Acid-fast Bacilli Examination Research Articles

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

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

Comparison of Examination Results of Acid-Fast Bacilli (AFB) Ziehl Neelsen (ZN) Method on BTA Preparations that are Directly Stained with Delayed Preparations

Tuberculosis is a direct infectious disease caused by the bacterium Mycobacterium tuberculosis. Most tuberculosis germs attack the lungs, which is known as Pulmonary Tuberculosis (pulmonary TB), but can also affect other organs, which is called extrapulmonary TB. Pulmonary TB germs in the form of rods, have special properties, namely acid resistance to staining. The purpose of this study was to determine the results of examination of acid fast bacilli (AFB) by the Ziehl Neelsen method on smear preparations which were immediately stained and left to stand for three days. The research was conducted using a descriptive approach with a sample of 10 people using a purposive sampling technique. In this study, staining was carried out twice, namely direct staining and delayed staining for 3 days and examined under a microscope. The results showed that there was no difference between the preparedness that was immediately colored and the one that was postponed for three days.

GeneXpert analysis of bronchoalveolar lavage (BAL) samples: promising diagnostic modality in patients with smear-negative pulmonary tuberculosis

PurposeThe aim of the study is to assess the diagnostic utility of bronchoalveolar lavage (BAL) samples with GeneXpert test in diagnosis of TB in smear-negative patients.MethodOne-hundred sixty-nine cases were included in this study, as they had a radiological finding suggested to have pulmonary tuberculosis, while the sputum direct smear examination for acid-fast bacilli was negative. All cases prepared to do fiber-optic bronchoscope with bronchoalveolar lavage collection after their consent and post bronchoscope sputum collection for further molecular and microbiological examination.ResultsThe combined diagnostic yield of all bronchoscopy procedures was 15.97% (27 cases of 169) and the final diagnosis of TB cases was established in 16 cases of 169 (9.4%) using BAL culture and in 20 cases of 169 (11.83%) by GeneXpert methods. Post bronchoscope direct sputum examination, culture, and GeneXpert evaluation gave diagnostic yield about 1.1%, 5.5%, and 7.1%, respectively. The specificity of GeneXpert examination of BAL and post bronchoscope sputum was 95.42% and 97.38%, respectively.ConclusionEarly detection of pulmonary tuberculosis using fiber-optic bronchoscope BAL examination and post bronchoscope sputum with GeneXpert method promotes the accurate decision to start antituberculous therapy in patients with smear negative.

Positive Profile of Acid-fast bacilli in Patients with Clinical Diagnosis of Pulmonary Tuberculosis at the Semarang Public Health Center

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Until now, tuberculosis is still a public health problem in the world. Tuberculosis is a dangerous infectious disease, the healing process also takes a long time. Acid-fast bacilli examination is an examination to determine the presence or absence of Mycobacterium tuberculosis bacteria. The factors that influence Tuberculosis patients are age, gender, education and occupation. The purpose is to knowing the description of AFB positivity in patients with clinical diagnosis of pulmonary tuberculosis at Balkesmas Semarang in 2020. This research was an observational study with descriptive research criteria through a retrospective approach. Results from 656 patients with clinical diagnosis of tuberculosis who underwent acid-fast bacilli examination, 220 patients (33.5%) were found positive and acid-fast bacilli were negative (64.5%). The results of the examination of acid-fast bacilli were positive with a scanty positivity degree of 3 patients (1.4%), acid-fast bacilli (+1) were 71 patients (32.3%), (+2) were 83 patients (37.7%), (+3) as many as 63 patients (28.6%). Based on the category of age 0-14 years as many as 1 patient (0.5%), 15-34 years as many as 78 patients (35.5%), 35-54 years as many as 96 patients (43.6%), 55-74 years as many as 44 patients (20%), 75 years as many as 1 patient (0.5%). Based on gender, there were 123 patients (56%) male and 97 female patients (44%). Conclusion the results of the examination of acid-fast bacilli were positive with a scanty positivity rate of 3 patients (1.4%), acid-fast bacilli (+1) 71 patients (32.3%), (+2) 83 patients (37.7%), (+3) 63 patients (28.5%). Based on gender with positive acid-fast bacilli, there were 123 male patients (56%) while female 97 patients (44%). Age with the most positive acid-fast bacilli results in the range 0–14 years 1 patient (0.5%), 15–34 years 78 patients (35.5%), 35-54 years 96 patients (43.6%), 55 –74 years.

