Neelsen Staining Research Articles

Dual infection of maxillary sinus masquerading as a malignant lesion; A rare presentation

Primary sinonasal tuberculosis is a rare form of TB even in developing countries where TB is prevalent and invasive mycotic infection is more common in immunocompromised patients. It is unusual to have a dual infection with tuberculosis and mycosis in the maxillary region mimicking a neoplastic process and causing bone erosion. A 49-year old male presented with 2-year history of left-sided facial swelling. On microscopic examination, epithelioid cell granulomas, chronic inflammatory infiltrate, macrophages, giant cells, and focal necrosis were seen. Ziehl Neelsen staining for acid-fast bacilli with 20% H2SO4 was positive. Fungal hyphae were also seen in the sections examined. Special stains (Periodic acid-Schiff and Grocott’s methenamine silver stain) for fungal hyphae were positive. Mycosis and tuberculosis should always be considered in the differential diagnosis of maxillary lesions or sinusitis.

Co-infection with Mycobacterium and 20% acid-fast Nocardia in an immunocompetent patient – A case report

Nocardiosis is an opportunistic infectious disease in immunocompromised individuals, which may be fatal and in people with healthy immune systems, which is reported as a case. Mixed infections with Nocardia and Mycobacterium tuberculosis complex (MTBC) are rare. We are reporting a case of co-infection with Nocardia spp. and MTBC in an immunocompetent patient presenting with neck swelling. Interestingly, in this case, the primary identification of Nocardia was done using 20% H2SO4 as decolorizer for Ziehl–Neelsen staining. The patient was given first-line anti-tubercular treatment for the first 2 months as an intensive phase, followed by isoniazid and rifampicin for an additional 4 months, with a total of 6 months treatment, along with linezolid (600 mg twice daily for 15 days). The patient subsequently improved.

Metastatic cholangiocarcinoma in a cow presenting as suspect bovine tuberculosis in Ireland

AbstractCholangiocarcinoma is a malignant tumour of bile duct epithelial cells, an uncommon primary hepatic neoplasm in cattle. A 9‐year‐old Simmental cow presented with watery diarrhoea, crusty skin lesions, loss of appetite and hepatomegaly. Suspecting severe liver disease, the cow was euthanased due to poor prognosis. During gross postmortem examination, large numbers of multifocal to coalescing nodules often with soft necrotic centres ranging from miliary to 7 cm in size were present in the liver, lung, mesentery, peritoneum and lymph nodes. These features were suggestive of bovine tuberculosis. However, direct tissue smears stained by Ziehl Neelsen stain were negative for the presence of acid‐fast bacteria, and subsequent histopathological and immunohistochemical investigations confirmed the presence of metastasizing cholangiocarcinoma. This case reminds clinicians and pathologists to keep an open mind during the diagnostic process and serves to highlight the value of histopathology in diagnosing seemingly characteristic gross lesions.

Occurrence of Cryptosporidium Oocysts in Faeces, Milk and Water Sources in Sedentary Fulani Herds in Selected Local Government Areas of Kaduna State, Nigeria

Abstract Cryptosporidiosis is a neglected tropical zoonotic disease, commonly associated with a diarrhoea, caused by a protozoan parasite of the genus Cryptosporidium. The aim of this study was to determine the occurrence of Cryptosporidium oocysts in faeces, milk, and water sources, and its associated risk factors in sedentary Fulani herds. Seven hundred and fifty faecal samples (240, 180, 240 and 90 from cattle, sheep, goats and dogs, respectively), and 120 samples each, of milk and water were collected for this study. Faecal samples were concentrated by formol ether concentration technique, then stained using Modified Ziehl Neelsen staining method, to detect Cryptosporidium oocysts. Cryptosporidium oocysts in milk and water samples were also concentrated and stained with same stain. The prevalence of Cryptosporidium oocysts in (cattle, dog, sheep and goat faeces were 18.3 %, 15.6 %, 13.9 % and 4.2 %, respectively.), Significantly higher prevalence was observed in calves ≤ 1 year (P = 0.002), female cattle (P = 0.007) and animals with poor body condition (P < 0.001) than in the other groups. Goats with poor body condition scores had significantly higher prevalence (P = 0.008) than other groups while dogs ≤ 6 months of age also had significantly higher prevalence (P = 0.03) than older dogs. The prevalence of Cryptosporidium oocysts in bulk cow milk was 11.7 % while a prevalence of 13.3 % was observed in the water bodies sampled. Hence the findings of this study are of great public health significance, therefore, inhabitants of these LGAs should be informed and educated on the need for improvement of sanitary measures during the course of milking these animals, and the need for adequate pasteurization, of milk before consumption.

