Extrapulmonary Cases Research Articles

Diagnostic Approach to Extrapulmonary Tuberculosis by Cartridge-based Nucleic Acid Amplification Test.

Tuberculosis (TB) is a highly infectious disease causing millions of cases worldwide. Though pulmonary TB is the most common form of infection, extrapulmonary cases are also very rampant and are responsible for a large number of cases. But the diagnosis of extrapulmonary cases is quite difficult because of varied manifestations and the paucibacillary nature of the infection. Cartridge-based nucleic acid amplification test (CBNAAT) is a simple, rapid test that is very efficient in the early diagnosis of these extrapulmonary cases [extrapulmonary TB (EPTB)]. A study was done to establish the usefulness of CBNAAT in the early diagnosis of EPTB cases. A comparative study was conducted in a rural tertiary care hospital in West Bengal, India, for 8 months (July 2021-February 2022). Samples were collected from different sites like pleural fluid, lymph nodes, cerebrospinal fluid (CSF), pus, ascitic fluid, and tissue aspirate and subjected to both CBNAAT and smear staining and examination under a fluorescent microscope. Positive samples were cultured, examined, and compared. From 593 samples collected from different sites in suspected cases of EPTB-52 samples were positive by CBNAAT, and six cases showed rifampicin resistance (RIF resistant). Smear staining of the samples by auramine-rhodamine stains and examined under the fluorescent microscope for acid-fast bacilli identifying 33 samples; the rest were negative. Slides showing acid-fast bacilli were cultured on Lowenstein-Jensen media. Cartridge-based nucleic acid amplification test (CBNAAT) is a very useful assay for the early diagnosis of extrapulmonary cases as it can accurately identify false negative samples by smear microscopy.

Epidemiology of Molecular Probes in Xpert MTB/RIF Assay in AJK, Pakistan

Objective: This study aimed to detect rifampicin-resistant tuberculosis cases and assess the frequency of missing probes in different study populations in Azad Jammu and Kashmir (AJK), Pakistan. Methodology: The study was conducted at the State TB Reference Laboratory, District Headquarters Teaching Hospital, Mirpur, AJK. A total of 2,790 specimens collected between March 2016 to August 2019 were analyzed. Pulmonary TB (PTB) accounted for 94% of the cases, while 6% were classified as extra-pulmonary cases. All respiratory and non-respiratory samples underwent fluorescence smear microscopy (AFB) and a real-time PCR test (Xpert MTB/RIF assay) to detect Mycobacterium tuberculosis (MTB) and rifampicin resistance. Results: Among the 2,790 suspected MTB patients, 734 (26%) were confirmed to have MTB using the Xpert MTB/RIF assay, while 564 (20%) tested positive by fluorescence microscopy. Of the MTB-positive patients, 720 (98%) were diagnosed with pulmonary TB, and 14 (2%) had extra-pulmonary TB. Rifampicin resistance (RR) was detected in 66 (9%) cases, with 97% of the resistant cases being pulmonary and 3% extra-pulmonary. The most frequently missing probe was E (Codon 529-533), accounting for 34% of the cases, followed by probe D (Codon 523-529) at 26%. The least frequently missing probe was C (Codon 523-529), observed in 3% of the cases. Probe B (Codon 512-518) was missing in 15.4% of cases, while probe A (Codon 518-523) was missing in 9.4% of cases. Conclusion: The utilization of molecular diagnostic techniques, such as the Xpert MTB/RIF assay, enables rapid identification of MTB and detection of rifampicin resistance. This study provides valuable baseline data on the prevalence of 81 bp mutations in the rpoB gene, highlighting the need for further evaluation of mutation patterns in AJK.