Sputum Smear Conversion as Prognostic Determinant of Timely Complete Therapy on Pulmonary Tuberculosis

Tuberculosis (TB) remains a major health problem worldwide. The bacteriological diagnosis of TB is confirmed by a sputum smear, which shows a positive result. Sputum culture conversion at two months of TB therapy has a higher possibility of completing therapy; however, this method is time-consuming and expensive. This study aimed to analyze the initial smear and smear conversion of sputum in the intensive phase therapy as a prognostic determinant of appropriate time-targeted therapy. This was a retrospective study on pulmonary TB patients collected from January 2016 to December 2017. The research subjects at the beginning of the intensive phase were divided into Acid-Fast Bacilli (AFB)-negative and AFB-positive (1+, 2+, 3+) sputum smears. The sputum smear examination was evaluated at the end of the intensive phase and the end of the six-month treatment. The pulmonary TB patients in this study were 430 patients, dominated by males with the main distribution age of 45-54 years. At the beginning of the intensive phase, the negative results of the AFB examination were 85.4% and the total positive results with 1+, 2+, or 3+ were 14.6%. At the end of the intensive phase, the sputum smear examination of all patients showed 100% conversion, and the sputum smear examination at the end of six months of treatment showed negative results. This study has revealed that sputum conversion at the end of the 2-month intensive phase can be used as a prognostic determinant of timely complete therapy on pulmonary tuberculosis.

Neuromyelitis optica and concomitant pulmonary tuberculosis: a case report\xa0

BackgroundConcomitant diagnosis of neuromyelitis optica spectrum disease and pulmonary tuberculosis has rarely been reported.Case reportWe report a case involving a young Tunisian male patient who developed dry cough followed, 2 months later, by weakness in the lower limbs. The findings of central nervous system imaging and anti-aquaporin-4 antibody positivity were compatible with the diagnosis of neuromyelitis optica spectrum disease. Constellation of the clinical and the typical radiological pulmonary findings in our patient, coming from an endemic region, allowed the diagnosis of pulmonary tuberculosis, although sputum smear examination for acid-fast bacilli and cultures was negative. The patient received anti-tuberculous polytherapy associated with immunomodulation, consisting of methylprednisolone and intravenous immunoglobulins. Pulmonary infection symptoms initially improved but with no motor recovery. The patient suddenly died at home 4 months after the onset of the first symptoms. Current data regarding the clinical presentation of this underreported concomitant or associated condition, the possible pathophysiological mechanisms, and the therapeutic options were reviewed.ConclusionsThis case underscores the necessity to understand the exact mechanism of these coincident entities and to clarify the best immunomodulatory choice since immunosuppression targeting neuromyelitis optica spectrum disease can lead to dissemination of pulmonary tuberculosis.

Role of tuberculin skin test (Mantoux test) as an aid in the diagnosis of tuberculosis disease and to identify persons with latent tuberculosis in highly endemic hilly region of Jammu and Kashmir

Background: Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis and one of the major diseases affecting children throughout the world. Mantoux test and direct microscopic examination of acid-fast bacilli (AFB) by Ziehl–Neelsen staining are diagnostic and are widely being used. Objective: The objective of the study was to evaluate the efficacy of the Mantoux test and sputum smear examination as a diagnostic aid in latent TB. Materials and Methods: A prospective observational study was conducted, among 100 suspected cases of TB, over a period of 14 months from May 2019 to June 2020. After obtaining informed consent, patients were subjected to all three diagnostic tests including the Mantoux test, sputum smear examination for AFB, and cartridge-based nucleic acid amplification test (CBNAAT). Results of Mantoux and sputum tests were compared with CBNAAT to assess the sensitivity and specificity of individual tests. Results: In our study, most of the patients (32%) belonged to the age group of 21–30 years. There was a slight female predominance in the study population (52% females and 48% males). Mantoux test was positive in 41 (41%) patients and negative in 59 (59%) patients. On sputum examination, 42 (42%) patients tested positive and 58 (58%) patients were negative. On CBNAAT, 74 (74%) samples were positive, 26 (26%) were found to be negative. The sensitivity and specificity of the Mantoux test were 49.35% and 86.95%, respectively, and 53.33% and 92%, respectively, for sputum smear examination. Conclusion: Mantoux test, sputum smear, and CBNAAT test when performed together act as an aid in diagnosing TB in patients with latent TB.