Diagnóstico de <i>Mycobacterium leprae</i> con Ziehl Neelsen en frotis de piel

The diagnosis of leprosy or Hansen's disease is based on a multifaceted approach that includes clinical evidence and laboratory methods that allow the demonstration of Mycobacterium spp to establish the treatment and prognosis of patients. Ziehl Neelsen staining is an alternative to detect the bacillus in skin smears, determine the classification of leprosy based on its bacillary load and control treatment in confirmed patients.

Mycobacterium genavense detection in a blood smear from a domestic ferret

AbstractThe domestic ferret is sensitive to mycobacterial infections, which are likely underdiagnosed. There are limited reports of therapy for mycobacteriosis in ferrets and most have failed. A ferret in poor body condition revealed marked organomegaly on diagnostic imaging. The complete blood count revealed a mild pseudoeosinophilia, which might be attributed to negatively stained bacilli phagocytised by monocytes observed in the blood smear. Ziehl–Neelsen stain was performed and showed acid‐fast bacilli within monocytes. Fine‐needle aspirates of the spleen and liver revealed the same finding. Mycobacterium genavense was identified by PCR and DNA sequencing from peripheral blood. Treatment with rifampicin, clarithromycin and enrofloxacin was initiated. The disseminated mycobacteriosis was suspected from the observation of bacilli on the blood smear. After 16 months, the ferret is still undergoing treatment. To prevent recurrence, continued monitoring of drug toxicity and effective therapy will be maintained even after the resolution of clinical signs (mostly organomegaly).

Granulomatous mastitis and other inflammatory mastitis simulating breast neoplasms – A retrospective study in the fine needle aspiration cytology clinic of a tertiary care center in eastern India

Background: Fine needle aspiration cytology (FNAC) is an important diagnostic modality in palpable breast lesions. This together with imaging modality is important in distinguishing benign from malignant lesions of the breast. Granulomatous/inflammatory mastitis forms a small subset of breast lesions that may present as a breast lump. Clinical and radiological features in these cases may mimic malignant breast pathology. Aims and Objectives: The aim of this study was to study the frequency of granulomatous mastitis and other inflammatory mastitis with respect to other neoplastic lesions of the breast, presented in FNAC clinics and to correlate the cytological findings with the clinical presentation of granulomatous and other inflammatory mastitis. Materials and Methods: A retrospective study was conducted in the Department of Pathology in a tertiary care center in Eastern India for duration of 4 years 5 months. Details of all patients who underwent FNAC for breast lesions during the study period were recorded in terms of their clinical presentation, cytological findings, imaging, and ancillary investigations. The findings were then tabulated in a master sheet and analysis done by descriptive statistics using SPSS 25. Results: A total of 154 cases were included with 5 cases (3.2%) of granulomatous and 12 cases (7.8%) of inflammatory mastitis. Age range for granulomatous/inflammatory mastitis was 20–70 years. Lump and pain were the most common complaints followed by inflammatory skin changes and nipple discharge. Very few cases also showed nipple retractions and very occasional systemic symptoms like fever. History of lactation was seen among five cases. Three cases showed positive acid-fast bacilli in Ziehl–Neelsen stain. Radiology was discordant with cytological findings in three cases, where the former suggested a breast neoplastic process. Conclusion: Granulomatous/inflammatory mastitis is a rarely diagnosed entity in breast cytopathology with no standard guidelines for management. Antibiotics antitubercular therapy and corticosteroids are some proposed lines of medical management. In treatment-resistant cases, wide local excision may be done depending on available resources and surveillance opportunities.

