Microscopic Examination Of Sputum Research Articles

Automated Methods for Tuberculosis Detection/Diagnosis: A Literature Review

Tuberculosis (TB) is one of the leading infectious causes of death worldwide. The effective management and public health control of this disease depends on early detection and careful treatment monitoring. For many years, the microscopy-based analysis of sputum smears has been the most common method to detect and quantify Mycobacterium tuberculosis (Mtb) bacteria. Nonetheless, this form of analysis is a challenging procedure since sputum examination can only be reliably performed by trained personnel with rigorous quality control systems in place. Additionally, it is affected by subjective judgement. Furthermore, although fluorescence-based sample staining methods have made the procedure easier in recent years, the microscopic examination of sputum is a time-consuming operation. Over the past two decades, attempts have been made to automate this practice. Most approaches have focused on establishing an automated method of diagnosis, while others have centred on measuring the bacterial load or detecting and localising Mtb cells for further research on the phenotypic characteristics of their morphology. The literature has incorporated machine learning (ML) and computer vision approaches as part of the methodology to achieve these goals. In this review, we first gathered publicly available TB sputum smear microscopy image sets and analysed the disparities in these datasets. Thereafter, we analysed the most common evaluation metrics used to assess the efficacy of each method in its particular field. Finally, we generated comprehensive summaries of prior work on ML and deep learning (DL) methods for automated TB detection, including a review of their limitations.

ANALISA BAKTERI TAHAN ASAM PADA DAHAK PEROKOK AKTIF PENDERITA TUBERKULOSIS PARU

Acid fast bacteria (AFB) are cell walls containing complex lipids so that in Ziehl-Neelsen staining they can bind dyes because they are not washed off by 3% HCl Alcohol (Alcoholic Acid). One of the host factors in pulmonary tuberculosis is smoking habits and exposure. Smoking habits will damage the defense mechanism of the lungs, which causes the lungs to be more easily infected with tuberculosis germs. The purpose of this study was to determine the results of analysis of acid-fast bacteria in the sputum of active smokers. The research method used was descriptive cross-sectional by examining acid-fast bacteria in the sputum of active smokers suspected of having pulmonary tuberculosis by microscopic examination of sputum (direct smear smear) using the Ziehl-Neelsen staining method. smear examination with Ziehl-Neelsen staining in patients with tuberculosis at Putri Hijau Hospital in 2022, totaling 20 samples, found 4 positive results and 16 samples with negative results.

Tuberculosis in Vaccinated versus Unvaccinated Children with BCG Vaccine in Niamey: Epidemiological, Diagnostic and Outcome Aspects

Introduction: Tuberculosis remains a public health problem worldwide. The BCG vaccination is one of response means. The objective of this work was to study impact of BCG vaccination on morbidity and mortality related to childhood tuberculosis in Niamey. Patients and methods: It was a multicenter prospective and comparative study from January to September 2017 in two-referral hospital centers of Niamey and the National Anti-Tuberculosis Center. The study population consisted exhaustively of children aged 0 to 15 years old suffering from tuberculosis. Epidemiological, diagnostic and evolving aspects in vaccinated and unvaccinated children were studied. Statistical tests used were Pearson's Chi² and Fisher's exact test (p <0.05). Results: Ninety-one children were studied. The BCG vaccination rate was 60.4%. The mean age of children was 6 years 11 months [3 months-15 years]. Children under 2 years of age were less affected (11%) in vaccinated children than in unvaccinated children (3.2%). No association was found between duration of tuberculosis signs (p = 0.37), expression of tuberculin skin test (p = 0.43), and the children's BCG vaccination status. On the other hand, there was a significant link between vaccination status and the results of microscopic examination of sputum or gastric fluid (p = 0.02), occurrence of complications (p = 0.014) and death risk (p = 0.003). Conclusion: This study shows that children’s BCG vaccination status interferes with some aspects of tuberculosis. Therefore, fighting against tuberculosis must be intensified, through combination of many strategies including vaccination.

