Negative Pulmonary Tuberculosis Research Articles

Diagnostic accuracy of high resolution computed tomography (HRCT) of chest in diagnosing sputum smear positive and sputum smear negative pulmonary tuberculosis (PTB).

Objective: To assess the diagnostic accuracy of high resolution computed tomography (HRCT) of chest in diagnosing sputum smear positive and negative pulmonary tuberculosis (PTB). Study Design: Cross-sectional study. Setting: Tertiary Care Hospital, Kharian Cantt. Period: Oct 2021 to April 2022. Methods: The retrospective reviews of medical records of patients undergone HRCT chest and sputum for AFB smear and culture due to pulmonary tuberculosis (PTB) suspicion were included. The HRCT and AFB findings for sample size of 220 was compared. SPSS was used to stratify outcomes on basis of sputum smear results. Diagnostic accuracy of HRCT chest was calculated by taking AFB as gold standard. The AFB findings and HRCT outcomes were compared through correlation analysis and paired t-test with p value < 0.05 considered as significant. Results: The sensitivity was found to be 86.23% with specificity of 86.48%, positive predictive value of 86.23%, negative predictive value of 86.48% and diagnostic accuracy of 86.36% for HRCT for diagnosing pulmonary tuberculosis (PTB). Conclusion: HRCT chest affirms high diagnostic potential for pulmonary tuberculosis (PTB) and should be used as a routine diagnostic tool for the disease.

Clinical and Imaging Characteristics of Smear Negative Pulmonary Tuberculosis Patients: A Comparative Study.

Prevalence surveys in Ethiopia indicate smear negative pulmonary tuberculosis (SNPTB) taking the major share of the overall TB burden. It has also been a diagnostic dilemma worldwide leading to diagnostic delays and difficulty in monitoring treatment outcomes. This study determines and compares the clinical and imaging findings in SNPTB and smear positive PTB (SPPTB). Methodology. A case-control study was conducted on 313 PTB (173 SNPTB) patients. Data and sputum samples were collected from consented patients. Smear microscopy, GeneXpert, and culture analyses were performed on sputum samples. Data were analyzed using Stata version 17; a P value < 0.05 was considered statistically significant. Of the 173 SNPTB patients, 42% were culture positive with discordances between test results reported by health facilities and Armauer Hansen Research Institute laboratory using concentrated smear microscopy. A previous history of TB and fewer cavitary lesions were significantly associated with SNPTB. Though overall clinical presentations of SNPTB patients resemble those seen in SPPTB patients, a prior history of TB was strongly associated with SNPTB. Subject to further investigations, the relatively higher discrepancies seen in TB diagnoses reflect the posed diagnostic challenges in SNPTB patients, as a higher proportion of these patients are also seen in Ethiopia.

A novel enzyme-linked ligand-sorbent assay (ELLSA) to screening pulmonary tuberculosis: a retrospective cross-sectional study

BackgroundLittle knowledge of antigen existence in the pulmonary tuberculosis (PTB) patient serum impeded its development in antigen detection technology, despite its considerable potential. MethodsHuman ligand proteins and their adsorbent Mycobacterium tuberculosis (M.tb) proteins in the serum of PTB patients were identified using human protein chip (HuProt™) and LC-MS/MS, successively. The monoclonal antibody of ligand proteins, C5orf24, and polyclonal antibody of 9 M.tb proteins were prepared on mice and rabbits which were used to develop a novel enzyme-linked ligand-sorbent assay (ELLSA). The 412 volunteers were divided into the PTB group (n = 250) and the healthy control (n = 162). The PTB group was further divided into ATB (n = 131), LTBI (n = 18), Clinical diagnosis (n = 18), and Suspected (n = 73). All samples were tested by ELLSA to evaluate the diagnostic performance of ELLSA in PTB patients. ResultsNine ligand proteins specific to PTB patients were identified on chips, with Chromosome 5 Open Reading Frame 24 (C5orf24) and kinocilin (KNCN) showing significantly higher signals. Proteomic analysis of the C5orf24-and KNCN-adsorbent protein complexes revealed 10 and 10 of the M.tb proteins, respectively. According to the composition reference of standard, the ELLSA based on C5orf24 ligand demonstrated a higher sensitivity of 69.6% and specificity of 90.18% in ATB patients and had a sensitivity of 64.22% in bacterial negative pulmonary tuberculosis, whereas the sensitivity of MGIT 960 and Xpert M.tb/RIF were 0%, respectively. ConclusionsM.tb proteins in serum can be enriched by ligand proteins and detected by ELLSA which proved to have excellent diagnostic performance for PTB.

