GeneXpert Research Articles

Reactive arthritis in connective tissue diseases; one should be vigilant for joint tuberculosis.

The incidence of tuberculosis (TB) is increasing worldwide. Bone and joint TB are the most common types of extra-pulmonary TB, but can easily be misdiagnosed, since articular TB commonly mimics other joint diseases, including reactive and degenerative arthritis, and articular manifestations associated with systemic autoimmune diseases. Furthermore, patients with systemic auto-immune diseases are often more prone to mycobacterial infection. The diagnosis of joint TB can be made using a combination of the following methods: clinical evaluation, imaging, tuberculin skin test, interferon-gamma release assays, nucleic acid amplification tests, and Gene X-pert MTB/rifampicin assay.

Cachexia in tuberculosis in South-East Asian and African regions: knowledge gaps and untapped opportunities.

Tuberculosis (TB) and cachexia are clinical entities that have a defined relationship, making them often found together. TB can lead to cachexia, while cachexia is a risk factor for TB. This article reviews cachexia in Tuberculosis patients in Southeast Asian and African regions by conducting a comprehensive literature search across electronic databases such as PubMed, Google Scholar, and Research Gate between 2013 and 2024 using keywords including 'Africa', 'cachexia', 'prevalence', 'implications', 'tuberculosis', and 'Southeast Asia. This article utilized only studies that satisfied the inclusion criteria, revealing knowledge gaps and untapped opportunities for cachexia in TB across Southeast Asian and African regions. Many Southeast Asian and Western Pacific patients initially receive a tuberculosis diagnosis. Sub-Saharan African countries are among the 30 high TB burden nations, according to the WHO. Food inadequacy and heightened energy expenditure can impair the immune system, leading to latent TB and subsequently, active infection. Symptoms needing attention: shortness of breath, productive cough, hyponatremia at 131mmol/l, hypoalbuminemia at 2.1g/dl, elevated aspartate transaminase at 75U/l, increased lactate dehydrogenase at 654, and normocytic anemia. Comorbidities, such as kidney disease, cardiovascular disease, and asthma, can influence the nutritional status of individuals with TB. While efforts like screening, contact tracing, and utilizing gene Xpert to detect TB cases were implemented, only a few proved effective. It is essential to conduct further studies, including RCTs, in Southeast Asia and Africa to evaluate and manage cachexia in TB patients.

Study the Occurrence of Mycobacterium Bovis in Tuberculosis of Peripheral Lymph Nodes and its Effect on the Course of the Disease.

The incidence of tuberculosis caused by Mycobacterium bovis, not only the pulmonary form, but also the form developing in the extrapulmonary organs, is also increasing from year to year. Despite the large number of EPTB, TBPLN occupies a leading place among diseases of this type and the study of its pathogenic strains is an urgent task in ensuring the effectiveness of treatment. In this regard, the main purpose of the presented manuscript is to determine the frequency of M. bovis in TBPLN, its effect on the development and course of the disease, as well as the effectiveness of treatment. For this purpose, for the first time, the features of education that occur in patients in peripheral lymph nodes using instrumental methods of ultrasound, computed tomography, and magnetic resonance imaging have been identified. In subsequent studies, 110 patients with peripheral lymph node pathology were diagnosed with TBPLN by detecting mycobacteria in pathological material using general hematological, microbiological and gene-molecular (Gene Xpert) methods. In order to ensure the high effectiveness of drugs used for medicinal purposes, strains of the pathogen were detected using histological, cytological studies, BCG test and specific analyzes such as Diaskintest, Quantiferon test, immunological tests. The study showed that about 80% of patients had M bovis in the overall assessment, 76.4% of patients were sensitive to rifampicin, 9.1% of patients had rifampicin-resistant bacteria, and 14.5% of patients did not have mycobacteria. Therapeutic measures were carried out in 2 different modes, such as standard and individual or with replacement, when all patients were divided into 2 groups. During the period from the 56-day intensive phase of standard treatment to the 84-day intensive phase, a total of 40 patients had a sharp decrease in lymph nodes, elimination of purulent inflammation, and after a while 22 patients in this group had a relapse. In the individual treatment regimen, Levofloxacin and linezolid were used instead of pyrazinamide. While the effectiveness of treatment was achieved in 48 patients of group II after 56 and 84 days of the intensive phase, relapses after a certain time were observed in only 6 patients. When choosing an individual treatment regimen in patients diagnosed with M. bovis, a decrease in relapses to 11.5% is achieved. When M. bovis is detected, an individual scheme of antibacterial treatment of tuberculosis is selected, in which, instead of pyrazinamide, it is recommended to choose one of the reserve lines, depending on the sensitivity of the pathogen to drugs.

