Early Morning Sputum Samples Research Articles

English

Tuberculosis (TB) is the most common serious opportunistic infection in Human- immunodeficiency-virus (HIV) positive patients and is the manifestation of AIDS in more than 50% of cases in developing countries. The present study was conducted from July 2012 to June 2014 at Al- Ameen Medical college Hospital, Bijapur, Southern India. The study was carried out to detect the prevalence of tuberculosis among HIV positive patients correlating with their CD4 counts. 90 confirmed HIV positive patients attending HIV-Voluntary Counselling and Testing Center (VCTC) located at the same hospital were included in the study. All were screened for pulmonary tuberculosis by testing early morning sputum samples by direct microscopy of AFB (Acid fast bacilli) stained smear and a base line chest radiograph (CXR) of the subjects as per RNTCP standard uidelines (7). HIV cases were further classified in correlation with their CD4 count. Of the 90 HIV infected persons, 49 (54.44%) were males and 41(45.55%) were females. Majority of them were in the age group 31-40yrs (47.7%) followed by 21-30 (22.2%). The overall prevalence of pulmonary tuberculosis was 16.66%. Co-infection was found to be higher in males than females (male: female = 9:6), and the age group of 31-40yrs were predominantly co-infected. Among 15 diagnosed pulmonary tuberculosis cases, 9 (60%) patients (7 males & 2 females) had CD4 count below 200cells/μl and 6 patients (40%) (2 males & 4 females) had CD4 count above 200cells/μl. The study shows total 16.66% TB prevalence in HIV positive patients and rate of tuberculosis is found to be more in patients with CD4 count less than 200(60%). As the tuberculosis is one of the important opportunistic infection in HIV positive patients, the screening for tuberculosis should be made mandatory for all HIV patients and require more strategic preventive measures that enhance body immunity among HIV patients are highly needed as early as possible before they develop active tuberculosis.

Surveillance of tuberculosis co-infection among HIV infected patients and their CD4+ cell count profile

ObjectiveTo determine the occurrence of tuberculosis (TB) among HIV infected patients and their CD4+ cell count profile. MethodsA total of 263 HIV-seropositive patients either hospitalized or reporting to the anti-retroviral therapy centre for follow up were included in the study. HIV-seropositive patients were then investigated clinically, radiologically and microbiologically for diagnosis of pulmonary TB as per the revised guidelines issued by WHO. Two early morning sputum samples were collected from patients, and isolation and identification of Mycobacterium tuberculosis was done as per standard protocol. ResultsOut of them 41 (15.6%) were TB positive and 222 (84.4%) were TB negative. Among TB positive patients, smear positive and culture positive patients were 19 (7.2%), while smear negative and culture positive were 9 (3.4%). Mean CD4+ T cell counts for HIV-seropositive and HIV-related TB patients were 156.14 cells/µL and 197.24 cells/µL respectively. ConclusionsThe clinical manifestations in HIV-related TB patients are quite variable and lead to difficulties in diagnosis. Thus radiological evaluation along with proper laboratory investigation in all clinically suspected cases of tuberculosis is the key for prompt diagnosis and treatment.

Pulmonary Tuberculosis and Its Risk Factors among Inmates of a Ghanaian Prison

Aims: To determine the prevalence of Pulmonary Tuberculosis (PTB) and its risk factors among prison inmates at the Ho central prison . Study Design : Cross - sectional study. Place and Duration of Study: Ho C entral Prison in the Ho Municipality of the Volta Region, between May and June 2014. Methodology: We included 389 prisoners who were screened using the World Health Organization PTB tool. Consenting suspected PTB case - patients were interviewed using a str uctured questionnaire. Variables collected were socio - demographic and prison - related factors. Spot and early morning sputum samples were collected from suspected case - patients for sputum smear microscopy. Prevalence of PTB and risk f actors were determined. Significance level

Molecular typing of Mycobacterium spp. isolates from Yemeni tuberculosis patients

The study was done to characterize at the species level Mycobacterium spp. isolates from Yemeni pulmonary tuberculosis patients. Early-morning sputum samples were collected from 170 patients referred to the National Tuberculosis Institute in Sana'a city with suspected pulmonary tuberculosis. Samples were processed with Ziehl-Neelsen stain and cultured in Ogawa and Lowenstein-Jensen media. The rpoB gene target sequence was amplified using mutagenesis forward and reverse primers followed by Hindlll enzyme digestion. Of the 120 isolates analysed, 118 (98.3%) were identified as M. tuberculosis complex and 2 (1.7%) were identified as mycobacteria other than M. tuberculosis. The results showed that those 2 isolates were multi-drug resistant and the DNA sequencing analysis showed that the alignment of nucleic acid of DNA in isolates of mycobacteria other than M. tuberculosis was different from that of M. tuberculosis complex.

