Positive Sputum Research Articles

Monitoring Anti-tuberculosis Treatment Response Using Analysis of Whole Blood Mycobacterium tuberculosis Specific T Cell Activation and Functional Markers.

BackgroundBlood-based biomarkers have been proposed as an alternative to current sputum-based treatment monitoring methods in active tuberculosis (ATB). The aim of this study was to validate previously described phenotypic, activation, and cytokine markers of treatment response in a West African cohort.MethodsWhole blood immune responses to Mycobacterium tuberculosis ESAT-6/CFP-10 (EC) and purified protein derivative (PPD) were measured in twenty adults at baseline and after 2 months of standard TB treatment. Patients were classified as fast or slow responders based on a negative or positive sputum culture result at 2 months, respectively. Cellular expression of activation markers (CD38, HLA-DR), memory markers (CD27), and functional intracellular cytokine and proliferation (IFN-γ, Ki-67, TNF-α) markers were measured using multi-color flow cytometry.ResultsThere was a significant increase in the proportion of CD4+CD27+ cells expressing CD38 and HLA-DR following EC stimulation at 2 months compared to baseline (p = 0.0328 and p = 0.0400, respectively). Following PPD stimulation, slow treatment responders had a significantly higher proportion of CD8+CD27–IFN-γ+ (p = 0.0105) and CD4+CD27+HLA-DR+CD38+ (p = 0.0077) T cells than fast responders at baseline. Receiver operating curve analysis of these subsets resulted in 80% sensitivity and 70 and 100% specificity, respectively (AUC of 0.82, p = 0.0156 and 0.84, p = 0.0102).ConclusionOur pilot data show reductions in expression of T cell activation markers were seen with treatment, but this was not associated with fast or slow sputum conversion at 2 months. However, baseline proportions of activated T cell subsets are potentially predictive of the subsequent speed of response to treatment.

Survival Analysis of Risk Factors for Mortality in a Cohort of Patients with Tuberculosis.

Identify the treatment effects and risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under the Directly Observed Treatment Short-Course (DOTS) program to reduce the mortality rate of tuberculosis. A retrospective cohort analysis was conducted on the outcomes of antituberculosis treatment of 7,032 patients with tuberculosis in the DOTS program, in the Tuberculosis Management Information System from 2014 to 2017 in Tianjin, China. The Kaplan–Meier method and multifactor Cox proportional risk regression model were used to analyze the risk factors for mortality during antituberculosis treatment under DOTS. The success rate of antituberculosis treatment was 90.24% and the mortality rate was 4.56% among 7,032 cases of tuberculosis in Tianjin. Cox regression analysis showed that advanced age, male sex, human immunodeficiency virus (HIV) positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) were risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under DOTS. The treatment effects in patients with pulmonary tuberculosis during antituberculosis treatment under DOTS were positive in Tianjin. Advanced age, male sex, HIV positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) increased the risk for mortality during antituberculosis treatment.

Factors associated with unfavorable treatment outcomes among pediatric tuberculosis cases in Harare, Zimbabwe during 2013–2017

BackgroundHistorical neglect of pediatric tuberculosis (TB), compounding the absence of a universally effective vaccine, highlights the importance of successful treatment in combating the global epidemic. Furthermore, compliance with international standards of pediatric TB treatment remains unknown in many high-burden, resource-limited settings. MethodsIn this cross-sectional study, using TB surveillance data, we assessed the treatment outcomes among 853 pediatric TB cases (<15 years old), a study sample that represented all the pediatric TB cases with treatment outcome records in Harare, Zimbabwe during 2013–2017. We also identified factors associated with treatment outcome by multivariate logistic regression. ResultsOf these 853 analyzed cases, 57% were either cured or had completed treatment. In a model accounting for confounding variables, hospital center and pretreatment sputum smear were associated with unfavorable treatment outcome. Cases from Beatrice Road Infectious Disease Hospital were four times as likely to have an unfavorable outcome compared with those from Wilkins Infectious Disease Hospital (adjusted odds ration [aOR]: 4.0; 95% CI 2.9–5.5). Children whose pretreatment sputum smear was positive were 2.4 times as likely to have an unfavorable outcome as those who were negative (aOR: 2.4; 95% CI 1.7–3.6). ConclusionPediatric TB case management needs to be improved, especially among those with a positive pretreatment sputum smear. Efforts to address TB treatment outcome disparities between clinical settings in high-burden settings, such as Harare, Zimbabwe, are essential in improving global TB control.