Accessibility of Finding Tuberculosis Case Actively, Separate Safely and Treat Effectively (FAST) Strategy for Early Detection of Suspected and Symptomatic Tuberculosis Patients: A Hospital Based Quantitative Study

Introduction: Tuberculosis is a contagious disease which has always been a challenge over the course of human history. It is known to spread mostly from persons with undiagnosed and suspected tuberculosis cases. Diagnosing tuberculosis in an early stage with effective treatment is one of the best ways to reduce the burden of tuberculosis. Finding cases Actively, Separate safely and Treat effectively (FAST) Strategy in Nepal, is a rapid diagnostic tool for rapid tuberculosis case detection. Aims: To access tuberculosis case Actively, Separate safely and Treat effectively (FAST) strategy for suspected and symptomatic tuberculosis patients coming to the hospital for early case detection and also to identify patient’s health care behaviour, technical barrier during surveillance. Methods: An observational quantitative study of active cough surveillance was carried at an entry point of FAST corner of Nepalgunj Medical College Teaching Hospital, Banke from April 2023 to December 2023. Scrutinized data was obtained by purposive sampling method with sample size 128 from FAST corner. Results: Maximum cases belonged to the aged group 65 and above having lower middle to lower socioeconomic status. Most of them were from joint family with contact history of tuberculosis in 35 (27.3) % of total cases. Out of total cases, 72 (56.25) % were confirmed with tuberculosis. Among those confirmed tuberculosis cases, multi drug resistance TB was found in 6 (4.7) %. Uses of mask was found significant (P< 0.05) in our study although number of these health care behaviour were less appropriate. Pneumonia was a significant association 17 (P = 0.004) with tuberculosis patient. Insufficient volunteers, and limited Gene xpert machine were major barriers to implement FAST strategy screening in Hospital. Conclusion: FAST strategy is feasible tool in high tuberculosis burden healthcare settings in Nepal. However, the technical and behavioral factors should be managed to ensure an effective approach.

Clinical profiles and related factors in tuberculosis patients with positive sputum smear mycobacterium tuberculosis tests

The aim of this study was to explore the related factors linked to the development and infectivity of tuberculosis. This was achieved by comparing the clinical characteristics of patients with pulmonary tuberculosis (TB) who tested positive in smear Mycobacterium tuberculosis tests with this who tested negative in smear mycobacterium tests but positive in sputum Gene Xpert tests. We gathered clinical data of 1612 recently hospitalized patients diagnosed with pulmonary tuberculosis who tested positive either in sputum Gene-Xpert test or sputum smear Mycobacterium tuberculosis tests. The data was collected from January 1, 2018 to August 5, 2023, at Sichuan Provincial People's Hospital. We conducted separately analyzes and comparisons of the clinical characteristics between the two groups of patients, aiming to discussed the related factors influencing the development and infectivity of tuberculosis. In comparison to the GeneXpert positive group, the sputum smear positive group exhibited a higher proportion of elderly patients (aged 75–89) and individuals classified as underweight (BMI < 18.5 kg/m2). Furthermore, this group was more prone to experiencing symptoms such as weight loss, coughing and sputum production, hemoptysis, shortness of breath, and difficulty breathing. Moreover, they are also more likely to develop extrapulmonary tuberculosis, such as tuberculous meningitis, tuberculous pleurisy, and tuberculous peritonitis. These clinical features, when present, not only increase the likelihood of a positive result in sputum smear tests but also suggest a high infectivity of pulmonary tuberculosis. Elderly individuals (aged 75 to 89) who are underweight (BMI < 18.5 kg/m2), display symptom of cough, expectoration, hemoptysis and dyspnea-particularly cough and expectoration-and those with extra pulmonary tuberculosis serve as indicators of highly infectious pulmonary tuberculosis patients. These patients may present with more severe condition, carrying a higher bacteria, and being more prone to bacterial elimination. Identification of these patients is crucial, and prompt actions such as timely and rapid isolation measures, cutting off transmission routes, and early empirical treatment of tuberculosis are essential to control the development of the disease.