Prevalence of Intestinal Parasitic Infections among Food Handlers from Greater Cairo, Egypt

Abstract Background Foodborne illnesses caused by intestinal parasitic infections (IPIs) are among the major health problems especially in developing countries. Food handlers play an important role in transmission of IPI during manufacturing, processing, handling, and serving of foodstuff. Objectives The aim of the present study was to determine the prevalence of IPIs among food handlers in Greater Cairo, Egypt and their associated risk factors. Methodology A cross sectional study was designed whereby 250 food handlers attending four provision health offices from different governorates of Greater Cairo were examined. The demographic data, job title and position, health certification as well as risk factors that might increase the transmission of IPIs were collected in a pre-designed questionnaire. Stool samples were collected from all participants and examined by direct wet/iodine mounts, formol diethyl acetate and modified Ziehl_Neelsen staining techniques. Results 65 food handlers (26%) were found to have IPIs. The commonest parasites detected were Entamoeba histolytica (24.6%), Entamoeba coli (20%), Blastocystis hominis (16.9%), Giardia intestinalis (12.3%), followed by Enterobius vermicularis (10.8 %), Ascaris lumbricoides (7.7 %) and Schistosoma mansoni (3.1%). Higher, statistically significant (P < 0.001), prevalence of IPIs was found among food handlers from rural areas, having low educational levels, not having previous health certificates and among those working in popular restaurants and those having poor personal hand hygienic measures. While no differences in prevalence of IPIs was found regarding age, sex, and work experience duration. Conclusion It was concluded that implementation of governmental policies ensuring routine medical checkup and continuous professional training and education of food handlers are essential for prevention of IPIs among food handlers.

Molecular detection of Cryptosporidium parvum in wild rodents (Phyllotis darwini) inhabiting protected and rural transitional areas in north-central Chile

Wild rodents often harbor Cryptosporidium species that can be transmitted to multiple mammal hosts. In Chile, little is known about Cryptosporidium in wild rodents, and available studies have been focused on morphological findings with no molecular-based evidence. A longitudinal survey was conducted between 2021 and 2022 to investigate the occurrence of Cryptosporidium spp. in populations of the Darwin's leaf-eared mouse (Phyllotis darwini) living in protected and rural transitional areas in north-central Chile, using staining and molecular methods. A total of 247 fecal samples were collected and examined by the modified Ziehl–Neelsen (ZN) staining test, 54 of which were positive for Cryptosporidium-like oocysts. Molecular analyses were carried out by PCR of the partial 18S ribosomal RNA and 60 kDa glycoprotein (gp60) genes. Cryptosporidium infection was confirmed in 34 samples (13.7 %) based on the PCR amplification, and individual (i.e., sex, and body mass index) and ecological variables (i.e., type of site and season) were not statistically significant (p > 0.05). Using the nucleotide sequencing of the partial 18S rRNA gene, Cryptosporidium parvum was identified in nine isolates. Also, C. parvum subgenotype family IIa was determined in seven samples by the partial gp60 gene, including the subtype IIaA17G4R1 in two samples. This is the first molecular evidence of Cryptosporidium parvum IIa in Phyllotis darwini in Chile. These results indicate potential cross-species transmition between wild rodents and domestic-wild animals in north-central Chile. More research is needed to understand better the role of wild rodents in the transmission of Cryptosporidium spp. in Chile.

Variations in Plasma Glucose, Testosterone, and Tumor Necrosis Factor-alpha in Relationship with Polycystic Ovary Syndrome and Viral Seromarkers in Infertile Women: A Case–Control Observational Study