POS-781 TUBERCULOSIS IN KIDNEY TRANSPLANT RECIPIENTS: EXPERIENCE OF NEPHROLOGY DEPARTEMENT OF SAHLOUL HOSPITAL

Tuberculosis is a serious post-renal-transplant complication. It is more frequent in allograft renal recipients than the general population because of immunosuppression therapy. Both diagnosis and treatment are challenging especially with atypical presentations. We have conducted a single-center retrospective case series describing the unique clinical and biological features of tuberculosis contracted after kidney transplantation. At our center, five of 274 recipients, transplanted between 2007 and 2018, were diagnosed. All five patients had living kidney donors, induction immunosuppression was intra-venous (IV) corticosteroids and thymoglobulin for four patients, and IV corticosteroids with basiliximab for the other one; whereas, maintenance therapy associated MycophénolateMofetil (MMF) and Tacrolimus in 3 cases, and MMF Sirolimus in the other two. None of the patients had tuberculosis history. Screening by sputum examination for acid-fast bacilli and Quantiferon testing before transplantation were negative in all cases. Tuberculosis occurred during the first transplantation year in two cases and after 19, 45 and 104 months for the others. Leading symptoms were prolonged fever (5 cases), coughing (5 cases), leucopenia (4 cases) chronic diarrhea (2 cases) and microcytic anemia (1 case). Tuberculosis was pulmonary in all cases with extra-pulmonary locations: colic (1 case), pleural (1 case), lymph nodes and hepatic (1 case) and medullar (1 case). Concomitant opportunistic infections were observed; cytomegalovirus (CMV) infection (1 case), Candida norvegensis pneumonia (1 case) and one Epstein-virus (EBV) infection. We have had no major complication. All kidney recipients have received anti-tuberculosis treatment for at least six months; with fairly good tolerance and without graft lost. Tuberculosis-endemic-countries such as Tunisia should be aware of post-transplantation risk. More invasive screening protocols should be discussed.

Hypopigmented mycosis fungoides mimicking leprosy successfully treated with oral and topical corticosteroids: a new great imitator?

Hypopigmented mycosis fungoides (HMF) is a rare variant of patch stage MF, which is often misdiagnosed. A 35-year-old male presented with non-pruritic white patches on his chest that had been present for 10 years. The patient had previously been treated for leprosy without any improvement. Physical examination showed well-defined multiple hypopigmented patches and macules on the chest, posterior trunk, and gluteus, with some lesions exhibiting anhidrosis and central erythema. The result of sensibility examination was unclear. Slit-skin-smear examination for acid-fast bacilli and anti-phenolic-glycolipid-1 examination were negative. Histopathological examination showed Pautrier microabscesses. The patient was diagnosed with HMF and was treated with 16 mg methylprednisolone b.i.d., topical application of desoximetasone, and 1% methoxsalen lotion followed by sun exposure. A significant improvement was observed during the following 6 months. This case shows that HMF needs to be considered in patients presenting with chronic unexplained hypopigmented patches to avoid unnecessary treatment and progression to more advanced stages.