Tuberculosis in migrants: epidemiology, resistance and outcome in Milan, Italy

Background Human migration and the ever-changing geopolitical scenarios are redefining the epidemiology and the management of tuberculosis (TB), especially in low-TB burden countries welcoming high rates of people from high-TB burden countries. Methods We conducted an observational retrospective mono-centric study in a Northern-Italy TB reference centre from 1 January 1990 to 31 December 2019, focusing on the differences in epidemiology, resistance patterns and treatment outcomes between Italians and migrants with active TB. Data were collected from medical records. Results A total of 10555 patients were included, 4614 Italians and 5941 migrants. Among migrants, higher rates of rifampin-resistant (RR) or multidrug-resistant (MDR) TB were reported, as well as higher rates of loss to follow-up. Among Italians, higher mortality rates and a higher number of extrapulmonary TB cases were found. Conclusion Our study describes one of the largest cohorts of patients with active TB in Italy, highlighting the need for tailored approaches in native and migrant populations.

Prevalence and Clinical Profile of Tuberculosis Patients in a Rural Teaching Hospital in South-South Nigeria: A Ten-Year Retrospective Study

Objective: This study aimed to determine the prevalence, distribution, and treatment outcomes of tuberculosis (TB) in a rural hospital in Nigeria.
 Methods: This was a retrospective cross-sectional study conducted between 2013 and 2022. The data on all patients diagnosed with TB during the study period were collected from the hospital's registry. The data was then entered into SPSS for analysis. The level of statistical significance was set at P < 0.05.
 Results: The overall prevalence of TB among TB suspects was 41.3%. Pulmonary TB was the most common form of TB, accounting for 87.1% of the cases, while extrapulmonary TB accounted for 12.9%. Among extrapulmonary TB cases, TB lymphadenitis was the most common (27.2%). The mean age of the patients was 44.7±10.9 years, with the majority of cases in the 51-60 and 31-40-year age groups. Males were more affected than females (59.1% vs. 40.9%), and 5.6% of TB patients were HIV-positive. The frequency of rifampicin-resistant TB was 9.5%. The majority of patients (96.5%) had a successful treatment outcome, with 28.9% being cured and 67.6% completing their treatment. Treatment failure occurred in 0.4% of TB cases, while 0.9% defaulted, and 2.2% died. Patients with rifampicin-resistant TB had lower odds of treatment success than those without rifampicin-resistant TB (P = 0.03; OR: 0.5; CI: 0.26-0.96).
 Conclusions: The study revealed that TB remains a significant public health problem in Nigeria, especially in rural areas. Therefore, there is a need for increased collaboration and stronger measures to prevent and control TB, particularly in low-resource settings.

Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area

BackgroundTuberculosis is a global public health problem. Extra-pulmonary tuberculosis accounts for an increasing proportion of cases worldwide, although information about epidemiological, clinical, or microbiological factors is lacking. MethodsWe conducted a retrospective observational study of tuberculosis cases diagnosed between 2016 and 2021, classified into Pulmonary and Extra-pulmonary tuberculosis. Univariable and multivariable logistic regression models were used to investigate risk factors of Extra-pulmonary tuberculosis. Results20.9% of overall cases were classified as Extra-pulmonary tuberculosis, with a rising trend from 22.6% in 2016 to 27.9% in 2021. Lymphatic tuberculosis accounted for 50.6% of cases, followed by pleural tuberculosis (24.1%). 55.4% of cases belonged toforeign-born patients. Microbiological culture tested positive in 92.8% of Extra-pulmonary cases. Logistic regression analysis showed that women were more predisposed to develop Extra-pulmonary tuberculosis (aOR 2.46, 95% CI 1.45–4.20) as well as elderly patients (aged ≥ 65 years) (aOR 2.47, 95% CI 1.19–5.13) and persons with previous history of tuberculosis (4.99, 95% CI 1.40–17.82). ConclusionsExtra-pulmonary Tuberculosis have increased within our study period. A profound decline occurred in 2021 tuberculosis cases, probably due to COVID-19. Women, elderly population, and persons with previous history of tuberculosis are at higher risk of developing Extra-pulmonary tuberculosis in our setting.

Tuberculosis in Poland in 2020.