Correlation Between MTB/RIF Gene Xpert Cycle Threshold Values and Clinical Radiological Severity of Pulmonary Tuberculosis

The determination of bacterial load was essential for assessing disease severity, transmission rate, and prognosis. Gene Xpert is a diagnostic test that provides Cycle Threshold (Ct) value as a potential measure of Mycobacterium Tuberculosis (Mtb) load. Despite its potential, there are limited reports exploring the relationship between Ct value and clinicoradiological severity. This study aimed to correlate Ct value and clinicoradiological severity of pulmonary tuberculosis (TB). The study was a retrospective design using medical record data of confirmed TB patients from January to December 2022. These patients were identified based on Gene Xpert test and classified as high, moderate, or low detection Mtb when Ct value was &lt;16, 16-22, and 22-28, respectively. In assessing the severity of clinical using the Bandim score, thoracic TB lesions was categorized by Chest XRay into minimal, moderate, and advanced. The total of 90 TB patients and the majority were males (78.9%) aged 46-65 years (59.0%), with comorbidities (95.0%). The most of the participants had mild clinical severity (44.4%), with Ct value of 16-22 (52.2%), and moderate lesions (35.6%). The most common lesions were fibroinfiltrates on the chest X-ray (61.1%). The Ct value of &lt;16 had a significant correlation with clinical severity of TB (p&lt;0.05) but no significant association with advanced lesions (p&gt;0.05). Based on the results, Ct value had a strong correlation with clinical severity in pulmonary TB. In addition, it could be used as a predictor for managing pulmonary TB patients and an important indicator for control programs.

Surgery for deformities in pediatric spinal tuberculosis: single centre review of 51 cases.

To retrospectively report on the clinical presentation, radiological features, indication, and outcome of surgical management of children with posttubercular spinal deformities with long term outcome. This retrospective study was conducted in a single center operated by a single surgeon from 2002 to 2022, and data from an electronic medical record was reviewed. The indications for surgery included failure of medical treatment, to prevent deformity (depending on location, extent of bone loss, stabilization patterns (A, B, or C), and the presence of "Spine at Risk" signs) or correct deformity and in the presence of major neurodeficit. 51 children (< 15years) of mean age 12.5, and mean follow-up of 7years (2-15) were included. Pain, deformity/instability, and limb weakness were seen in 34 (66.6%) patients (mean mJOA score was 13.44, which improved to 14.7 and 16.8 at immediate postoperative and latest follow-up), with 17 (33.3%) patients presenting with deformity alone. Dorsal affection was commonest (60.8%), followed by lumbosacral (19.6%) and cervical (19.6%), with multilevel/skip lesions seen in four patients. The mean coronal/sagittal Cobb at presentation was 24.2°/40.96°, which improved to 8.2°/25.6° in the immediate and 8.8°/24.8° at the latest follow-up. Gene Xpert positivity was found in 95%, AFB culture positivity in 84%, and histopathology was positive in 91%. All patients had posterior surgery with an additional anterior reconstruction in 6. The complication rate was 5.8% (N = 3); 2 had implant loosening requiring revision surgery, 1 with prolonged discharging sinus with MDR TB, healed with chemotherapy. Pediatric post-tuberculous spinal deformities require identification of those who are likely to worsen, and close follow-up is mandatory. Failure of medical management, major destruction of vertebral bodies, type C stabilization pattern, and worsening deformity/neurodeficit require surgery with a good outcome.

