EPTB Cases Research Articles

دراسة إسترجاعية لحالات مرض السل في مدينة اجدابيا بليبيا خلال الفترة 2010-2020

Tuberculosis (TB) is one of the most potentially fatal contagious diseases worldwide, especially in the developing countries. The aim of this study was to assess the pattern of TB in Ajdabiya, Libya. This cross-sectional study was carried out from January 2010 to December 2020 using medical records from the TBRegistry at National Center for Disease Control situated in Ajdabiya. The investigated variables included demographic characteristics, type of TB infection, and affected organs. All data were coded and statistically analyzed. Results showed that the total of 536 patients was enrolled in this study: 299 (55.8%) were males and 237 (44.2%) were females. In both sexes, 238 (44.4%) patients were affected with PTB, 214 (39.9%) patients were affected with EPTB, only 84 (15.7%) were presumptive patients. The highest incidence occurred in there productive age group 25-34 years (23.3 %) and housewives (27.6%). During the 11 years study period, the highest percentage of cases was during 2018and the lowest frequency was during 2011. The largest proportion of EPTB cases was pleural TB 45.3% followed by lymphatic TB 23.4%, then bone TB 11.2%. Conclusion: Young, middle-aged male cases were highest in percentage. The highest percentage of TB was registered in 2018. Keywords: (TB) tuberculosis, (PTB) pulmonary, (EPTB) extraplmonary, Ajdabya.

Persistently high plasma procalcitonin levels despite successful treatment of tuberculous pleuritis and tuberculous lymphadenitis patients

In a prospective cohort study, we evaluated plasma PCT levels in 48 TB lymphadenitis (TBLN) and 41 TB pleuritis (TBPE) patients. Measurements of PCT were done in unstimulated plasma of microbiologically and clinically confirmed TBLN and TBPE patients registered for anti-TB treatment at a tertiary care hospital in Lahore, Pakistan. Plasma levels of PCT were found to be raised in 89% of the patients at baseline with a median of 1.5 ng/ml. Levels were higher (p = 0.001) in TBLN as compared to TBPE (2.69, 0.96 ng/ml). PCT levels were not related to the bacterial burden depicted by culture positivity in these patients. PCT showed a negative correlation with the severity of constitutional symptoms (rho = − 0.238, p = 0.034), and inflammatory biomarkers; ferritin (rho = − 0.43, p < 0.001), INF-γ (rho = − 0.314, p = 0.003), TNF-α (rho = − 0.220, p = 0.039), IL-6 (rho = − 0.224, p = 0.035), and several chemokines of CCL and CCXL group. Raised plasma levels of PCT did not decrease with anti-TB treatment, indicating it is not a good biomarker to monitor treatment response in TBLN and TBPE patients. More studies with a larger number of confirmed EPTB cases are needed to define the role of PCT and its interaction with other biomarkers in EPTB.

Genomic investigation of bone tuberculosis highlighted the role of subclinical pulmonary tuberculosis in transmission

BackgroundExtrapulmonary tuberculosis (EPTB) without symptomatic pulmonary involvement has been thought to be non-transmissible, but EPTB with asymptomatic pulmonary tuberculosis (PTB) could transmit tuberculosis (TB). Genomic investigation of Mycobacterium tuberculosis (Mtb) isolates from EPTB may provide insight into its epidemiological role in TB transmission. MethodsBetween January 2017 and May 2020, 107 Mtb isolates were obtained from surgical drainage of bone TB patients at the Beijing Chest Hospital, and 218 Mtb strains were isolated from PTB cases. These 325 Mtb isolates were whole-genome sequenced to reconstruct a phylogenetic tree, identify transmission clusters, and infer transmission links using a Bayesian approach. Possible subclinical PTB in the bone TB patients was investigated with chest imaging by two independent experts. ResultsAmong 107 bone TB patients, 10 were in genomic clusters (≤12 SNPs). Phylogenetic analysis suggested that three bone TB patients transmitted the infection to secondary cases, supported by epidemiological investigations. Pulmonary imaging of 44 bone TB patients revealed that 79.5 % (35/44) had radiological abnormalities suggestive of subclinical PTB. ConclusionsThis study provides genomic evidence that bone TB patients without clinically diagnosed PTB can be sources of TB transmission, underscoring the importance of screening for subclinical, transmissible PTB among EPTB cases.