To evaluate the main features of epidemiology of tuberculosis (TB) in 2020 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2020, data from Statistics Poland on deaths from tuberculosis in 2019, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." In 2020, 3,388 TB cases were reported in Poland. The incidence rate was 8.8 cases per 100,000 with large variability between voivodeships from 5.5 to 13.3 per 100,000. A decrease in the incidence was found in 15 voivodeships, the most significant in Śląskie voivodship (63.9%). The number of all pulmonary tuberculosis cases was 3,237 i.e. 8.4 per 100,000. Pulmonary cases represented 95.5% of all TB cases. In 2020, 151 extrapulmonary TB cases were notified (4.5% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,573 cases (79.5% of all pulmonary TB cases, the incidence rate 6.7 per 100,000). The number of smear-positive pulmonary TB cases was 1,771 i.e. 4.6 per 100,000 (54.7% of all pulmonary TB cases). In 2020, there were 38 cases (15 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.6% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with increasing age from 0.7 per 100,000 among children (0-14 years) to 15.0 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 12.1 per 100,000. There were 39 cases in children up to 14 years of age (1.2% of the total) and 49 cases in adolescents between 15 and 19 years of age - rates 0.7 and 2.7 per 100,000 respectively. In 2020, there were 2,506 cases of tuberculosis in men and 882 in women. The TB incidence in men - 13.5 per 100,000 was 3.0 times higher than among women - 4.5. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 26.8 vs. 4.1 and in age group 55 to 59 years - 28.7 vs. 4.8. In 2020, there were 116 patients of foreign origin among all cases of tuberculosis in Poland (3.4%). In 2019, TB was the cause of death for 456 people (mortality rate - 1.2 per 100,000). TB incidence in Poland in 2020 was 36.7% lower than in 2019. Such significant declines in the incidence have not been observed in the last two decades. As in previous years, there were differences in incidence rates between voivodeships with an unexpectedly sharp decrease in incidence in Silesia (Śląskie voivodeship). The percentage of tuberculosis cases with bacteriological confirmation exceeded 78%, more than in EU/EEA countries (67.3%). The percentage of MDR-TB cases was still lower than the average in EU/EEA countries (1.6% vs. 3.8%). The highest incidence rates were found in Poland in the older age groups (EU/EEAaged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.2%, less than the average in EU/EEA countries (3.8%). The incidence of tuberculosis in men was three times higher than in women in Poland, and six times higher in patients aged 50 to 59. The impact of migration on the TB pattern in Poland has not yet become significant in 2020. The percentage of foreigners among TB patients was 3.4% (33% in EU/EEA countries).

Extrapulmonary tuberculosis: diagnostic features

Objective. To study demographic, clinical characteristics and concomitant pathology of patients with extrapulmonary tuberculosis (EPTB) in Gomel city and Gomel region for the period 2017-2021. To evaluate the informative value of different techniques for the detection of Mycobacterium tuberculosis (MBT) in non-respiratory samples in the diagnosis of extrapulmonary tuberculosis.Materials and methods. A retrospective study of extrapulmonary tuberculosis cases registered from 2017 to 2021 in Gomel and Gomel region (308 patients) was carried out. The results of microscopic, bacteriological and molecular genetic methods of non-respiratory and respiratory samples relevant in the diagnosis of extrapulmonary forms of tuberculosis were analyzed.Results. Demographic and clinical characteristics of patients with EPTB in Gomel and Gomel region for the period 20172021 were revealed. Concomitant pathology in patients with EPTB was analyzed, the features of EPTB diagnostics were studied. It was determined that EPTB is more susceptible to males aged 31 to 50 years and to women aged over 60 years. EPTB is more frequently diagnosed in patients from urban areas and when patients come to medical institutions with nonspecific complaints, except for intrathoracic lymph node tuberculosis (ITLN).Conclusion. In the structure of clinical forms of EPTB, lesions of bones and joints (62.7%) and intrathoracic lymph nodes (19.5%) predominate. HIV-positive patients are more common in the ITLN group. MBT is most often detected in the following localizations of extrapulmonary process: intrathoracic and peripheral lymph nodes, pleural tuberculosis. The most highly informative method of examination of biological nonrespiratory material for detection of MBT in extrapulmonary localization is molecular genetic study.