Diagnosis Model in Smear-Negative Pulmonary Tuberculosis Using Faster R-CNN

Background: One of the most important human organs in the respiratory system is the lung. The main function of the lung is the respiration process, which is responsible for pumping air into the body. The health of the lung organs is very important, because if this organ is disturbed it will affect the health of the rest of the body. One of the diseases that attacks the lungs is Tuberculosis (TB). TB disease can be cured, but if it is delayed in getting treatment it can increase the risk of death. Method: This research developed a Smear Negative Pulmonary Tuberculosis diagnosis model using the Deep Learning method using the Faster R-CNN algorithm. The data used in this research are x-ray images of the lungs at the Jakarta Repository Center - Indonesian Tuberculosis Eradication Center (JRC-PPTI) clinic, totaling 220 datasets. At the preprocessing stage, the images used for training and testing were used with a size of 1280 x 1280 to see the effect on the accuracy of the prediction results of the Faster RCNN model. The test results are in the form of accuracy values that reflect the performance of the Faster RCNN model in classifying normal (without TB) and abnormal (with TB) test data. Results: The research implementation carried out the training process and testing process for 75% of training images, and 25% for testing images. Training images are labeled using the Img label. In the testing stage of the faster RCNN model, the accuracy value was 62.04%, precision was 40.00%, recall was 64.52% and F1-score was 49.38%. Conclusion: From the results of this research it is concluded that the Faster RCNN model test results using the ResNet 50 model have an accuracy value of 62.04%, Precision of 40.00%, Recall of 64.52% and F1-score of 49.38%.

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.

In-vivo expressed mycobacterial transcripts as diagnostic targets for pulmonary tuberculosis

The nucleic acid amplification tests (NAATs) such as Xpert MTB/RIF have transformed the TB diagnostic field by significantly increasing the case detection. However, newer improved diagnostic assays are still needed to meet the WHO targets to end TB. Present study is based on a novel approach of utilizing the in-vivo expressed specific mycobacterial transcriptomic biomarkers for the diagnosis of pulmonary tuberculosis (PTB). Total 61 subjects were recruited including smear positive (smear+; n = 15), smear negative (smear-; n = 30) PTB patients and disease controls (n = 16). Transcripts of three mycobacterial genes Rv0986, Rv0971c and Rv3121 were analyzed using real time PCR (qRT-PCR) in sputum samples. qRT-PCR with Rv0986, Rv0971c and Rv3121 identified smear + PTB patients with 100 %, 78.6 % and 86.7 % sensitivity respectively. In smear- PTB patients, both Rv0986 and Rv0971c based qRT-PCR resulted in 63 %, sensitivity whereas Rv3121 identified these patients with ∼40 % sensitivity only. The sensitivity of the assay for smear-patients increased to 85 % when combinatorial analysis of qRT-PCR data for all the three genes was used. Thus, in-vivo expressed mycobacterial transcripts have promising potential as biomarkers for PTB diagnosis.

Role of GeneXpert in Diagnosis of Smear Negative Pulmonary Tuberculosis

Abstract Background Pulmonary TB considered as a global health problem with specific concern in developing countries that need rapid methods in diagnosis with accurate results. Objective To evaluate the diagnostic yield of GeneXpert assay in diagnosis of TB infection in patients with negative sputum smear. Methods A total 346 cases with suspect clinical and radiological finding for TB infection was subjected to direct sputum analysis under microscope to find acid fast bacilli (AFB); the negative smear then subjected to GeneXpet assay analysis and sputum culture on LJ media. Results All cases with negative GeneXpert results, had negative culture, while 45 cases of 50 that had positive GeneXpert assay finding showed positive culture. The diagnostic yield of test was excellent (94.7%). The sensitivity, specificity, PPV and NPV were 100, 89.8, 90 and 100 respectively. Conclusion The performance of GeneXpert assay in diagnosing TB among smear negative patients was reasonable, and may fast the decision of treatment.

