Positive Acid-fast Bacilli Research Articles

How radiology can help pulmonary tuberculosis diagnosis: analysis of 49 patients

To identify the most frequent radiological findings of pulmonary tuberculosis using CT of the chest, to determine those with the highest degree of correlation, and, if possible, to identify the most suggestive radiological findings for acid-fast bacilli (AFB) positive disease. The radiological and clinical data of 49 patients submitted to CT during diagnosis were retrospectively analysed. The association between findings was assessed using Fisher's exact test, while correlation at CT scan was evaluated with the Spearman analysis. Bronchiectasis/bronchioloectasis (89.8%), nodule(s) (81.6%), tree-in-bud (TIB), and consolidation (79.6% each) figured among the most common parenchymal findings. Lymphadenopathy (26.5%) was the most common nodal finding. TIB and cavity showed the highest correlation (r = 0.577), followed by TIB and bronchi(olo)ectasis (r = 0.498), TIB and consolidation (r = 0.497), nodule(s), and ground glass opacity (r = 0.488). High correlation was found in only the seven most frequent parenchymal findings. Consolidation, TIB, and cavity were useful to predict the AFB stain positivity. Our series confirms the extreme heterogeneity of pulmonary tuberculosis. It also proves there are couple of findings which can drive us to the right diagnosis. While a triad of findings predicts AFB positivity, we have not found any predictive sign of AFB negativity; consequently, all patients with suspected imaging and clinical findings for TB should be isolated.

Risk Factors for Delayed Isolation of Patients with Active Pulmonary Tuberculosis in an Acute-care Hospital

The objective of the current study was to determine the factors associated with delayed isolation of pulmonary tuberculosis (TB). In this retrospective study, data of patients newly diagnosed with pulmonary TB from January 2015 through December 2017 at a referral hospital were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of admission. We analyzed the clinical, microbiological, and radiological factors associated with delayed isolation of pulmonary TB. A total of 134 patients with positive sputum acid-fast bacilli (AFB) cultures were analyzed, of which 44 (33%) were isolated within 3 days after admission. In multivariate logistic regression analysis, older age (p = 0.01), admission to departments other than Infectious Disease or Pulmonology (p = 0.005), and presence of malignancy (p = 0.02) were associated with delayed isolation. Patients with a radiologic diagnosis of active pulmonary TB were likely to be isolated early (p = 0.01). Better awareness of pulmonary TB among attending practitioners in hospital settings is required. Delay in isolation is associated with older age, malignancy, hospitalization to departments other than Infectious Disease or Pulmonology, and non-confident radiologic diagnosis of active pulmonary TB.

Tuberculosis in the Bone Marrow: A Case Report

Mycobacterium tuberculosis of bone marrow that is considered one of the rare extrapulmonary tuberculosis (TB). Herein we report one case of tuberculosis of the bone marrow. A 82-year-old Thai woman presented with fever, fatigue, and weight loss of 4 kg in one month. The physical examination revealed only pallor and the ejection murmur at the upper parasternal border. Her chest film was unremarkable but the computed tomography of the chest revealed the reticular infiltration at both lower lungs and multiple small mediastinal lymphadenopathies. Although her blood smear did not show the leukoerythroblastic blood picture with the tear drop red blood cells (RBCs) or pancytopenia, her bone marrow biopsy showed a few granulomas with positive acid fast bacilli (AFB). The common risk factors such as diabetes, human immunodeficiency virus (HIV) infection, low CD4 counts, chronic kidney disease, malnutrition, and immunosuppressant therapy which might contribute her to be vulnerable to TB, were not found. The definite diagnosis was TB in the bone marrow and she clinically responded well to the 4-drug antituberculous regimen. Our case suggests that even though the leukoerythroblastosis with the tear drop RBCs or pancytopenia, the clues of the bone marrow involvement, is not found, the study of the bone marrow should not be precluded from the plan of the investigations for the diagnosis in a case of fever of unknown origin.

Multidrug-resistant tuberculosis over 20 years at a referral hospital in South Korea: trends and outcomes.