Prediction of treatment failure and compliance in patients with tuberculosis

BackgroundTo improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data.MethodsA multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015–2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea.ResultsA total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76).ConclusionTo reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.

Mycobacterium avium Complex: Addressing Gaps in Diagnosis and Management.

Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and an important cause of disease. The most common species causing pulmonary disease are members of Mycobacterium avium complex (MAC). MAC pulmonary disease (MAC-PD) can be chronic, debilitating, costly, and associated with a high mortality. However, MAC diagnoses are often delayed due to the nonspecific presentation of MAC-PD and radiological findings that overlap with other pulmonary diseases. Patients with risk factors and who meet the diagnostic criteria—which include clinical, radiological, and microbiologic criteria—should be considered for treatment. Diagnosis requires 2 or more positive sputum cultures or 1 bronchoscopic specimen culture. The recommendation for those who are treated is a 3-drug regimen including macrolide, rifamycin, and ethambutol that is continued for 12 months beyond sputum culture conversion to negative. MAC-PD is difficult to treat, with frequent drug-related side effects and suboptimal treatment outcomes. Refractory and recurrent disease is common, leading to lifelong follow-up of patients. There are limited treatment options for patients with macrolide-resistant or refractory disease. Amikacin liposome inhalation suspension is recommended for treatment-refractory patients whose cultures remain positive after 6 months of guideline-based therapy. Among the research priorities to improve patient outcomes and quality of life are developing new, more rapid diagnostic tests, investigating biomarkers associated with disease progression, and identifying new drugs and routes of administration as well as new, shorter, and better-tolerated regimens.

C-reactive protein as a prognostic marker and guidance for use of antibiotic therapy in patients presenting with lower respiratory tract manifestations in intensive care unit in tertiary care centre

Introduction: C-reactive protein is a acute phase reactant protein synthesized in the liver and in response to various stimuli. It is a simple blood test to distinguish between viral and bacterial pneumonia. It is a cheap and easily available useful adjunctive test to limit the use of antibiotics in patients presenting with lower respiratory tract manifestations. Materials and Methods: It is a prospective study of 60 patients admitted with lower respiratory signs and symptoms in Intensive Care Unit of Mallareddy institute of medical sciences, Hyderabad, Telangana. Serum CRP level measured by latex agglutination method and other markers of infection like Complete blood count, Sputum microscopy culture and sensitivity and chest X-ray were done on presentation. CRP concentration of more than 20mg/l taken as positive. Number of CRP positive patients were correlated with patients of increased WBC count and positive sputum routine culture and sensitivity and results were compared using chi -square test. Result: Total 60 patients were taken for study out of which 38 were male and 22 were female. Out of which 24(40%) were diagnosed with pneumonia,6(10%) with pulmonary koch’s,7(11.6%) with acute exacerbation of asthma,11(18.3%) were COPD,4(6%) with congestive cardiac failure, 5(8.3%) with autoimmune disorder and 3(5%) with interstitial lung disease. Among them 29(48.3%) patients were found to have CRP value of more than 20mg/dl which is considered as positive, out of these 29 patients, 16(55.17%) were having pneumonia which was confirmed on imaging and sputum culture and sensitivity. Out of these 29 patients with CRP positive 21(72.4%) were found to have sputum culture and sensitivity as positive for bacteria in which 4(19%) were diagnosed as autoimmune disorder,2(9%) with bronchial asthma, 10(47.6%) with pneumonia, 3(14.2%) with COPD, 2(9.5%) with pulmonary Koch’s. Among 29 patients with positive CRP,18(62%) patients have the WBC count of >11,000cells/mm3. Patients with

Neutrophils to Lymphocyte Ratio as a Biomarker in Bronchiectasis Exacerbation: A Retrospective Study.