DIAGNOSTIC ROLE OF GASTRIC ASPIRATION IN SMEAR NEGATIVE PULMONARY TUBERCULOSIS IN ADULT

To study the diagnostic utility of gastric aspiration in sputum negative pulmonary tuberculosis by identifying gastric smear for AFB and culture.To compare the outcome among HIV positive and negative individuals. To study how many were false negative due to improper techniques in sputum sample submission. To compare the radiological patterns with yield in gastric aspiration.To investigate the role of bronchoscopy in smears negative pulmonary tuberculosis.From this study, gastric aspirate for smear positivity among sputum smear negative pulmonary tuberculosis was 24% and gastric culture positivity was 22%. Gastric aspirate for AFB smear and culture can be used as a tool in diagnosis of pulmonary tuberculosis in patients who cannot submit sputum and patients who are smear negative as suggested by the study.Gastric aspirate performed on 2 consecutive days may improve the diagnostic yield.Gastric aspirate performed among HIV positive patients was only 10%.Gastric aspirate positivity in culture had a high yield among chest xray with suspected pulmonary tuberculosis with consolidation pattern(38%).There is practice of prescribing fluoroquinolone for community acquired pneumonia in private. The patients seeking treatment in a tertiary care centre are not naïve population .Many of them would have had treatment and exposed to fluoroqunilones before presenting to us and hence these patients are at the risk of developing fluroquinolone resistant pulmonary tuberculosis. DOTS program in India is functioning at the level of primary health centre where sophisticated techniques like bronchoscopy are not available, patient presenting with no sputum under suspicion of tuberculosis, gastric aspirate can be performed as a diagnostic technique which is a simple outpatient procedure.

Significance of serum copper zinc ratio in smear negative pulmonary tuberculosis cases in Rohilkhand region

Tuberculosis being a highly contagious chronic pulmonary and systemic disease is explicit cause of morbidity and mortality worldwide. There is a direct relationship between zinc and copper in maturation of immunity, Cu/Zn ratio in serum serves to assess levels of oxidative stress in infectious diseases and thus could be used as a diagnostic tool in early diagnosis of smear negative tuberculosis. To study and evaluate significance of serum Cu and Zn concentration and Cu/Zn ratio in smear negative pulmonary tuberculosis patients in comparison to apparently healthy controls. Observational case control study was carried out on patients attending IPD and OPD, Department of Pulmonary Medicine, RMCH. Fifty cases of smear negative PTB patients(group A) was taken and compared with fifty age and sex matched apparently healthy controls(group B). Serum Cu and Zn were estimated in both groups by colorimetric method using EM Chem5Plus V2 Semi autoanalyzer. Data is presented as mean ± SD. Comparison of serum levels of the parameters between the two groups was performed by Student’s‘t’ test. The p value &amp;#60;0.05 was considered as statistically significant. We found serum Zinc to be significantly lower in group I than group II(p&amp;#60;0.00), serum Copper &amp; Cu/Zn ratio to be significantly higher in group I than II(p&amp;#60;0.00). The results suggests that early estimation of serum Cu, Zn &amp; Cu/Zn ratio serves as useful diagnostic marker for smear negative pulmonary TB cases though more extensive multicentric study will provide more insights.

Development of a new cellular immunological detection method for tuberculosis based on HupB protein induced IL-6 release test.