Addressing the challenges in laboratory confirmation of paediatric tuberculosis: the role of induced sputum specimen

Tuberculosis (TB) remained the single leading infectious cause of ill health and death globally until the COVID-19 pandemic occurred. Tuberculosis contributes significantly to childhood mortality of about 16% among HIV-negative children worldwide. Childhood tuberculosis is a significant epidemiological tool as childhood TB represents recent transmission in the community and reflects the presence of an infected adult. Previously clinical research, diagnostic methods, and therapeutic discoveries have focused on adult tuberculosis to the neglect of childhood tuberculosis. Limited pediatric surveillance data, poor case ascertainment, and limited resources and capabilities have hindered the attainment of the true burden of childhood tuberculosis in countries with high tuberculosis disease burden. The difficulty in characterising the true burden of tuberculosis is mainly from the difficulty in obtaining adequate and reliable diagnostic samples to confirm TB in children. Sputum induction has proven to be feasible and effective in several LMIC settings. Gene Xpert MTB/Rif; polymerase chain reaction, performed on induced sputum samples is more sensitive in the detection of paucibacillary TB in children as compared to sputum smear testing. This allows for early diagnosis and timely initiation of therapy. It is necessary that we continue to utilize the available tools to improve TB diagnosis in children and ensure we meet End TB and SDG goal 3 targets on time

A Case Report on Peritoneal Tuberculosis in an Immunocompromised Patient

Background: Peritoneal tuberculosis (PTB) is one of the most challenging forms of extra pulmonary tuberculosis. Abdominal TB cases make up above 3% of all extra pulmonary TB as per the Index TB Guidelines. PTB is commonly due to reactivation of latent tuberculosis in the peritoneum. Numerous cases were still misdiagnosed due to nonspecific presentation. The golden standard for diagnosis is laparoscopic biopsy. Presenting signs and symptoms of PTB are unspecific such as ascites, abdominal pain and distension, fever, weight loss, diarrhea/constipation. Peritoneal tuberculosis is a significant cause of ascites in developing countries. The causative agent of peritoneal tuberculosis is Mycobacterium tuberculosis. Case Presentation: In this case study, a 52 year old male had complaints of progressive abdominal distension and fever for 2 weeks. Patient underwent diagnostic paracentesis, upper and lower GI endoscopy, biopsy and gene xpert to confirm peritoneal tuberculosis. Patient with peritoneal TB have gradually progressive abdominal swelling due to ascites and abdominal pain. Conclusion: Peritoneal tuberculosis should be considered in differential diagnosis. Differential diagnosis, especially in the developing countries or under developed countries. This case highlights the easy diagnosis of the condition other than the other case reports.

Evaluation of the GeneXpert MTB/RIF Assay for Rapid Diagnosis of Tuberculosis and Detection of Rifampin Resistance in Tuberculous Patients Admitted to Abbassia Chest Hospital

Abstract Background Tuberculosis is considered one of the major infectious diseases especially in the developing countries and a significant diagnostic and therapeutic challenge worldwide. Gene Xpert MTB/RIF assay is a diagnostic test which depends on a real-time polymerase chain reaction for rapid diagnosis of Mycobacterium Tuberculosis and rifampicin resistance in a single test. Aim To evaluate the diagnostic utility of Gene Xpert MTB/RIF assay for rapid diagnosis of pulmonary and extrapulmonary tuberculosis as well as the detection of rifampin resistance in specimens obtained from suspected tuberculous patients in Abbassia Chest Hospital. Patients and Methods Pulmonary and extrapulmonary samples from 77 cases with suspected TB were collected. All retrieved samples were examined with: direct smear microscopy for AFB, culture for Mycobacterium tuberculosis (L.J. media) along with Drug susceptibility testing (D.S.T.) for positive cultures. As well as the gene Xpert MTB/RIF assay and their results were compared to those of both culture and D.S.T. (as gold standard reference methods). Results Gene Xpert MTB/RIF assay showed the highest sensitivity, negative predictive value (NPV) and diagnostic accuracy in detection of pulmonary TB (96.4, 96.4 and 93.1% respectively), with 90%specificity. Xpert MTB/RIF assay showed the lowest sensitivity in diagnosing TB pleural effusion (66.6%) but with the highest specificity and positive predictive value (PPV) (100% for both). As regards diagnosing TB lymphadenitis, gene Xpert MTB/RIF assay showed 75% sensitivity and the lowest specificity (33.3%). Considering rifampin resistance, gene Xpert MTB/RIF assay showed 100% specificity in detection of RIF- Resistance with variable sensitivity according to the type of TB, being the highest in pulmonary TB (90.9% sensitivity). Conclusion Gene Xpert MTB/RIF assay could be used as the first line diagnostic tool for diagnosis of pulmonary TB because of its high diagnostic yield. Yet, it’s not recommended to replace the culture for diagnosing extrapulmonary TB especially in diagnosing tuberculous pleural effusion (pauci-bacillary specimens) which has limited diagnostic utility. Also, the assay showed 100% specificity in diagnosing rifampicin resistance guiding physicians to justifiably starting second line anti-TB treatment.