IntroductionBronchiectasis is a disorder resulting mainly from bronchial inflammation caused by recurrent or chronic infections. It is characterized by permanently dilated airways due to bronchial wall destruction. Exacerbations have a key role in bronchiectasis as they are associated with a negative impact on patient prognosis. Exacerbations are generally infectious events caused mostly by bacterial microorganisms. Infective or inflammatory agents cause neutrophil recruitment into the airways, which leads to proteolytic enzymes such as neutrophil elastase and matrix metalloproteinases release, resulting in airway matrix destruction. Neutrophil to lymphocyte ratio (NLR) is used as a biomarker of inflammation. It is calculated by dividing the number of neutrophils by the number of lymphocytes. Our aim is to evaluate Neutrophils to Lymphocyte Ratio in patients with bronchiectasis exacerbation and its correlation to microbiological data.Methods The study involved patients with a diagnosis of bronchiectasis based on high-resolution computerised tomography (HRCT) of the chest who fulfilled the criteria of bronchiectasis exacerbation. Complete blood counts with differential counts, which included total white blood cells, neutrophils and lymphocytes, were obtained. NLR and C-reactive protein (CRP) levels were measured in patients with bronchiectasis exacerbation and in healthy controls. NLR was calculated as the ratio of the neutrophils to lymphocytes. The mean NLR values in patients with bronchiectasis exacerbation were compared to mean NLR values in healthy controls. The NLR values were compared to CRP levels in patients with bronchiectasis exacerbation. Sputum cultures were performed in all patients. The mean NLR values in patients with positive sputum cultures were compared with mean NLR values in patients with negative sputum cultures, and mean NLR values in patients with isolated Pseudomonas aeruginosa in sputum cultures were compared to mean NLR values in patients with other infectious agents isolated.ResultsThe study population consisted of 80 patients with bronchiectasis exacerbation - 54 males and 26 females - with a mean age of 77.3±8.4 years, and 64 healthy controls - 36 males and 28 females - with a mean age of 62.9±15.3 years. The mean CRP levels in patients with bronchiectasis exacerbation were 75.03±73.87 mg/l. The mean NLR value in patients with bronchiectasis exacerbation was 9.2±7.8 and the mean NLR value of controls was 3.1±2.9 (p<0.001). The NLR values in patients with bronchiectasis exacerbation had no linear correlation with CRP values in these patients (r=0.002, p=0.992). Fifty-two patients had positive sputum cultures and 28 patients had negative sputum cultures. The mean NLR value in patients with positive sputum cultures was 10.5±9.1, and in patients with negative sputum cultures, it was 6.7±3.6 (p<0.012). The mean NLR value in patients with P.aeruginosa was 10.1±9.5, and in patients with other microorganisms isolated, it was 10.8±8.9 (p=0.784).ConclusionsNeutrophil to lymphocyte ratio values are statistically greater in patients with bronchiectasis exacerbation compared to healthy controls. There is no linear correlation between NLR and CRP in these patients. NLR values are statistically greater in patients with positive sputum cultures compared to those with negative sputum cultures. Therefore, NLR can be used for predicting positive cultures in patients with bronchiectasis exacerbation.

Analysis of clinical characteristics of 21 cases of acute fibrinous and organizing pneumonia

Objective: To summarize the clinical features of 21 cases of acute fibrinous and organizing pneumonia (AFOP) confirmed by pathology, thereby improving clinicians' understanding of this disease and avoiding misdiagnosis in clinical practice. Methods: Twenty-one patients diagnosed pathologically with AFOP from January 2016 to April 2019 were analyzed retrospectively. The clinical symptoms, laboratory examination results, imaging features, treatments and outcomes were analyzed comprehensively. Results: There were 10 males and 11 females, with an average age of (58±10) years. All the cases presented subacute disease onset. The main symptoms were cough, expectoration and fever. The results from laboratory examination showed that the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly higher than the normal levels. The total number of leukocytes, the percentage of neutrophils, and procalcitonin were also higher than the normal levels. Among these patients, 4 cases showed positive sputum bacteriology. Nine patients were found to have probable etiological factors (infections in 4, tumors in 4 cases, and connective tissue disease in 1 case). Twelve patients had no confirmed etiological factors. As to radiological findings, the patterns were multiple patchy infiltrates(16/21), solitary mass (3/21) and multiple nodules in both lungs (2/21). Most lesions were subpleural in distribution (15/21), with air bronchogram sign (11/21), pleural effusion (9/21), and cavity (4/21). Three patients received anti-infective therapy only. The infiltration in lung disappeared within 2 months in one patient, but the lesion still existed in one case after three years of follow-up. However, one patient were lost during the follow-up. Eighteen patients were treated with oral glucocorticoids, and about 50% of the patients showed significant improvement in symptoms and imaging findings within one month. The average follow-up time was (22±10) months, and there was no death. Conclusions: The clinical and imaging findings of AFOP are nonspecific. The exact mechanism of its pathogenesis is not clear. Infection and tumor may be related to the pathogenesis of AFOP. AFOP with subacute onset has a good response to glucocorticoid treatment with a better prognosis.