COMPARATIVE EXAMINATION OF CONVENTIONAL DIRECT SPUTUM AND INDIRECT SEDIMENTATION ON CYTOSPIN TUBERCULOSIS PATIENT SPUTUM SAMPLES

Microscopic examination of sputum using the Ziehl-Neelsen stain is the gold standard for Tuberculosis (TB), but it must be performed by experts with special skills. The purpose of this study is to accelerate the determination of the microscopic results using the Ziehl-Neelsen stain. This research is an experimental method in which the test sample is treated and the sputum sample is controlled with up to 25 samples. The method development is very important to increase the sensitivity and specificity of the results of TB examination using microscopes. This observation shows that the indirect cytospin method has a narrower reading range on a circle with a diameter of only 7 mm, making it easier for a bacterial count compared to the traditional direct method with a size of 2 x 3 cm oval shape. The results of the microscopic examination were 21 positive specimens and 4 negative specimens. Mycobacterium tuberculosis with Ziehl-Neelsen staining gave the same results with a sensitivity and specificity of 100%.

Microscopic Profile of AFB in the Sputum of a Patient's Family Diagnosed with Positive AFB in the Advanced Phase

Tuberculosis (TBC) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. The high prevalence of pulmonary tuberculosis in the community, the coverage of the prevention program with the DOTS strategy is still low, so the aspects of controlling transmission risk factors are important, especially transmission of high risk to the families of sufferers. The method of examination performed to diagnose TBC is microscopic examination of sputum. This study aims to determine the microscopic description of Acid Resistant Basil (ARB) in family members who live in one house with patients with TBC smear positive treatment advanced phase at the Balkesmas Semarang area. This research method is descriptive (non-experimental) with total sampling. The results of the study were that there was no ARB in the sputum of family members living in one house with patients with TBC smear positive treatment advanced phase of 31 samples from 17 respondents with 11 (32.3%) sputum samples mixed with saliva, 20 (58.8%) samples saliva and 3 respondents did not give two samples (8.8%). The conclusion of the study is the microscopic description of examination of sputum preparations as many as 31 samples from 17 respondents and 6 families 100% no BTA was found.

Improved Diagnosis of Pulmonary Tuberculosis using Bleach (Sodium hypochlorite) Concentration Technique at Tertiary Care Hospital

Introduction: In the Revised National Tuberculosis Control Program (RNTCP), microscopic examination of sputum for acid-fast bacilli (AFB) is currently the backbone for the diagnosis of pulmonary tuberculosis. Studies have shown liquefaction and concentration of sputum by 5% sodium hypochlorite is useful in providing increased sensitivity and safety for the handling of specimens. Objective: To assess the utility of the 5% Sodium hypochlorite concentration method in increasing the sensitivity of smear microscopy for detection of AFB for diagnosis of pulmonary tuberculosis. Methods: The study included a total of 1000 sputum samples from 500 patients with suspected pulmonary tuberculosis. Direct smears were prepared from the sputum samples as per RNTCP guidelines. The remaining sputum was used for bleach concentration and smears prepared from the concentrated material. Both smears were stained by Ziehl-Neelsen staining and screened for acid-fast bacilli and graded according to the RNTCP guidelines. Results: A total of 158 samples (15.8%) from 89 patients were positive by a routine direct method whereas by concentration method 236 samples (23.6%) from 143 patients were found positive diagnosing additional 54 patients. The gain in sputum smear positivity of 7.8% over the routine method is highly significant (p=0.0000, χ2= 270) with a 10.8% increase in case detection. Conclusions: Improvement in the sensitivity of smears microscopy will be useful in case detection of tuberculosis especially in resource-poor countries. The increased positivity of microscopy by bleach method indicates that would prove useful if included in the RNTCP to improve case detection. Keywords: Concentration; smear positivity; sodium hypochlorite; tuberculosis.

