Extrapulmonary Tuberculosis Patients Research Articles

Mortality among extrapulmonary tuberculosis patients in the HIV endemic setting: lessons from a tertiary level hospital in Mbeya, Tanzania

Extrapulmonary tuberculosis (EPTB) has received less attention than pulmonary tuberculosis due to its non-contagious nature. EPTB can affect any organ and is more prevalent in people living with HIV. Low- and middle-income countries are now facing the double burden of non-communicable diseases (NCDs) and HIV, complicating the management of patients with symptoms that could be compatible with both EPTB and NCDs. Little is known about the risk of death of patients presenting with symptoms compatible with EPTB. We included patients with a clinical suspicion of EPTB from a tertiary level hospital in Mbeya, Tanzania, to assess their risk of dying. A total of 113 (61%) patients were classified as having EPTB, and 72 (39%) as having non-TB, with corresponding mortality rates of 40% and 41%. Associated factors for mortality in the TB groups was hospitalization and male sex. Risk factors for hospitalization was having disease manifestation at any site other than lymph nodes, and comorbidities. Our results imply that NCDs serve as significant comorbidities amplifying the mortality risk in EPTB. To strive towards universal health coverage, focus should be on building robust health systems that can tackle both infectious diseases, such as EPTB, and NCDs.

Extra-pulmonary tuberculosis frequency and the risk factors influence (case of the PHE-Batna regional unit) (2017-2022)

Context: Tuberculosis is an infectious disease that is endemic in developing countries. The causal agent is Mycobacterium tuberculosis. Extra-pulmonary tuberculosis (EPTB) is receiving renewed attention due to an unexplained increase in its relative frequency. The aim of this study was to carry out a retrospective descriptive survey to assess the frequency of extra-pulmonary tuberculosis in an eastern Algeria population range. Methods: this study took place at the regional tuberculosis Batna’s Public hospitalian establishment unit; over a period of 64 months (2017-2022). 2405 files were studied through the collection of information recorded at laboratory level. Results: Out of 2405 samples, 102 were positive (4.24%). There was a clear predominance of females (64.70%) and males (35.29%), giving a sex ratio of 1.8. The age group most affected was 11 to 49. Pus was the most common specimen with a percentage of 44.12%, followed by urine (28.43%), CSF (14.70%). The incidence of extra pulmonary tuberculosis in patients in Batna’s Department and neighbouring Departments is 4.24%, with adult women being the most affected. Conclusion: Extrapulmonary tuberculosis is common and should not be neglected; it is no longer a pathology of the past but still remains relevant today.

Dynamics of Matricellular Protein Levels in Blood Predict Recovery in Patients with Human Immunodeficiency Virus-Tuberculosis Coinfection.

Chronic immune activation in tuberculosis (TB) associated with human immunodeficiency virus (HIV) infection (HIV/TB) modifies their clinical course. We prospectively measured osteopontin (OPN), full-length galectin-9 (FL-Gal9), and total-Gal9 (T-Gal9) levels in 32 patients with HIV/TB coinfection treated with anti-tuberculosis and antiretroviral therapies over 6-18 months to determine the amelioration of inflammatory conditions in response to the therapies. We observed a significant time-dependent decrease in FL-Gal9 in both pulmonary TB (PTB, n = 20) and extrapulmonary TB (EPTB, n = 12) patients. The levels of T-Gal9, OPN, and CRP decreased significantly after treatment in only PTB patients. We calculated the inflammatory score (INS) indicating immunologic recovery based on the decline in OPN, FL-Gal9, T-Gal9, and CRP levels. Baseline levels of T-Gal9 and OPN positively correlated with INS in all TB and only PTB patients, respectively, indicating that their levels predict better recovery. In contrast, FL-Gal9 levels at the second visit negatively correlated with INS in EPTB patients. The decrease rate in OPN levels at the second visit also correlated positively with INS in PTB patients. Women showed a higher INS and lower levels of FL-Gal9 than men. The patients with moderate grade severity on chest X-ray had higher CD4 cell numbers than those with limited grade severity. Monitoring these markers will help to predict and assess the response to therapy as well as to devise strategies to reduce the complications caused by chronic immune activation in patients with HIV/TB coinfection.