As a virulence factor, HupB plays important roles in the survival of MTB after infection and modulates the host immune response. In the current study, we aim to explore a new cellular immunological detection method for tuberculosis infection detection based on HupB protein. HupB was used to stimulate PBMCs extracted from pulmonary tuberculosis (PTB) patients, and secreted cytokines was examined. Then, we constructed a single center and a multi-center clinical trials to collect PBMCs from PTB patients, nPTB patients, or healthy volunteers to verify our findings. Cytokine's screening illustrated that IL-6 was the only cytokine released after HupB stimulation. Single-center and multi-center clinical trials showed that HupB stimulation significantly increased the level of IL-6 in the supernatant of PBMCs from PTB patients. Then we compared the specificity and sensitivity of HupB induced IL-6 release assay with ESAT-6 and CFP10 induced interferon γ release assay (IGRA), and found in smear positive PTB patients, the specificity and sensitivity of HupB induced IL-6 release assay was better than IGRA, and in smear negative PTB patients, the sensitivity was better. Combination of both assays provided an improved specificity and sensitivity for tuberculosis diagnosis. This study explored an immunological detection method for tuberculosis infection cells based on HupB protein-induced IL-6 release test, which can be used to enhance the diagnosis diagnostic accuracy of TB.

A Study on Sputum Induction in the Diagnosis of Smear Negative or Sputum -Scarce Presumptive Tuberculosis in HIV Patients in A Tertiary Care Center

Background: HIV infection and TB are two major public health problems in most of the developing countries including India. TB also the most common opportunistic infection seen in HIV infected patients in India 1,2. Tuberculosis is a significant increase in the worldwide incidence of TB which is contributed majorly by HIV infection. AIM: To study the role of Sputum Induction to aid in the diagnosis of Smear Negative or Sputum Scare Presumptive Pulmonary Tuberculosis in adults with HIV. Material &amp; Methods: Prospective hospital based observational study. The present study was conducted in the department of TB &amp; Respiratory medicine, Osmania Medical College, Hyderabad. The subjects of the study were selected among the HIV positive with Presumptive Pulmonary Tuberculosis patients who visited the outpatient department or had been admitted in our hospital who agreed for voluntary participation. A total of 50 Presumptive Pulmonary Tuberculosis with HIV co- infection were taken as sample size. Results: The majority of cases (38 %) were in the age group of 31-40 yrs. Mean age of the study group population is 39.76 ± 9.24. The predominant symptom in the present study was loss of appetite. Out of 50 patients 34% (17 patients) were known Diabetic and 10% (5 patients) were known Hypertensive. Most of the patients in my study are smokers (40%). The mean CD4 count in the present study is 182.68. Majority (72%) of patients in the present study did not have previous history of TB. On General examination majority of the patients had Lymphadenopathy. Out of 45 adequate Induced sputum cases, 89% (40 cases) were Negative for Sputum AFB and whereas 11% (5 cases) were Positive for Sputum AFB. Conclusion: Sputum induction is a safe, simple and valuable procedure to obtain adequate sputum samples in suspected cases of pulmonary tuberculosis and can obviate the need for much sophisticated and invasive procedures like bronchoscopy. Sputum induction improves the diagnostic yield for AFB in patients unable to expectorate adequate sputum sample.

The Relationship between Ventilation and Physical Quality of Houses with Pulmonary Tuberculosis Cases in the Working Area of Sragen Primary Healthcare Center, Sragen Regency

Introduction: Pulmonary tuberculosis is ranked the second health problem in the world, including Indonesia with reasonably high mortality rates. This study examined the association between the ventilation, physical condition, and the prevalence of pulmonary tuberculosis in the working area of the Sragen Primary Healthcare Center. Methods: This study used a case-control design and purposive sampling to select 40 patients with positive smear pulmonary tuberculosis as the case group and 40 subjects with negative smear pulmonary tuberculosis as the control group who lived in the same area. Results and Discussion: Ventilation volume per hour (p = 0.007; OR = 3.889; 95% CI = 1.533–9.868), ventilation area (p = 0.014; OR = 3.462; 95% CI = 1.379–8.691), lighting intensity (p = 0.007; OR = 3.955; 95% CI = 1.546–10.114) and a humidity level (p = 0.001; OR = 5.762; 95% CI = 2.065–16.079) were associated with the prevalence of pulmonary tuberculosis in patients of the productive age group who attended the Sragen Primary Healthcare Center. The results of the multivariate analysis conclude that ventilation (OR = 5.900), humidity level (OR = 8.414), and occupancy density (OR = 0.113) had joint influences with a significant contribution of 41.3% to TB prevalence. Conclusion: House’ ventilation and humidity are the main factors contributing to the incidence of pulmonary tuberculosis in the working area of Sragen Primary Healthcare Center.

