Mycobacterium Tuberculosis In Patients Research Articles

Tuberculosis and Nontuberculous Mycobacterial Infections in Patients with Spondyloarthritis: A Population-Based Study.

Background and Objectives: Tuberculosis is caused by Mycobacterium tuberculosis (MTB), while nontuberculous mycobacteria (NTM) encompass a group of mycobacterial species that are distinct from the MTB complex and leprae. Spondyloarthritis (SpA) is a group of chronic inflammatory diseases with shared clinical characteristics and is treated with biological agents; however, their use may elevate the risk of MTB and NTM infections. This study aimed to compare the incidence and risk of MTB and NTM infections in patients with SpA, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), using a population-based approach. Materials and Methods: This study included 2333 patients with SpA and 9332 age- and sex-matched controls from the Korea National Health Insurance Service-National Sample Cohort database from 2002 to 2019. The patients were identified using the International Classification of Diseases-10 codes for AS, PsA, MTB, and NTM. Results: The results showed that a negligible percentage of patients with SpA developed NTM (0.002%) and MTB (0.016%), with no significant difference in the incidence rate ratio (IRR) compared to controls. Among patients with SpA treated with biologics, the IRRs for NTM and MTB were 5.66 and 3.069, respectively; however, these were not statistically significant. No cases of NTM or MTB infection were reported in female patients with SpA treated with biologics. In both the SpA patient group and the control group, the incidence of MTB was higher in individuals over 60 years old compared to those under 60 years old. Cox proportional hazard analysis revealed a significant adjusted hazard ratio of 1.479 for MTB in patients with SpA after adjusting for age, sex, smoking history, insurance level, and comorbidities. However, this significance was not maintained when biological therapy was further adjusted. Conclusions: Our study indicated that the risks of NTM and MTB infection are not elevated in patients with SpA. Although biological use may potentially increase the risk of MTB infection, it does not lead to a significant increase in incidence rates. Proactive screening for latent tuberculosis and adequate prophylaxis using biologics can effectively manage the risk of NTM and MTB infections.

Characterization of Genetic Mutations in Multi-Drug-Resistant Isolates of Mycobacterium tuberculosis Bacilli Conferring Resistance to a Second-Line Anti-tuberculosis Drug.

Multi-drug-resistant tuberculosis (MDR-TB) has become a major public health concern globally. Mutations in first- and second-line drug targets such as katG, inhA, rpoB, rrs, eis, gyrA, and gyrB have been associated with drug resistance. Monitoring predominant mutations in the MDR-TB patient population is essential to monitor and devise future therapeutic regimes. The present study is aimed to characterize genetic mutations in MDR isolates of Mycobacterium tuberculosis (MTB)bacilli conferring resistance to a second-line anti-tuberculosis drug in the Eastern Indian population. This cross-sectional study was conducted in the Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, and in the Tuberculosis Demonstration & Training Centre, Agamkuan, Patna. A total of 3270 patients suspected to have MDR-TB were recruited in the study. Two sputum samples, one on the spot, and the other in the morning were collected from each patient and the diagnosis ofrifampicin-sensitive (RS)/rifampicin-resistant (RR/MDR) TB was done by Gene-Xpert test. One hundred fifty RS-TB samples and 150 RR/MDR-TBsamples were considered for line probe assay (LPA). RSsamples were subjected to first-line LPA using Genotype® MTBDR Plus ver 2.0 and RR/MDRsamples were considered for second-line LPA using Genotype®MTBDRslver 2.0. All sputum samples were subjected to sputum smear microscopy using the Ziehl-Neelsen staining method.Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 26.0 (IBM Corp. Armonk, NY) and R (version 4.1; R Core Team 2021). In the present study, out of 3270 patients, we detected RR/MDR-TB in 235 patients (7.19%),RS-TB in 812 patients (24.83%), the rest of the patients negative for MTB (2223, 67.98%). Out of 150 RR/MDR-TB sputum samples tested, resistance to fluoroquinolone (FQ) was observed in 41 samples. The selected patients had predominantly FQ resistance due to the gyrA gene mutations (97.56%, n=40) compared to the gyrB gene mutations (2.44%, n=1). We observed >60% of the mutations in the gyrA gene in codon 94 (MUT3C (D94G), MUT3A (D94A), and MUT3D (D94H).In addition, we found the mutations MUT1 (A90V) and MUT2 (S91P)in the codons 90 and 91 of the gyrA gene in the considered MTB patient population. The identified genes can be further validated to be considered as therapeutic targets, but more therapeutics and advanced strategies should be applied in the management of MTB.