A referral centre in South Korea. To investigate trends in drug resistance, treatment modalities and outcomes, and adverse events of multidrug-resistant tuberculosis (MDR-TB) over two decades. MDR-TB patients treated at Seoul National Hospital University between 1996 and 2015 were divided into four 5-year cohorts according to the date of initial diagnosis. Changes in demographic characteristics, drug resistance, drugs used, treatment outcomes and adverse events over time were elucidated. Between 1996 and 2015, 418 patients were treated for MDR-TB: 86 patients between 1996 and 2000, 125 between 2001 and 2005, 123 between 2006 and 2010, and 84 between 2011 and 2015. The proportion of patients with positive acid-fast bacilli sputum (60.5-29.7%, P < 0.001) or cavities on chest radiographs (86.0-40.5%, P < 0.001) decreased over time. Resistance to pyrazinamide, fluoroquinolones, cycloserine and p-aminosalicylic acid decreased. Later-generation fluoroquinolones (77.9-90.5%) and linezolid (0-26.2%) became more frequently prescribed. The treatment success rate increased (45.3-88.1%, P < 0.001); neurological adverse events, including peripheral neuropathy also increased (4.7-13.1%, P = 0.027). MDR-TB patients presented with less severe disease and better resistance profiles over time in South Korea, with treatment outcomes improving continuously.

Role of EBUS-TBNA in the Diagnosis of Tuberculosis and Sarcoidosis.

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has diagnostic accuracy and negative predictive value for the diagnosis of mediastinal tubercular lymphadenitis, especially when culture and cytological diagnosis is combined with high clinical suspicion. Both sarcoidosis and tuberculosis (TB) demonstrate granulomatous inflammation on cytology. Diagnosis of sarcoidosis in regions with a high burden of TB is challenging. We conducted a prospective study in 179 cases of suspected granulomatous pathology in mediastinal lymphadenopathy cases to evaluate the role of EBUS-TBNA in diagnosis of sarcoidosis and TB. It was found that extensive caseous necrosis, acid-fast bacilli positivity on Ziehl–Neelsen staining, and/or microbiological culture positivity have high positive predictive value for the diagnosis of TB.

Factors Associated with Pulmonary Tuberculosis of Positive Acid Fast Bacilli in Surabaya

The study aimed to explain the most important factors in the incidence of positive acid-resistant pulmonary tuberculosis. This study used a cross-sectional approach. The sample was 68, consisting of 34 AFB (Acid Fast Bacilli) positive and 34 AFB negative, determined by initial examination. Data was collected via questionnaires and analysed by univariate (frequency distribution) and bivariate using Chi Square test with significance number <0.05. The most influential BCG immunization status, education, smoking, occupation, knowledge, nutritional status, occupancy density, income and gender, indicate the relationship but the risk is neutral, while age and comorbidities have no significant associated risk. The risk factors contributing to positive AFB in Perak Timur and Tanah Kali Kedinding areas were BCG immunization status, education, smoking habit, occupation, knowledge, nutrition status and occupancy density.

Pulmonary tuberculosis in the immunocompromised patients

Background/Aim. During the last few decades, immunocompromising diseases led to an increase in the number of tuberculosis cases. The aim of this study was to examine the influence of immunocompromising diseases on the course of tuberculosis. Methods. The research included two groups, each consisting of 40 subjects with tuberculosis, who were treated at the Institute for Pulmonary Diseases of Vojvodina during 2010 and 2011. The first group had no immunocompromising diseases (the kontrol group), whereas the second group contained patients with accompanying immunocompromising diseases. The data from the patients? medical history, from the Center for Microbiology and from the Radiology Center were used. The two groups were compared according to the following characteristics: age, sex, bacteriological status, radiological presence of the disease, presence of adverse effects of drugs, presence of resistance to drugs, duration of the therapy regimen and the duration of hospitalization. Results. The group of immunocompromised patients was older in average than the control group and included a higher percentage of males. The immunocompromised group had statistically important longer average time required for the sputum smear conversion (p = 0.000) and for the conversion of sputum cultures to M. tuberculosis (p = 0.010), more frequent presence of cavity (p = 0.030), longer average therapy regimen duration (p = 0.000) and higher average number of hospital days (p = 0.000) compared to the control group. The most frequent localization of changes in the immunocompromised patients was in all lobes of both lungs (32.5%) whereas the changes in the control group were mostly localized in the upper lung lobes (62.5%). There was no statistically important difference in the finding of sputum smear positive acidfast bacilli on direct micoscropy, the presence of adverse effects of drugs and M. tuberculosis resistance to drugs between the two groups of patients. Conclusion. The immunocompromising diseases change the course of tuberculosis, primarily by affecting bacteriological status, radiological presentation, the length of therapy regimen and the duration of hospitalization.