Stealth Adapted Viruses with Genetically Unstable Rhesus Monkey Cellular Sequences A Possible Forerunner of Complex Human Illnesses

Real time PCR is a widely used for molecular diagnosis of tuberculosis in routine diagnosis laboratory. There are many commercially avaliable system. The sensitivity of the system varies according to DNA extraction from the sample and target specific primers and probes and commercial systems. In this study, the sensitivity and specificity of AdvanSure TB/NTM real time PCR kit were evaluated for detecting mycobacteria in smear positive and negative sputum specimens of 35 active pulmonary tuberculosis patients. All specimens were corrected using EZN staining, solid (Löwenstein Jensen) and liquid culture (MGIT). Culture and clinical findings were used as gold standards in the evaluation of all PCR results. Overall true positivity was found 25 ( 71.42%). When smear negative samples were evaluated together with culture results, only 3 patients were found positive by PCR test in 10 samples (30%).

Molecular Detection of Drug resistant and Non Tuberculosis Mycobacteria using Line Probe Assay: A case study from North India

Growing concerns about the spread of multidrug-resistant tuberculosis (MDR-TB) and the emergence of extensively drug-resistant TB have triggered substantial interest in the development and application of rapid tests for the detection of drug-resistant TB. Molecular assays to detect gene mutations that signal drug resistance are widely recognized as being most suited for rapid diagnosis. Among molecular assays, line probe assays (LPA) have shown great promise. In this study, we have tested eight hundred thirty smear positive sputum samples by LPA for the presence of M. tuberculosis complex and resistance to isoniazid and rifampicin as per the diagnostic mandate of an accredited reference laboratory. As per the mandate, samples that were positive for M. tuberculosis complex were cultured, and then again tested by LPA. A retrospective analysis of the results was carried out. M. tuberculosis complex could be detected in 797 (96.02%) but not in 33 (3.9%) of smear-positive sputum samples. Of the 797 positive samples, 24 (3.0%) were MDR, 6 (0.75%) were rifampicin mono-resistant and 33(4.1%) were INH mono-resistant. LPAs have a continued role for use in settings where rapid identification of INH resistance and clinically relevant NTM are priorities.

Effect of Diabetes Mellitus on Tuberculosis Treatment Outcomes among Tuberculosis Patients in Kelantan, Malaysia.

Background:There is growing evidence that DM may play an important role in the occurrence of unsuccessful TB treatment outcomes. This study was undertaken to examine the prevalence of DM among TB population, compare the profile of TB patients with and without DM and determine the effect of DM on unsuccessful treatment outcomes among TB patients in Kelantan state, Malaysia from 2012 to 2016.Methods:A cross sectional study was conducted in Sep 2017 using data from registered TB cases in Kelantan state, Malaysia from 2012 to 2016. The profile of TB patients with and without DM were compared in univariable analysis. Multiple logistic regression was used to determine association between DM and unsuccessful treatment outcomes.Results:A total of 1854 TB patients were diagnosed with DM. The annual proportion was ranging from 26 to 29%. TB patients with DM had an older age, live single, low educational status, poor chest x ray finding and diagnosed with smear positive sputum compared to TB patients without DM. TB patients with DM had three times higher risk to develop unsuccessful TB treatment outcomes compared to TB patients without DM (95% CI 2.47–3.58; P = 0.012) in multivariable analysis.Conclusion:Those with DM had the worst prognosis of TB outcomes among the significant risk factors. TB control program in Malaysia will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination.