Change in psychological parameters and quality of life among individuals with pulmonary and extrapulmonary tuberculosis following the intensive phase of therapy: A longitudinal observational study from central India

BackgroundTuberculosis (TB) is a global health concern, impacting millions annually, with limited attention to the psychological distress it inflicts. Psychological comorbidities, such as depression, anxiety, and stress, significantly affect the quality of life (QoL) of TB patients. Available literature on this topic is restricted to the pulmonary TB (PTB) patients; while psychological issues of the extrapulmonary TB (EPTB) patients who comprise a significant proportion of this disease entity remains unexplored. Additionally, the impact of anti-TB treatment on psychological parameters has received limited attention and vice-versa. This study aimed to assess depression, anxiety, stress, and QoL of TB patients at diagnosis and to understand how these parameters change after the intensive phase of treatment. MethodsA longitudinal observational study involving 40 TB patients (31 EPTB and 9 TB) was conducted to assess depression, anxiety, stress and QoL among them. Participants were followed up after the intensive treatment phase. ResultsAt baseline, 32.5% (n = 13) and 65% (n = 26) participants experienced moderate-severe depression, and moderate-severe anxiety, and stress, respectively. QoL was notably compromised, especially in the psychological domain. Post-intensive treatment, anxiety and depression showed significant improvement (Z = −2.271, p = 0.023 and Z = −2.093, p = 0.036), but QoL and stress levels remained largely unchanged (p > 0.05). ConclusionThis study highlights the high prevalence of psychological distress and poor QoL among TB patients. Following intensive phase of therapy, severity of depression and anxiety reduced significantly; however, change in stress-level and QoL was non-significant. Although study is limited by in terms for small sample size, the need of holistic, multidisciplinary treatment approach (including mental health professionals) for such patients can't be overemphasized. Implementing baseline psychological screenings and providing mental health support if required, are critical to improve the overall health and QoL of these individuals.

Concomitant bedaquiline and delamanid therapy in patients with drug-resistant extra-pulmonary tuberculosis in Mumbai, India

BackgroundWorld Health Organization suggests concurrent bedaquiline-delamanid (BDQ-DLM) as part of individualised regimens for eligible patients with pulmonary drug-resistant tuberculosis (DR-TB); however, data for patients with drug-resistant extrapulmonary tuberculosis (EPTB) is extremely limited. This study documents the treatment outcomes and adverse events associated with concurrent BDQ-DLM-based regimens in patients with drug-resistant EPTB at a Médecins Sans Frontières clinic in Mumbai, India. MethodsRetrospective cohort study based on routinely collected programmatic data. Individualised regimens were based on drug-susceptibility testing and previous drug exposure. Drug-resistant EPTB patients initiated on regimens containing concurrent BDQ and DLM from April 2016 to October 2019 were included.Patients who completed treatment were followed up at 12 months. ResultsOf 17 patients, median age was 23 years (IQR = 21–30 years) and 12/17 (71 %) were female. Pre-extensively drug-resistant tuberculosis and extensively drug-resistant TB was reported in 13/17 (76.4 %) and 2/17 (11.7 %) patients respectively. Microbiological reports were unavailable for two patients with central nervous system TB. Lymph node TB was the commonest form of EPTB in 9/17 (53 %) of patients. Median duration of treatment was 18.9 months. At least one grade three or four severe adverse event (SAE) was reported by 13/17 (76.4 %) patients. Thirteen (76.4 %) patients had favourable outcomes. None of the patients relapsed or died in the one-year period of post-treatment follow-up. ConclusionConcurrent BDQ-DLM-based regimens in drug-resistant EPTB were effective and associated with manageable adverse events.

Frequency and Structure of Drug Resistance of M. tuberculosis in Pulmonary and Extrapulmonary Tuberculosis

The objective: to assess changes in the data on drug resistance of M. tuberculosis for 2015-2021 and compare it with data for 2012-2014.Subjects and Methods. Using continuous sampling, the frequency of drug resistance of Mycobacterium tuberculosis (MTB DR) was studied in isolates from 151 pulmonary tuberculosis (PTB) patients and isolates from 805 extrapulmonary tuberculosis (EPTB) patients, who were treated at the clinic of St. Petersburg Research Institute of Phthisiopulmonology in 2015-2021. The results were compared with similar data for 2012-2014 which was published in 2016.Results. In 2015-2021 versus 2012-2014, the overall frequency of MTB DR decreased by 4.2% in pulmonary tuberculosis patients (from 90.1 to 85.9%) and by 2.9% in extrapulmonary tuberculosis patients (from 80.2 to 77.4%). The structure of MTB DR in pulmonary tuberculosis changed insignificantly, the frequency of MDR decreased from 42.5 to 36.5%, and XDR (as per the definitions before 2022) remained the same – 39.5%. In extrapulmonary tuberculosis, the structure of MTB DR deteriorated due to lower frequency of MDR (from 66.3 to 48.3%) and higher frequency of XDR (from 3.2 to 19.0%, p<0.01).