HTA38 Accuracy and Economic Evaluation of the Interferon Gamma Release Test (IGRA) for Detection of Latent Infection By Mycobacterium Tuberculosis in Patients with Immune-Mediated Diseases or Receptors of Solid Organ Transplants

Latent tuberculosis infection (LTBI) has a high global prevalence and can progress to its active form in immunocompromised patients. There is also considerable uncertainty about diagnostic tests accuracy because there is no gold standard. The purpose was to evaluate the accuracy of the interferon gamma release test (IGRA) to detect LTBI and predict the active tuberculosis in solid organ transplant candidates (1st group) and patients with immune-mediated inflammatory diseases (2nd group).

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

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

Prevalence of Mycobacterium tuberculosis in patients infected with HIV by microscopical and molecular methods

prevalence of Mycobacterium tuberculosis in patients infected with HIV by microscopical and molecular methods

Three cases of oral mucosal tuberculosis in patients on tumour-necrosis-factor-α blockers.

We present three cases of oral mucosal lesions caused by Mycobacterium tuberculosis in patients treated with anti-tumour necrosis factor-α for psoriasis or rheumatoid arthritis. Diagnosis of oral mucosal tuberculosis was not easily established in any of the cases. A comparison between these cases and other previously described forms of oral mucosal tuberculosis is presented.

Impact of the COVID-19 Pandemic on Urogenital Tuberculosis in Uzbekistan

The objective: to determine the impact of the COVID-19 pandemic on the structure and course of urogenital tuberculosis (UGTB) in Uzbekistan.Subjects and Methods. A retrospective cohort comparative study of the urogenital tuberculosis structure by clinical data for 2018-2021 was carried out. The data of 2,866 patients with extrapulmonary tuberculosis were analyzed including 1,208 patients with urogenital tuberculosis.Results. Of the 1,208 patients with urogenital tuberculosis, 327 were registered in 2018, 300 in 2019, 219 in 2020 (the first year of the COVID-19 pandemic), and 362 in 2021. The smallest number of cases registered in 2020 is due to lock-out activities. In 2021, there was a 2-fold increase in the number of patients with co-morbid forms of urogenital tuberculosis versus 2019 (pre-pandemic period). The frequency of detection of Mycobacterium tuberculosis in patients with urogenital tuberculosis in 2021 also increased by 4.3-5 times compared to 2019. The largest number of cases with the co-infection of urogenital tuberculosis and COVID-19 was recorded in 2020 – in 13.2% of identified patients. Concurrent urogenital tuberculosis and encrusting cystitis were observed in 4 (1.1%) patients detected in 2021. The underdetection of urogenital tuberculosis patients in 2020 resulted in the higher proportion of surgeries in 2021.

Transrenal DNA detection of Mycobacterium tuberculosis in patients with pulmonary tuberculosis.

Multiple attempts have been made to use biological samples other than sputum to diagnose tuberculosis (TB). Sputum acid-fast bacillus (AFB) microscopy is the fastest, most straightforward, and most inexpensive method for diagnosing pulmonary TB. However, urine can be used in place of sputum owing to its various advantages, such as a noninvasive method of collection, convenient handling and storage, and minimal risk of infection in health-care workers involved in sample collection. In this study, we aimed to assess the suitability of urine as a sample to obtain transrenal DNA (trDNA) to diagnose TB. This study involved several patients with TB undergoing inpatient treatment, whose AFB microscopy showed negative inversion. Here, 51 urine samples were collected from 40 patients with TB and examined to confirm the presence of trDNA. First, we compared the efficiency of two trDNA extraction methods. Although molecular diagnosis using GeneXpert yielded negative results, a peculiarity was observed. There was no significant difference between GeneXpert findings and our results nor was there any difference in the sequential trDNA samples obtained. However, even when GeneXpert results were negative, trDNA was detected in seven out of ten samples using the anchor extraction method. Further studies are needed to establish biomarkers for the progression of TB treatment.