Overview of rapid molecular test (RMT)–gene xpert mtb/rif ultra results in pulmonary tuberculosis patients based on the history of therapy

Overview of rapid molecular test (RMT)–gene xpert mtb/rif ultra results in pulmonary tuberculosis patients based on the history of therapy

Mycobacterium tuberculosis and rifampicin-resistant tuberculosis among tuberculosis presumptive patients in selected zones of Tigray, Northern Ethiopia, 2016–2019

IntroductionTuberculosis (TB) is the second leading cause of mortality from an infectious disease worldwide. Multidrug-resistant tuberculosis (MDR-TB), where rifampicin-resistant TB is the biggest contributor, remains a global health threat. There is scant data on MTB and rifampicin resistance (RR-MTB) using Gene Xpert MTB/RIF assay in Ethiopia. This study aimed to determine the prevalence of MTB and RR-MTB among presumptive TB patients in Tigray, Northern Ethiopia. MethodsA multi-center retrospective cross-sectional study was conducted from October 2019 to December 2019 among presumptive MTB patients from four hospitals in Tigray. Records of sputum sample results of presumptive MTB patients analyzed with Gene Xpert MTB/RIF assay from January 2016 to December 2019 were investigated. Data were extracted using a data-extraction tool from registration books and analyzed using SPSS ver.21. Statistically significant was set at p-value ≤0.05. ResultsFrom 17,329 presumptive adult MTB patients who had submitted sputum samples for TB diagnosis, 16,437 (94.9 %) had complete records and were included in the study. More than half (60.2 %) of them were males and ages ranged from 18 to 98 years. Majority of the participants: 15,047(91.5 %) were new cases and 11,750 (71.5 %) were with unknown HIV status. Prevalence of MTB was 9.7 % (95 % CI: 9.2–10.2 %) of these, rifampicin resistant-MTB was 8.7 % (95 % CI: 7.32–10.09 %). Age (being >29 years) [p < 0.001] and new cases [AOR = 0.46; 95%CI = 0.39, 0.53, p < 0.001] were associated with low TB infection. Age groups of 18–29 years were associated with higher RR-MTB [AOR = 3.08; 95 % CI = 1.07, 8.72, p = 0.036]. ConclusionNearly one-tenth of the presumptive tuberculosis patients tested positive for MTB; out of these, 8.7 % were RR-MTB. The high prevalence of TB and RR-MTB at a young age and previously treated cases calls for a concerted effort to improve and monitor TB treatment to reduce the problem.