Study Background: Polycystic ovary syndrome (PCOS) is a common cause of infertility in Nigeria which is associated with insulin resistance. Insulin resistance may be induced by elevated inflammatory cytokines, androgen excess (testosterone), and irregular menstruation or anovulation. Aim and Objective: This work was designed to determine possible variations in plasma glucose, testosterone, and tumor necrosis factor-alpha (TNFα) in relationship with PCOS and viral seromarkers in infertile women. Materials and Methods: Two hundred and fourteen (214) primary infertility women with PCOS aged 37 ± 4.93 years diagnosed through ultrasound were recruited as test subjects while one hundred (100) age-matched primary infertility women without PCOS were recruited as control. All subjects were negative to Giemsa thick blood film staining for the detection of Plasmodium and Ziehl–Neelsen staining for the detection of acid–fast bacilli. HIVp24 antigen and antibody, plasma testosterone, antibody to hepatitis C virus (anti-HCV), and envelope antigen to hepatitis B Virus (HBeAg) were determined in the subjects by enzyme-linked immunosorbent assay while blood glucose was measured spectrophotometrically. Results: The results obtained showed a higher frequency of 0.93% (2) HIVP24antigen-antibody, 6.5% (17) anti-HCV, 14.5% (31) HBeAg, and 0.5% (1) HIVP24 + HBeAg (except for HIVP24 antigen and antibody) in PCOS women than the frequency of viral seromarkers of 1% (1) HIVP24 antigen and antibody, 6% (6) anti-HCV, 8% (8) HBeAg, and 0% (0) HIVP24 + HBeAg in non-PCOS control women. There was a significant association between PCOS and expression of viral seromarkers; there was a significantly higher fasting plasma glucose and testosterone level in all PCOS women with or without viral seromarkers (P < 0.05). There was a significantly higher plasma TNFα in PCOS women that expressed viral seromarkers than in PCOS women who do not express any of the viral seromarkers (P < 0.05). There was a significantly higher plasma TNFα in PCOS and non-PCOS women although more in PCOS women that expressed viral seromarkers than in women without any viral seromarker (P < 0.05). Conclusion: PCOS may be characterized by elevated plasma fasting glucose, testosterone, and expression of viral seromarkers while viral infection could also trigger higher plasma TNFα in PCOS women than in non-PCOS women infected with viral agent.

Prevalence of Cryptosporidium Infection among Children Attending Maryam Abacha Women and Children Hospital, Sokoto State, Nigeria

Study's Excerpt/Novelty This study investigates the prevalence of Cryptosporidium among children attending Maryam Abacha Women and Children Hospital, Sokoto, using Formol ether concentration and Modified Ziehl Neelsen staining methods. It identifies a high prevalence of (71.1%) and shows a strong correlation between Cryptosporidium infection, diarrhea, and source of drinking water. These findings underscore the necessity for routine diagnostic testing of Cryptosporidium among children for improved detection, treatment, and overall patient outcomes in the region. Full Abstract Cryptosporidium infection is ranked as the second most common cause of diarrheal disease and fatalities among children in developing nations. Nonetheless, due to the fact that many healthcare providers do not consistently request Cryptosporidium diagnostic tests, the prevalence of cryptosporidiosis is probably underestimated. The current study is therefore aimed at investigating the prevalence of cryptosporidiosis among children attending Maryam Abacha Women and Children Hospital (MAWCH), Sokoto. During the timeframe of April to June 2021, stool samples were collected from 114 diarrheic and non-diarrheic children and analyzed using Formol ether concentration and Modified Ziehl Neelsen staining methods. Out of 114 samples analyzed, 81(71.1%) were positive for Cryptosporidium oocysts. A higher prevalence of Cryptosporidiosis was observed in males 45(39.5%) compared to females 36(31.6%) participants and higher 41(36.0%) in younger children aged 0-1 years than the older children. Similarly, a greater prevalence of Cryptosporidiosis was observed in diarrheic children (42.1%) than in non-diarrheic children (28.9%). A statistically significant relationship was observed between the occurrence of Cryptosporidium and diarrhea (P = 0.002) and the source of drinking water (P = 0.001). Routine diagnosis of Cryptosporidiosis among children is vital and can enhance effective diagnosis, treatment, and consequently, improvement in the patients' well-being.

Occurrence and factors associated with Cryptosporidium infection in livestock in three districts of Zambia

Cryptosporidium is one of the most important enteric diarrhoeal parasites that infect humans and animals worldwide. The current study investigated the occurrence and risk factors associated with Cryptosporidium infection in ruminants aged ≤6 months in Monze, Mumbwa, and Lusaka districts of Zambia. Faecal samples were collected from 328 calves, 190 lambs, and 245 goat kids and analysed for Cryptosporidium oocysts using modified Ziehl Neelsen staining. A closed structured questionnaire was used to obtain epidemiological characteristics and potential risk factors for Cryptosporidium infection. The overall occurrence of Cryptosporidium was 7.9% (60/763), while that in calves, lambs and goat kids was 14.5% (47/328), 5.3% (10/190), and 1.2% (3/245) respectively. Watery/pasty stool and sampling during the rainy season were independently associated with increased risk of infection. In calves, the odds of infection increased during the rainy season, while daily kraal cleaning reduced the infection risk. Lambs showed increased odds of infection with pasty/watery stool and male sex, whereas the wearing of protective clothing by handlers significantly reduced the risk. There were district variations in infection occurrence with Mumbwa district having higher prevalence. The findings of this study show that livestock in Zambia continue to be frequently infected with Cryptosporidium. Protective measures and appropriate farm cleanliness should be implemented in control of this infection. Regional and host-species-specific variations emphasize the need for targeted interventions. These findings, therefore, contribute to effective strategies for Cryptosporidium control, promoting good livestock health and management.