Clinical manifestations and prognosis of tuberculous spondylitis in an adolescent with disseminated tuberculosis: a case report

Indonesia is one of the countries with the highest number of tuberculosis (TB) cases globally. Around 10-20% of adolescents with TB infection progress to pulmonary TB, and less than 0.5% develop miliary or central nervous system TB. TB spondylitis occurs in only 5.6% of extrapulmonary TB patients. The clinical manifestations of disseminated and TB spondylitis are heterogeneous and insidious, with several potential risk- and prognostic factors. We report the case of a 16-year-old male admitted with abdominal distension, paraplegia, and urinary retention. He was diagnosed with disseminated TB with TB spondylitis. This case was unique because the patient had no classic symptoms of pulmonary TB. This report focuses on the diagnosis, comprehensive management, and prognosis of TB spondylitis, as well as the risk factors for disseminated TB. The management consisted of antituberculous agents and surgery. The prognosis is influenced by the patient’s age, severity of kyphosis deformity, number of vertebrae involved, lesion site, and patient’s health status, including nutritional status.

Effect of Combined HAART Plus ATT in Patients of Extrapulmonary Tuberculosis in HIV Patients and Effect on Quality of Life

Effect of Combined HAART Plus ATT in Patients of Extrapulmonary Tuberculosis in HIV Patients and Effect on Quality of Life

Prevalence of extra-pulmonary tuberculosis in Africa: A systematic review and meta-analysis.

The burden of extra-pulmonary tuberculosis (EPTB) is not well quantified in TB endemic countries such as those in sub-Saharan Africa. This study aimed to quantify that burden via a systematic review of the prevalence of EPTB in African countries. Studies were retrieved by searching five databases; 105 studies published between 1990 and 2023 were included. The studies described the prevalence of EPTB among the general population (4 studies), TB patients (68) and patients with other conditions, including HIV (15), meningitis (3), renal failure (3) and other comorbidities, some of which are cancer (12). Due to the low number of studies reporting EPTB in patients with conditions other than TB, the meta-analysis was performed on studies reporting on EPTB among TB patients (68 studies). Meta-analysis was performed on the 68 studies (271,073 participants) using a random-effects model to estimate the pooled prevalence of EPTB. Meta-regression was used to explore possible explanations for heterogeneity according to regions and time periods. The pooled prevalence of EPTB among TB patients was 26% (95% CI 23-29%). There was substantial heterogeneity of prevalence for the five African regions. The Eastern region had the highest prevalence of 32% (95% CI 28-37%) and the lowest in Western Africa, 16% (95% CI 10-24%). There was no significant difference in the prevalence of EPTB between the 3 eleven-year time periods. Our systematic review and meta-analysis give insight into the burden of EPTB in Africa. This review could inform clinical and programmatic practices-a higher suspicion index for clinicians and more effort for better services. This could contribute to efforts aiming to end TB, which have historically been focused on PTB.Coordinated efforts that target both EPTB and PTB are needed.

Xpert MTB/RIF Ultra for the rapid diagnosis of extrapulmonary tuberculosis in a clinical setting of high tuberculosis prevalence country and interpretation of ‘trace’ results