CLINICAL PROFILE OF PATIENTS WITH MUSCULOSKELETAL TUBERCULOSIS VISITING A TERTIARY CARE CENTRE IN INDIA

Background: Musculoskeletal tuberculosis a major cause of mortality and morbidity in India and other developing countries. Musculoskeletal TB comprises around 10 to 30% of all EPTB cases. Even though skeletal tuberculosis is an important debilitating disease, the literature in statistical data regarding the socio-demographic distribution and clinical presentation of disease is very scarce. Objective: To study the socio- demographic and clinical profile of musculoskeletal tuberculosis patients reaching the Orthopaedics Department in a tertiary care hospital in India. Methodology: 186 patients with musculoskeletal tuberculosis who have completed treatment were called for a follow up and data regarding demographic, person and illness related factors affecting disease were collected and were tabulated and represented in various charts and diagrams, and analysed. Results: Almost equal sex distribution was seen. Maximum proportion (26%) of the patients were belonging to 40-49 age group, with a mean age of 49.6 years. Patients with age &lt;40 had less incidence compared to middle aged and elderly patients. Maximum number of patients were belonging to upper lower class (102 out of 186). Spine was the commonest site involved among the 138 cases. Spinal involvement was predominant in dorso- lumbar junction followed by thoracic spine and lumbar spine. 100% patients had pain as the presenting complaint and other complaints were not consistent. Only 16% of the patients had history of pulmonary tuberculosis and history of contact with tuberculosis case was present in 25% cases. 28% cases were diabetic and other comorbidities were less frequent. 19% of the cases had multi drug resistance. Conclusion: It was seen that Musculoskeletal tuberculosis is most frequently seen in middle age with majority of spine affected cases. The study reinforces the acquaintance of tuberculosis with low socioeconomic status and to some extend the debilitating diseases. It often has an atypical presentation leading to delay in diagnosis.

Diagnostic value of chemiluminescence for urinary lipoarabinomannan antigen assay in active tuberculosis: insights from a retrospective study.

This study aimed to assess the efficacy of chemiluminescence-based urinary lipoarabinomannan (LAM) antigen assay as a diagnostic tool for identifying active tuberculosis. A retrospective study was conducted on 166 Tuberculosis (TB), 22 Non-Tuberculous Mycobacteria (NTM), 69 Non-TB cases, and 73 healthy controls from Zhangjiagang First Peoples Hospital between July 2022 and November 2022. Clinical and laboratory data were collected, including urine samples for LAM antigen detection, sputum samples and pleural effusion for GeneXpert, TB-DNA, and culture. TB group exhibited a higher LAM positivity rate (P < 0.001). CD4 count and diabetes as independent factors influencing the diagnostic accuracy of LAM. The LAM assay showed a sensitivity of 50.6% and a specificity of 95.65%. Notably, LAM's sensitivity was superior to TB-DNA (50.60% vs. 38.16%, P < 0.05). LAM's PTB detection rate was 51.7%, superior to TB-DNA (P = 0.047). Moreover, in EPTB cases, the LAM detection rate was 42.11%, surpassing Gene Xpert (P = 0.042), as well as exceeding the detection rates of TB-DNA and sputum culture. LAM antigen detection using chemiluminescence has demonstrated outstanding clinical diagnostic value for active TB, especially in the diagnosis of extrapulmonary TB. The convenience of sample collection in this diagnostic approach allows for widespread application in the clinical diagnosis of active tuberculosis, particularly in cases of EPTB and sputum-negative patients.