Immunohistochemistry and real-time Polymerase Chain Reaction: importance in the diagnosis of intestinal tuberculosis in a Peruvian population

IntroductionThe diagnosis of intestinal tuberculosis is challenging even nowadays. This study aims to report the positivity rates of new diagnostic methods such as immunohistochemistry and Real-Time Polymerase Chain Reaction in patients with intestinal tuberculosis, as well as describe the pathological and endoscopic features of intestinal tuberculosis in our population.MethodsThis was a retrospective observational study conducted in patients diagnosed with intestinal tuberculosis, between 2010 to 2023 from the Hospital Nacional Daniel Alcides Carrion and a Private Pathology Center, both located in Peru. Clinical data was obtained, histologic features were independently re-evaluated by three pathologists; and immunohistochemistry and real-time Polymerase Chain Reaction evaluation were performed. The 33 patients with intestinal tuberculosis who fulfilled the inclusion criteria were recruited.ResultsImmunohistochemistry was positive in 90.9% of cases, while real-time Polymerase Chain Reaction was positive in 38.7%. The ileocecal region was the most affected area (33.3%), and the most frequent endoscopic appearance was an ulcer (63.6%). Most of the granulomas were composed solely of epithelioid histiocytes (75.8%). Crypt architectural disarray was the second most frequent histologic finding (78.8%) after granulomas, but most of them were mild.ConclusionSince immunohistochemistry does not require an intact cell wall, it demonstrates higher sensitivity compared to Ziehl–Neelsen staining. Therefore, it could be helpful for the diagnosis of paucibacillary tuberculosis.

Incidence of Cryptosporidium: A Neglected Parasite in Immunocompetent Adults in Swabi

Objective: To highlight the increasing incidence of Cryptosporidium in immunocompetent adults and the resultant altered epidemiology. Methodology: This study was conducted over a period of one year, from 1st January 2023 to 1st of January, 2024 at Microbiology Laboratory MTI- GKMC/BKMC, Swabi. Modified Ziehl Neelsen staining was performed on the received stool samples from patients presenting with wide range of symptoms associated with Irritable Bowel Syndrome (IBS). Abdominal pain, recurrent episodes of diarrhea and weight loss were the main symptoms. Modified ZN stain being one of the most reliable, quick and cost effective methods for the detection of cysts of Cryptosporidium using 40X and oil immersion lens was used for diagnosis. Results: A total of 62 samples were received from immunocompetent patients in the said period out of which 34% were positive for the oocysts of Cryptosporidium species. Out of a total of 21 positive samples 62% were males and 38% were females. The age range of the patients spanned between 20 to 60 years. Conclusion: Knowing this high incidence 34% of Cryptosporidium spp. in the healthy adults, necessitates to prioritize steps for the prevention of this infection by implementation of public health measures.

Active Tuberculosis Risk Associated with Malignancies: A 4-Year Retrospective Study in a Tertiary Care Hospital

Background Tuberculosis (TB) remains an important public health problem worldwide. Risk of acquiring TB in patients diagnosed with cancers remains high and can result due to reactivation or reinfection. We share the experience in a large tertiary care hospital. Materials and Methods Clinical samples from presumptive TB patients while on cancer therapy were tested by smear Ziehl–Neelsen (ZN) staining, GeneXpert MTB/RIF (Gx), TB polymerase chain reaction (PCR), and liquid culture (MGIT 960) from January 1, 2019, to December 31, 2022. Statistical Analysis Stata 14.0 software was used for statistical analysis. The p-value calculation was done by Pearson's chi-square test. Results Of 906 patients investigated, 42 (4.64%) tested positive for TB. Seven (1.37%) tested positive by ZN staining, 10 patients (6%) had culture positive by MGIT, 20 (10.53%) and 5 (13.51%) samples were positive by Gx and PCR, respectively. Maximum number of TB-positive patients were found to be suffering from carcinoma lung (28%) followed by leukemia (25%), gastrointestinal cancer (13%), and genitourinary cancer (13%), respectively. Seven of the 42 patients succumbed to the disease; the cases belonged to Hodgkin's lymphoma (75% mortality), leukemia (30% mortality), and genitourinary cancer (20% mortality). Conclusion The incidence of active TB is high in cancer patients, especially lung cancer, leukemia, gastrointestinal, and genitourinary cancers. Mortality was high in Hodgkin's lymphoma patients who developed TB. Screening for TB at the time of diagnosis of a high TB risk cancer would help initiate early treatment. We recommend targeted screening for TB in patients with these high-risk cancers, at the time of diagnosis and periodically through cancer treatment.