Burden of Mycobacterium tuberculosis and Associated Factors among Presumptive Extra pulmonary Tuberculosis Patients from Selected Health Facilities, Addis Ababa, Ethiopia

BackgroundExtra pulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis (TB), a devastating disease of public health concern. The complexity of the cases, the involvement of many organs, resource constraints, and concerns regarding drug resistance make disease diagnosis and treatment difficult. This study aimed to determine the burden of tuberculosis and associated factors among presumptive EPTB patients in selected hospitals in Addis Ababa. Material and methodsA cross-sectional study was conducted from February to August 2022 in selected public hospitals in Addis Ababa. Those who attended the hospitals and were presumptively diagnosed as EPTB patient were included in the study. Sociodemographic and clinical data were collected using a semistructured questionnaire. The GeneXpert MTB/RIF assay, Mycobacterium Growth Indicator Tube (MGIT) culture, and solid culture using Löwenstein–Jensen (LJ) medium were used. The data were entered and analyzed using SPSS version 23, and a p-value ≤ 0.05 was considered as statistically significant. ResultsFrom a total of 308 participants enrolled in this study, the measured burdens of extrapulmonary tuberculosis using the Xpert MTB/RIF assay, liquid culture, and solid culture were 54 (17.5%), 45 (14.6%), and 39 (12.7%), respectively. In this study, sex, contact history with known TB cases, having a purulent type of aspirate, and being HIV positive had statistically significant associations with EPTB. ConclusionsThe burden of extrapulmonary tuberculosis among presumptive extrapulmonary tuberculosis cases was found to be significant. Sex, contact history with a known TB case, having apurulent type of aspirate, and being HIV positive were found to be associated with extrapulmonary tuberculosis infection. Strict adherence to the national tuberculosis diagnosis and treatment guidelines is important, while the true burden of the disease should be ascertained using standard diagnostic tests for better prevention and control interventions.

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.

Implementation of a tuberculosis elimination project, India 2018-2019.

To describe the changes in tuberculosis case notifications by the private sector after implementation of the Joint Effort for Elimination of Tuberculosis project in India in 2018. We retrieved data from the project recorded in India's national tuberculosis surveillance system. We analysed data on 95 project districts in six states (Andhra Pradesh, Himachal Pradesh, Karnataka, Punjab including Chandigarh, Telangana and West Bengal) to assess changes in the number of tuberculosis notifications, private provider notifiers and microbiological confirmations of cases from 2017 (baseline) to 2019. We compared case notification rates in districts where the project was implemented with the rates in districts where it was not. From 2017 to 2019, tuberculosis notifications increased by 138.1% (from 44 695 to 106 404), and case notification rates more than doubled from 20 to 44 per 100 000 population. The number of private notifiers increased by over threefold, from 2912 to 9525, during this period. The number of microbiologically confirmed pulmonary and extra-pulmonary tuberculosis cases notified increased by more than two times (from 10 780 to 25 384) and nearly three times (from 1477 to 4096), respectively. The districts where the project was implemented showed a 150.3% increase in case notification rates per 100 000 population from 2017 to 2019 (from 16.8 to 41.9) while in non-project districts, this increase was only 89.8% (from 6.1 to 11.6). The substantial increase in tuberculosis notifications demonstrate the value of the project in engaging the private sector. Scaling up these interventions is important to consolidate and extend these gains towards tuberculosis elimination.

Impact on tuberculosis diagnostic during COVID-19 pandemic in a tertiary care hospital

IntroductionThe aim of this study is to review how did the first three COVID-19 waves affected the diagnostic of tuberculosis and to describe the extra-pulmonary Mycobacterium tuberculosis complex (TB) diagnosis. Materials and methodsA retrospective observational study was done during the first three waves of pandemic to ascertain the impact on TB samples and to recover the extra-pulmonary TB cases we included the first two years of COVID-19. All relevant data was recovered from hospital and Clinical Microbiology records. ResultsPrepandemic period showed an average of 44 samples per week for TB study; during the first three waves this number dropped to 23.1 per week. A reduction of 67.7% of pulmonary TB diagnosis was observed and an increase of 33.3% diagnosis of extra-pulmonary TB was noted when comparing pre-pandemic and pandemic period. DiscussionThe number of declared cases and samples for TB diagnosis dropped during the first three COVID-19 waves due to the overstretched Public Health System which could lead to a delay in diagnosis, treatment and to the spread of TB disease in the general population. Surveillance programs should be reinforced to avoid this.