Clinical Cure and Microbiological Eradication in Respiratory Tract Infections

Aims: To study the concordance between clinical cure and microbial eradication in severe respiratory tract infections. Methods & Material: A prospective cohort study was done at a tertiary care teaching hospital. Patients above 18 years of age with respiratory tract infections confirmed with positive sputum cultures participated in the study. Microbiological eradication was considered complete when no microorganism was isolated on 2 consecutive sputum cultures. Results: The number of valid cases was 102. The mean age of patients was 58.6±16.1 (range, 19-82 years). Complete eradication of microorganisms was achieved in 54.5%(n=55) cases. In 33% (n=34) clinically successful cases, strains like Pseudomonas, Acinetobacter and Kleibsiella were not eradicated and were isolated at study end point on repeat sputum culture. Relapse was observed in 9.2% (n=9) cases. On multiple logistic regression to ascertain the impact of independent variables on dependent variable (clinical cure/ microbiological cure), it was observed that increasing age, odds ratio=1.66(95% CI, 1.34-2.03), patient?s background OR=6.4 (95% CI, 0.68-63.4), ventilatory support OR=2.8 (95% CI, 0.4-22.4) significantly (P<0.05) influenced end stage clinical outcome. Increasing age, odds ratio=2.33 (95% CI, 1.56- 2.84) and ventilatory support OR=3.4 (95% CI, 2.46-4.66) significantly (P<0.05) influenced microbiological eradication. Conclusion: Clinical endpoint and microbiological eradication correlated in 54.5% cases. Discordance or failed eradication was more frequent in infections with Acinetobacter, Enterobacter and Pseudomonas. Failure to eradicate microorganisms was commonly associated with emergence of resistance to antibiotics.

Changes in ARB Sputum Positivity, BMI and TNF-? Levels of Pulmonary TB Patients with ARB Positive During One-month Intensive Treatment

Backgoround: TNF-? plays a role in the occurrence of anorexia and weight loss in pulmonary tubercolusis (TB) patients. Evaluation of treatment response can be done with clinical, microbiological and radiological evaluation. In patients without cough, Body Mass Index (BMI) and TNF-? levels can be used to evaluate clinical treatment response. Objectives: The aim of the study is to measure the Acid Resistant Bacteria (ARB) sputum positivity decrease, TNF-? levels and increased BMI after 2 weeks and 4 weeks intensive treatment of pulmonary TB patients with new case of ARB positive. Methods: The sample size was 14 people with ARB positive pulmonary TB cases, consisting of 9 men and 5 women. It was done sputup smear, BMI and TNF-? examination before treatment, at week 2 and week 4 of intensive phase treatment Result: At the end of the second week, TNF-? levels decreased significantly compared to baseline TNF-? levels with p = 0.015. There was a non significant increase of BMI at the end of the second and fourth week with p = 0.309 and p = 0.270 respectively. The decrease in ARB sputum smear positivity at the end of the second week compared to the fourth week was not statistically significant with p = 0.157. There was a strong correlation between TNF-? and IMT levels before treatment with negative correlation, r = -0.702 and p = 0.005. Conclusion: Levels of TNF-? at the end of the second week decreased significantly compared to baseline TNF-? levels. There was a strong correlation between TNF-? levels and BMI prior to treatment.

Dual-Energy Computed Tomography Lung in patients of Pulmonary Tuberculosis.

Objectives:The objective of this study was to characterize findings of high-resolution computed tomography (HRCT) and dual-energy CT (DECT) (80 keV, 140 keV, and mixed) in pulmonary tuberculosis (TB) patients and to compare and correlate HRCT and DECT findings.Material and Methods:This cross-sectional study was conducted on 67 patients of 18–65 years of age who were suspected cases of pulmonary TB with signs and symptoms of cough, fever, hemoptysis, sputum, night sweats, and weight loss with positive sputum AFB examinations/bronchoalveolar lavage. All the patients subjected to HRCT scan and followed with DECT scan. Comparison of various imaging techniques (DECT 80 keV, DECT 140 keV, and DECT mixed) with HRCT was done for detecting lung findings and data so obtained were subjected to statistical analysis.Results:On comparing the various imaging techniques with HRCT for detecting consolidation, tree in bud pattern, cavitary lesions, ground-glass opacity, bronchiectasis, atelectasis, nodules, granuloma, peribronchial thickening, and fibrosis, the maximum agreement of HRCT was found with DECT 80 keV and minimum agreement was found with DECT 140 keV.Conclusion:The study concluded that DECT 80 keV monochromatic reconstructions among 80 keV, mixed, and 140 keV monochromatic reconstructions in lung parenchyma window settings are a faster and better analytical tool for the assessment of findings of pulmonary TB when compared with HRCT.