Pott’s disease and scrofuloderma as presentation of clinically extrapulmonary tuberculosis in 15 years old girl: a case report

Backgrounds: Extrapulmonary tuberculosis (TB) accounts for 15–20% of all tuberculosis cases, with the lymph node being the most commonly affected organ. Spinal tuberculosis and scrofuloderma are rare manifestations of extrapulmonary TB and constitute less than 5% of the cases. Establishing the diagnosis is a challenge. Eradication and prevention of sequelae complicate further management of the disease. This study aims to describe the clinical manifestation and the management of spondylitis tuberculosis and scrofuloderma in a child. Case presentation: A 15-year-old girl came with a chief complaint of lower extremities weakness for a week following monthly chronic low back pain. She also reported a painless lesion on her back with no sign of acute inflammation. She also complained of intermittent fever with night sweats and lost 3 kilos of body weight in the last two months. From physical examination, we found a kyphotic posture and severe malnutrition. Skin examination revealed an open wound on her right lower back, size 4x3 cm, with no sign of inflammation. The tuberculin skin test was positive with 15 mm induration. The spinal magnetic resonance imaging revealed destruction of the vertebral corpus thoracal segment, hyperintense sacrum, and right ileum bone with a cold abscess, suggesting spondylitis TB. A wound biopsy with hematoxylin-eosin stain concluded chronic granulomatous inflammation and showed multinucleated giant cell Langhans-type, suggestive of cutaneous tuberculosis. Microbiology examination (PCR GeneXpert) from wound biopsy and ziehl neelsen stain failed to detect Mycobacterium tuberculosis. The patient was diagnosed with Pott’s disease and scrofuloderma. Anti-tuberculous therapy commenced, and the patient responded well after several months of treatment. Conclusions: The diagnosis of extrapulmonary TB manifests as spinal tuberculosis, and scrofuloderma could be made from clinical manifestation and imaging.

Identification of major protozoal enteropathogens causing calf diarrhea in dairy farms in and around Holeta Town, Oromia Special Zone, Ethiopia

Calf diarrhea can be caused by a variety of pathogens, including bacteria, viruses, protozoa, and intestinal parasites. Giardia, Eimeria, and Cryptosporidium are the most significant protozoan parasites and are all individually and ollectively infectious. A case-series study was carried out in and around Holeta dairy farms, Oromia Special Zone, Ethiopia, from November 2017 to April 2018 to identify the main protozoan enteropathogens from diarrheic calves. Samples were purposely collected from three dairy farms: Serkalem Dairy Farm (SDF), Holeta Agricultural Research Centre (HARC), and Ada Berga Agricultural Research Centre (ABARC). A total of 93 fecal samples were taken from diarrheic calves of up to 4 months of age. Protozoan enteropathogens were identified using flotation and modified Ziehl Neelsen staining methods. Cryptosporidium, Eimeria, and Giardia were detected in 44 (47.3%), 50 (53.8%), and 34 (36.6%) of the diarrheic fecal samples examined, respectively. The findings indicated that there were 17 (18.27%) cases of Cryptosporidium, Eimeria, and Giardia as mixed infections, 16 (17.2%) cases of Cryptosporidium and Eimeria, 5 (5.4%) cases of Cryptosporidium and Giardia, and 4 (4.3%) cases of Eimeria and Giardia, compared to 13 (13.97%), 6 (6.45%), and 5 (5.4%) cases of Cryptosporidium, Eimeria and Giardia as single infections, respectively. The selected farms had significant prevalence levels of three common protozoa: Eimeria, Giardia, and Cryptosporidium. Further molecular research is required to identify the species and genotype levels of protozoal enteropathogens and related risk factors.