Coexistence of tuberculous chancre on a chronic nonhealing wound and bilateral submandibular scrofuloderma

Cutaneous tuberculosis is caused by Mycobacterium tuberculosis with varied clinical features depending on the dissemination route and host immune status. Scrofuloderma is a type of cutaneous tuberculosis that often occurs in locations where there is an infected lymph node or bone underneath, whereas tuberculous chancre often appears in sites that are prone to trauma. Although several cases have been reported, the coexistence of more than one type of cutaneous tuberculosis is very rare. We report a 21-year-old immunocompetent male with a chronic nonhealing lesion on the left tibia followed by bilateral purulent ulcers on the submandibular area. Acid-fast bacilli examination was positive for M. tuberculosis, and the patient was diagnosed with tuberculous chancre and scrofuloderma, respectively. This case showed the importance of high clinical suspicion of cutaneous tuberculosis and the possibility of the coexistence of more than one type of cutaneous tuberculosis in order to avoid misdiagnosis and delay in treatment.

Utility of Bronchoalveolar Lavage in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

INTRODUCTION: Sputum smear examination for acid fast bacilli (AFB) by Ziehl-Neelsen stain (ZN stain) is the initial approach to the diagnosis of pulmonary tuberculosis (PTB). But 50% of the cases are reported to be sputum smear negative. This study was aimed to investigate the diagnostic yield of fibreoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. The sample was tested for Mycobacterium tuberculosis using the XpertMTB/RIF assay, which is a new test that detects Mycobacterium tuberculosis complex and resistance to rifampin in less than two hours.
 MATERIAL AND METHODS: This is a prospective cross sectional study carried out on 58 sputum smear negative patients who were clinically suspected to have pulmonary tuberculosis from April 2017 to January 2019. All patients are subjected to FOB, BAL and BAL specimens were stained for AFB and also sent for Xpert (MTB)/RIF.
 RESULTS: Among 58 patients enrolled for the study 26 patients were positive for acid fast bacilli (AFB) through BAL stain and Xpert (MTB)/RIF combined.
 CONCLUSION: FOB guided BAL is a reliable, alternative and rapid method for diagnosing smear negative pulmonary tuberculosis with minimal complications.

Vitamin D level and it is association with the severity of pulmonary tuberculosis in patients attended to Kosti Teaching Hospital, Sudan.

Globally, tuberculosis is one of the major causes of morbidity and mortality in many countries. Previous studies suggest that the incidence and severity of tuberculosis are associated with low levels of vitamin D (Vit D). Therefore, this study aimed to determine the occurrence and associated factors of vitamin D3 deficiency in pulmonary tuberculosis patients at White Nile State, Sudan. 101 individuals of diagnosed pulmonary tuberculosis patients (71 males and 30 females) and 100 non-TB controls (58 males and 42 females) were included in this study. Sputum samples were obtained from TB patients and subjected to examination for acid-fast bacilli (AFB) using Ziehl-Neelsen (ZN) stain and Gene Xpert analysis. Blood samples were collected from both groups and Serum 25(OH)-vitamin D3 was determined by an Enzyme-Linked Immunosorbent Assay. HIV infection in Tuberculosis (TB) group was also investigated using the immunochromatographic test. In our study, the majority of TB patients were suffered from TB relapse (36.6%); non-HIV infected individuals (99.1%) or showed a positive result for AFB (61.4%) in Gene Xpert analysis. Moreover, there is a significant difference in microscopy findings and bacillary levels of AFB, and Rifampicin (RIF) susceptibility pattern of M. tuberculosis strain among sputum samples of TB patients, P-values less 0.0001. Furthermore, we found that TB patients were suffered from vitamin D deficiency. In particular, the mean of vitamin D level was significantly much lower in TB patients (26.7 ± 1.6) compared to non-TB controls (117.3 ± 3.2), P-value equal 0.0001. Likewise, it's much lower in females, individuals of 21–40 years old, and patients with high bacillary levels or those infected by Rifampicin resistance strain. Accordingly, our study was highlighted the TB and Vit D deficiency relationship and showed the need for further studies to a better understanding of the impact of TB on Vit D level and investigate whether vitamin D supplementation can have a role in the prevention and treatment of tuberculosis.