CHARACTERISTIC RELATIONSHIP OF LUNG TB LABORATORY OFFICER PUSKESMAS WITH ERROR RATE RESULTS OF SPUTUM EXAMINATION SUSPECTED PULMONARY TB IN KUDUS REGENCY

English translation. 
 The problem studied in this study is whether there is a relationship between the characteristics of lung tb laboratory officers puskesmas with the error rate of sputum examination results suspected pulmonary TB in Kudus Regency. The purpose of this study is to find out the relationship between the characteristics of lung tb laboratory officers with the error rate of sputum examination results of lung TB suspects in Kudus Regency. This type of research is explanatory reseach with a cross sectional approach. The free variables in the study were educational background, training, knowledge of direct microscopic sputum examination, staffing status, working life and workload while the bound variables were error rates. The population and samples in this study were all officers of the Tb Paru Puskesmas laboratory in Kudus Regency numbered 21 people. The instrument used is a questionnaire. Primary data is obtained through interviews. Secondary data is obtained from data in the Holy District Health Office. The data obtained is processed using the chi square test with an meaningful level (α) of 0.05. Based on the results of the study obtained that the characteristics of officers related to the error rate are training (p = 0.012, CC = 0.506), knowledge of direct microscopic examination of sputum (p = 0.004, CC = 0.594), staffing status (p = 0.025, CC = 0.484), working period (p = 0.004, CC = 0.594), and workload (p = 0.025, CC = 0.484). Based on the results of the research advice submitted is that training should be given to all tb laboratory officers of The Puskesmas lung on a regular basis every year because training is one of the efforts to improve the quality of human resources in terms of knowledge, attitudes and skills.

SKRINING TUBERKULOSIS (TB) PARU

AFB positive detection cases increase in 2011 until 2013 at Sukoharjo District, but TB CDR is still below national and local targets. Nguter PHC has highest CDR among other subdistrict, that is 84.6% in 2012 and 68.9% in 2013. The objective of this study is screening pulmonary TB patients in Nguter PHC region. Target population screening was ≥ 15 years who often contact with AFB positive patients who in of September 2013 to 2014 period. We did screening by interview about clinical symptom and sputum examination. Diagnostic test are distribution and combination of clinical symptoms, microscopic examination of sputum in Nguter PHC, and cross check sputum to BBKPM Surakarta. The analysis are find the value of p, sensitivity, specificity, PPV, NPV, and Kappa value. We get 160 respondents. Results of microscopic examination of sputum find 15 people (9,38%) were AFB positive and prevalence is 9.38%. Clinical symptoms that have highest sensitivity is cough for 2-3 weeks or more (100%). Kappa value for the cross check is 80% (good deal) with an error rate of 6.67 rate . The screening helps capture suspected pulmonary TB much more (national target 5-15%). It is recommended that training on the management of TB laboratory analyst officers in all PHC so the value of the agreement (kappa) with BBKPM can be increased and the error rate can be decreased.

Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. A 48 years, female presented at TUTH emergency with fever on and off for nine months, cough and shortness of breath for three months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.

Role of Anaemia and Magnesium Levels at the Initiation of Tuberculosis Therapy with Sputum Conversion among Pulmonary Tuberculosis Patients.