Genetic susceptibility to Tuberculosis in an infant with BCG-osis

Mendelian susceptibility to mycobacterial diseases (MSMD) is a group of innate immunity defects characterized by inborn susceptibility to intracellular pathogens. These are due to defects in the interleukin 12-23-interferon gamma y axis. Twenty-three genetic mutations have been identified in this axis, of which mutation in the IL12RB1 gene is the most common genetic defect of MSMD identified. An 11-month-old infant presented with features of axillary lymphadenitis and skin lesions both of which were positive for acid-fast bacilli on Ziehl– Neelsen stain and GeneXpert. Keeping a high index of suspicion of primary immunodeficiency, the child was evaluated further and was diagnosed as a case of MSMD with IL12RB1 gene mutation.

A comparative study of accuracy between gene Xpert (cartridge-based nucleic acid amplification test) and line probe assay in retreatment cases of sputum-positive pulmonary tuberculosis

Abstract Background: Many studies have compared the efficacy of Gene Xpert (cartridge-based nucleic acid amplification test [CBNAAT]) and line probe assay (LPA) techniques; however, a systematic and meticulous comparison of these two techniques is lacking. Objective: To study the accuracy of GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay and LPA in the detection of MTB complex in smear-positive retreatment cases of pulmonary tuberculosis (TB). Materials and Methods: This diagnostic evaluation study was conducted on 300 retreatment cases of pulmonary TB. The patients who were receiving retreatment were identified by sputum for acid fast Bacilli by Ziehl–Neelsen staining method and were instructed to provide sputum samples for CBNAAT and LPA. These sputum samples were then processed for liquid culture as part of the routine diagnostic procedure. Results: Majority of the patients (52.3%) were of 31–45 years of age. Males (56%) were more than females (44%). Most of the cases were relapse (88%). Ninety-three percent were reactive on sputum culture. Seventy percent had RIF resistance on CBNAAT. Isoniazid and RIF resistance was seen in 69.7% on LPA. 23.3% were sensitive on LPA and 7% had isoniazid resistance. The sensitivity, specificity, positive predictive value, and negative predictive for CBNAAT as compared with LPA were 75%, 100%, 100%, and 22.2%, respectively. Conclusion: Both LPA and CBNAAT are equally effective in detecting MTB in the given sputum sample. However, LPA is preferred over can be very helpful as it can point out the Isoniazid (INH) and Rifampicin (RIF) resistant nature of the bacterium.

Clinical, radiological varieties and diagnostic facilities of smear negative pulmonary tuberculosis in HIV uninfected patients, a retrospective analysis

Abstract Context Pulmonary tuberculosis (TB) is still one of the most common infectious diseases in the world. It is the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). WHO estimated TB incidence in Egypt in 2019 at 12 000. Purpose The aim of this study was to make a re-look at the epidemiological characteristics, clinical presentations, and radiological findings of patients with smear-negative pulmonary tuberculosis (SNPT) in non-HIV infected patients. Methods Retrospective analysis was performed including non-HIV patients with smear negative TB, with studying of demographics, symptoms, radiological patterns, and radiological distribution and the used diagnostic methods. Statistical analysis The demographic, clinical, and radiological data were gathered together, tabulated, and statistically analyzed. Data analysis was performed by Statistical Package for Social Science (SPSS – version 22). Results 74 smear-negative TB, non-HIV, age mean 47.17 ± 12.8 SD, 72.2% were males, DM was present in (39.2%), fever in (83.3%), weight loss in (61.1%), cough in (59.7%), consolidation pattern in (63.8%), cavities in (36.1%), an apical segment of right upper lobe in (41.9%), bronchoscopic lavage with Ziehl–Neelsen stain (BAL ZN) diagnosed (52.7%) of sputum negative cases. Conclusion Common variables among recorded cases were male sex, middle-aged individuals, Diabetes Mellitus (DM), toxic manifestation, an involved right apical segment of the upper lobe, consolidation and cavitary patterns, and most cases were diagnosed by bronchoscopic lavage with Ziehl–Neelsen.