Teratoma of the pericardium revealed by seronegative polyarthritis: A case report

Introduction: Rheumatoid arthritis (RA) is an inflammatory, autoimmune disease with preferential involvement of the synovium in the proximal joints of the hands and feet. Formerly known as chronic progressive polyarthritis or chronic rheumatoid arthritis, its course is characterised by joint erosion and destruction. Coronary heart disease and strokes, the consequences of atheromatous disease, are part of rheumatoid arthritis and are responsible for the increased morbidity and mortality observed in this disease. Cardiac tumours in children are rare. The frequent use of echocardiography has helped to detect them earlier and with greater sensitivity. Most cardiac tumours in children are congenital, primary and benign. Most are discovered in children under one year of age. The aim of this study is to report the discovery of this type of tumour in a 10-year-old child being treated for seronegative polyarthritis. Observation: We report the observation of a 10-year-old girl, from a non-consanguineous marriage, with a history of systemic arthritis on difal 25mg *2/d + MTX 0.8mg/kg/week. Present since the age of 3 with recurrent arthralgias, admitted for polyarthralgias, fever with chest pain and whose examination found swelling, pain and limitation of passive and active movement of the left knee joint and elbow joint. Biological work-up revealed inflammatory microcytic hypochromic anaemia, normal ferritin, elevated CRP and ESR, ECBU, stool culture, ASLO serology, sputum BK, sputum TB PCR, Gene Xpert in sputum, Quantiiferon, SAM work-up and rheumatoid factors (RF) were negative, antinuclear antibodies (ANA) positive. EX. Ophthalmology and abdominal ultrasound normal, chest X-ray reveals cardiomegaly (ICT 0.6), X-ray of the spine + knee + elbow showed a discreet increase in the transparency of the bone structure. ETT found an oval mass measuring 20/25mm at the level of the junction between OD and VD not managing the reflux of the tricuspid valve and THORACIC CT in favour of a mass adherent to the pericardium evoking in the first instance a teratoma. Conclusion: Cardiac tumours in children are rare, and pericardial teratomas are often benign. In this study, we emphasise the importance of looking for underlying cardiac disease in the presence of recurrent episodes of arthralgia in children. Early positive diagnosis of the disease and the therapeutic implications are vital.

Genotyping the human papillomavirus and associated risk factors in mono- and co-infection with human immunodeficiency virus among women attending KIU-TH

The study set out to identify the circulating “high-risk HPV (Hr-HPV) genotype” and examine the risk factors linked to HPV/HIV co-infection and HPV single infection among women receiving medical attention at the Kampala International University Teaching Hospital (KIU-TH). A total of 114 women attending the KIU-TH Clinton Health Accesses Initiative (CHAI) and gynecology units were enrolled. Questionnaires were administered and information regarding the “risk factors associated with Hr-HPV infection” was collected. Subjects were examined for cervical cytological features with use of “visual inspection with acetic acid” (VIA) and Pap smears, and HPV genotype were assessed using the Xpert gene. The analysis of data was done using SPSS v29. The study hypotheses were tested at the common level of P ≤ 0.05. In this study, 37(32%) patients were positive for VIA, 28(24%) were Pap smear-positive, and 3(3%) and 2(2%) were atypical “squamous cells” of undetermined significant (ASCUS) positive for VIA and Pap smears, respectively. Furthermore, a study revealed that 20% of Hr-HPV was from co-infections and 10% from mono-infections. The circulating Hr-HPV genotype were HPV (17.2%), HPV16(9%), and HPV 18/45(7%). Results showed significant relationships (P &lt; 0.05) between condom use, marital status and having many partners as “risk factors” and Hr-HPV infection. In contrast, age, education, vaccination, and educational level were not. This study revealed several factors linked to HPV infection and calls for the integration of cervical cancer screening using the combination of both VIA and Pap smear or gene Xpert, as well as creating awareness and implementation of vaccination programs within Bushenyi District and the country at large.

Xpert HIV-1 qual point-of-care testing for HIV early infant diagnosis in Tanzania: experiences and perceptions of health care workers in a 2016 study