Impact of fine needle aspiration cytology strategy implemented at the microscopy center level for diagnosis of tuberculous lymphadenitis

IntroductionIn India, EPTB accounts for about 50% of TB cases especially in people living with HIV/AIDS. Microbiological confirmation is present in only about 15% of EPTB cases. Tuberculous Lymphadenitis is the most common form of EPTB in India, accounting for around 35% of EPTB cases. Fine needle aspiration cytology has been found to be highly sensitive and specific in the diagnosis of tuberculous lymphadenitis with 83–94% accuracy. The procedure of AFB detection is exactly the same for the FNAC obtained smears as for the presently examined sputum smears at the DMCs. The aim of the present study was to determine the feasibility and effectiveness of FNAC strategy implemented at DMC level for detection of tuberculous lymphadenitis cases. MethodsThe present study was a randomized cluster trial with one control and one intervention arm. At the intervention units (DMCs) all suspected tuberculous lymphadenitis cases was subjected to FNAC of the suspected superficial lymph nodes by the trained Medical Officers. The control group was free from any such intervention. Effectiveness and feasibility of FNAC strategy in the intervention group was determined by relevant indicators. ResultsAt the seven intervention DMCs, FNAC was performed on a total number of 1298 suspected cases of Tuberculous Lymphadenitis. Among them 294 cases were selected in the intervention arm and 196 cases in the control arm. Intervals between advice of FNAC and performance of FNAC as well as start of therapy was significantly low in the intervention arm. Complication was insignificant. The concordance between FNAC reports generated at the DMCs and that at Medical College estimated by agreement measurement kappa (0.970) suggested a high level of agreement. ConclusionImplementation of FNAC strategy at the DMC level for detection of tuberculous lymphadenitis cases was found to be feasible as well as effective.

Treatment outcome on pulmonary tuberculosis and extra pulmonary tuberculosis in government general hospital, ongole

Background: Tuberculosis is a global disease leading to cause death worldwide. The Revised National Tuberculosis Control Programme (RNTCP), Directly Observed Treatment Short Course (DOTS), was launched to reduce tuberculosis mortality, improve patient adherence to treatment, and prevent the development of drug resistance. The aim of this study was treatment outcome of tuberculosis. Treatment outcome is an important indication of tuberculosis control programme. Methodology: An ambispective observational study was conducted in a government general hospital from August 2019 to January 2020 on the treatment outcomes of PTB and EPTB in the 15 years and older age group, both males and females, on category I regimens. Patients with comorbidities like HIV, diabetes, and social habits like smoking were included. Record based TB diagnosed data (August 2019 to January 2020) are taken and asses their treatment outcome after 6months of complete therapy. The recorded and collected data were analysed to evaluate the success rate of treatment outcomes for PTB and EPTB. Results: A total of 350 subjects were enrolled in the study, of which 311 are included and 39 are excluded due to incomplete data. The study with age group of 15 and above years where males 218(70.10%) and females 93(29.90%). Total pulmonary tuberculosis cases are 277 (89.07%), and extrapulmonary tuberculosis cases are 34 (10.93%). Subjects with HIV 48(15.43%), Diabetes 54(17.37%) and Tobacco smoking 85(27.33%). The treatment outcome was observed as follows: cured 144 (46.30%), treatment completed 98 (31.51%), transfer out 10 (3.21%), died 27 (8.69%), treatment failure 7 (2.26%), treatment lost to follow-up 14 (4.50%), and treatment regimen changed 11 (3.53%). At the end of the treatment, the success rate was found to be 78%. Conclusion: This study shows that the TB patients' treatment success rate was 78%, which is slightly less than the RNTCP norms. The died rate was 8% which is higher than national average. Perhaps the services need to improve tuberculosis case detection in HIV patients, while cure rates have to be improved in RNTCP. EPTB case enrolment is very low, whereas the referral system has to improve its services. So that EPTB cases enrolment may increase its number. The early detection may enhance the cure rates in patients.

Diagnostic value of serum ADA level in extra pulmonary tuberculosis cases in a tertiary care hospital, Bihar

Travelling through time, space and history if there is one disease which always comes to our mind is tuberculosis (TB). Still on many occasions it remains undiagnosed and hence not treated appropriately. In many instances patient is not able to give proper sputum sample or in a way it should be. On the top of it in resource poor countries availability of health care professionals is an issue to examine the sputum. Furthermore, when extra pulmonary TB is the case invasive diagnostic procedures such as biopsy becomes important which is a challenging thing to perform in many of our setups in our state. So, the aim of this study was to investigate the diagnostic value of ADA in extra pulmonary TB. Methods: It is an analytical study in which serum ADA values in EPTB cases were compared with controls.100 patients matched for age and sex were included. Data analysis was done using SPSS version 27. Results: Our data analysis showed mean ADA levels in EPTB patients was 43.6 which was significantly higher than control group(p value &lt;0.001).