Use of Xpert MTB/RIF for diagnosis of pediatric tuberculosis in Indonesia

Background The Xpert MTB/RIF assay demonstrated a better diagnostic value than sputum smear for TB in adults and children.&#x0D; Objective To evaluate the use of Xpert MTB/RIF for TB diagnosis in children.&#x0D; Methods We conducted a prospective study in Yogyakarta, Indonesia, involving 19 primary health centers (PHCs) and one provincial hospital. Children aged 0-14 years with suspected TB who visited the study sites were screened. Subjects underwent history-taking, physical examination, tuberculin skin test, chest X-ray, as well as sputum induction for Xpert MTB/RIF assay, sputum smear, and TB culture. The diagnosis of TB was made by doctors based on the results of investigations, as follows: certain TB (bacteriological confirmation), probable TB, and possible TB.&#x0D; Results Of 80 subjects, 21 (26%) were diagnosed with TB disease (4 certain TB and 17 probable TB). Sputum induction was successfully performed in 79 children. None of the children had positive sputum smears. Mycobacterium tuberculosis was detected by Xpert MTB/RIF in 4 children, accounting for 5% of all children with suspected TB, or 19% among children with TB disease. The 4 Xpert MTB/RIF-positive subjects had severe TB disease and were rifampicin-sensitive.&#x0D; Conclusion Xpert MTB/RIF may improve case finding among children with severe TB disease with negative sputum smear.

Evaluation of the pneumococcal urinary antigen test (PUT): a retrospective study.

To determine the usefulness of the pneumococcal urinary antigen test (PUT) and to describe the characteristics of pneumococcal pneumonia. In this retrospective study, we examined the effects of prior antibiotic treatment, pneumonia onset period, and sputum quality on the results of PUT. Clinical information was collected via medical records from all adult patients who were hospitalized at the Fujita Health University Bantane Hospital with "pneumonia" as a new diagnosis from April 2015 to March 2018. A total of 482 patients with pneumonia were included, of whom 103 had pneumococcal pneumonia. The frequency of PUT positivity did not differ significantly in patients with a pneumonia onset period of ≥3 days compared with those with a period of ≤2 days (P=0.514). Patients with a history of prior antimicrobial therapy had a significantly lower rate of positive sputum culture vs those with no such history (P=0.005); however, PUT positivity in the two groups did not differ significantly (P=0.367). Our results showed that urinary antigen testing for pneumococcal pneumonia is useful for diagnosis regardless of prior antibiotic treatment and time since symptom onset.

Surgical treatment of pulmonary tuberculosis in patients with concurrent parenteral viral hepatitis

The objective: to assess the effect of parenteral viral hepatitis on the manifestations of respiratory tuberculosis and the nature of surgical interventions for tuberculosis.Subjects and methods. An ambispective observational study was conducted with a continuous sampling of 475 respiratory tuberculosis patients over 18 years old who underwent surgical interventions. The patients are divided into two groups: the group of RTB+PVH consisted of 92 patients with concurrent respiratory tuberculosis and chronic parenteral viral hepatitis; the group of RTB included 383 patients with respiratory tuberculosis and no parenteral viral hepatitis.Results. It was found that compared with RTB group, in RTB+PVH group (regardless of the type of hepatitis virus), a chronic course of tuberculosis was registered significantly more often (42.4%; p = 0.005; OS = 2.0); more often bacillary excretion was documented (68.5%; p = 0.035; OR = 1.7), including those with multiple and extensive drug resistance (52.4% of cases with positive sputum tests, p = 0.048; OR = 1.8). Radical (69.6%; p = 0.05; OS = 1.7) and small-scale surgical interventions (64.1%; p = 0.037; OS = 1.8) were significantly less frequently performed in RTB+PVH patients; and such patients often developed postoperative complications (8.7%; p = 0.009; OS = 2.9).