Analysis of molecular mechanisms of drug resistance of Mycobacterium tuberculosis in patients with pulmonary tuberculosis and its pharmacoeconomics

Purpose: To investigate the molecular mechanisms of drug resistance of Mycobacterium tuberculosis in patients with pulmonary tuberculosis and its pharmacoeconomics. 
 Methods: Data pertaining to patients with primary tuberculosis treated in the First Affiliated Hospital of Zhaoqing Medical College, Zhaoqing, China from January 2020 to June 2021 were retrospectively analyzed. Sputum specimens were collected from all eligible patients, and 151 uncontaminated specimens with good bacteriophage activity were screened. 
 Results: A total of 107 Mycobacterium tuberculosis strains were isolated from the 151 specimens, 31 of which strains were resistant to varying degrees to rifampicin, isoniazid, streptomycin, and ethambutol with an overall resistance of 28.97 %. There were 16 strains with rpoB mutation, 22 strains with katG mutation, and 8 strains with inhA mutation. The difference in the sputum negative rate, lesion absorption rate, and tuberculosis cavity closure rate, and total medical cost between the two group were not statistically significant (p > 0.05). The incidence of adverse reactions in the FDC group was significantly lower than that in the blister pack group (p < 0.05). 
 Conclusion: The total resistance of Mycobacterium tuberculosis in primary tuberculosis patients remains at a high level, and the development of resistance is associated with mutations in rpoB, katG, and inhA genes. FDC regimen provides more pharmacoeconomic and therapeutic benefits than blister pack regimen.

Occurrence Rate of Rifampicin-Resistant Mycobacterium tuberculosis in Patients Attending Chest Clinics in Selected Hospitals in Akure Metropolis

Occurrence Rate of Rifampicin-Resistant Mycobacterium tuberculosis in Patients Attending Chest Clinics in Selected Hospitals in Akure Metropolis

Prevalence of Mycobacterium tuberculosis in patients suffering from chronic respiratory diseases in a tertiary care hospital using Gene Xpert as the diagnostic tool

Background: Chronic respiratory diseases constitute a grave problem throughout the world and particularly in the middle- and low-income countries. The burden of these diseases leads to poor quality of life and disability of affected individuals leading to premature deaths and a great economic loss to their families and society. Tuberculosis remains one of the deadliest communicable diseases. Though culture is the gold standard for the diagnosis of tuberculosis, the long period of time required for a positive result leads to the transmission of the disease in the community. Objective: The study was conducted to study the prevalence of Mycobacterium tuberculosis in patients suffering from chronic respiratory diseases. Materials and Methods: Bronchoalveolar lavage fluid samples of patients with chronic respiratory diseases undergoing bronchoscopy were collected under aseptic conditions after obtaining approval from the Institutional Ethics Committee. Each sample was subjected to Ziehl Neelsen stain and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on Xpert MTB/RIF manufactured by Cepheid (Sunnyvale, CA). Results: Eighteen of 110 cases (16.36%) showed the presence of M. tuberculosis in the samples, of which rifampicin resistance was detected in 2 (11.11%) cases. Conclusions: M. tuberculosis remains a common underlying pathogen in the cases of chronic respiratory diseases.

Bilateral Adrenal Adenomas Attributed to Extrapulmonary Mycobacterium Tuberculosis

Introduction: Adrenal infections are rare, with the Mycobacterium tuberculosis (MTB) being the most common causative agent in the developing world. MTB usually spreads to the adrenal glands hematogenously where it may be clinically manifested years after systemic infection. Here, we present a case of bilateral adrenal MTB infection associated with MTB peritonitis. Case Presentation: A 46-year-old male, from Ecuador, without significant medical history and no medical follow-up presented to the emergency room with a two-week history of abdominal pain, nausea, diarrhea, and significant weight loss. He denied fever, cough, or night sweats. No smoking, alcohol, or illicit drug use. He works as a construction worker without a history of sick contacts. Vital signs were stable, with abdominal distension and fluid shifting dullness on exam. Blood work revealed leucocyte count of 5.58K (4-11K), INR 1.2 (0.9–1.1), Sodium 132 mEq/L (136–145 mEq/L) with albumin 3.3 mg/dL (3.5–5.2 mg/dL), total bilirubin level, 1.3 mg/dL (0–1.2 mg/dL), and AST and alkaline phosphatase levels, 73 U/L (0–40 U/L) and 186 U/L (40–129 U/L) respectively. Computerized tomography (CT) of the abdomen showed large ascites, omental nodularity, calcified gall bladder, bilateral adrenal nodules, and multiple abdominal lymphadenopathies. Chest CT revealed right apical reticulonodular densities. A diagnostic paracentesis revealed an exudative effusion with serum ascites albumin gradient of 0.7, and negative acid fast bacilli (AFB) and adenosine deaminase enzyme. Ascitic cellular analysis was negative for malignant cells. AFB blood and sputum cultures were negative, though Quantiferon gold test was positive and a skin tuberculin test was 13x13mm. Tumor markers CA19-9, CEA, and alpha-fetoprotein came back negative. Additionally, serum aldosterone, plasma metanephrines, DHEA-S, AM Testosterone, ACTH, and morning cortisol levels were normal. The patient had a negative 1-mg dexamethasone suppression test. Positron emission tomography (PET) scan showed a hypermetabolic left adrenal mass (4.9x3.2 cm) and nodular peritoneum with no fluorodeoxyglucose (FDG) uptake in the enlarged abdominal lymph nodes. Peritoneal biopsy analysis revealed non-caseating granuloma positive for MTB. The adrenal biopsy was not performed given the extensive intra-abdominal disease. The patient was started on anti-MTB treatment (Isoniazid, rifampicin, pyrazinamide, and ethambutol) with significant clinical improvement and a slight decrease in the adrenal masses following abdominal imaging. Conclusion: Extrapulmonary MTB should be part of a differential diagnosis for bilateral adrenal masses. Adrenal glands could be infected by a variety of pathogenic microorganisms either by direct contact or hematogenous dissemination. A high index of suspicion is required for the diagnosis of MTB in patients with atypical presentation.