Frequency of Newly Diagnosis Patients of T2DM and COPD in the Department of Pulmonology at HMC Hospital Peshawar a Qualitative, Cross-Sectional, and Observational Study

Background: Since the immune system weakens in people with DM, Tuberculosis is one of the most prevalent infectious diseases . Objective: This study aimed to determine the prevalence of various forms of active Tuberculosis among people with diabetes. Methodology: This Cross-sectional, observational, and qualitative methods were use din this investigation. Patients with diabetes whom et the inclusion criteria (cough with or without expectoration, hemoptysis, persistent fever, and unexplained weight loss) were questioned in one of three pulmonology department outpatient clinics (OPDs). The short duration of diabetes, ageless than ten and more than 85 years, and all cases of immune compensation and secondary diabetes were excluded. When looking in to the possibility of TB, a thorough history, clinical exam, and tests were performed once permission was obtained. All of the information was loaded into SPSS version 24 for further analysis As a result, 151 people were chosen for further testing for TB out of a total of 550 patients questioned. Active TB was found in just 19 individuals (13percent).The mean age was5 2.03±10.01,the male-to-female ratio was01.08:01.04,and the mean duration of diabetes observed was 10.04years. All were type 2 diabetics exception which turned out to be type 01. Out of the total cases of Tuberculosis, 54% were determined to be pulmonary cases and45% were extrapulmonary cases. Pulmonary cancer had an 11% primary rate, an 18% secondary rate, and a 6% milliary rate. Smear positivity was identified in 57% of patients, and multidrug-resistant Tuberculosis was discovered in 21%, about twice the rate seen in non-diabetic cases. Results: As a result, 151 people were chosen for further testing for TB, and 550 patients were questioned. Active TB was found in just 19 individuals (13 per cent). The mean age was 52.03 ±10.01, the male-to-femaleratiowas01.08:01.04,and the mean duration of diabetes observed was 10.04 years. All were type 2 diabetics except one which turned out to be type 01. Out of the total cases of Tuberculosis, 54% were determined to be pulmonary cases and 45% were extra pulmonary cases. Pulmonary cancer had an11%primary rate,and 18% secondary rate, and a 6%milliaryrate.Smear positivity was identified in 57% of patients, and multidrug-resistant Tuberculosis was discovered in 21%,about twice the rate seen in non diabetic cases. Conclusion: Tuberculosis frequency is more prevalent in people with diabetes than in the general population. Extrapulmonary Tuberculosis occurs more often in people with diabetes compared to those without the disease. Diabetics should be screened more often for the illness so that MDR-TB doesn't spread and become a major public health issue in this underdeveloped nation. Keywords: Diabetes, pulmonary Tuberculosis, extra-pulmonary Tuberculosis, tuberculosis variants, drug-resistant Tuberculosis

Clinical imaging of primary pulmonary nucleoprotein of the testis carcinoma.

Primary pulmonary nucleoprotein of the testis (NUT) carcinoma is very rare in the clinic. In this study, the clinicopathological manifestations and imaging features of the primary pulmonary NUT carcinoma were investigated to improve the diagnosis of this disease. Six patients with pathologically diagnosed pulmonary NUT carcinoma were analyzed, including three males and three females, aged 19-64 (49.00 ± 16.40) years, with clinical manifestations of cough in two cases, hoarseness in one case, blood in sputum in one case, chest pain in one case, and physical examination findings in one case, with a disease duration of 5 days to 4 months. The clinical and imaging data including CT and PET/CT were retrospectively analyzed. Further literature reviews were analyzed in both pulmonary and extrapulmonary NUT carcinoma cases who performed 18F-FDG PET/CT. Most of the patients with pulmonary NUT carcinomas presented as heterogeneous lobulated masses (83.33%), four cases (66.67%) were located in the upper lobe of the left lung, one case (16.67%) in the middle lobe of the right lung, and one case (16.67%) in the lower lobe of the right lung, with the maximum diameter ranging from 1.30 to 8.90 cm and the median of 3.55 cm, most of them were irregularly shaped, with more lobulated margins and more heterogeneous density (83.33%), and the enhancement was mild. PET/CT showed increased 18F-FDG uptake in the lesion and metastatic areas. Both the pulmonary NUT patients in this study and literature reviews showed the SUVmax of the tumor ranged from 5 to 40 with an average value of 12.8, whereas that of extrapulmonary lesions had a range of SUVmax at 4.5-64.1 and a mean of 13.8. In patients with central lung masses, rapid disease progression, and poor response to initial treatment, the possibility of NUT cancer should be considered and anti-NUT monoclonal antibody immunohistochemical staining, combined with genetic detection, if necessary, should be performed as soon as possible. CT and PET/CT imaging are essential for the staging, management, treatment response assessment, and monitoring of pulmonary NUT cancer.