Evaluation of Advansure TB/NTM Real Time PCR Kit for Detection of Mycobacteria in Sputum Specimens

Real time PCR is a widely used for molecular diagnosis of tuberculosis in routine diagnosis laboratory. There are many commercially avaliable system. The sensitivity of the system varies according to DNA extraction from the sample and target specific primers and probes and commercial systems. In this study, the sensitivity and specificity of AdvanSure TB/NTM real time PCR kit were evaluated for detecting mycobacteria in smear positive and negative sputum specimens of 35 active pulmonary tuberculosis patients. All specimens were corrected using EZN staining, solid (Löwenstein Jensen) and liquid culture (MGIT). Culture and clinical findings were used as gold standards in the evaluation of all PCR results. Overall true positivity was found 25 ( 71.42%). When smear negative samples were evaluated together with culture results, only 3 patients were found positive by PCR test in 10 samples (30%).

Urine lipoarabinomannan as a marker for low-risk of NTM infection in the CF airway

BackgroundIndividuals with Cystic fibrosis (CF) are the most vulnerable population for pulmonary infection with nontuberculous mycobacteria (NTM). Screening, diagnosis, and assessment of treatment response currently depend on traditional culture techniques, but sputum analysis for NTM in CF is challenging, and associated with a low sensitivity. The cell wall lipoarabinomannan (LAM), a lipoglycan found in all mycobacterial species, and has been validated as a biomarker in urine for active Mycobacterium tuberculosis infection. MethodsUrine from a CF cohort (n = 44) well-characterized for NTM infection status by airway cultures was analyzed for LAM by gas chromatography/mass spectrometry. All subjects with positive sputum cultures for NTM had varying amounts of LAM in their urine. No LAM was detected in subjects who never had a positive culture (14/45). One individual initially classified as NTM sputum negative subsequently developed NTM disease 657 days after the initial urine LAM testing. Repeat urine LAM testing turned positive, correlating to her positive NTM status. Subjects infected with subspecies of M. abscessus had greater LAM quantities than those infected with M. avium complex (MAC). There was no correlation with disease activity or treatment status and LAM quantity. A TB Capture ELISA using anti-LAM antibodies demonstrated very poor sensitivity in identifying individuals with positive NTM sputum cultures. ConclusionThese findings support the conclusion that urine LAM related to NTM infection may be a useful screening test to determine patients at low risk for having a positive NTM sputum culture, as part of a lifetime screening strategy in the CF population.

Longitudinal monitoring of sinonasal and oral bacterial reservoirs to prevent chronic lung infection in people with cystic fibrosis.

BackgroundParanasal sinuses act as bacterial reservoirs and contribute to transmitting bacteria to the lower airway of patients with cystic fibrosis (CF). Also, passage of bacteria from the oral cavity to the lungs may occur.MethodsWe evaluated the presence of Pseudomonas aeruginosa, Staphylococcus aureus, Stenotrophomonas maltophilia, Achromobacter xylosoxidans and Serratia marcescens in sputum and nasal lavage of 59 patients with CF, and also collected saliva and used toothbrushes from 38 of them. We assessed the clonal identity of the strains isolated from the different samples by pulsed-field gel electrophoresis.ResultsAbout 80% of the patients were positive for at least one of the bacterial species examined in nasal lavage and sputum. Among the subjects with positive sputum, 74% presented the same species in the nasal lavage and saliva, and 26% on their toothbrush. S. aureus was the most abundant species in all samples. Clonal identity (≥80% similarity) of the strains isolated among the different samples from each patient was confirmed in almost all cases. Longitudinal observation helped to identify five patients who were colonised in the lower airways after an initial period of nasal or oral colonisation.ConclusionNasal and oral sites act as bacterial reservoirs, favouring the transmission of potentially pathogenic microorganisms to the lower airway. The lack of eradication from these sites might undermine the antibiotic therapy applied to treat the lung infection, allowing the persistence of the bacteria within the patient if colonisation of these sites is not assessed, and no specific therapy is performed.