Viable Mycobacterium tuberculosis in sputum after pulmonary tuberculosis cure

BackgroundPulmonary tuberculosis (TB) with detectable Mycobacterium tuberculosis in the sputum is a major source of transmission. In resource limited TB endemic settings, cure is declared through sputum smear examination for acid fast bacilli without performing culture. This may lead to erroneous treatment outcomes as viable bacteria may be missed due to the low sensitivity of direct smear method. The aim of this study was to investigate if sterilizing cure is achieved among the new pulmonary TB cases declared cured by sputum smear conversion and to evaluate the impact of addition of ethambutol in the continuation phase in achieving it.MethodsNew sputum smear-positive pulmonary TB patients registered at a tertiary care hospital in Pakistan from November 2013 to March 2014 were followed under standard Directly Observed Treatment Short Course strategy for 6 months. Half of these patients received ethambutol in addition to isoniazid and rifampicin in the continuation phase. Sputum specimens were examined on microscopy at 2 months and at the end of treatment. Sputa of patients with negative direct smear examination at the end of treatment were cultured.ResultsAmong 5746 TB suspects, 1595 were new sputum smear positive pulmonary TB cases, and 533 were registered at our hospital. Among these, 504 converted sputum negative at 2 months and 348 converted at the end of 6 months of treatment and were declared cured. Sputa of 204/348 patients were cultured, and 12/204 (6%) were culture-positive. Culture positivity at 6 months was not associated with bacterial load, smoking, diabetes, presence of cavities, history of contact with TB patients, age, sex, socioeconomic status, or addition of ethambutol in the continuation phase.ConclusionViable cultivable bacilli were detected in 6% of cured patients, which would have significant impact on the control of TB. This highlights the need for an inexpensive and accurate surrogate marker for culture as it is not feasible to perform culture in routine for monitoring treatment response in the low-resource settings. The treatment outcome did not improve by addition of ethambutol emphasizing the need to find the optimal duration of treatment for individual or carefully selected groups of patients.

COMPARATIVE ASSESSMENT OF BIOCHEMICAL AND IMMUNOLOGICAL MARKERS IN TUBERCULOSIS

Introduction: Pulmonary tuberculosis is major public health problem in developing countries like India.Millions of people have died from tuberculosis. Many times it is difficult to get sputum sample from the patients. Some tests lack specificity, some other lack sensitivity. Hence, there is need of precise and faster diagnosis for patients attending hospitals. In this study, we compared the detection potential of biochemical and immunological markers(ADA, LDH and Mycobacterium tuberculosis H37Ra ES-31 & EST-6 antigens & antibodies based ELISAs) in pulmonary tuberculosis.
 Methods: 50 pulmonary tuberculosis cases confirmed by sputum examinationfor acid fast bacilli (AFB) and 50 age and sex matched control subjects were included in this study.ADA & LDH were estimated by using commercial kits. Tubercular antigens and antibodies were detected by ELISA method.
 Results: SerumADA detected pulmonary tuberculosis with sensitivityand specificityof 94%. Sensitivity and specificity of serum LDH in detecting pulmonary tuberculosis was found to be 94% and 36% respectively.Serumtubercular antigens detected pulmonary tuberculosis with sensitivity and specificity of 88%. Sensitivity and specificity of serum tubercular antibodies in detecting pulmonary tuberculosis was found to be 80% and 90% respectively.
 Conclusion: Adenosine deaminase has better detection potential over other markers in pulmonary tuberculosis.
 Keywords: Adenosine deaminase, Lactate dehydrogenase, Tuberculosis antigen-antibody

KETEPATAN PEMERIKSAAN BTA APUSAN LANGSUNG DAN METODE KONSENTRASI DENGAN KULTUR DALAM MENDIAGNOSIS TUBERKULOSIS PARU DI MEDAN