Clinico-Epidemiological Profile and Diagnostic Procedures of Tuberculosis in Children: A Retrospective Study from OPD of Tertiary Care Center in Bangladesh

Background: Childhood Tuberculosis (TB) is an important cause of mortality and morbidity, which causes a significant TB burden in developing countries. Objectives: The aim of this study was to describe clinical profile and diagnostic procedures used in outpatient department (OPD) of a tertiary care hospital. Methods: It was a retrospective study conducted in OPD of Paediatrics Department, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh. Age range of studied populations, 3 months to 18 years who presented with clinical features of TB and were later diagnosed with tuberculosis according to national guidelines for the management of tuberculosis in children, 2021 were enrolled in this study. A total of 108 diagnosed cases of Tuberculosis between August 2021 and July 2022 were enrolled in this study. Data were collected from OPD records and transferred into MS excel sheet for data processing & analysis. Results: Among 834 suspected patients, 108 patients aged 3 months to 18 years were diagnosed with tuberculosis. The highest number of cases 47 (43.51%) were found in 11 - 18 years age group. Gender distribution of the patient showed 58 (53.70%) were male and 50 (46.29%) were female. Among 108 TB cases, 44 (40.74%) were pulmonary TB and 64 (59.25%) were extrapulmonary Tb. Among 64 extrapulmonary TB cases 38 (59.37%) cases were diagnosed as TB lymphadenitis. Fever 83 (76.85%), weight loss 62 (57.4%), cough 50 (46.29%), lump in neck and axilla 38 (35.18%) were found in most of the cases. A positive Mantoux test was found in 68 (62.96%) patients. Chest x-ray findings showed patchy opacity and consolidation in 46 (42.59%) cases. Suggestive FNAC from lymph node was observed among 35 (32.4%) cases. For bacteriological confirmation sputum gene Xpert and stool xpert ultra were positive among 10 (9.25%) and 23 (21.29%) cases. Conclusion: In this study, extrapulmonary TB (EPTB) cases were more than pulmonary TB (PTB) in children. Diagnosis of tuberculosis was based on clinical suspicion supported by various investigations especially bacteriological detection with stool X pert ultra in children.

Clinical profile of pulmonary and extrapulmonary cases of tuberculosis at a tertiary care center

Background: Tuberculosis (TB) is a major communicable disease responsible for chronic illness globally. TB infects the lung primarily. It can transmit to other organs through lymphatic and hematogenous spread. It is preventable and treatable by early diagnosis and treatment with anti-tubercular drugs. Aims and Objectives: The aims of this study were to know the clinical profile of the patients with pulmonary and extrapulmonary TB (EPTB). Materials and Methods: This observational cross-sectional study at was conducted at DGH, SBKS MI and RC, Vadodara for total duration of 18 months. Total 102 patients with TB were enrolled in the study. All patients underwent clinical examination, microbiological examination, and radiological examination through chest X-ray. Results: In this study, the mean age group is of 21–30 years (21.6%), 51–60 years (18.6%), 70 years (11.8%), and 41–50 years (3.9%). Majority of patients were male (57.8%) followed by females (42.2%). Patients were mostly from rural area (62.7%). Farmers (49%) were most commonly involved. In this study, 69% were pulmonary TB and 31% were of EPTB. (59%) lymph node TB. About 56% were sputum positive and 44% were sputum negative in pulmonary TB. Total 32 EPTB patient samples for acid-fast bacilli (AFB), 14 patients were positive, and 18 patients were negative for AFB. Conclusion: The conclusion from this study is cases of TB are mostly male, between 21 and 30 years of age. Most of the patients are from rural area and most common occupation being involved is farmers. In our study, the incidence of pulmonary TB was much higher in comparison to EPTB. Among extrapulmonary cases of TB, lymph node TB was most common in this study.