Cytomorphological Spectrums in Tuberculous Lymphadenitis: Understanding the Stages of Disease

Introduction: Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis and one of the main causes of lymphadenopathy. Fine Needle Aspiration Cytology (FNAC) has played a substantial role in diagnosis of tuberculous lymphadenopathy and it has become a first-line diagnostic technique. The aim of this study was to describe and understand the spectrum of cytomorphological changes seen in tuberculous lymphadenitis corresponding to stages of disease and to associate the cytomorphological changes with Acid Fast Bacilli (AFB) positivity.&#x0D; Methods: This is a retrospective cytomorphological study of cytologically diagnosed tuberculous lymphadenitis. The recorded details of clinical presentation and site of the lymph nodes were noted. The slides were stained with Papanicolaou, Giemsa and AFB.&#x0D; Result: There were a total of 203 cases with age ranging from 3- 75 years. Four cytomorphological patterns observed were Necrotising Granulomatous Lymphadenitis (NGL; 45.32%), Granulomatous Lymphadenitis (GL, 18.22%), Necrotising Suppurative Lymphadenitis (NSL; 21.18%) and Necrotising Lymphadenitis (NL; 15.27%). Necrotising patterns were observed in immunocompromised individuals like HIV infected patients, in patients with previous history of tuberculosis and in patients with chronic renal disease. Strong AFB positivity was observed in necrotising patterns. Lymph nodes of head and neck region were the most common site of involvement with cervical being the commonest.&#x0D; Conclusion: Necrotizing patterns are observed in the later stages of disease or in the immunocompromised patients. Strong positivity for AFB is observed in the smears with necrotizing patterns and less in the granulomatous pattern.

Treatment of Mycobacterium avium Complex Pulmonary Disease.

The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.

FREQUENCY OF ACID FAST BACILLI (AFB);

Objective: To determine the frequency of Acid Fast Bacilli (AFB) in samplessubmitted for Ziehl Neelson (Z.N) Technique. Design: An Observational study. Place andduration of study: This study was carried out from july 2010 to Dec 2012 at Dept. of Clinicalpathology Main Laboratory Jinnah Post Graduate Medical Centre (JPMC) Karachi. Material &amp;Method: A total of 5064 samples were received in the department of clinical pathology mainlaboratory, JPMC, Karachi during the study period. We determined the presence of AFB insamples by Z.N Technique. Result: Out of total 5064 samples, 518(10.2%) specimens revealedthe presence of AFB. The samples received were: sputum 4787 (503 positive; 10.5%), pus 56 (01positive; 1.7%), fluid 118 (no positive), gastric 93 (14 positive; 15%); urine 10 (not positive).Conclusions:- Lower rate of positivity for Acid Fast Bacilli by Z.N Technique can be increased byFluorescence microscopy and culture technique.

807. A Risk-Stratified Approach to Healthcare-Associated Tuberculosis Exposures Following the “Stone in the Pond” Principle

BackgroundLarge-scale tuberculosis (TB) exposure investigations cause anxiety to healthcare personnel (HCP) and patients, in addition to being resource and time intensive. TB contact tracing in England and Singapore follow the “stone in the pond” principle. We propose a similar risk-stratified approach to TB exposure investigations in an area of low incidence.MethodsThis retrospective study was conducted at a 1,541 bed academic medical center in New Haven, CT between January 14 and 11, 2017. Microbiology records, patient charts, and infection prevention databases were reviewed to find TB exposures. A scoring system adapted from CDC’s “Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis” was developed to predict infectivity (two points for laryngeal TB, one point each for: cavitary TB, ≥1 positive respiratory acid fast bacilli smear or Xpert MTB/RIF, multi-drug-resistant (MDR) TB, foreign-born status, immunocompromised status, cough/hemoptysis, or procedure associated with positive TB culture). Using the “stone in the pond” principle, contacts were graded based on the type of exposure (Figure 1). Based on high, medium, and low risk, our new risk-stratified approach was applied to contact tracing.ResultsDuring the study period, 17 of 29 patients with pulmonary TB led to exposures. A subset of seven TB patients with complete exposure data was selected for further analysis. The original exposure investigations led to contact tracing of 586 HCP and 72 patients. No active or latent TB cases were identified among these exposed contacts. Using our scoring system, these seven patients were categorized into three high, two medium, and two low infectivity risk groups. On applying our new risk-stratified approach, contact tracing could be reduced by 42% and 84% for medium and low-risk exposures, respectively, by excluding these HCP groups from investigation (Figure 2).ConclusionWe recommend a risk-stratified approach to healthcare-associated TB exposure investigations similar to the “stone in the pond” principle, based on index patient’s infectivity risk and type of exposure. This has potential to optimize resources and possibly reduce anxiety in medium and low-risk TB exposures in an area of low TB incidence. Disclosures All authors: No reported disclosures.