 Introduction: Tuberculosis diagnostic, using microscopic examination of direct smear of acid-fast bacili (AFB) from the spectrum of lung tuberculosis suspect is still important criteria today, but the sensitivity of this method is low enough, especially in the samples which contain a small number of bacteria. Culture is stronger, but it takes long time, high cost, and it is not conducted in all laboratories. BTA microscopic examination can use direct smear and concentration method. Staining technique which is usually used in microscopic examination is Ziehl Neelsen. The sensitivity of direct smear method tends to be low and can be increased by using concentration method because bacteria can be easily found. Objective of the research: The objective of the research was to find out the effectiveness of direct smear examination of AFB , and concentration method was compared with culture. Materials and Method: The samples consisted of 60 sputum samples from the patients of lung tuberculosis suspects who visited BP4 Medan and from private practices of tuberculosis specialists, and the samples had fulfilled inclusive criteria. Microscopic examination of acid-fast bacilli using direct smear and concentration method with Petroff method, using Ziehl Neelsen staining and culture with Lowenstein Jensen was conducted. Then we performed diagnostic test for direct smear and concentration method to compare it with culture. Result of the research: AFB examination with concentration method had sensitivity of 68.75%, specificity of 82.14%, the value of positive prediction of 81,48%, the value of negative prediction of 69.70%, ratio of positive likelihood of 3.85, and ratio of negative likelihood of 0.38, compared with culture method examination in finding BTA in sputum of lung tuberculosis suspects. The result of microscopic examination of direct smear method had the sensitivity of 59.38%, specificity of 92.68%, the value of positive prediction of 90.48%, the value of negative prediction of 66.67%, ratio of positive likelihood of 8.31, and ratio of negative likelihood of 0.44, compared with culture method examination in finding BTA in sputum of lung tuberculosis suspects. Conclusion: The ability of acid-fast bacilli examination of concentration methodsin diagnosis oflung tuberculosisis 9.37% higher thanthe directsmear but direct smear method gives bigger clinical benefit in diagnosing lung tuberculosis, compared with concentration method

Assessment of prevalence of active pulmonary tuberculosis among patients with ocular tuberculosis

Background Tuberculosis (TB) is considered a multisystemic disease showing many extrapulmonary presentations. TB uveitis is one of the common forms of extrapulmonary TB. The lung is still the first organ to be attacked by TB, and pulmonary TB is the only infectious form of the disease. Aim The aim of the study was to detect the prevalence of active pulmonary TB among patients with TB uveitis. Patients and methods The present study included 37 patients with diagnosis of ocular TB on the basis of previous history, ocular examination, and exclusion of other suspected causes of uveitis. In addition, positive tuberculin skin test, or positive interferon-gamma release assays were carried out. All included patients were subjected to sputum examination for acid-fast bacilli and plain radiography of chest P-A view, and certain cases had a bronchoalveolar lavage. Patients with active pulmonary TB were detected. Both groups (patients with active pulmonary TB and patients with free chest) were compared with regard to all the previously mentioned studied parameters. Results The mean age of the studied patients was 34.8±12.5 years. All the studied patients showed positive tuberculin test with a mean of 18.5±3.4 mm. With regard to the Quantiferon Gold test, 34 patients (91.9%) had positive results. Concerning radiography, only 10 (27%) patients had normal radiograph, the rest of the patients showed various radiological lesions. Thirty (81.1%) patients were diagnosed to have active pulmonary TB. Sputum examination for acid-fast bacilli revealed that 22 (59.5%) patients had positive results; an additional eight patients (who had negative results on sputum examination) showed positive results when they underwent a bronchoalveolar lavage. There was no statistically significant difference with regard to all the previously mentioned parameters between patients with active pulmonary TB and patients with a free chest. Conclusion The present study revealed that a considerable percentage of the patients with TB uveitis had active pulmonary TB.

Hello michaelsie Search Arini Astasari Widodo, Githa Rahmayunitha, Triana Agustin, Rinadewi Astriningrum Diagnostic procedures in pediatric dermatology

Diagnostic procedures in pediatric dermatology are different and significantly more challenging than those in adult patients, especially on how to approach the patients. We need to acknowledge that pediatric patients have unique anatomical, physiological, and psychological aspects. Compared to adults, children have smaller procedure area, are less cooperative, and more difficult to understand. For these reasons, we should perform diagnostic procedures on children cautiously. Having extensive knowledge in this field can facilitate us to carry out an ethical, efficient, targeted procedure with less risk. This article reviewed the most appropriate, most comfortable, and least invasive diagnostic procedures for children. Some of the most commonly performed pediatric dermatology procedures highlighted in this article are potassium hydroxide examination, Gram staining examination, acid fast bacilli examination, skin test for allergies, and skin biopsy for children. We also discuss the process of obtaining a written informed consent from the parents who were involved in decision making process and play a crucial role in assisting physicians to calm their children during the diagnostic procedures. Keywords: children, dermatology, diagnostic procedures