Epidemiological profile of extrapulmonary tuberculosis and its association with diabetes in tertiary care center in Northern Kerala

Background: India accounts for 24% of the global TB burden and 29% of deaths. Although HIV is considered the most potent risk factor for TB, the high prevalence of diabetes mellitus in the world and its effect on TB burden is greater than HIV infection. DM is common in the south Indian state of Kerala with a prevalence of 16% to 20%. Objectives of current study were to describe the epidemiological profile of EPTB cases diagnosed in a tertiary care center in northern Kerala and to find the association between EPTB and DM cases.Methods: A record-based descriptive study. All TB cases from first January 2019 to December 2021 at the Government medical college Kannur Pariyaram were the study population. Data was collected from the Nikshay portal, treatment register and CBNAAT register maintained in DOTS center, Pariyaram. The data were analysed using MS Excel and SPSS 26. The Chi-square test was applied to find an association between variables. p&lt;0.05 is considered statistically significant.Results: Of the 882 cases included in the study, 476 (53.96%) were having PTB and 406 (46.03%) were having EPTB. Among males PTB (358, 59.3%) and among females EPTB (160 ,57.6%) were more prevalent (p&lt;0.001). In the younger age group EPTB and in the older age group PTB were more reported (p&lt;0.001). Among EPTB, the majority of the cases (66.5%) belong to the age group 21-60 years. Smokers among PTB and EPTB were 78 (16.4%) and 33 (8.1%) respectively.Conclusions: Female gender and younger age were more associated with EPTB compared to PTB.DM and smoking were more associated with PTB compared to EPTB. Common sites of EPTB were the lymph node, abdominal, pleural, and spine.

Recovery rates of mycobacterium from suspected extra-pulmonary tuberculosis patients using liquid culture at a tertiary referral centre of India

Tuberculosis still remains a serious public health problem in developing countries. Rapid isolation of mycobacteria is critical for accurate diagnosis and management of tuberculosis. In the present study BACTEC MGIT 960 system was evaluated against Lowenstein Jensen (LJ) medium for isolation of mycobacteria from different extra-pulmonary specimens (N = 371). The samples were processed using NaOH-NALC method and inoculated in BACTEC MGIT and on LJ medium. The BACTEC MGIT 960 system detected 93 (25.06%) samples positive for acid fast bacilli and by LJ only 38 samples (10.24%) was positive. Furthermore, total 99 (26.68%) samples were detected positive by both the culture methods. The mean turnaround time to detection of mycobacteria by MGIT 960 were significantly less (12.4 days) as compared with LJ (22.76 days). In conclusion, BACTEC MGIT 960 system is more sensitive and rapid culture system for isolation of mycobacteria. However LJ culture method also suggested to further increase the detection rate of EPTB cases.

Clinical characteristics, common sites and drug resistance profile in culture-confirmed extrapulmonary TB/HIV co-infection patients, Southwest China

There are few reports on extrapulmonary tuberculosis/human immunodeficiency virus (EPTB/HIV) co-infection patients, especially the resistance profile of culture-confirmed EPTB. The purpose of our study was to analyse the clinical characteristics, common sites and drug resistance profile of culture-confirmed EPTB/HIV co-infection patients in Southwest China (2017-2020). A total of 201 EPTB/HIV co-infection cases were selected for this study. Patient demographics and clinical characteristics were collected. Mycobacterium tuberculosis drug susceptibility testing (DST) was performed by the microporous plate method. Among 2884 culture-confirmed EPTB cases, patients were predominantly male (1921/2884; 66.6%) and the mean age was 31 years. There were 201 patients (7.0%) with EPTB/HIV co-infection, among which 170 (84.6%) were male and the mean age was 42 years (range 13-86 years). During the 7-year study period, the mean number of EPTB/HIV co-infection cases was 29 per year (range 12-49 per year) at the studied institution. Diarrhoea, headache and fever were the most common presenting symptoms. DST showed resistance to any anti-TB drug in 62 isolates (30.8%), while multidrug-resistant TB and extensively drug-resistant TB were found in 14 (7.0%) and 10 (5.0%) cases, respectively. The distribution of EPTB tissue type was mainly meningeal and lymphatic, but varied between the sexes. The immune level of EPTB/HIV co-infected patients was low and most were in advanced-stage AIDS. Patients were mainly young males and the site of EPTB was mainly meningeal and lymphatic. The most common symptoms were diarrhoea, headache and fever. High rates of drug resistance were found.