Molecular characterization and drug resistance patterns of Mycobacterium tuberculosis complex in extrapulmonary tuberculosis patients in Addis Ababa, Ethiopia.

Molecular characterization of Mycobacterium tuberculosis (MTB) is important to understand the pathogenesis, diagnosis, treatment, and prevention of tuberculosis (TB). However, there is limited information on molecular characteristics and drug-resistant patterns of MTB in patients with extra-pulmonary tuberculosis (EPTB) in Ethiopia. Thus, this study aimed to determine the molecular characteristics and drug resistance patterns of MTB in patients with EPTB in Addis Ababa, Ethiopia. This study was conducted on frozen stored isolates of EPTB survey conducted in Addis Ababa, Ethiopia. A drug susceptibility test was performed using BACTEC-MGIT 960. Species and strain identification were performed using the Geno-Type MTBC and spoligotyping technique, respectively. Data were entered into the MIRU-VNTRplus database to assess the spoligotype patterns of MTB. Analysis was performed using SPSS version 23, and participants' characteristics were presented by numbers and proportions. Of 151 MTB isolates, 29 (19.2%) were resistant to at least one drug. The highest proportion of isolates was resistant to Isoniazid (14.6%) and Pyrazinamide (14.6%). Nine percent of isolates had multidrug-resistant TB (MDR-TB), and 21.4% of them had pre-extensively drug-resistant TB (pre-XDR-TB). Among the 151 MTB isolates characterized by spoligotyping, 142 (94.6%) had known patterns, while 9 (6.0%) isolates were not matched with the MIRU-VNTRplus spoligotype database. Of the isolates which had known patterns, 2% was M.bovis while 98% M. tuberculosis. Forty-one different spoligotype patterns were identified. The most frequently identified SpolDB4 (SIT) wereSIT149 (21.2%), SIT53 (14.6%) and SIT26 (9.6%). The predominant genotypes identified were T (53.6%), Central Asia Strain (19.2%) and Haarlem (9.9%). The present study showed a high proportion of MDR-TB and pre-XDR-TB among EPTB patients. The strains were mostly grouped into SIT149, SIT53, and SIT26. The T family lineage was the most prevalent genotype. MDR-TB and pre-XDR-TB prevention is required to combat these strains in EPTB. A large scale study is required to describe the molecular characteristics and drug resistance patterns of MTB isolates in EPTB patients.

A survey of co-infection of some pathogenic bacteria with TB in patients attending Federal Medical Center Katsina, Nigeria