772. Factors Associated With Healthcare Delay of Active Pulmonary Tuberculosis After Hospitalization

BackgroundHospitals are undesirable reservoirs for a respiratory outbreak. Active pulmonary tuberculosis (TB) can be readily transmitted among hospitalized patients. Early recognition of pulmonary TB is an essential priority against transmission. The aim of this study was to evaluate factors associated with delayed identification of pulmonary TB in hospital settings.MethodsMedical records of newly diagnosed TB patients admitted to a referral hospital from January 2015 through December 2017 were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days after admission. We analyzed clinical, microbiological, radiological, and healthcare factors associated with delayed recognition of pulmonary TB. Patients who were not suspected of having active pulmonary TB had no remarks about TB on their initial chest radiograph interpretation by radiologists. Multivariate logistic regression analysis was performed with significant factors included.ResultsA total of 136 patients were analyzed who had positive sputum acid-fast bacilli (AFB) cultures. Of these, 45 (33%) patients were isolated 3 days after admission and had longer days of exposure before isolation (median 9, interquartile range [IQR] 6–14, P < 0.001) in comparison to others (median 0, IQR 0–1). Patients with older age (odds ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.08, P = 0.01), patients who were admitted to departments other than infectious diseases or pulmonology (OR = 6.23, 95% CI 2.17–17.89, P = 0.001) and patients who were not suspected of having active pulmonary TB by radiologists (OR = 11.36, 95% CI 4.11–31.39, P < 0.001) were more likely to have delayed recognition of pulmonary TB.ConclusionIn a country with intermediate TB prevalence, better awareness for pulmonary TB is required for all hospitalized patients who are admitted to departments other than infectious diseases or pulmonology. Although active pulmonary TB is not suspected by a radiologist, sputum AFB smear, and culture are necessary when new lesions are present in chest radiographs.Disclosures All authors: No reported disclosures.