A RETROSPECTIVE ANALYSIS OF EXTRAPULMONARY TUBERCULOSIS PATIENTS WITH INVOLVEMENT OF DIFFERENT ANATOMICAL SITES ATTENDING TERTIARY CARE CENTRE

OBJECTIVE: To assess the number of new cases of Extrapulmonary tuberculosis, by characterizing patients based on anatomical site. METHODS: This is a retrospective, descriptive study of diagnosed patients of EPTB of all age groups and was conducted in the MGM medical college and hospital, Aurangabad, a tertiary care hospital. Data for this study was obtained from JAN 2018 to DEC 2020. RESULTS: This study showed that out of all EPTB cases, the incidence of Lymph node T.B is higher followed by Pleural T.B. The incidence of EPTB is higher in younger population. CONCLUSION: Our study points out the population which is at higher risk of EPTB. Since diagnosing EPTB is difcult as the samples taken from the affected organs are paucibacillary giving rise to higher chance of misdiagnosing such patients. Astrong clinical suspicion plays a crucial role in the early diagnosis and treatment of such patients.

Tuberculosis Treatment Outcome and Associated Factors Among Tuberculosis Patients Under Directly Observed Treatment Short-Course at Arba Minch General Hospital, Southern Ethiopia: A Five-Year Retrospective Study

Background: Although directly observed treatment short course has been implemented among different countries, tuberculosis (TB) remains a major public health issue in the 21 st century and Ethiopia is the eighth highest-burden country in the world. Thus, assessment of TB treatment outcomes and its associated factors in DOTS are among the major indicators of the performance of a national TB control program. Objective: The aim of this study was to assess tuberculosis treatment outcome and associated factors among TB patients under directly observed treatment short-course at Arba Minch General Hospital TB clinic, Southern Ethiopia from September 2015 to August 2020.MethodsAn Institutional based retrospective study was conducted by reviewing the five years (1 st September 2015 to 30 th August 2020) TB treatment registries at the TB clinic of Arba Minch General Hospital. A total of 498 TB patients from the registration with complete information were enrolled. Patients’ data like age, sex, residence, type of TB, the status of TB case, smear result of PTB, HIV co-infection, year of TB diagnosis, and treatment outcomes were extracted from the TB treatment registration with a data collection checklist. SPSS version 25 statistical software was used for final data analysis. Results: From the overall enrolled TB patients, 312 (62.7%) were males and about 286 (57.4%) were from rural areas. In terms of TB type 94% were pulmonary TB, of which 66% were smear negative (PTB-) and 86.3% were new TB cases. The proportion of TB/HIV co-infection was 17.7%. Overall, 440 (88.4%) TB patients had successful treatment outcomes (28.5% cured and 59.9% completed treatment), while 11.6% patients had unsuccessful treatment outcomes (7.8% defaulted, 2.2 died, and 1.6% treatment failure). The unsuccessful TB treatment outcome was significantly associated with re-treatment TB cases [AOR=3.345, 95% CI: (1.739-6.436)], smear-negative PTB cases, [AOR = 2.558, 95% CI: (1.229-5.323)] and with EPTB [AOR = 4.817, 95% CI: (2.101-11.044)]. Conclusion: The high TB treatment success rate in our setting is in line the target set by the WHO. However, successful treatment outcome was very law in EPTB, re-treatment, and smear negative PTB cases. Therefore, targeted measures should be considered to decrease poor tuberculosis treatment outcomes among high-risk patients through; careful monitoring, making the DOTS program more accessible and counselling. Funding: This research was supported by Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Southern Ethiopia. Declaration of Interest: The authors declare that they have no conflicts of interest for this work. Ethical Approval: This study was approved by the Arba Minch University, College of Medicine and Health Sciences, Department of Medical Laboratory Sciences