To evaluate the diagnostic performance of Xpert MTB/RIF Ultra (Ultra) for the diagnosis of extrapulmonary tuberculosis (EPTB) from different types of extrapulmonary specimens in comparison with culture and composite microbiological reference standard (CRS). A total of 240 specimens were prospectively collected from presumptive EPTB patients between July 2021–January 2022 and tested by Ultra, Xpert, culture and acid-fast bacilli (AFB) smear microscopy. Out of 240 specimens, 35.8 %, 20.8 %, 11.3 %, and 7.1 % were detected as Mycobacterium tuberculosis complex by Ultra, Xpert, culture and AFB microscopy, respectively. An additional 15.0 % cases were detected by Ultra compared to Xpert MTB/RIF (Xpert) assay. A total of 28 (11.7 %) cases were identified as ‘trace’ category by Ultra with indeterminate rifampicin resistance result; of which 36.4 % were clinically confirmed as EPTB. Compared to culture, the sensitivity and specificity of Ultra and Xpert were 100 % and 72.3 %; 92.6 % and 88.3 %, respectively. In comparison with CRS, these were respectively: 98.9 % and 100 %; 57.5 % and 100 %. For individual category of specimens, sensitivity of Ultra was 100 % with varying specificity. We found that Ultra was highly sensitive for the rapid diagnosis of EPTB and has extensive potential over current diagnostics in high TB burden countries, but ‘trace’ results should be interpreted with caution.

Diagnostic Performance and Comparative Analysis of Conventional Drug Susceptibility Testing, Line Probe Assay, and GeneXpert in Extrapulmonary Tuberculosis Cases: A Cross-sectional Observational Study

Introduction: Tuberculosis (TB), a known threat to mankind for ages, causes a significant burden on healthcare worldwide. The alarming rise of Extrapulmonary Tuberculosis (EPTB) has led healthcare professionals to opt for molecular diagnostics. Despite the availability of rapid diagnostics, conventional culture Drug Susceptibility Testing (DST) is still considered the gold standard in diagnosing TB. Aim: To assess the diagnostic accuracy of culture DST which is considered the gold standard. Materials and Methods: This cross-sectional observational study included 150 suspected EPTB patients and was conducted over a period of one year (September 2018 to August 2019) at Lokmanya Tilak Municipal Medical College and Sion Hospital (LTMMC), a tertiary care hospital in central Mumbai, Maharashtra, India. The hospital is located adjacent to Dharavi, the largest slum area with a high population density, which contributes to the majority of patients attending clinics. Patients attending the pulmonary medicine Outpatient Department (OPD) with extrapulmonary manifestations and suspected cases of EPTB were enrolled in the study. Samples, excluding sputum, were sent to the Department of Microbiology, LTMMC, Sion Hospital for GeneXpert analysis. The samples were further evaluated by microscopy, GeneXpert, and culture DST to detect the presence of Mycobacterium tuberculosis (M. tuberculosis) and drug susceptibility, respectively. Patients positive for Pulmonary Tuberculosis (PTB) were excluded from the study. Categorical variables were described using percentages. A Chi-square test was applied, and a p-value of <0.05 was considered significant. All statistical analyses were performed using SPSS statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 150 extrapulmonary samples, 23 (15.33%) samples were culture positive for M. tuberculosis and were subjected to DST using the 1% proportion method and GeneXpert assay. The MDR isolates were tested using the firstline Line Probe Assay (LPA). Eleven (47.8%) showed resistance to first-line antitubercular drugs. Among the 12 new cases, only 2 (16.7%) showed resistance compared to 9 (81.8%) in previously treated cases. A discordance of 8.7% was observed between DST with GeneXpert and LPA. Additionally, a discordance of 8.7% was observed between DST and LPA for rifampicin resistance and 4.3% for isoniazid resistance. Conclusion: The paucibacillary nature of extrapulmonary samples contributes to the challenging diagnosis of EPTB cases, leading to increased drug resistance. Highlighting the importance of the conventional solid culture DST method, this study strongly recommends the use of conventional DST accompanied by LPA for extrapulmonary cases.

Burden of type 2 diabetes among pulmonary and extra pulmonary tuberculosis patients diagnosed in a tertiary care institute in Puducherry

Background: Most often diabetes and tuberculosis present together and complicate each other at many levels. Studies show people with diabetes were at three times higher risk of developing tuberculosis. Study done in Kerala have reported that the prevalence of diabetes is higher among males and among smear positive pulmonary tuberculosis cases. Objective was to measure the burden of type 2 diabetes mellitus among pulmonary and extra pulmonary tuberculosis patients diagnosed in a tertiary care institute in Puducherry. Methods: Data was obtained from National tuberculosis elimination programme (NTEP) referral register of Pondicherry Institute of Medical Science. All the patients who have diagnosed to have tuberculosis from January 2022 to July 2022 were included. Diabetic status among pulmonary and extrapulmonary tuberculosis patients was also collected. Results: Among the patients with tuberculosis, 67% of patients were males. A total of 38.8% of cases were found to have diabetes and out of these cases, 23.8% of patients were known case of diabetes and 16.4%of cases were patients with newly diagnosed diabetes. It is observed that, among patients with pulmonary tuberculosis, 32.8% of cases and among patients with extrapulmonary tuberculosis 5.9% of cases were found to have diabetes. Conclusions: The present study showed that burden of type 2 diabetes mellitus was more among pulmonary tuberculosis.