The Use of Broncho-Alveolar or Gastric Lavage for the Diagnosis of Pulmonary Tuberculosis in Ouagadougou, Burkina Faso

Background: the national and international guidelines of the WHO and the IUALTD recommend priority sputum smears for diagnosis of pulmonary tuberculosis. We studied the use and diagnostic yield of sputum, broncho-alveolar and gastric lavage (BAL, GL) in the reference national mycobacteria Laboratory (NRL) (Burkina Faso) to see if clinicians follow the recommendations in the prescription of specimens. Methods: We analyzed by microscopy all samples sent to the RNL from 8 public and 6 private health care facilities in 2010. Results: 2638 patients were included. We have reported on 2414 early morning sputum samples, BAL from 191 patients and gastric lavage from 33. There were significant differences in the type of sample submitted per institution. Sputum formed 95% of the 862 samples from one hospital, whereas 78% of the 223 samples submitted by one private clinic were BAL samples. No sputum samples were submitted from these patients and in this clinic the diagnostic yield of BAL was just 4%. The overall diagnostic yield for early morning sputum specimens was 12% (290/2414), for BAL 3.7% (7/191) and for GL 6% (2/33). Conclusion: there was considerable variation in the diagnostic procedure used. Invasive methods are used at some sites in preference to safer and simpler means of obtaining material for diagnosis. Our review shows the need for constant vigilance and close adherence to internationally accepted guidelines for the diagnosis of pulmonary TB.

Moraxella catarrhalis: An emerging pathogen in bronchopulmonary infections

Background: Moraxella catarrhalis (M. catarrhalis) is a common pathogen in the human upper respiratory tract. This microbe is also implicated in chronic lower respiratory tract infections as well as conjunctivitis, sinusitis, meningitis, otitis media, osteomyelitis, endocarditis, etc. Objectives: This study was carried out to know various facets of M. catarrhalis infection among adults with bronchopulmonary infections and the related antibiotic susceptibility pattern. Materials and Methods: A hospital-based study was carried out among adult participants with history of respiratory tract infection admitted to a tertiary care teaching hospital in Karnataka during the period of May 2007 to April 2010. A total of 912 early morning sputum samples were collected, processed with standard procedures, and analyzed. Results: Out of all the sputum samples, M. catarrhalis was the third most important pathogen (16.01%). Most of these M. catarrhalis isolates were sourced from participants with bronchopneumonia (31.51%), followed by chronic bronchitis (25.34%), bronchiectasis (25.34%), and bronchial asthma (17.81%). M. catarrhalis infection was predominantly noted among males (78.08%) and in older age group (22.60%), i.e., 61-70 years. All strains of M. catarrhalis were sensitive to tetracycline, co-trimoxazole, chloramphenicol, and gentamicin; 75.34% were resistant to penicillin, ampicillin, and amoxycillin. Surprisingly, all strains were resistant to erythromycin; 37 (25.34%) were beta-lactamase positive. Conclusions: M. catarrhalis is one of the emerging pathogens in bronchopulmonary infections, and the beta-lactamase-producing strains imply its ability for antibiotic resistance.