Comparative study of fine needle Aspiration Cytology, Acid Fast Bacilli staining and Cartridge Based Nucleic Acid Amplification test in the diagnosis of extrapulmonary tuberculosis

Introduction: Tuberculosis (TB) is an important health problem in the developing countries. Extrapulmonary sites of TB commonly include lymph nodes, pleura, gastrointestinal system, genitourinary system, central nervous system, bones. Most of the EPTB cases present with lymphadenopathy and effusion. The conventional methods to diagnose EPTB includes fine needle aspiration cytology (FNAC) and demonstration of acid fast bacilli (AFB) using Zeihl- Neelson (ZN) staining. Objectives: 1). To assess the efficacy of FNAC positivity in comparison to CB-NAAT in the diagnosis of EPTB. 2). To assess the efficacy of AFB positivity in comparison to CB-NAAT in the diagnosis of EPTB. Materials and Methods: The present retrospective record based study was conducted at the Department of Pathology and CB-NAAT Centre, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka. The study was started after obtaining approval from the Institutional Ethics Committee. The records of suspected 100 EPTB patients who had under gone FNAC, ZN stain and CB-NAAT test for EPTB diagnosis during the study period of four months from March to June 2018 were analysed. Results: A total of 100 subjects were included in the final analysis. In our study, youngest patient was 8 months and oldest was 75 years. Of the 100 cases, lymph node involvement accounted for 96 cases and soft tissue swellings accounted for 4 cases. The diagnosis of FNAC of 100 cases were reactive lymphoid hyperplasia, suppurative lesion, epithelioid granuloma without necrosis, epithelioid granuloma with necrosis, caseous necrosis without epithelioid cells and lymphoma and their proportion were 30%, 21%, 22%, 13%, 12% and 2% respectively. Out of 47 cases with FNAC findings favouring EPTB, 30 were CB-NAAT positive and 17 were CB-NAAT negative. Out of 53 cases with negative FNA findings, CB-NAAT was positive in 5 cases (14.2%). Only 13 cases were positive for AFB when compared to 30 CB-NAAT positive cases. Among the 35 CB-NAAT positive

Difficulties with the implemented xpert MTB/RIF for determining diagnosis of pulmonary and extrapulmonary tuberculosis in adults and children

Background and aimsHandling of PTB and EPTB patients with adequate standard detection of MTBC and anti-TB drug sensitivity using accurate and rapid methods could provide good TB management and clinical treatment outcomes. The Xpert MTB/RIF assay is an automated, cartridge-based NAAT that can simultaneously detect MTBC and RIF resistance within 2 h. The aim of this study was to evaluate the implementation of Xpert for determining diagnosis of PTB and EPTB in adults and children. MethodsA descriptive study was performed using e-TB Manager data from the MDR-TB Clinic at Dr. Soetomo Academic Hospital. Suspected TB cases were from the areas of East Java Province from January 2016 to December 2018. Xpert assay was conducted using standardized criteria for clinically suspected TB, and MTBC-positive results with RR were examined by the culture method using MGIT 960 BACTEC System. ResultsA total of 1181 (1181/3009, 39.25%) sputum samples from suspected new MDR-PTB cases tested positive for MTBC with 3.02% RR. Among 3893 sputum samples from previously treated probable MDR-PTB cases tested using Xpert, 1936 (49.73%) were MTBC positive with 13.20% RR. Among 59 new suspected MDR-PTB cases tested using MGIT 960 BACTEC System, 55 tested positive for MTBC, although all RR strains were highly sensitive to amikacin (100%), kanamycin (95%), and ofloxacin (89%). A total of 49 children with suspected PTB were tested using Xpert, revealing low positivity (12%) for MTBC, with all RR strains being rifampicin sensitive (RS). Of the 86 suspected EPTB cases tested using Xpert, very few were MTBC-positive (26%), with 91% RS. ConclusionsThis study revealed that in adults and children with PTB and EPTB, the Xpert assay achieved a low positivity detection rate for MTBC in samples from new or previously treated cases, and this could be the result of many factors.