Tuberculosis (TB) is known to be one of the oldest forms of human diseases which still remain the leading cause of death worldwide. It is characterized as a pulmonary disease which occurs due to accumulation of Mycobacterium tuberculosis (MTB) onto the lungs alveolar surfaces. M. tuberculosis is an implicated pathogenic bacteria associated with T.B. It is the chronic infectious disease caused by the tubercle bacillus (M. tuberculosis). This study was aimed to determine co-infection of other pathogenic bacteria within MTB patients attending Federal Medical Centre (FMC), Katsina. The study design was cross-sectional, conducted to isolate some pathogenic bacteria that co-infected TB patients who are Acid fast bacilli (AFB) positive and AFB negative. The samples obtained were cultured on Blood, Chocolate and MacConkey agar and incubated at 37oC for 24 hours. Pure isolates were confirmed using Grams Staining and biochemical reaction. Data obtained were presented as simple percentage and using statistical analysis which revealed that the incidence was common among the age categories 51-60 with 28%, followed by those ≥60 years with 20%. The lowest prevalence was recorded the at age category 11-20 with 10%. Based on gender, males presented with the higher incidence (35/50) i.e. 70% than female (15/50) i.e. 30%. Klebsiella pneumoniae, Staphyllococcus aureus and Pseudomonas aeruginosa were the most prevalent organisms isolated with 21.9%, 19.66% and 19.10% respectively. E. coli with 05.62% being had the least isolates. The research demonstrated the existence of both Gram positive and Gram negative bacterial pathogens that co-infect with TB patients, especially among the elderly males. Further research should be tailored towards investigating other pathogens that co-infect with MTB patients, such as fungi and viruses, in diversified hospitals in Katsina state and beyond. 
 Keywords: AFB, Pathogenic bacteria, Tuberculosis and Mycobacterium and Federal Medical Centre, Katsina.

Mycobacteriumtuberculosis antigens repress Th1 immune response suppression and promotes lung cancer metastasis through PD-1/PDl-1 signaling pathway

Given one-third of the world’s population is infected with Mycobacteriumtuberculosis (MTB), it is important to identify the underling molecular mechanism between development of TB and lung cancer. This study investigated the immune response to MTB infection on lung metastasis in lung cancer cells via T cell-mediated immune response. To clarify this problem, we analyzed the expression levels of PD-1, PD-L1, and PD-L2 and immune function in antigen-specific T cell as derived from MTB patients or spleen lymphocytes derived from wild-type and PD-1 knockout mice with MTB antigen stimulation and Lewis lung cancer cells injection. Our data indicate that the expression levels of PD-1, PD-L1, and PD-L2 were elevated in active pulmonary TB patients, as well as in mice received MTB and lung cancer cells treatment. We also observed the T cell-mediated cellular immune response were inhibited by MTB while MTB significantly promote tumor metastasis in lung. In conclusion, the PD-1/PD-L pathway is required MTB repressed T-cell immune response and promotes tumor metastasis. This study provides evidence that blockade of PD-1/PD-L1 signaling pathway may benefit patients with MTB or other chronic infection and even prevent them from development of cancer.

In vivo evolution of drug-resistant Mycobacterium tuberculosis in patients during long-term treatment

BackgroundIn the current scenario, the drug-resistant tuberculosis is a significant challenge in the control of tuberculosis worldwide. In order to investigate the in vivo evolution of drug-resistant M. tuberculosis, the present study envisaged sequencing of the draft genomes of 18 serial isolates from four pre-extensively drug-resistant (pre-XDR) tuberculosis patients for continuous genetic alterations.ResultsAll of the isolates harbored single nucleotide polymorphisms (SNPs) ranging from 1303 to 1309 with M. tuberculosis H37Rv as the reference. SNPs ranged from 0 to 12 within patients. The evolution rates were higher than the reported SNPs of 0.5 in the four patients. All the isolates exhibited mutations at sites of known drug targets, while some contained mutations in uncertain drug targets including folC, proZ, and pyrG. The compensatory substitutions for rescuing these deleterious mutations during evolution were only found in RpoC I491T in one patient. Many loci with microheterogeneity showed transient mutations in different isolates. Ninety three SNPs exhibited significant association with refractory pre-XDR TB isolates.ConclusionsOur results showed evolutionary changes in the serial genetic characteristics of the pre-XDR TB patients due to accumulation of the fixed drug-resistant related mutations, and the transient mutations under continuous antibiotics pressure over several years.