DIAGNOSING MILLIARY MYCOBACTERIUM BOVIS FROM THE PROSTATE OF AN IMMUNOCOMPETENT HOST

SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/09/2018 03:45 PM - 04:45 PM INTRODUCTION: Zoonotic infection from Mycobacterium Bovis remains an important consideration for tuberculous disease in the developing world. We present a challenging case of hematogenous Mycobacterial dissemination from an uncommon culprit. CASE PRESENTATION: A 53 year old Bacillus-Calmette-Guerin (BCG) vaccinated and otherwise healthy Mexican male presented with complaints of fever, productive cough, arthralgias and weight loss over the preceding 21 days. He had already completed two separate outpatient courses of oral antibiotics without improvement. He denied any travel outside of the continental United States over the last 13 years and denied any recent sick contacts. He also owned 2 pet parrots. His physical exam and initial laboratory work up was unremarkable. A Chest X-ray (Fig. 1) revealed diffuse, bilateral, micronodular opacities, warranting further evaluation with Computed Tomography (CT) (Fig. 2). Initial acid-fast bacilli (AFB) sputum stains, bronchoalveolar lavage stains, cytology brushings and trans-bronchial biopsies were all negative. Hypersensitivity pneumonitis and opportunistic fungal panels were obtained which were unremarkable. Interferon gamma release assay was positive however equivocal given patient's BCG vaccination status. CT Chest, Abdomen and Pelvis (Fig. 3) was performed, which incidentally revealed an enlarged, heterogeneous prostate with fluid collections. Ultrasound guided aspiration of the prostate yielded pus and a strongly positive AFB smear. Eventually, the AFB cultures from the initial BAL came back positive. The patient was started on RIPE therapy with symptomatic improvement. Final speciation returned as M. Bovis and accordingly, pyrazinamide was stopped. DISCUSSION: M. bovis disease was common in the industrialized world before the practice of pasteurization became widely implemented in the 1940s. Current estimates in the USA and Europe identify between 1.3%-1.6% of tuberculosis cases attributable to M. Bovis. Infections are typically contracted via ingestion of unpasteurized dairy products from infected livestock and may remain dormant for many years, as was likely the situation in this case. Given the oral inoculation route, most cases of M.bovis manifest primarily with extrapulmonary findings. Of note, M. Bovis has documented intrinsic resistance to pyrazinamide which necessitates modification of typical RIPE treatment strategy. CONCLUSIONS: Diagnosis of disseminated TB remains a challenge. Regarding M. Bovis, the mean time to diagnosis has increased among practitioners given the diminishing incidence of infection. Vigilance of the disseminated and often extra-pulmonary form of tuberculosis caused by M. Bovis continues to be warranted. Patients at particular risk for M.bovis are those from developing countries, with frequent exposure to livestock and/or the practice of unpasteurized dairy product consumption. Reference #1: Scott. C. Human Tuberculosis Caused by Mycobacterium bovis in the United States, 2006-2013. Clin Infect Dis. 2016 Sep 1;63(5):594-601. Reference #2: Sherman LF. Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999 Dec;3(12):1088-95. Reference #3: Majoor, C.J. Epidemiology of Mycobacterium bovis disease in humans, The Netherlands, 1993-2007. Emerg Infect Dis. 2011 Mar;17(3):457-63. DISCLOSURES: no disclosure on file for Christopher Barrios; No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Scott Maughan, source=Web Response No relevant relationships by Pujan Patel, source=Web Response

A 20-year-old Lady with Peritoneal Tuberculosis Presented as Acute Abdomen and A Review of Peritoneal Tuberculosis

Tuberculosis can entail any component of the gastrointestinaltract and is the sixth most common site of extra pulmonaryassociation. Both the incidence and severity ofabdominal tuberculosis are predictable to amplify withgrowingnumbers of HIV infection. Peritoneal tuberculosis, a type of abdominal tuberculosis, occurs in three forms: wet typewith ascites, dry type with adhesions, and fibrotic type withomental thickening and loculated ascites. Clinically, peritoneal tuberculosis ischaracterized by fever, abdominal pain, anorexia, weightloss, and ascites. Nevertheless, not any of these symptoms is accuratefor the disease, so it is frequently misdiagnosed, especiallyas carcinomatous peritonitis in the elderly. Diagnosisnear the beginning of peritoneal tuberculosis is of keyimpact in the control of thedisease. Chest X-rays demonstratesupport of associated pulmonarylesions in less than 25% of cases. Laparoscopywith direct biopsy is an exceptionalinvestigativetechniqueand should be considered for each patient with unsolvedascites. A classicconclusion requires detection ofbacilli in ascitic fluid or peritoneum tissue. However, acidfaststaining is frequently negative and cultures are positivein 30-40% of cases, making bacteriological evidence ofthe disease extremely difficult. In recent times, advances in moleculartechniques have provided aninnovative approach to the fast diagnosisof tuberculosis by nucleic acid probes and polymerasechain reaction. But if molecular techniques fail or unavailable, then presence of caseating granuloma in biopsy material is accepted as hallmark of extra-pulmonary tuberculosis and as significant as positive Acid Fast Bacillus (AFB) in pulmonary tuberculosis. Management is with conventionalanti-tubercular treatment for at least six months.J Shaheed Suhrawardy Med Coll, December 2016, Vol.8(2); 63-68

Indicators for prediction of Mycobacterium tuberculosis positivity detected with bronchoalveolar lavage fluid