Extrapulmonary Tuberculosis in Denmark From 2009 to 2014; Characteristics and Predictors for Treatment Outcome.

BackgroundExtrapulmonary tuberculosis (EPTB) represents an increasing percentage of tuberculosis (TB) cases in Europe. However, strategies on TB prevention and successful treatment outcomes primarily target pulmonary TB. In this nationwide study, we present characteristics of EPTB, treatment outcomes, and predictors for unfavorable treatment outcomes.MethodsAll patients diagnosed with EPTB from 2009 to 2014 were included. Logistic regression analyses were used to identify risk factors for unfavorable outcome. The following definitions were used: unfavorable outcome: the sum of treatment failed, lost to follow-up, and not evaluated; patient delay: time from TB-related symptom onset until first hospital contact related to TB; doctor delay: time from first TB-related contact in the health care system to start of TB treatment.ResultsA total of 450 EPTB cases were notified, which represented 21.1% of all TB cases in Denmark. Immigrants accounted for 82.9%. Lymph nodes were the most common site of EPTB (55.4%) followed by pleural TB (13.4%). Patient delay was significantly longer among immigrants than Danes (60 vs 30 days; P < .01), whereas doctor delay was significantly longer among Danes (38.5 vs 28 days; P < .01). Treatment completion rates were high and reached 90.9% in 2014. Male gender (odds ratio [OR], 5.18; 95% confidence interval [CI], 1.79–15.04) and age 0–24 years (OR, 16.39; 95% CI, 2.02–132.64) were significantly associated with unfavorable outcome.ConclusionsEPTB represented a significant number of all TB cases and was predominantly seen among younger immigrants in Denmark. To maintain high treatment completion rates, increased focus on male gender and young age is needed.

A record based analysis of treatment outcome in Tuberculosis patients registered under Tuberculosis unit, Umbraj, District Satara of Western Maharashtra

Introduction: India has the highest number of tuberculosis in the world, accounting for nearly one fifth of the world's burden. Despite the national anti-tuberculosis program, tuberculosis remains the cause of death in India. The study, therefore, was designed to evaluate the RNTCP programme, which was revised by the evaluation and treatment of patients enrolled under the tuberculosis program in Umbraj, Maharashtra. Materials and Methods: The present study was conducted at Tuberculosis Centre, Umbraj for the year 2014 which was record based study and information was collected by accessing the records maintained at the level of tuberculosis unit. All this information was collected for the year 2014. Result: In the present, the success rate for PTB was 87.7% and EPTB was 98.2%. Among the pulmonary tuberculosis cases, cure rate was 54.4% while treatment completion rate was 33.3%. Among the EPTB cases, treatment completion rate was 98.2% with death rate 1.8%. The default rate of 2.0%, transferred out rate of 1.0% and 2.6 % failure rate were reported in year 2014. Conclusion: Tuberculosis suspect rate is consistently low at unit. Though microscopic activity and DOTS activity are appropriate there is deficiency in trained personnel and lacking in achievement of treatment outcome as per the guidelines. Keywords: Revised national tuberculosis control programme, Tuberculosis unit, PTB, EPTB.