Diagnosis of the Sputum Smear Positive and Sputum Smear Negative Pulmonary Tuberculosis - The Role of High - Resolution Computed Tomography of Chest

BACKGROUND&#x0D; Mycobacterium tuberculosis complex causes pulmonary tuberculosis (PT) which is a major public health problem worldwide and endemic in India. PT diagnosis is done by high-resolution computed tomography (HRCT) which has high sensitivity and specificity.&#x0D; METHODS&#x0D; At a tertiary hospital, this cross-sectional study was conducted for 3 years. Patients presenting with productive cough with or without haemoptysis, shortness of breath, fever with night sweats or weight loss were suspected of having tuberculosis and underwent HRCT. PT was defined as the presence of consolidation, centrilobular nodules, and branching nodules with a tree in bud appearance with or without lymphadenopathy and pleural effusion on HRCT.&#x0D; RESULTS&#x0D; In this study, a total of 118 patients with a mean age of 51.85 ± 16.86 years were included. 64 (54.2%) were males and 54 (45.76%) were females out of 118 patients. Sputum smear was negative in a total of 66 (55.9%) patients and positive in 52(44.06%) patients. 84.26% was the diagnostic accuracy of HRCT in diagnosing PT with sensitivity, specificity, PPV and NPV of 84.28%, 83.33%, 78.98%, and 99.02%, respectively. HRCT had diagnostic accuracy, sensitivity, specificity, PPV and NPV of 86.40%, 89.46%, 83.42%, 94.14% and 72.43%, respectively in sputum smear positive patients. Whereas it was 83.87%, 91.54%, 75.40%, 64.57%, and 92.14%, respectively in sputum smear negative patients.&#x0D; CONCLUSIONS&#x0D; In diagnosing sputum smear-positive and sputum smear-negative PT, HRCT has high sensitivity. The specificity of HRCT was high in diagnosing sputum smear-positive PT, whereas in case of sputum smear-negative PT it was slightly low.

Comparison of Induced Sputum and Bronchoalveolar Lavage Fluid Examination in the Diagnosis of Sputum Negative Pulmonary Tuberculosis

Tuberculosis (TB) is one of the common infections in the world, especially in developing countries like India. Therefore, early diagnosis is important. This study was undertaken to compare the yield of sputum, induction with bronchoalveolar lavage (BAL) in smear-negative suspected pulmonary TB patients in a tertiary care hospital in Agra. Fifty patients were included in the study. In all patients, induced sputum, fibreoptic bronchoscopy and BAL fluid were subjected to diagnostic testing. On acid-fast smear examination, induced sputum and BAL fluid tested positive in 27/50 and 25/50 patients, respectively with a sensitivity of 83.3% and 90% respectively (p<0.0001). On comparing sputum induction versus BAL on culture, 30 patients were positive by sputum induction and 27 patients were positive on BAL fluid, with the sensitivity of 85.7% and 77.1%, respectively. The results showed that the sputum induction showed a significantly higher yield than that of BAL fluid (p=0.0013). Sputum induction offers an alternative approach in the diagnosis of smear-negative suspected pulmonary TB patients and would enhance sensitivity for the diagnosis of TB.

Contribution of bronchoscopic lavage to the diagnosis of smear negative pulmonary tuberculosis

Objectives: Sputum acid-fact bacilli (AFB) and Xpert examinations are the most commonly used methods in early diagnosis for pulmonary tuberculosis. It becomes difficult for the clinician to initiate treatment in patients with negative sputum smear and Xpert examinations at the stage of diagnosis. Waiting for culture results for diagnosis causes delay in treatment and increases the risk of disease transmission. We aimed to investigate the contribution of bronchoscopic lavage (BL) obtained with flexible fiberoptic bronchoscopy (FOB) to the diagnosis of tuberculosis. Methods: The BL results of 36 patients hospitalized in the tuberculosis clinic who were clinically suspected of tuberculosis, but whose sputum AFB and Xpert results were negative, and whose bronchoscopic lavages were taken by FOB, were retrospectively evaluated. Results: BL Xpert examination was the method that made the most contribution to the diagnosis with a rate of 27.7%. BL smear AFB results did not contribute to the diagnosis statistically. Sputum and BL tuberculosis culture results were found to be close to each other. In total, the diagnosis of 50% of the patients was confirmed. Conclusions: Performing Xpert examinations on bronchoscopic materials of patients with negative sputum examinations significantly increase the rate of early diagnosis.