English

BACKGROUND: The diagnosis of Tuberculosis (TB), with its high incidence and atypical manifestations in HIV, demands a reliable, rapid and cost effective diagnostic method. Fluorescent staining (Auramine phenol) carries advantage of easy interpretation of AFB compared to conventional Ziehl Neelsen staining (ZN). AIM: To compare the efficacy between ZN and fluorescent staining in detection of AFB in sputum among the HIV seropositives. MATERIAL AND METHODS: Adult HIV positive individuals, attending GHTM from March to May 2008, with clinical and/or radiological presentations suggestive of Pulmonary TB with no previous exposure to ATT were studied. From 225 clients, early morning sputum sample were subjected to Fluorescent, ZN staining and culture in LJ medium. Results analyzed to determine the sensitivity and specificity of ZN and Fluorescent methods, considering culture as gold standard. RESULTS : Of the 225 samples, 43 (19.1%) and 28 (12.4%) were smear positive by fluorescent and ZN stain respectively of which 27 (12%) samples were positive on both stains. The culture turned positive with 44 (19.5%) samples. Based on these reports, the sensitivity and specificity of fluorescent staining was 95.45% and 99.45% respectively and that of ZN stain was 63.64% and 100% respectively. CONCLUSION: Fluorescent staining is found superior to ZN staining and this concludes it is a better tool for screening PTB in HIV positives and needs further larger studies to recommend in public health program

A sample of patients affected with chronic respiratory tract infection

Background and objectives: Cryptococcosis is subacute or chronic respiratory disease caused by yeast like fungus called Cryptococcus neoformans. The disease may metastasize to CNS and other parts of the body. The objective of the study is to find the prevalence of this disease in a sample of patients in Erbil. Method: One hundred and twenty eight patients with chronic respiratory tract infection were included in this study. Early morning sputum sample was collected from each patient and subjected to both direct examination and culture Results: The study showed 24 positive cases of Cryptococcosis, from the total 128 patients examined; 16 of them (66.6%) gave positive culture for Cryptococcus neoformans while 8 (33.3%) gave positive culture for opportunistic species of Cryptococcus. The latter were immunocompromised individuals. Conclusion: It is concluded that looking for Cryptococcus, is quite significant in patients with chronic respiratory diseases.

016 A case of reversible dementia

A 45-year-male, presented with progressive cognitive decline in multiple domains over a 12 month period, he gradually developed impaired memory, psychomotor retardation, unsteadiness and falls. This accelerated prior to his...

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% (P < 0.001) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection.

Recurrent aspiration and upper lobe cavitation

In May, 2010, a 49-year-old woman presented to the outpatient clinic with a 4-month history of feeling generally unwell with night sweats and a persistent productive cough of green and yellow sputum. She described coughing when lying fl at, particularly in the early morning hours. Medical history included laparo scopic adjustable gastric banding fi tted in September, 2008, for class III obesity, when her body-mass index (BMI) was 45·4 kg/m². She had been referred to a weight management clinic in July, 2008, at age 49 (BMI 46·2 kg/m²), and subsequently qualifi ed for gastric banding. Her initial response to surgery was modest and she underwent further band fi lls in 2008 and 2009. She was a known asthmatic and had been treated by her general practitioner for exacerbation of her asthma but with no improvement. On examination, her BMI was 32·6 kg/m² and her observations were within normal limits. Blood tests showed a high concentration of C-reactive protein (81 mg/L) and a high ESR (96 mm/h). Chest radiograph showed left upper zone cavitation. Given the radiographic appearance and the presence of persistent night sweats, tuberculosis was suspected. She was referred to the tuberculosis clinic and a subsequent thoracic CT scan confi rmed the presence of a 3·2 cm × 2·8 cm irregular cavitating lesion within the apical segment of the left upper lobe (fi gure). A moderate dilatation of the oesophagus, but no signifi cant thoracic lymphadenopathy, was also seen. Subsequent early morning sputum samples for acid fast bacilli were persistently negative and sputum culture showed only normal respiratory fl ora. Aspergillus precipitins were negative and an autoimmune screen showed no abnormalities. A bronchoscopy and subsequent washings did not yield acid fast bacilli. At this point, the diagnosis of recurrent aspiration and cavitation secondary to a severe restriction from her gastric banding was suspected. She was allergic to penicillin, and therefore treated with metronidazole and doxycycline.Her symptoms persisted, and after 6 weeks of anti-biotics she had only had short-term symptom relief. Therefore, her gastric band was completely emptied, after which her symptoms quickly resolved. A subsequent barium meal showed resolution of her oesophageal dilatation. Based on chest radiographs, the lung cavitation had fully resolved, along with her symptoms. At last follow-up in May, 2011, her BMI was 34·8 kg/m² and her gastric band had been cautiously refi lled with no symptom recurrence.Laparoscopic adjustable gastric banding is regarded as the least invasive surgical option for morbid obesity. However, the procedure is associated with high frequency of late complications, with pouch expansion and band slippage or erosion being the most common.