Ziehl Neelsen vs. Auramine staining technique for detection of acid fast bacilli

Background: The culture and molecular test are the best methods for isolation and identification of Mycobacterium tuberculosis in developed countries. But, in developing countries like Nepal with a significant number of tuberculosis (TB) cases and limited resources, the diagnosis of TB relies primarily on smear microscopy for Acid fast bacilli (AFB).Objective: To compare the results of direct sputum examination for AFB stained by Ziehl Neelsen and Auramine technique.Method: Cross sectional comparative study was conducted in tuberculosis research laboratory, BPKIHS from April to June 2013. A total of 100 sputum samples were collected randomly. Four slides were smeared and labeled for each as neat ZN, neat Auramine, concentrate ZN and concentrate Auramine. Slides were processed as per WHO laboratory guidelines.Results: The findings of this study revealed that 3% positive with neat Auramine was negative for ZN stain. Similarly, 5% positive cases with Auramine concentrate were negative with ZN concentrate technique. Auramine stain was able to detect all ZN positive as positive but only 83 cases were detected as negative among 88 case of ZN negative. Both concentration techniques showed 12% of positive with significant relationship. With this; Auramine showed 100% sensitivity, 94.6% specificity, positive predictive values and negative predictive values 70.5, 100% respectively.Conclusion: Auramine stain stands efficient on comparison and can be used as an alternative to ZN stain, with added value of allowing a large number of sputum specimens to be examined in a given time as low power is used for examination.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, Page: 59-66

Laryngeal & Lower lung field tuberculosis in pregnancy: A case report

Lower lung field tuberculosis (LLF TB) is atypical presentation of tuberculosis. LLF TB is missed routinely because of confusing clinical and radiological presentation and usually these cases initially treated as pneumonia. In this case report, we observed 25 year pregnant female with dysphonia and cough as presenting feature of LLF TB. Chest radiograph was showing ‘typical’ LLF TB pattern with Cavity in lower zone on right side. Sputum examination for acid fast bacilli was positive in higher grades with ‘laryngeal ulcerative lesions’ in direct laryngoscopy examination. She was treated with recommended four drug regimen and documented ‘cure’ at the end of six months. High index of suspicion is must while evaluating these cases and all possible measures to diagnose underlying tuberculosis to have successful treatment outcome.

A prospective evaluation of hemoptysis cases in a tertiary referral hospital

Cheat physicians frequently come across the symptom hemoptysis, an alerting symptom which may result from a wide variety of disorders. Objective: We aimed to determine the main causes of hemoptysis in a referral hospi. tal for chest diseases Methods: All the patients referred to our chest unit with hemoptysis during the two years of the studs period were included in the study. The medical history was taken and physical examination and chest radiograph were performed for each patient. Sputum examination for acid fast bacilli, echocardiography, ear-nose-throat examination and upper gastrointestinal system endoscopy, computer as well as tomography of thorax, were the further diagnostic investigations, the latter for selected patients. The mean age of the 72 patients (53 males, 19 females) who were included in this study was 48 + 17 years. Results: bronchiectasis was the most common cause of hemoptysis (22.
 4 followed by lung cancer (18.9%), active tuberculosis (11.2%), and inactive tuberculosis (10.5%). Sputum smear for acid fast bacilli was performed in 51 patients and was positive in 15.6% of them. Computed tomography of thorax WART formed in 51 patients and was pathologie in 81.3%. Fiberoptic bronchoscopy was performed in 23 patients and locall the bleeding site in 67.4% of the patients. Conclusion: the most common cause of hemoptysis was bronchi. ectar lung cancer and tuberculosis in our hospital. Based on this finding, we suggest that the diagnostic approach to the patients presenting with hemoptysis should include first a detailed medical history, physical examination, and chest radiography. Secondly a sputum smear for acid fast bacilli: thirdly computed tomography of the thorax and finally fiberoptic bronchoscopy.