Diagnostic Yield of Fiberoptic Bronchoscopy Washings among Patients of Sputum Smear Negative Pulmonary Tuberculosis

Fiberoptic bronchoscopy with bronchial washing is done for diagnosis of pulmonary tuberculosis among patients who cannot produce sputum spontaneously. Aim: To evaluate the diagnostic yield of Fiberoptic Bronchoscopy for detection of positive cases in cases of Smear negative pulmonary tuberculosis. Study Design: Cross-sectional study. Methodology: All patients (n=80) were advised NPO for 6 hours before carrying out the procedure. It was done using local anesthesia while retrievement of the instilled amount by 25% was considered successful. The bronchial washings were sent for AFB staining in-order to confirm the presence or absence of Mycobacterium Tuberculosis. Bronchial washing smear was considered positive if 1-9 AFB/HPF are seen on direct microscopy. Statistical Analysis: SPSS v.26 analyzed the data. Stratification of diagnostic yield was done with respect to age and gender. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. Results: The diagnostic yield of FOB for detection of positive cases in cases of Smear negative PTB was 57.5%. The highest diagnostic yield was seen in patients in the age group 16-32 and 49-60 years old patients i.e. 37% in both groups. For both genders diagnostic yield for FOB was 50%. However patient’s age and gender were insignificantly associated with diagnostic yield of FOB. Conclusion: It was concluded that FOB can provide a rapid and definitive diagnosis of pulmonary tuberculosis in sputum negative patients. Keywords: Diagnostic Yield, Fiberoptic Bronchoscopy, Smear Negative and Pulmonary Tuberculosis.

Diagnostic accuracy of different bronchoscopic specimens in sputum Xpert MBT/RIF- negative pulmonary TB patients.

Tuberculosis (TB) control remains a critical public health problem worldwide. Rapid diagnosis and proper treatment are beneficial for the effective control of tuberculosis transmission. Diagnostic challenges arise when a patient has a clinical and radiological suspicion of tuberculosis but cannot produce sputum, sputum acid-fast bacilli, or Xpert Mycobacterium tuberculosis/rifampicin (Xpert MTB/RIF) is negative, resulting in suboptimal management. As a result, more invasive techniques must be used on these patients to establish the diagnosis. A retrospective study recruited 330 suspected pulmonary TB patients with negative sputum of Xpert MBT/RIF who underwent bronchoscopy between March 2018 and December 2021. The diagnostic yields of bronchoalveolar lavage fluid (acid-fast bacilli, Xpert MTB/RIF, and culture) and histopathologic examination (HPE) were calculated and compared to the final diagnosis and culture as a gold standard. Out of 330 suspected pulmonary TB patients, 181 had a final diagnosis of TB, and 149 had non-TB. The sensitivity of BALF (culture, Xpert, acid-fast bacilli) and trans-bronchial lung biopsy (HPE) was 80.7%, 72.9%, 21.1%, and 87.1%, respectively. Multiple nodules were associated with significantly higher BALF Xpert MTB, bronchoalveolar lavage fluid culture, and trans-bronchial lung biopsy (HPE) positivity. Bronchoscopic specimens are essential for accurate and rapid diagnosis of sputum Xpert MBT/RIF negative patients with high clinical and radiological suspicion of tuberculosis.

Persistent expression of activation markers on Mycobacterium tuberculosis-specific CD4 T cells in smear negative TB patients.