Both pulmonary Tuberculosis (TB) and anaemia are prevalent in India. Magnesium levels also influence TB. There is limited and inconsistent literature on the association among anaemia, serum magnesium levels and sputum conversion during tuberculosis treatment. To study the effect of anaemia and serum magnesium levels on sputum conversion in pulmonary TB patients. One hundred each of newly diagnosed sputum smear positive Pulmonary Tuberculosis (PTB), sputum smear negative PTB patients initiated on Directly Observed Treatment Short Course chemotherapy (DOTS) and healthy age and sex matched controls were recruited in the study. Patients were followed up prospectively until completion of first two months of intensive phase. Patients were evaluated before initiation of TB treatment by performing the complete blood counts with peripheral blood smear, serum biochemistry, serum iron, serum magnesium, serum ferritin and microscopic examination of sputum. After giving two months of Antitubercular Therapy (ATT), sputum smears were re-examined for presence of acid fast bacilli. Haemoglobin values less than 13 g/dl in males or 12 g/dl in females was defined as anaemia. Mean and Standard deviations were calculated. Independent t-test was used to compare between the groups. Serum iron and serum ferritin was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls. Anaemia was present in 162 (81%) patients of the study PTB cases. About 60% of anaemia in sputum positive cases was iron deficiency anaemia. Serum magnesium level was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls though not in hypomagnesemic range. Delayed sputum smear conversion occurred in 12 (12%) sputum positive PTB patients. Of these, eight had severe iron deficiency anaemia, four with moderate anaemia. All 12 delayed sputum smear conversion had serum magnesium levels < 1.7 mg/dl (below normal reference range) (mean 1.42 ±0.22 mg/dl). Sputum was found to be positive even after two months of ATT course because of baseline anaemia and lower levels of serum magnesium. Further multicentric studies are warranted to study mechanisms for TB associated anaemia and possible role of intervention for anaemia in TB patients. One needs to find out the mechanisms behind the role of anaemia and lower magnesium levels in delaying the sputum smear conversion in order to lay the foundation of effective interventions. Randomized controlled trials are warranted to generate higher levels of evidences to support our findings.

Psychiatric Disorders: Risk Factor for Unsuccesful Treatment of TB Cases in Romania

SESSION TITLE: Tuberculosis SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Tuberculosis and psychiatric diseases share common risk factors (poverty, homelessness, HIV positive serology, alcohol/substance abuse) leading to frequent comorbidity. Begining with 2002, the incidence of TB in Romania is continuously decreasing: 142.2% 000-2002, 105.5% 000-2008, 72.9% 000 - 2013, but Romania is one of the european contry with very high incidence. The aim of our study was to establish the impact of psihiatrical diseases between TB cases in Romania among 2010 - 2013 and also to follow the evolution of these cases compared by the TB cases in general population. METHODS: Using data from the National TB Control Program, we analyzed the evolution of the proportion of tuberculosis cases occurred at patient with psychiatric diseases between 2010 - 2013. The indicators used to reflect the evolution of TB in these groups were: the rate of TB at homeless people among all TB cases; bacteriological confirmation rate calculated as the rate of bacteriologically confirmed cases of all the studied cases; therapy success rate, calculated as the ratio of the number of patients with cured pulmonary TB or with completed treatment to the number of patients declared with pulmonary TB; mortality rate among TB cases at psihiatrical patients. RESULTS: Between 2010 and 2013, the number of TB cases at patient with mental illness and their percent among all TB patients increased (283=1,34% in 2010, 318=1,90% in 2013). The percent of new cases remains high (73,49% in 2010 73,58% in 2013). Mean age of these patients increased from 40.05±17.58 in 2010 to 43.01±17.97 in 2013; 63.67% of patients were men, more than 50% living in rural areas. Pulmonary localisation is predominent (87,69% of cases). Microscopic examination of sputum revealed acid-fast bacillus in less than 60% of TB cases each year; bacteriological confirmation in culture was 67,33% in 2011%, but only 61,8% in 2012. Only 54,68% in 2011 and 57,07% in 2013 of psychiatric TB patient were successfully treated. Mortality rate is higher that in general population with TB: 16,47% in 2011 and almost 25% in 2013. CONCLUSIONS: The number and rate of psychiatrical cases among TB patients is increasing. The bacteriological confirmation of these cases is lower that in general population,probably due to poor cooperation of these patients and difficulties in sputum prelevation for bacteriological exam. Concerning the results of treatment at that category of patients, we have to underline the high percent of failure and abandoned treatment (more than 18%) and mortality rate (25% in 2013). CLINICAL IMPLICATIONS: We consider the necesity of the campain of active depistation in patients mental illness not only for active TB, but also for LTBI. The close monitoring of cases during TB treatment both by respiratory specialist and psychiatrist is another hint for TB network. DISCLOSURE: The following authors have nothing to disclose: Mara Popescu-Hagen, Rodica Traistaru, Mihaela Tanasescu, Nicoleta Cioran, Paraschiva Postolache No Product/Research Disclosure Information