Pulmonary vs. extra-pulmonary tuberculosis hospitalizations in the US [1998–2014

BackgroundFew studies have explored the relative burden and trends in pulmonary (PTB) vs. extra-pulmonary (EPTB) tuberculosis in the United States using a nationally representative sample. MethodsThis study examined trends in hospitalization rates, length-of-stay (LOS), in-hospital mortality and inflation-adjusted charges, for PTB vs. EPTB using the Nationwide/National Inpatient Sample (NIS) from 1998 to 2014. Descriptive and multivariable analyses (linear, negative binomial and logistic) were utilized adjusting for demographics, co-morbidity and hospital characteristics. ResultsDuring the study period there were a survey-adjusted, estimated 258,631 PTB (75.5%), 76,476 EPTB (22.3%) and 7552 concurrent PTB and EPTB (2.2%) discharges. Whites accounted for 27.6% of PTB, 21.9% of EPTB and 17.6% of concurrent discharges; and self-pay or no insurance accounted for 22.2%, 18.4%, and 25.9%, respectively. EPTB was more common among blacks (22.5%), and combined TB more common among Hispanics (24.8%). Mean LOS was 11.4 days, 13.2 days, and 19.5 days; with mean nominal charges of $48,031, $62,255, and $89,364 for PTB, EPTB and combined TB respectively. Inpatient mortality for all three groups was approximately 5.7%. Miliary TB and TB of meninges and central nervous system were positively associated with mortality (odds ratios of 2.44 and 2.11, respectively), as was alcohol abuse (OR 1.21). Trend analyses showed decreased hospitalizations for all TB types, no change in LOS trends, decreased mortality for PTB and ETB and increased charges for PTB and ETB from 1998 to 2014. Increased utilization, higher charges and higher risk of mortality (to some extent) among the EPTB cases warrant improved methods for screening, diagnosis and treatment. ConclusionThough rates of TB hospitalization are declining, EPTB is becoming relatively more common and is more costly compared to pulmonary TB. Screening methods that focus on identification of ETB contrary to current practice guidelines are needed to aid ETB case finding.

Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities

BackgroundExtra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes.MethodsA retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes.ResultsThere were 1222 EPTB patients presenting 13.1% of all TB cases during 2006–2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231–1.028]; p = 0.05). On multivariate analysis, age group 56–65 years (1.658 [1.157–2.376]; p = 0.006), relapse cases (7.078 [1.585–31.613]; p = 0.010), EPTB-DM (1.773 [1.165–2.698]; p = 0.008), patients with no formal (2.266 [1.254–4.095]; p = 0.001) and secondary level of education (1.889 [1.085–3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311–1.746]; p < 0.001), Malays (1.251 [1.056–1.482]; p = 0.010) and Indians (1.450 [1.142–1.842]; p = 0.002), TB-HIV (3.215 [2.347–4.405]; p < 0.001), EPDM-HIV (4.361 [1.657–11.474]; p = 0.003), EPTB-HIV-HEP (4.083 [2.785–5.987]; p < 0.001), those living in urban areas (1.272 [1.109–1.459]; p = 0.001) and no formal education (1.361 [1.018–1.820]; p = 0.037).ConclusionThe findings of this study extend the knowledge of EPTB epidemiology and highlight the need for improved EPTB detection in Malaysia, especially in subpopulations with high risk for EPTB and unsuccessful treatment outcomes.

Diagnostic accuracy of loop-mediated isothermal amplification assay for extra-pulmonary tuberculosis in Indian population

BackgroundConfirmatory diagnosis of extra-pulmonary tuberculosis remains a true challenge owing to difficulty in procuring appropriate specimen, inefficient laboratory methods and paucibacillary nature of infection. These obstructions become all the very difficult in pediatric EPTB cases, due to non-specific clinical signs and symptoms, low sensitivity of smear microscopy and culture, lack of awareness among clinicians, etc. Aim of the studyThe present study aimed to evaluate the diagnostic accuracy of rapid and cost-effective loop-mediated isothermal amplification (LAMP) assay for EPTB diagnosis in children. MethodsA total of 154 cases were analyzed by EPTB-site smear microscopy, culture, PCRs for IS6110, MPB64 & Pab genes, nested PCR and LAMP assay. Single-gene PCRs were performed by custom-synthesized primers. Nested PCR was performed using the 3B BIOTUB Kit and the LAMP assay was done using the Nu-LAMP TB kit. ResultsWe observed that the molecular tests displayed 4-fold higher positivity rate (minimum 46%) in comparison to the microbiological tests (maximum 11.03%). In contrast to the composite reference standard, LAMP assay was found to be 79.6% sensitive and 78% specific for EPTB diagnosis in childhood cases. ConclusionsOur results indicate that LAMP assay is a promising technique for efficient diagnosis of EPTB in children belonging to resource-limited regions.