BackgroundHIV early infant diagnosis (HEID) at the centralized laboratory faces many challenges that impact the cascade of timely HEID. Point of Care (PoC) HEID has shown to reduce test turnaround times, allow for task shifting and has the potential to reduce infant mortality. We aimed at assessing the feasibility of nurse based PoC-HEID in five facilities of Mbeya region.MethodsWe analysed data from healthcare workers at five obstetric health facilities that participated in the BABY study which enrolled mothers living with HIV and their HIV exposed infants who were followed up until 6 weeks post-delivery. Nurses and laboratory personnel were trained and performed HEID procedures using the Xpert HIV-1 Qual PoC systems. Involved personnel were interviewed on feasibility, knowledge and competency of procedures and overall impression of the use of HIV-1 Qual PoC system in clinical settings.ResultsA total of 28 health care workers (HCWs) who participated in the study between 2014 and 2016 were interviewed, 23 being nurses, 1 clinical officer, 1 lab scientist and 3 lab technicians The median age was 39.5 years. Majority of the nurses (22/24) and all lab staff were confident using Gene Xpert PoC test after being trained. None of them rated Gene Xpert handling as too complicated despite minor challenges. Five HCWs (5/24) reported power cut as the most often occurring problem. As an overall impression, all interviewees agreed on PoC HEID to be used in clinical settings however, about half of them (11/24) indicated that the PoC-HEID procedures add a burden onto their routine workload.ConclusionOverall, health care workers in our study demonstrated very good perceptions and experiences of using PoC HEID. Efforts should be invested on quality training, targeted task distribution at the clinics, continual supportive supervision and power back up mechanisms to make the wide-scale adoption of nurse based PoC HEID testing a possibility.

Diagnosis of Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using Gastric Aspirate in Children with Pneumonic Consolidation

Background: In Bangladesh, there is increased evidence of TB-associated pneumonia in children are currently missed or diagnosed too late resulting in deterioration of condition. The objective of this study was to detect the frequency of pulmonary TB in children presented with pneumonic consolidation by Xpert MTB/RIF assay using gastric aspirate. Materials &amp; Methods: This was a prospective observational study. Admitted children from 6 months to 14 years old from January to December 2020 with clinical features consistent with pneumonia and radiographically confirmed consolidations were enrolled in this study. MT and Xpert MTB/RIF assay using gastric aspirates were done in all cases. Data regarding frequency of TB, clinical features and lab findings of enrolled patients were collected and analyzed. Results: Total 7/60 (11.67%) enrolled patients, were confirmed as Pulmonary Tuberculosis by Gene Xpert using gastric aspirates. The most common clinical signs were fever and cough in all (100%) patients. Others had chest pain 23(38.33%), breathing difficulty 21(35%), vomiting 17(28.33%). Younger children less than 5 years (P=.045), contact with TB patient (P= .001), long duration of fever (P = .001), presence of severe acute malnutrition (P = .001) high ESR (P= .009), positive MT (P=.017) were associated with positive rate of Xpert MTB/RIF assay in children. Conclusions: Xpert MTB/RIF assay can assist in fast diagnosing childhood pulmonary TB especially in patients with fever more than one week, malnutrition and having contact with TB patient. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 65-70

Diagnostic Value of Combined-Diagnostic Methods of Brain Tuberculoma Tissue Specimens: A Case Series.

Background: The diagnosis of brain tuberculoma (BT) is sometimes challenging. Herein, we presented a case series to evaluate the combined-diagnostic methods, including acid-fast bacilli (AFB) stain, polymerase chain reaction (PCR), Gene Xpert, and histopathology, of tuberculoma tissue specimens (TTSs). Patients and Methods: A total of 16 patients (11 human immunodeficiency virus [HIV]-positive, 5 HIV-negative) with BT confirmed by combined-diagnostic methods of TTS were included in this study. Clinical data, including clinical symptoms, laboratory tests, neuroimaging features, histopathology, treatment, and prognosis, were assessed in all patients. Results: There were 10 male and 6 female patients (range, 18-73 years). Acid-fast bacilli stain and PCR of TTSs were positive in 11 and 10 patients, respectively. The sensitivity of Gene Xpert of TTSs was (80.0%; 8/10). Nine (56.3%; 9/16) patients were diagnosed with BT by histopathology. After receiving antituberculosis treatment, 12 (75.0%; 12/16) patients improved clinically to a considerable extent. Conclusions: The combined-diagnostic methods of TTS may improve the diagnostic efficiency of BT.