Pulmonary strongyloidiasis: A case report from Western Uttar Pradesh

Infections due to Strongyloides stercoralis are unusual in western Uttar Pradesh. We report a case in which S. stercoralis was isolated from the sputum of an immunocompetent female patient who presented with fever and hemoptysis. No elevation of eosinophils had been shown during peripheral blood smear examination. Microscopic examination of sputum for acid-fast bacilli with light emitted diode (LED) microscope and stool revealed the larval form of S. stercoralis. The patient was treated with ivermectin and recovered gradually.

Serodiagnosis of Mycobacterium avium complex disease in humans: translational research from basic mycobacteriology to clinical medicine.

Rapid and accurate diagnosis of infectious diseases, including mycobacterial disease such as tuberculosis (TB) and diseases due to nontuberculous mycobacteria (NTM), is a very important element of global health. The gold standard in diagnosis of mycobacterial diseases remains clinical examination, combined with direct microscopic examination of sputum and culture of bacteria. Culture of slowly growing mycobacteria, including Mycobacterium tuberculosis and NTM (such as M. avium complex: MAC), can take up to 4 to 6 weeks, and in 10-20% of cases the bacillus is not successfully cultivated. Diagnosis of MAC pulmonary disease (MAC-PD) is complicated and time-consuming (usually at least 1 month). I have characterized the nature of MAC antigens and immune responses from the aspect of basic mycobacteriology, and then translated to clinical science. My multicenter study in Japan has demonstrated the usefulness of a serodiagnostic test to determine serum IgA antibodies against mycobacterial glycopeptidolipid (GPL) core antigen for diagnosing MAC-PD within a few hours. To validate in a larger number of patients, at diverse geographic locations, and among other races, the test was also assessed the usefulness internationally in the United States and Taiwan. In this review, I discuss development of serodiagnosis of MAC-PD by translational research and international collaboration study.

English

BACKGROUND: HIV & Tuberculosis is a common co- infection that we come across in developing countries. Diagnosis is done by demonstration of acid fast bacilli (AFB) &Tuberculin skin test (TST). Skin test depends on cell mediated immune response which is generally compromised in HIV infected. OBJECTIVE: To compare the demonstration of AFB &TST reactivity in tuberculosis patients who are HIV seropositive & seronegative MATERIALS & METHODS: The study was conducted in the tuberculosis hospital which is attached to the Mysore medical college, Mysore. All patients clinically suspected or diagnostically confirmed as pulmonary tuberculosis were subjected for HIV screening test as per NACO guidelines .Total of 200 patients included for the study out of which 100 each were HIV seropositive & seronegative. They were subjected for microscopic examination of sputum& TST. Sputum microscopy was performed as per RNTCP guidelines. PPD antigen was injected intra- dermally on the left forearm & read after 48 hours & results were noted down. RESULTS: Study group divided into two categories. Category A: Pulmonary tuberculosis patients with HIV seropositivity Category B: Pulmonary tuberculosis patients with HIV seronegativity. Male preponderance was observed in both 79% & 70% with the mean age of 32.7 ± 7.3 years, in females seronegativity was more i.e.30% compared to 21% in seropositive with mean age of 29.3 ± 5.6 years. AFB demonstrated by Sputum microscopy in 99% HIV seronegatives & 54% of HIV seropositives. TST results classified into groups with No response, induration of 1-5mm,6-9mm & >10mm. Among category A 9 of them exhibited No response,32 of them 1-5mm,27 of them 6-9mm & 32 of them >10mm.All category B has responded to TST with only one patient with 1-5mm,25 with 6-9mm,74 with >10mm. DISCUSSION: There is statistically significant difference (p>0.05) in TST &AFB demonstration in pulmonary tuberculosis patients with HIV seropositive & seronegative. Sensitivity of TST is reduced as TST is indicator of cell mediated immune response which is generally compromised in HIV seropositive. Demonstration of AFB is also reduced in HIV seropositive cases. CONCLUSION: TST & demonstration of AFB are common tests done to screen for HIV-TB co infection in HIV seropositive. As the sensitivity of these tests are reduced in HIV seropositive it needs to be interpreted with care.