Tuberculosis of Bones and Joints in Orthopedic

Background: Mycobacterium Tuberculosis (TB) is a major global health concern and burden on developing countries economy. Pakistan ranks in top 10 countries of the world with high load of TB and a big chunk of this disease process is extra pulmonary TB (EPTB). Among extra pulmonary sites, is bone and joint TB is very common yet under reported. Recent literature has found up to 35% of all extra pulmonary cases are bone and joint TB. Purpose: We aim to do an analysis of frequency of bone and joint TB in our institution in all new patients getting registered for treatment of TB. Methodology: This was retrospective analysis 8 years of Data collected in Gulab Devi Hospital Lahore. Data was analyzed using Microsoft excel software and results are tabulated. Findings: Total number of new registered patients of Extra-pulmonary Tuberculosis (EPTB) were 13000 (20%). Out of these EPTB patients, bone and joint TB diagnosis was made in 690(5.3%) patients. Out of these 690 patients, 400 (58%) cases were recorded in Indoor facility and 290 (42%) cases were seen in outdoor facility. Most common site is Spine 340 cases (85%) followed by Hip joint 16 cases (4%), knee joint 12 cases (3%) and upper limb 16 cases (4%). Practical Implication: Regarding management of newly registered cases, Gulab Devi hospital is working in collaboration with world Health Organization TB control program and Provincial TB control Program Punjab (PTP). All new cases are managed by multi-disciplinary team and after initial registration are referred to their relevant specialties. Conclusion: Axial skeleton remains the most common site in al literature and so is the conclusion of our analysis. Detailed research work is still needed in several aspects of this ancient disease to reduce the morbidity and mortality associated with it. Keywords: Bone and joint TB, Pulmonary Tuberculosis, Extra pulmonary Tuberculosis

Tuberculosis of the Elbow Joint – A Rare Case Report

Musculoskeletal tuberculosis accounts for nearly 10% of all extra pulmonary cases with spine being the most common site. Tuberculosis involving the elbow joint is extremely rare accounting for less than 5% of all skeletal lesions. Early diagnosis and treatment is crucial to prevent serious joint and bone destruction. Here, we present a rare case of primary TB elbow joint in a 46 year old female.

1424. Central Nervous System Tuberculosis in a Large Healthcare System

Abstract Background Central nervous system tuberculosis (CNS-TB) accounts for 5-10% of extrapulmonary TB cases. It takes 3 clinical forms: meningitis, tuberculoma, and arachnoiditis. Modern case descriptions of the presentation of CNS-TB are rare. The goal of this study is to examine the presentation, diagnostic studies, and associated comorbidities of CNS-TB. Methods In our academic healthcare system, cases of culture confirmed CNS-TB were identified in a database maintained by the infection control group. This is a retrospective case series of the 11 adults with confirmed CNS-TB. Results 273 patients were identified with TB infection from 2008 to 2022. 104 (38%) had extra pulmonary disease. 11 (4%) had CNS infection. Patient characteristics are described in Table 1. 5 (45%) of the patients with CNS disease also had pulmonary disease. Mean age of diagnosis was 42. 5 (45%) were male and 9 (82%) were African American. 5 (45%) had HIV; mean CD4 count was 100 (8-255). Diagnostics are shown in Table 2. CSF studies revealed a mean WBC of 295/mm3 (4-808), protein of 605 mg/dL (27-4476), and Glucose of 31 (12-64) mg/dL. 4 (36%) patients presented with British Research Medical Council (BMRC) clinical stage I disease and 7 (64%) with stage II disease. 8 (73%) patients had an abnormal CT or MRI scan of the head, with representative images seen in Figure 1. 5 patients (45%) had lesions consistent with tuberculomas. 1 (9%) had arachnoiditis identified on imaging. 1 (9%) patient died. Conclusion 38% of patients diagnosed with TB at our center had extrapulmonary disease compared to 17.5% reported in the literature. The 4% rate of CNS-TB was similar to previously reported. Our series describes abnormal imaging as well as CSF studies showing leukocytosis, pleocytosis, and hypoglycorrhachia consistent with previously described findings. Though numbers were small, no significant difference was found between HIV positive and negative patients. Although mortality was rare in our series, the patient who died had advanced AIDS and multidrug resistant meningitis. Given the significant global mortality of this disease, this series highlights the need for more current studies describing the presentation and diagnostic characteristics of modern CNS-TB so clinicians can better recognize and treat the condition without delay. Disclosures All Authors: No reported disclosures.