Clinical, Laboratory and Radiological Correlates of Xpert MTB/RIF Assay Study in Cerebrospinal Fluid in CNS Tuberculosis

Background: Cerebrospinal fluid (CSF) Xpert MTB/RIF assay is an initial test for the diagnosis of tuberculous meningitis (TBM). Nevertheless, it is not very clear which of the factors govern CSF-Gene Xpert/MTB positivity. Objective: Hence, we aimed to assess the relationship, if any, between the clinical, laboratory and radiological parameters of the central nervous system (CNS) tuberculosis patients and the Gene Xpert study in CSF in such patients. Methods and Material: First, we studied 200 patients with CNS tuberculosis according to the case definition, and subsequently, we performed a Gene Xpert study on the CSF of these patients. Then, we correlated the clinical, radiological, and CSF criteria with the Gene Xpert positivity using the univariate binary logistic regression method via SPSS 20 (P-value &lt;0.05). Results: Seventy-five (37.5%) patients (57.3% females) of median 24 years of age, were CSF-Gene Xpert/MTB-positive and 125 (62.5%) patients were negative. The mean duration of illness (P = 0.017), weight loss or failure to thrive (P &lt; 0.001), loss of consciousness or seizure (P = 0.001), signs of meningeal irritation (P = 0.027), stage III of TBM (P &lt; 0.001), evidence of dissemination (P = 0.003), basal exudates (P = 0.004), hydrocephalus (P = 0.018), CSF lymphocytic predominance (P &lt; 0.001), and reduced CSF glucose (P = 0.011) correlated significantly with positive the Gene Xpert/MTB results. Also, Gene Xpert had a sensitivity of 80% and a specificity of 74.84% against culture Xpert. Conclusions: Xpert MTB/RIF might be more useful in the later stages of the disease and those with more severe disease.

Prevalence of tuberculosis in children using Gene Xpert on gastric lavage samples

Prevalence of tuberculosis in children using Gene Xpert on gastric lavage samples

Mycobacterium tuberculosis and human immunodeficiency virus co-infection and associated variables among presumptive pulmonary tuberculosis patients in Ethiopia; a health institution based cross-sectional study

BackgroundCo-infection of Mycobacterium tuberculosis (MTB) and the Human Immunodeficiency Virus (HIV) is a major global public health issue, particularly in border areas of resource-limited nations, including Ethiopia. ObjectiveTo explore the prevalence and associated variables of MTB/HIV co-infection among PTB presumptive patients in Northwest Ethiopia. MethodsFrom February to August 2021, a cross-sectional institutional investigation was conducted at the Metema and Abrehajira hospitals. Semi-structured questionnaires were used to collect socio-demographic and clinical data. The MTB/RIF Xpert assay was used to process sputum, and 3 ml of veins blood was collected for HIV rapid test (STAT-PAK, ABON, and SD BIOLINE HIV test algorithm) following the Ethiopian National HIV test algorithm. The Gene Xpert assay's sample processing control was checked to ensure data quality. Data entered into Epi-Data were exported to SPSS version 20 for analysis. Statistically significant variables (p-value ≤0.2) from bivariable analysis were included in multivariable analysis. A p-value ≤ 0.05 was judged statistically significant. ResultsThis study included 314 PTB presumptive patients with a median age of 35.0 years, of which 178 (56.69 %) were males. Among all patients, 40(12.7 %) and 51(16.2 %) were PTB, and HIV seropositivity, respectively. Of the PTB patients, 14/40 (35 %) (95 % CI: 24.4–45.6) were co-infected with HIV/AIDS. Married patients were 70 % less likely than unmarried individuals (AOR = 0.3 CI; 0.07–0.98) to have MTB/HIV co-infection. Patients who had contact history with MDR-TB patients (AOR = 5 CI; 1.37–18.00), and those who had a history of alcohol use (AOR = 12.2 CI; 2.56–57.8) were more likely to have MTB-HIV co-infection than their peers. ConclusionOur findings showed that MTB-HIV co-infection is one of the most important community health concerns in the study area. Therefore, MTB/HIV cooperation activities should be fully in place to prevent co-infection and its impact on the population.