Diagnostic Accuracy of Serum 1,3-β- d -Glucan for Pneumocystis jiroveci Pneumonia, Invasive Candidiasis, and Invasive Aspergillosis: Systematic Review and Meta-Analysis

Serum 1,3-β-d-glucan (BG) assay may be helpful as a marker for the diagnosis of Pneumocystis jiroveci pneumonia (PJP) and invasive fungal infection (IFI). We conducted a systematic review to assess the diagnostic accuracy of this assay. We searched MEDLINE, Web of Science, Cochrane Collaboration databases, Ichushi-Web, reference lists of retrieved studies, and review articles. Our search included studies of serum BG assay that used (i) positive cytological or direct microscopic examination of sputum or bronchoalveolar lavage fluid for PJP and (ii) European Organization for Research and Treatment of Cancer or similar criteria for IFI as a reference standard and provided data to calculate sensitivity and specificity. Only major fungal infections such as invasive candidiasis and invasive aspergillosis were included in the IFI group. Twelve studies for PJP and 31 studies for IFI were included from January 1966 to November 2010. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC-SROC) for PJP were 96% (95% confidence interval [95% CI], 92% to 98%), 84% (95% CI, 83% to 86%), 102.3 (95% CI, 59.2 to 176.6) and 0.96 (95% CI, 0.94 to 0.99), respectively. No heterogeneity was found. For IFI, the values were 80% (95% CI, 77% to 82%), 82% (95% CI, 81% to 83%), 25.7 (95% CI, 15.0 to 44.1), and 0.88 (95% CI, 0.82 to 0.93). Heterogeneity was significant. The diagnostic accuracy of the BG assay is high for PJP and moderate for IFI. Because the sensitivity for PJP is particularly high, the BG assay can be used as a screening tool for PJP.

Tuberculose pulmonaire simulant une miliaire métastatique d’un carcinome vésiculaire de la thyroïde à la scintigraphie du corps entier à l’iode 131

Iodine 131 whole body scan and serum thyroglobulin rate constitute often useful and valuable tools in the follow-up of patients differentiated thyroid carcinoma after primary therapy. For this purpose, the detection of radioiodine uptake foci outside the thyroid bed and the physiological sites of collecting are often allotted to the presence of metastatic localizations. However, the description of false-positives can induce an expensive and inadequate diagnostic and therapeutic complement. The authors report the observation of a patient followed for a treated follicular thyroid carcinoma, at which the iodine 131 whole body control had shown an aspect of metastasic miliary contrasting with an undetectable serum thyroglobulin. The tuberculin skin test and microscopic examination of sputum was positive. The patient was put under anti-tuberculous antibiotherapy and the evolution was very favorable. The identification of false-positives to the 131 iodine whole body scan appears necessary to improve the follow-up of patients and for ousting an iterative and completely useless therapeutic doses.

Increased sensitivity of sputum microscopy with sodium hypochlorite concentration technique: A practical experience at RNTCP center