Treatment Outcomes and Risk Factors Associated with Unsuccessful Treatment Outcomes among Extra Pulmonary Tuberculosis Patients

Background The World Health Organization report 2021 states that about 10.6 million people got tuberculosis, and 17.0% of them had extra-pulmonary tuberculosis. There is not much published research on extra-pulmonary tuberculosis in Pakistan. The objective of this study was to find out the success rate and the predictors for unsuccessful treatment outcomes of EPTB patients. Methods This study was retrospective cohort study, the study included 320 EPTB patients who were registered and treated at BMCH Quetta, Balochistan, from January 1, 2021 to June 30, 2021. SPSS version 21 was used to analyze the data, and a p-value 0.05 was used to determine statistical significance. Results The treatment had a success rate of 74.4% overall, with 12.4% of the patients LTFU, 5.6% died, and 2.4% failed the treatment. Age older than 60 years (OR = 10.440, p = 0.000) and having meningeal tuberculosis (OR = 3.506, p = 0.008) were found to be predictors for unsuccessful treatment outcomes. Conclusion The success rate of EPTB did not meet the End TB Strategy’s goal of >90%, as set by the World Health Organization. Therefore, elderly patients and those with meningeal tuberculosis need special attention to improve treatment outcomes.

Risk Factors of Childhood Extrapulmonary Tuberculosis Compared to Pulmonary Tuberculosis in Bangladesh: A Hospital-based Study

Abstract Introduction: Childhood tuberculosis (TB) is one of the common causes of child mortality and morbidity in Bangladesh. The study aimed to assess the risk factors of extrapulmonary TB (EPTB) and pulmonary TB (PTB) in children and compare those with PTB amongst children. Materials and Methods: This hospital-based comparative study included EPTB and PTB cases ≤18 years. The groups were compared regarding various risk factors, including age, gender, socio-economic status, education level, nutritional status, family history, active and passive smoking, household contact, ventilation, overcrowding and contact duration. Results: Both EPTB and PTB patients were seen more in lower socio-economic groups (94%), and PTB was slightly higher (49% vs. 45% EPTB). Around 61% of EPTB cases occurred in the 11–18 age group, with a higher prevalence amongst females (61%) compared to males. Age was shown to have a significant association with EPTB, while the absence of ventilation, poor health status, overcrowding and contact duration displayed non-significant positive associations. The female gender, higher education, passive smoking and Bacillus Calmette–Guerin vaccination demonstrated statistically non-significant negative associations with EPTB in reference to PTB. Conclusion: It is essential to adequately address the risk factors to prevent children from both types of TB.

Care-seeking pathways and diagnostic delays in extrapulmonary TB patients

SETTING: This study was conducted at a private tertiary hospital engaged with the TB control programme in the city of Lahore, Pakistan.OBJECTIVE: To assess the healthcare-seeking pathways, different delays and factors associated with delays among the patients who presented in the outpatient department with tuberculous lymphadenitis and pleuritis, the most common manifestations of extrapulmonary TB.DESIGN: This cross-sectional study was conducted prospectively from April 2016 to August 2017.RESULTS: The median age of the 339 patients analysed was 22 years (IQR 17–30); tuberculous lymphadenitis was predominant in females (63%), while pleuritis affected more males (64%). Overall, 62% reported seeking care from healthcare providers before diagnosis, of whom 62% sought care from private facilities, 32% visited facilities >2 times and 8% visited traditional healers. Diagnostic delay was associated with tuberculous lymphadenitis, age 15–44 years, poor socio-economic status and poor TB knowledge.CONCLUSION: There was considerable delay in the management of extrapulmonary TB patients, and the health-system delay was the major contributor, leading to increased patient suffering. Efforts towards minimising health-system delay need to be prioritised for patient screening and diagnosis, with a feasible algorithm that is workable in resource-limited settings.