T cell activation (HLA-DR, CD-38), proliferation (KI-67), and functional (IFN-γ, TNF-α) markers have recently been shown to be useful in predicting and monitoring anti-TB responses in smear positive TB, but previous research did not characterize the activation and proliferation profiles after therapy of smear negative TB. In this study, we used polychromatic flow cytometry to assess selected PPD-specific T cell markers using fresh PBMC of smear negative and positive pulmonary tuberculosis (PTB) patients, recruited from health facilities in Addis Ababa. Levels of activation (HLA-DR, CD38) and proliferation (Ki-67) among total unstimulated CD4 T cells decreased significantly after therapy, particularly at month 6. Similarly, levels of PPD-specific T cell activation markers (HLA-DR, CD-38) were significantly lower in smear positive PTB patients following treatment, whereas a consistent decline in these markers was less apparent among smear negative PTB patients at the sixth month. After six months of standard anti-TB therapy, persistent levels of activation of HLA-DR and CD-38 from PPD specific CD4+T cells in this study could indicate that those markers have little value in monitoring and predicting anti-TB treatment response in smear negative pulmonary TB patients in Ethiopian context.

Epidemiology of recurrent pulmonary tuberculosis by bacteriological features of 100 million residents in China

BackgroundRecurrence continues to place significant burden on patients and tuberculosis programmes worldwide, and previous studies have rarely provided analysis in negative recurrence cases. We characterized the epidemiological features of recurrent pulmonary tuberculosis (PTB) patients, estimated its probability associated with different bacteriology results and risk factors.MethodsUsing 2005–2018 provincial surveillance data from Henan, China, where the permanent population approximately were 100 million, we described the epidemiological and bacteriological features of recurrent PTB. The Kaplan–Meier method and Cox proportional hazard models, respectively, were used to estimate probability of recurrent PTB and risk factors.ResultsA total of 7143 (1.5%) PTB patients had recurrence, and of 21.1% were bacteriological positive on both laboratory tests (positive–positive), and of 34.9% were negative–negative. Compared with bacteriological negative recurrent PTB at first episodes, the bacteriological positive cases were more male (81.70% vs 72.79%; P < 0.001), higher mortality risk (1.78% vs 0.92%; P = 0.003), lower proportion of cured or completed treatment (82.81% vs 84.97%; P = 0.022), and longer time from onset to end-of-treatment. The probability of recurrence was higher in bacteriological positive cases than those in bacteriological negative cases (0.5% vs 0.4% at 20 months; P < 0.05).ConclusionsBased on patient’s epidemiological characteristics and bacteriological type, it was necessary to actively enact measures to control their recurrent.

Distribution of bacteriologically positive and bacteriologically negative pulmonary tuberculosis in Northwest China: spatiotemporal analysis

Pulmonary tuberculosis (PTB) is a major health issue in Northwest China. Most previous studies on the spatiotemporal patterns of PTB considered all PTB cases as a whole; they did not distinguish notified bacteriologically positive PTB (BP-PTB) and notified bacteriologically negative PTB (BN-PTB). Thus, the spatiotemporal characteristics of notified BP-PTB and BN-PTB are still unclear. A retrospective county-level spatial epidemiological study (2011–2018) was conducted in Shaanxi, Northwest China. In total, 44,894 BP-PTB cases were notified, with an average annual incidence rate of 14.80 per 100,000 persons between 2011 and 2018. Global Moran’s I values for notified BP-PTB ranged from 0.19 to 0.49 (P < 0.001). Anselin’s local Moran’s I analysis showed that the high–high (HH) cluster for notified BP-PTB incidence was mainly located in the southernmost region. The primary spatiotemporal cluster for notified BP-PTB (LLR = 612.52, RR = 1.77, P < 0.001) occurred in the central region of the Guanzhong Plain in 2011. In total, 116,447 BN-PTB cases were notified, with an average annual incidence rate of 38.38 per 100,000 persons between 2011 and 2018. Global Moran’s I values for notified BN-PTB ranged from 0.39 to 0.69 (P < 0.001). The HH clusters of notified BN-PTB were mainly located in the north between 2011 and 2014 and in the south after 2015. The primary spatiotemporal cluster for notified BN-PTB (LLR = 1084.59, RR = 1.85, P < 0.001) occurred in the mountainous areas of the southernmost region from 2014 to 2017. Spatiotemporal clustering of BP-PTB and BN-PTB was detected in the poverty-stricken mountainous areas of Shaanxi, Northwest China. Our study provides evidence for intensifying PTB control activities in these geographical clusters.