Rifampicin resistance among patients with Tuberculosis at the Olabisi Onabanjo University Teaching Hospital, Sagamu

Background: Tuberculosis (TB) is a major public health problem in Nigeria. The emergence of multidrug-resistant Tuberculosis poses a threat to global Tuberculosis control and if not effectively addressed, may wipe out the achievements of previous efforts in controlling Tuberculosis. Objectives: To determine the prevalence and factors associated with rifampicin resistance amongpatients receiving care for TB at the OlabisiOnabanjo University Teaching Hospital, Sagamu. Methods: A retrospective study of presumptive Tuberculosis cases managed between January 2013 and December 2016 at the Directly Observed Treatment clinic, OlabisiOnabanjoUniversity Teaching Hospital Sagamu, Ogun State, Nigeria,was done. One sputum sample was obtained from each patient for the Gene Xpert® test to diagnoseTB and to determine rifampicin resistance among patients with confirmed Mycobacterium tuberculosis infection. HIV screening was also carried out on all the patients using HIV Rapid Test kits. The sociodemographic data were retrieved from the presumptive Tuberculosis register. Results: A total of 1572 presumptive TB patients were screened for TB, out of which 187 (11.8%) were confirmed to be infected with Mycobacterium tuberculosis (MTB). A total of 20 (10.7%) of the 187 MTB patients had rifampicin resistance using Gene Xpert® method. Rifampicin resistance rate was significantlyassociated with re-treatment TB category but not with age, sex or HIV status. Conclusion: The study showed rifampicin drug resistance among confirmed TB patients. There is a need to decentralizethe use of Gene Xpert® test for TB to the peripheral facilities and make it a point of care test for presumptive TB patients.

Impact of CD4 count in the development of mycobacterium tuberculosis in patients with HIV infection in a tertiary care centre

Background: Patients with Human Immunodeficiency Virus (HIV) infection are predisposed to numerous opportunistic infections due to decreased cell mediated immunity, Tuberculosis being most common. Low CD4 count is associated with low immunity and higher risk of tuberculosis.Methods: Author conducted a retrospective study in the department of Pulmonary medicine in a tertiary care teaching hospital during January to December 2017. Author collected data of all the patients with HIV diagnosed with Tuberculosis from the ART centre. Author collected demographic details including age, sex, symptoms at presentation, details of diagnosis of TB including type of tuberculosis, CBNAAT results, CD4 count at the diagnosis of TB, details of ART therapy and ATT therapy and outcomes of treatment.Results: Eighty one patients with HIV-TB co- infection were included in the study. Males (70.37%) were more affected than females. Mean age of the study group was 39.97±10 years. Sixty one patients (75.4%) were diagnosed with Pulmonary Tuberculosis and 20 (24.6%) patients were diagnosed with extra pulmonary TB. Mean CD4 counts of the cohort was 226±110/µl. Eighty percent of patients developed Tuberculosis with CD4 count <250/µl.Conclusions: Author found in this study higher proportions of tuberculosis (80.2%) in patients with HIV infection with CD4 count <200/µl. Author also found higher proportion of pulmonary Koch’s in patients with low CD4 count (CD4 <200/µl).

Туберкулез легких с множественной лекарственной устойчивостью возбудителя у больных сахарным диабетом

Туберкулез легких с множественной лекарственной устойчивостью возбудителя у больных сахарным диабетом

The informative value of various methods for identifying acid-fast bacilli in relation to the degree of tuberculosis process activity

To reveal the morphological characteristics of Mycobacterium tuberculosis in patients with long-lasting tuberculosis. Twenty-four autopsies of verified fibrous-cavernous tuberculosis were examined. Paraffin sections were stained with hematoxylin and eosin, carbol fuchsin (Ziehl-Neelsen), or auramine-rhodamine (followed by luminescence microscopic examination); an immunohistochemical (IHC) study with serum to PAV (Protein antigen B) was conducted. The changes characteristic of progressive tuberculosis were revealed in all the cases. The Ziehl-Neelsen staining revealed isolated clusters of acid-fast bacilli (a total of 1,000 in less than 10 fields of view). When stained with auramine-rhodamine, the number of found mycobacteria proved to be significantly larger (a total of 1,000 to 10,000 in 10-50 fields of view) and that was greatest in the IHC study (a total of over 10,000 in more than 50 fields of view). At the same type, all types of studies revealed that the localization of mycobacteria was exclusively extracellular. The Ziehl-Neelsen staining indicated that the proportion of typical bacilli was much higher (85-95%; mean 88.13±2.14) than that (50-85%; mean 64.38±4.24%) identified when stained with auramine-rhodamine and even more significantly more than that (50-70%; mean 57.29±2.78%) detected during the IHC study. The indicators were equally different for the atypical morphological forms of mycobacteria identified in minimal quantities by the Ziehl-Nielsen staining and in large quantities by fluorescence and IHC studies. There is evidence for the ability of mycobacteria to have morphological polymorphism and for the need to clarify the pathogenesis of tuberculosis.