Impact on tuberculosis diagnostic during COVID-19 pandemic in a tertiary care hospital

IntroductionThe aim of this study is to review how did the first three COVID-19 waves affected the diagnostic of tuberculosis and to describe the extra-pulmonary Mycobacterium tuberculosis complex (TB) diagnosis. Materials and methodsA retrospective observational study was done during the first three waves of pandemic to ascertain the impact on TB samples and to recover the extra-pulmonary TB cases we included the first two years of COVID-19. All relevant data was recovered from hospital and Clinical Microbiology records. ResultsPrepandemic period showed an average of 44 samples per week for TB study; during the first three waves this number dropped to 23.1 per week. A reduction of 67.7% of pulmonary TB diagnosis was observed and an increase of 33.3% diagnosis of extra-pulmonary TB was noted when comparing pre-pandemic and pandemic period. DiscussionThe number of declared cases and samples for TB diagnosis dropped during the first three COVID-19 waves due to the overstretched Public Health System which could lead to a delay in diagnosis, treatment and to the spread of TB disease in the general population. Surveillance programs should be reinforced to avoid this.

Utility of anti-Mycobacterium tuberculosis antibody (ab905) for detection of mycobacterial antigens in formalin-fixed paraffin-embedded tissues from clinically and histologically suggestive extrapulmonary tuberculosis cases

BackgroundThe detection of acid-fast bacilli in extrapulmonary tissue samples is challenging due to its paucibacillary nature. The present study assessed the utility of immunohistochemistry (IHC) using anti-Mycobacterium tuberculosis antibody (ab905) for detecting the presence of mycobacterial antigens in archived formalin-fixed paraffin-embedded (FFPE) tissues. MethodsFFPE tissues [surgical biopsies (n = 32) and post-mortem tissues (n = 8)] from clinically and histologically suggestive extrapulmonary tuberculosis (EPTB) cases at the Korle Bu Teaching Hospital, Accra, Ghana from 2015 to 2020 were stained with IHC (anti-Mycobacterium tuberculosis antibody) and Ziehl-Neelsen (ZN) stain. The staining outcomes of IHC and ZN were compared, and their sensitivity and specificity determined against histopathology as reference standard. ResultsLymph nodes were about 40% (16/40) of the samples analyzed. IHC stained positive in 43.8% (7/16) biopsies and 87.5% (4/5) post-mortem samples ranging from 43.8% (7/16) in lymph nodes to 80% (4/5) in gastrointestinal organs. The overall sensitivity for IHC was 52.50% (95% CI: 36.13%–68.49%) and 0% (95% CI: 0.00%–8.81%) for ZN. Specificity was 72.50% (95% CI: 56.11%–85.40%) and 75% (95% CI: 58.80–87.31%) for IHC and ZN respectively. ConclusionsIHC using anti-Mycobacterium tuberculosis antibody (ab905) can detect mycobacterial antigens in diverse range of paucibacillary extrapulmonary tissue sections. It is potentially a useful tool for the diagnosis of EPTB in FFPE tissues in a routine pathology laboratory.