Prevalence of pulmonary cryptococcosis in hiv/aids patients

Cryptococcus neoformans causes both pulmonary and meninges infection in healthy and immunocompromised hosts. The objective of this study was to determine the prevalence of pulmonary cryptococcosis in HIV/AIDS patients and assess the clinical presentations due to the infection. The subjects recruited for this study were confirmed HIV/AIDS patients, presenting with pneumonia complications. The demographic and clinical features were abstracted from the medical records and administered questionnaire. Early morning sputum samples were collected from the patients and examined by bacteriological methods. The isolated Cryptococcus neoformans were sub-cultured onto thistle bird seed agar and the identity was confirmed with API 20C Kit. Out of 250 patients investigated, 47 (18.8%) had pulmonary cryptococcosis. The C.neoformans isolates were more in females, 26 (10.4%) than the males, 21 (8.4%), while the age group of 20-40 years old had 39 (15.6%) isolates. The clinical features that were associated with the pulmonary cryptococcosis were the production of purulent and bloody sputum, and fever. The patients with prolonged duration of HIV/AIDS and are not on HAART regimens had higher C.neoformans isolates. The isolation of C.neoformans from HIV/AIDS patients is a major public health concern, since it complicates the severity of the disease. There is a need for routine check of pulmonary cryptococcosis, especially, in those who do not avail themselves for antiretroviral therapy.

Molecular detection of rifampin and isoniazid resistance to guide chronic TB patient management in Burkina Faso

BackgroundDrug-resistant tuberculosis (DR-TB) is considered a real threat to the achievement of TB control. Testing of mycobacterial culture and testing of drug susceptibility (DST) capacity are limited in resource-poor countries, therefore inadequate treatment may occur, favouring resistance development. We evaluated the molecular assay GenoType® MTBDRplus (Hain Lifescience, Germany) in order to detect DR-TB directly in clinical specimens as a means of providing a more accurate management of chronic TB patients in Burkina Faso, a country with a high TB-HIV co-infection prevalence.MethodsSamples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy) were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA) and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType® MTBDRplus.ResultsWe obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients.Among 108 chronic TB cases we identified patients who (i) harboured rifampin- and isoniazid-susceptible strains (n 24), (ii) were negative for MTB complex DNA (n 24), and (iii) had non-tuberculous mycobacteria infections (n 13). The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the rpoB gene (43.8% of cases). Other mutations recognized were the H526D (15.6%), the H526Y (15.6%), and the S531L (9.4%).All isoniazid-resistant cases (n 36) identified by the molecular assay were carrying a S315T substitution in the katG gene. In 41.7% of cases, a mutation affecting the promoter region of the inhA gene was also detected.ConclusionThe GenoType® MTBDRplus assay performed directly on sputum specimens improves the management of chronic TB cases allowing more appropriate anti-TB regimens.

One - day 2 Sputum Samples AFB Microscopy Versus Standard Two - day 3 Sputum Samples AFB Microscopy in a Nigerian Rural Tuberculosis Center

Aim: To compare one-day 2 sputum samples AFB microscopy with standard two-day 3 sputum samples AFB microscopy in a Nigerian rural tuberculosis center. Method: A total of 752 suspected tuberculosis patients were studied between May and July, 2006. Two sputum samples collected “on the spot” and one hour later served as study test procedure while three sputum samples collected in the usual standard sputum microscopy procedure served as control. Results: There was no significant difference in the diagnostic values between the study tests and the control (standard) tests (P=0.57). The study test was also observed to be highly sensitive and specific. Conclusion and Recommendation: One-day 2 sputum sample microscopy for AFB conducted one hour apart should be encouraged to avoid the inconvenience of asking patient to come back the next day. Early morning sputum sample the next day should be reserved for only those who had only one positive sputum result. Keywords : tuberculosis, AFB microscopy, sputum sample, Nigerian rural tuberculosis center. Journal of College of Medicine Vol. 13 (2) 2008: pp. 101-104