracle problem. Testing a SCM system poses great challenges to software testers. One of these challenges is the need to generate a limited number of test cases of a given regression test suite in a manner that does not compromise its defect detection ability. This paper presents a novel five-stage fault-based testing procedure for SCM, a model-based approach to generate test cases for differential diagnosis of Tuberculosis. We used Prime Path Coverage and Edge-Pair Coverage as coverage criteria to ensure maximum coverage to identify feasible paths. We analyzed the proposed testing procedure with the help of three metrics consisting of Fault Detection Density, Fault Detection Effectiveness and Mutation Adequacy Score. We evaluated the effectiveness of our testing procedure by running the suggested test cases on a sample historical data of tuberculosis patients. The experimental results show that our developed testing procedure has some advantages such as creating mutant graphs and Fuzzy Cognitive Map Engine while resolving the problem of eliminating infeasible test cases for effective decision making.

Respiratory sarcoidosis: immunopathogenetic aspects and diagnostic problems

The analysis of the state of the problem on the sarcoidosis of the respiratory organs at the present stage has been carried out. The aspects of sarcouidosis immunopathogenesis are considered. Attention is focused on the variability of clinical and morphological manifestations and the expediency of identifying clinical and morphological phenotypes of sarcoidosis.In the differential diagnosis of tuberculosis and sarcoidosis, a comprehensive study of biopsy specimens is recommended, including a morphological study and a molecular study for mycobacterium tuberculosis. The negative result of a molecular study of a tissue substrate improves the accuracy and reliability of morphological verification of sarcoidosis.

Disseminated lung disease in elderly patient with multimorbidity and HIV infection (clinical case)

Disseminated lung diseases have similar non-specific manifestations in various etiologies, pathogenesis, and morphology. Pulmonary dissemination is the concept of X-ray, there are no pathognomonic symptoms on a radiograph that are inherent in a particular disease with pulmonary dissemination, therefore, in real clinical practice, differential diagnosis in pulmonary dissemination is the prerogative of the physician. Diseases that are manifested by pulmonary dissemination can be classified by dissemination of infectious causes (tuberculosis, HIV-associated dissemination, fungal lesions), malignant pulmonary lesions (carcinomatosis, cancer lymphangitis), cardiogenic dissemination and interstitial lung diseases. In recent years, the incidence of allergic interstitial lung diseases has increased. Infectious lesions of the lungs in patients with HIV infection and reduced immune status in many cases also have a disseminated form and cause difficulties in the differential diagnosis of tuberculosis. The article presents a clinical case of pneumocystis pneumonia in an HIV-infected patient with pulmonary dissemination syndrome on X-ray. The difficulties of the diagnostic search with low compliance of the patient and the physician are shown (a patient registered with HIV for 10 years hid this fact of his history from the attending physician and gave a written refusal to get tested for HIV fibrobronchoscopy). The possibility of introducing compulsory HIV screening for all patients admitted to the hospital with disseminated processes in the lungs has been considered.