Background:In revised national tuberculosis control program (RNTCP), microscopic examination of sputum for AFB plays an important role in the initial diagnosis of tuberculosis. Bacillary concentration after decontamination and liquefaction by 5% sodium hypochlorite is useful in providing increased sensitivity and safety for handling of specimen.Materials and Methods:In this cross-sectional, prospective study, carried out at NKP Salve Institute of Medical Sciences and RC, Nagpur, patients were included according to RNTCP criteria. One set of smears was made according to the RNTCP guidelines while another set was prepared by concentration after decontamination with 5% sodium hypochlorite. Both set of smears were stained according to RNTCP method and were screened by two observers separately to remove observer’s bias and graded according to the RNTCP guidelines. A total of 591 sputum samples from 219 patients were included in the study with 168 males (76.71%) and 51 females (23.28%).Results:A total of 77 samples (13.02%) from 34 patients were positive by routine method whereas by concentration method 119 samples (20.13%) from 49 patients were found positive diagnosing 15 additional patients. This rise of 7.11% in sputum positivity over routine is highly significant (P=0.001021, χ2=10.78) with 44.11% increase in diagnosed cases.Conclusion:There is a statistically significant rise in smear positive cases after concentration with 5% sodium hypochlorite solution. Considering its low cost, decontaminating and liquefaction properties with better sensitivity, this method is safe and can be of vital importance; at least for smear negative cases.

Pulmonary tuberculosis among HIV seropositives attending a counseling center in Kolkata

The study was carried out to detect the prevalence of pulmonary tuberculosis among HIV-seropositive individuals (HIV/TB co-infection) who attended counseling center of National Institute of Cholera and Enteric Diseases, Kolkata. A total of 109 HIV-seropositive individuals were screened. Of them, 36 (33%) had HIV/TB co-infection diagnosed by chest X-ray and presence of acid fast bacillus (AFB) detected by repeated microscopic examination of sputum. Blood samples were examined for CD4 and CD8 counts and ratio. Findings of blood examination showed that low CD4 count (<50/μl) had statistically significant association (P = 0.007) with HIV/TB co-infection as compared to HIV infection only. However, no significant correlation with CD4:CD8 ratio in HIV/TB co-infection was observed.

Therapeutic efficacy of pelotherapy and naftalan applications in patients with slowly resolving pneumonia

Clinical, laboratory, functional, and radiological examination of 82 patients with slowly resolving pneumonia was performed. The average age of the patients was 42.0 ± 2.4 yrs, 34 (41.5 %) were males and 48 (58.5 %) were females. The patients were randomly divided into 3 comparative groups: the 1st and the 2nd groups received pelotherapy and naftalan, respectively, in combination with medications for relief of symptoms and physiotherapy. The 3rd group (control) patients received medications for relief of symptoms and physiotherapy. Implementation of these methods in treatment of patients with slowly resolving pneumonia could promote regress of residual inflammation, considerably shorten length of the disease, reduce medication load and need in healthcare resources that, in turn, could reduce healthcare expenditures for treatment of such patients. Clinical results were confirmed by short- and long- term results of morphologic and blood biochemical investigations, microscopic examination of sputum, lung function testing, immunological, bronchoscopic and radiological data, investigations of physical capacity and quality of life.

Tuberculous uveitis after treatment with etanercept

Etanercept is a tumor necrosis factor (TNF) inhibitor that has been licensed in the United States for the treatment of adult and juvenile rheumatoid arthritis as well as psoriatic arthritis. Reactivation of tuberculosis is a complication of its use. We report the first case of tuberculous uveitis due to etanercept. We performed a clinical chart review. A 58-year-old Caucasian woman was referred to our hospital for chronic unilateral granulomatous panuveitis of the right eye (RE). She was on etanercept and methotrexate for rheumatoid arthritis. Since the patient was immunosuppressed with etanercept and since the uveitis was granulomatous we considered tuberculosis as a possible etiology. An aqueous humor tap was performed and sent for polymerase chain reaction analyses of Herpes simplex, Herpes zoster, and Mycobacterium tuberculosis (MT). This last test was positive. Another aqueous humor sample was taken and sent for microscopic examination of sputum for acid-fast bacilli and culture, both of which were positive for MT. A diagnosis of tuberculous uveitis was established; the patient was treated with rifampin, isoniazid pyrazinamide, and ethambutol and etanercept was stopped. Four months later there were no cells in the anterior chamber and the vitreous was clear. To our knowledge this is the first reported case of tuberculous uveitis following treatment with etanercept. This etiology has to be considered in patients taking this drug who present with intraocular inflammation.