BackgroundThe diagnosis of active pulmonary tuberculosis (TB) remains a challenge in clinic, especially for sputum negative pulmonary TB. Bronchoalveolar lavage fluid (BALF) has higher sensitivity than sputum for detection of Mycobacterium tuberculosis (Mtb). However, bronchoscopy is invasive and costly, and not suitable for all patients. In order to make TB patients get more benefit from BALF for diagnosis, we explore which indicator might be used to optimize the choice of bronchoscopy.MethodsA total of 1539 sputum-smear-negative pulmonary TB suspects who underwent bronchoscopy were recruited for evaluation. The sensitivity, specificity and accuracy of Mtb detection in sputum and BALF were compared. Odds ratios and 95% confidence intervals were used to assess variables that associated with positive acid-fast bacilli (AFB) smear, Mtb culture and nucleic acid amplification test (NAAT) of BALF in sputum-negative and non-sputum-producing pulmonary TB suspects.ResultsBALF has significantly higher sensitivity (63.4%) than sputum (43.5%) for Mtb detection by culture and NAAT. 19.7% (122/620) sputum-negative and 40.0% (163/408) non-sputum-producing suspects had positive bacteriological results in BALF. Among sputum-negative and non-sputum-producing pulmonary TB suspects, the positivity of Mtb detection in BALF is associated with a younger age, the presence of pulmonary cavities and a positive result of interferon-gamma release assay (IGRA). Sputum-negative patients under 35 years old with positive IGRA and pulmonary cavity had 84.8% positivity of Mtb in BALF.ConclusionsOur study indicated that combination of age, the presence of pulmonary cavity, and the result of IGRA is useful to predict the positivity of Mtb detection in BALF among sputum-negative and non-sputum producing pulmonary TB suspects. Those who are under 35 years old, positive for the presence of pulmonary cavity and IGRA, should undergo bronchoscopy to collect BAFL for Mtb tests, as they have the highest possibility to get bacteriologically confirmation of TB.

Association between level of interferon gamma and acid-fast bacillipositivity in pulmonary tuberculosis

Tuberculosis is an infectious disease which caused by Mycobacterium tuberculosis (M. tuberculosis) that infected numerous organ especially the lung. A person’s immunity is very affecting for a person exposed to pulmonary tuberculosis. T-helper-1 cell (Th1) is very influential in the immune system especially in interfering intracellular bacterial infection. One of the cytokines known produced by Th1 cell is interferon gamma (IFN-γ) which is in eliminating M. tuberculosis. The study aims to identify the association between level of IFN-γ and AFB positivity in pulmonary tuberculosis patients in Medan. It is a case-control study. The subjects of the study were 60 new cases of pulmonary tuberculosis with AFB sputum smear- positive that never received ATT consisting 20 cases AFB (+1), 20 cases AFB (+2) and 20 cases AFB (+3).Samples were plasma collected from the venous blood of pulmonary tuberculosis patients. The plasma then underwent laboratory assay with ELISA techniques. Independent t-test was p<0.05 considered significant. Level of IFN-γ in TB AFB (+1) is higher than TB AFB (+2) and (+3), with thesignificant statistical result (p=0.001).

Programmatic Impact of Implementing GeneXpert MTB/ RIF Assay for the Detection of Mycobacterium Tuberculosis in Respiratory Specimens from Pulmonary Tuberculosis Suspected Patients in Resource Limited Laboratory Settings of Eastern Nepal

Background:In Nepal, introduction of GeneXpert MTB/RIF assay (Xpert assay) as an initial confirmation test for tuberculosis (TB) has been considered to have impact as a significant decrease in number of clinically diagnosed pulmonary tuberculosis (PTB) cases than previous years. This study aims to find out the distribution profile of suspected tuberculosis cases according to patients age, gender, treatment history and HIV status as well as to evaluate the utility of the Xpert assay over conventional acid-fast bacilli (AFB) staining method for the proper diagnosis of M. Tuberculosis in respiratory specimens from the tuberculosis (TB) suspected patient samples. Methods:The prospective cross-sectional analytical study was conducted in National Anti-Tuberculosis Center (NATA) center- Biratnagar and Primary Healthcare Center (PHC) - Manglabare, Morang District, of eastern Nepal from January 2014 to August 2014. Laboratory investigation was done by conventional AFB staining followed by Xpert assay. Results:A total of 1549 sputum samples were initially analyzed. AFB staining resulted in 1441 AFB smear negative samples and 88 AFB smear positive samples, whereas 20 samples were directly processed for Xpert assay. The male: female smear positive ratio was 2.8:1 and was higher among age groups (21-40) years. Tuberculosis among HIV patients was found 22.22%. Xpert assay demonstrates that out of 1441 smear negative AFB cases, 258 were found to have TB positive, whereas out of 88 smears positive AFB cases 12 were found to have TB negative. The sensitivity of the Xpert assay in patients classified as AFB smear positive was found 85.4% and the specificity in smear negative patients was 81%. Conclusion:The study concluded that implementation of Gene Xpert MTB/RIF assay is a helpful tool for early and rapid detection of tuberculosis with greater sensitivity and specificity over traditional AFB staining techniques.

Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis.

Pulmonary tuberculosis is one of the major health concerns in the developing countries. Isolation of acid-fast bacilli (AFB) or tuberculosis bacilli from the sputum is required for the diagnosis. A proportion of suspected pulmonary tuberculosis (PTB) cases either clinically or radiologically will not produce sputum or will have sputum negative for AFB. These subsets of cases pose a diagnostic challenge to the treating clinicians. In this study, we present our experience and outcomes with flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis. This was a prospective cross-sectional study, conducted at SDS Tuberculosis research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India, from 2010 to 2016. A total of 1095 flexible bronchoscopies were done during this period, out of which 180 were patients with sputum negative for AFB, but were strongly suspected to have pulmonary tuberculosis on clinical examination or radiologically. There were 106 males and 74 females. The age ranged between 11 and 68years. All patients underwent complete evaluation of the tracheobronchial tree followed by bronchoalveolar lavage (BAL). Microbiological studies used were Ziehl-Neelsen (ZN) staining and culture in Lowenstein-Jensen (LJ) medium. Mucosal lesions suspected of tuberculosis were subjected to biopsy and histopathological confirmation. The data was analyzed. Out of 180 patients, 106 (58.88%) cases had positive AFB smear on BAL. The culture confirmed the diagnosis of pulmonary tuberculosis in 120 cases (66.66%). Histopathology showed caseous granuloma in 38 (42.22%) cases, nonspecific inflammation in 40 (44.44%) cases, and malignancy in 12 (13.33%) cases out of 90 cases, who underwent biopsy. There were no post-procedural complications. Bronchoscopy is the useful tool in the diagnosis of pulmonary tuberculosis in patients with sputum-negative pulmonary tuberculosis. It is also helpful in differentiating conditions having the clinical picture that mimics pulmonary tuberculosis.

Cytodiagnosis of tuberculosis using modified bleach method on lymph node aspirates.

Background:The conventional Ziehl–Neelsen (ZN) staining method for demonstration of acid-fast bacilli (AFB) by direct microscopy plays a key role in the diagnosis of tuberculosis. Its major disadvantage is low sensitivity.Aims:The present study was undertaken to emphasize the role of bleach concentration method over conventional ZN smear for detection of AFB in fine-needle aspiration (FNA) material of clinically suspected tuberculous lymphadenitis.Settings and Design:Tertiary care teaching hospital, cross-sectional design.Materials and Methods:FNAs were done on 150 patients with clinical suspicion of tuberculosis presenting with lymphadenopathy. Smears from the aspirates were processed for routine cytology and the conventional ZN method. The remaining material in the needle hub and/or the syringe was used for the bleach method. The significance of the bleach method over the conventional ZN method and cytology was analyzed.Results:Among the 150 aspirates, 57% (85/150) were indicative of tuberculosis on cytology, 37% (55/150) were positive for AFB on conventional ZN method, and the smear positivity for AFB increased to 41% (62/150) on bleach method.Conclusion:The bleach method is simple, safe and inexpensive. It improves the microscopic detection of AFB and can be a useful contribution to routine cytology.

Cytomorphological Spectrum of Lymph Node Lesions on FNA with Special Reference to Acid Fast Bacilli Positivity in Tuberculous Lymphadenitis: A 3-Year Study in a Medical College Hospital in Mandya, Karnataka

Cytomorphological Spectrum of Lymph Node Lesions on FNA with Special Reference to Acid Fast Bacilli Positivity in Tuberculous Lymphadenitis: A 3-Year Study in a Medical College Hospital in Mandya, Karnataka