Usefulness of truenat-derived DNA from extrapulmonary specimens in direct detection of drug resistant tuberculosis by line probe assay

Objectives: Isoniazid (INH) and second-line drug resistance (DR) detection through line probe assay (LPA) takes long in extrapulmonary (EP) specimens because culture growth needs to be obtained to perform deoxyribonucleic acid (DNA) extraction due to the paucibacillary nature of these specimens. Knowing the DR pattern at the earliest is key to success of the treatment. Delay in appropriate tuberculosis (TB) treatment in EP TB patients runs the risk of DR amplification, significant disease damage, and patient loss to follow-up. Here, LPA was attempted on truenat-derived DNA elute from EP specimens, which, in routine, is discarded after the truenat test, to determine drug sensitivity test (DST) for INH and, where necessary, for second-line drugs (Fluoroquinolones, Kanamycin, amikacin, and capreomycin). Material and Methods: Truenat, acid-fast bacilli culture, and fluorescent microscopy were performed on all EP samples that were received at the laboratory during June–September 2022. DNA elute that was left over from 59 truenat Mycobacterium tuberculosis (MTB) positive EP samples were subjected to Genotype MTBDR plus Ver 2.0 assay. Results: MTBDR plus assay (DNA elute) detected MTB and rifampicin (RIF) and INH DST in 47 samples (79.6%) having truenat MTB count of 7.8 × 102 colony-forming unit/milliliter and above. It also detected RIF DST in 65.2% truenat RIF indeterminate samples and DST for both RIF and INH in 60% of culture negative EP specimens. DST results by LPA (DNA elute) completely concorded with standard indirect LPA (on 21 culture isolates from smear-negative specimens). The MTBDRsl yield was however relatively low (11.1%), although second line LPA (SLLPA) was performed only on 9 first-line DR samples. Conclusions: Left-over truenat-derived DNA elute is a significant sample by-product that can significantly speed up and increase the yield of determination of MTB DST in EP samples for RIF and INH, the most critical drugs for TB treatment.

The epidemiological characteristics and infection risk factors for extrapulmonary tuberculosis in patients hospitalized with pulmonary tuberculosis infection in China from 2017 to 2021

BackgroundPulmonary tuberculosis (PTB) complicated with extrapulmonary tuberculosis (EPTB) infection can aggravate the disease, but there have been few reports.MethodsRetrospective analysis was used to collect the clinical data of PTB patients with pathogen positive in a teaching hospital from 2017 to 2021. We describe the incidence, the invasive site of EPTB patients, and analyze the infection risk factors for PTB with EPTB by univariate and multivariate logistic regression models. We also compared the complications, disease burden with chi-square test and rank-sum test.ResultsA total of 1806 PTB were included, of which 263 (14.6%) were complicated with EPTB. The common invasive sites for EPTB were neck lymph nodes (16.49%), intestines (16.13%), and meninges (10.75%). Age ≤ 40 (OR = 1.735; 95%CI [1.267–2.376]; P = 0.001), malnutrition (OR = 2.029; 95%CI [1.097–3.753]; P = 0.022), anemia (OR = 1.739; 95%CI[1.127–2.683]; P = 0.012), and osteoporosis (OR = 4.147; 95%CI [1.577–10.905]; P = 0.004) were all independent risk factors for PTB infection with EPTB. The incidence of extrathoracic hydrothorax, intestinal bacterial infection, urinary tract bacterial infection, and abdominal bacterial infection were higher in patients with PTB with EPTB. PTB with EPTB patients also had longer median hospitalization durations (19 vs. 14 days), during which time they incurred higher total costs, laboratory test costs, imaging examination costs, and drug use costs.ConclusionThis study found important risk factors for PTB complicated with EPTB, such as age ≤ 40, malnutrition, anemia, and osteoporosis. PTB with EPTB patients have more extrapulmonary complications and higher hospitalization disease burden.

INDEX guidelines for extra-pulmonary tuberculosis: knowledge and practice among clinicians in Bengaluru, Karnataka

Background: Extra-pulmonary tuberculosis (EPTB) remains a major problem in developing countries, which acquire diagnostic and management challenges. The study was conducted to characterize the diagnosed EPTB cases, and to understand the perspectives of clinicians on diagnosis and challenges in its management. Methods: A total of 150 EPTB patients' medical records were reviewed at two tertiary hospitals in Bengaluru, Karnataka for the period January 2017 to December 2017. The questionnaire-based interview was conducted among clinicians (n=42) during the study period. Results: The mean age and weight of EPTB patients (females (77, 51%) and males (73, 49%) were 32.5 (±17.5) years and 44.5 (±16.3) kilograms, respectively. Pleural TB (44, 29%), cervical lymph node TB (LNTB) (32, 21%) and abdominal TB (17, 11%) were the most common sites of EPTB involvement, followed by bones and joints TB (11, 7%), spine TB (10, 7%), hilar/mediastinal TB (9, 6%), tuberculoma (8, 5%), TB meningitis (6, 4%), abdominal LNTB (6, 4%), urinary TB (4, 3%) and others (3, 2%). We found GeneXpert was the basis of EPTB diagnosis in 43.3% of cases followed by acid-fast bacilli (AFB) smear microscopy (20.7%) and culture (12.5%). Of 150 EPTB suspected cases, 73% (110) were started anti-TB treatment (ATT), including 8% (12) having received ATT previously. According to LIKERT scale options, 90% of clinicians agreed GeneXpert as a promising diagnostic tool for diagnosis as compared to other microbiological (79%) and histopathological tests (55%). Conclusions: The quality of EPTB diagnosis and management practices at these institutions is satisfactory according to the principles laid down in INDEX TB guidelines or the national guidelines.

Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia.

Drug resistance in tuberculosis poses challenges to both the control and prevention of the disease. The extent of resistance is not well known in developing countries, including Ethiopia. This study was conducted to determine the drug resistance patterns and mutation characteristics of Mycobacterium tuberculosis among extra pulmonary tuberculosis patients in selected health facilities in Addis Ababa. A cross-sectional study was conducted from February 2022 to August 2022 in selected hospitals in Addis Ababa. Socio-demographic and clinical data were collected using structured questionnaire. Mycobacterium tuberculosis complex (MTBC) isolates were tested for phenotypic drug susceptibility patterns using the Mycobacterium growth indicator tube (MGIT) method for first-line drugs and mutation characteristics using the Line Probe Assay (LPA) method. The data were analyzed using: SPSS version 23, and a P-value ≤ 0.05 was considered statistically significant. From a total of 308 patient samples from presumptive extra pulmonary patients, 44 (14.3%) were positive for MTBC. Any drug resistance was discovered in 25% of 44 MTBC isolates evaluated for five first-line drugs phenotypically, with isoniazid (INH) and pyrazinamide (PZA) resistance accounting for a greater proportion with 13.6% and 11.4% of the isolates, respectively. Two (4.5%) of the isolates were MDR-TB. Out of 44 isolates tested using the Geno Type MTBDRplus assay, 5 (11.4%) showed mutations at katG and 2 (4.5%) showed mutations in the rpoB genes. Both the phenotypic and genotypic drug susceptibility test results showed a high proportion of INH resistance. All INH resistance-conferring mutations were identified from katG gene. The overall prevalence of MDR-TB was also high. For early case detection and treatment, expanding diagnostic capacity for first-line DST is a vital step to limit further spread of drug resistant TB strains in the study area.

Quantification of mycobacterial proteins in extrapulmonary tuberculosis cases by nano-based real-time immuno-PCR.

Aim: Diagnosis of extrapulmonary tuberculosis (EPTB) is difficult, and a rapid and dependable diagnostic test is urgently needed. Methods: A nano-based assay, SYBR Green magnetic bead-coupled gold nanoparticle-based real-time immuno-polymerase chain reaction (MB-AuNP-RT-I-PCR) was studied for the quantitative detection of Mycobacterium tuberculosis MPT-64+CFP-10 proteins in clinically suspected EPTB patients. Results: A wide range (270fg/ml-9.9ng/ml) of MPT-64+CFP-10 was quantified by MB-AuNP-RT-I-PCR in EPTB cases, whereas magneto-ELISA demonstrated a narrow range (1.8-10ng/ml). Furthermore, high sensitivity (88.2%) and specificity (100%) were attained by MB-AuNP-RT-I-PCR in EPTB (n=51) and non-TB control (n=49) subjects, respectively. Both MB-AuNP-I-PCR/magneto-ELISA exhibited significantly lower (p<0.05-0.01) sensitivities than MB-AuNP-RT-I-PCR. Conclusion: The MB-AuNP-RT-I-PCR described hereinshows good diagnostic accuracy, which may translate into a credible diagnostic kit.