Presence Of Acid-fast Bacilli Research Articles

An unusual cause for recurrent perianal sepsis in Currarino syndrome: Case report and review of the literature

Abstract Currarino syndrome (CS) is a rare symptom complex comprising an anorectal malformation, a sacral bone abnormality and a presacral mass. Recurrent sepsis of the perianal area is a well-described post-operative morbidity. We report the case of a 4-year-old boy with CS and chronic perianal sepsis in the form of a draining sinus at the level of S5, which had plagued him since removal of a benign sacrococcygeal teratoma at the age of 1 year. Normal alfa feto protein and beta-human chorionic gonadotropin levels ruled out malignant recurrence of a sacrococcygeal teratoma, whilst an MRI showed a large presacral abscess with no fistulous connection to the rectum. Biopsy and drainage of the abscess was performed through a posterior sagittal approach and pus was sent for microscopy, culture and sensitivity. Microscopy demonstrated the presence of acid-fast bacilli, confirming infection with Mycobacterium tuberculosis (TB). A review of the literature revealed paucity in the documentation of microbes related to this common complication with no previous reports of TB as the aetiological pathogen. This case is of particular interest as the patient was not immunocompromised, had no TB contacts or history of previous TB infection, and highlights the importance of actively excluding the cause of recurrent perianal sepsis, particularly in syndromes where sepsis is a common complication.

Pancreatic tuberculosis.

Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.

Clinical and gross pathological findings of Johne's disease in a calf: A case report

Objective: This case report describes a clinical case of Johne’s disease (JD) in a Friesian calf aging one and half years. Materials and methods: Physical examination of the calf was carried out, history of the farm as well as samples for laboratory examinations were obtained. The laboratory examinations included hematological examinations by direct wet mount, hematocrit centrifugation technique and Giemsa stain, biochemical evaluation of serum, bacterial culture and isolation from feces and aspirate from the swollen jaw. Results: Clinical history showed that the farm had a history of JD, and routine health screening revealed that one of the calves had clinical signs suggestive of Johne’s disease. Physical examination of the calf revealed a lumpy jaw, enlarged bilateral pre-scapular and pre-femoral lymph nodes, while hematological and biochemical findings showed a normocytic normochromic anemia, severe leukocytosis with neutropilic left shift and lymphocytosis with hyperproteinemia characterized by hyperglobulinemia. Fecal bacterial tests showed the presence of acid fast bacilli. Based on the history and laboratory findings, the cow was diagnosed with JD. In order to ensure effective control measures, the calf was culled from the heard. Postmortem examination revealed inflamed pre-scapular and pre-femoral lymph nodes with the presence of paramphistomes in the rumen mucosa. Conclusion: Since JD is a chronic disease that lingers in livestock farms, there is need for early identification and culling of infected animal in order to limit its devastation on the farm.

Studies on patho-epidemiology of Johne's disease in buffaloes of Malwa region

In the present study, 250 buffaloes of 2 to 7 years of age slaughtered at Cantonment Board slaughter house, Mhow and Indore were examined for chronic enteritis. The incidence of chronic enteritis was found to be 74.4% (186/250), based on the observation of gross and microscopic lesions in intestine and mesenteric lymph nodes. Among 186 cases of enteritis, 5(2%) were of mycobacterial origin (Mycobacterium avium subspecies paratuberculosis), 22(8.8%) of other bacterial origin, 39(15.6%) of parasitic origin and 120(48%) were of non-specific origin. The main difference of Mycobacterium avium subspecies paratuberculosis group with the remaining groups of chronic enteritis was that the intestinal wall was found variably thickened and mucosal corrugation, especially in proximity to the ileo-caecal junction. Histopathology revealed focal aggregates of epithelioid cells in the form of microgranulomas in the small intestine with infiltration of plasma cells in the lamina propriaand granulomas in the paracortical regions of the mesenteric lymph nodes. ZiehlNeelsen's staining showed presence of acid-fast bacilli both in impression smears and tissue sections. On histochemistry tissue section of intestine showed depletion of glycogen and increased mucin activity. Hematological values of Johne's disease cases did not differ significantly from enteritis of other origins, with only moderate difference in the monocyte values. Serum creatinine, blood urea nitrogen, serum glutamic pyruvic transaminase and serum glutamic oxaloacetic transaminase biochemical tests showed highly significant changes compared to normal values. Total protein and C-reactive protein values were variable.

Tuberculous parotid abscess

Abstract Tuberculous parotid abscess is a rare condition and is uncommon. We describe tuberculous abscess of right parotid gland of a 2.5-year-old female child. Diagnosis was confirmed by fine needle aspiration (FNAC) of the lesion that showed presence of acid fast bacilli (AFB). The patient is currently on anti-tuberculous treatment and is progressing satisfactorily.

Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, northeast Ethiopia

BackgroundTB-HIV co-infection is one of the biggest public health challenges in sub-Saharan Africa. Although there is a wealth of information on TB-HIV co-infection among settled populations in Africa and elsewhere, to our knowledge, there are no published reports on TB-HIV co-infection from pastoral communities. In this study, we report the prevalence of TB, HIV and TB-HIV co-infection among pulmonary TB suspects in the Afar Regional State of Ethiopia.DesignIn a cross-sectional study design, 325 pulmonary TB suspects were included from five health facilities. Three sputum samples (spot-morning-spot) were collected from each participant. Sputum samples were examined for the presence of acid fast bacilli using Ziehl–Neelsen staining method, and culture was done on the remaining sputum samples. Participants were interviewed and HIV tested.ResultsOf the 325 pulmonary TB suspects, 44 (13.5%) were smear positive, and 105 (32.3%) were culture positive. Among smear-positive patients, five were culture negative and, therefore, a total of 110 (33.8%) suspects were bacteriologically confirmed pulmonary TB patients. Out of 287 pulmonary TB suspects who were tested for HIV infection, 82 (28.6%) were HIV positive. A significantly higher proportion of bacteriologically confirmed pulmonary TB patients [40 (40.4%)] were HIV co-infected compared with patients without bacteriological evidence for pulmonary TB [42 (22.3%)]. However, among ethnic Afar pastoralists, HIV infections in smear- and/or culture-negative pulmonary TB suspects [7 (7.6%)] and bacteriologically confirmed pulmonary TB patients [4 (11.8%)] were comparable. On multivariable logistic regression analysis, Afar ethnicity was independently associated with low HIV infection [OR=0.16 (95% CI: 0.07–0.37)], whereas literacy was independently associated with higher HIV infection [OR=2.21 (95% CI: 1.05–4.64)].ConclusionsAlthough the overall prevalence of TB-HIV co-infection in the current study is high, ethnic Afars had significantly lower HIV infection both in suspects as well as TB patients. The data suggest that the prevalence of HIV infection among Afar pastoralists is probably low. However, population-based prevalence studies are needed to substantiate our findings.

Do Instructional Videos on Sputum Submission Result in Increased Tuberculosis Case Detection? A Randomized Controlled Trial.

ObjectiveWe examined the effect of an instructional video about the production of diagnostic sputum on case detection of tuberculosis (TB), and evaluated the acceptance of the video.Trial DesignRandomized controlled trial.MethodsWe prepared a culturally adapted instructional video for sputum submission. We analyzed 200 presumptive TB cases coughing for more than two weeks who attended the outpatient department of the governmental Municipal Hospital in Mwananyamala (Dar es Salaam, Tanzania). They were randomly assigned to either receive instructions on sputum submission using the video before submission (intervention group, n = 100) or standard of care (control group, n = 100). Sputum samples were examined for volume, quality and presence of acid-fast bacilli by experienced laboratory technicians blinded to study groups.ResultsMedian age was 39.1 years (interquartile range 37.0–50.0); 94 (47%) were females, 106 (53%) were males, and 49 (24.5%) were HIV-infected. We found that the instructional video intervention was associated with detection of a higher proportion of microscopically confirmed cases (56%, 95% confidence interval [95% CI] 45.7–65.9%, sputum smear positive patients in the intervention group versus 23%, 95% CI 15.2–32.5%, in the control group, p <0.0001), an increase in volume of specimen defined as a volume ≥3ml (78%, 95% CI 68.6–85.7%, versus 45%, 95% CI 35.0–55.3%, p <0.0001), and specimens less likely to be salivary (14%, 95% CI 7.9–22.4%, versus 39%, 95% CI 29.4–49.3%, p = 0.0001). Older age, but not the HIV status or sex, modified the effectiveness of the intervention by improving it positively. When asked how well the video instructions were understood, the majority of patients in the intervention group reported to have understood the video instructions well (97%). Most of the patients thought the video would be useful in the cultural setting of Tanzania (92%).ConclusionsSputum submission instructional videos increased the yield of tuberculosis cases through better quality of sputum samples. If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests. This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings.Trial RegistrationPan African Clinical Trials Registry PACTR201504001098231

Eosinophilic Structure: Should it be Included in Routine Cytology Reporting of Tuberculosis Lymphadenitis?

Fine needle aspiration cytology is a simple, rapid procedure routinely employed for the diagnosis of tuberculosis lymphadenitis. Positivity for acid fast bacilli (AFB) in Ziehl-Neilsen stained smear is still considered as gold standard for diagnosis of Tuberculosis, but all lesions may not yield AFB, thus pose diagnostic problems. Few cytomorphological changes i.e. Eosinophilic structure (ES) in the stained smears correlates with the presence of AFB thus, helping us in rapid diagnosis. To evaluate the correlation between AFB and ES in necrotic lymph node aspirates. This is a retrospective study conducted from January to December 2014. Lymphnodes upon purulent aspiration which were reported as granulomatous lymphadenitis suggestive of tuberculosis were included in the study. All the stained smears (H&E, MGG and ZN Stains) for each case were retrieved from the files and rescreened for the presence of ES, granulomas and AFB. Presences of ES were correlated with AFB. Stastistical analysis was done using Chi-square test. Our study included 103 cases. The common age group involved was 21-40 years, with female predominance. Cervical lymph nodes were most commonly involved. In relation to ES and AFB, four different cytological pictures were seen i.e., ES and AFB-(31%); ES-AFB+(16.5%); ES+, AFB+(39%); ES+AFB-(14.5%). Chi-square test showed a highly significant stastistical association between ES and AFB with p=0.001. Eosinophilic structure is one of the cytomorphological features to be considered in necrotic lymph node aspirate which has a significant correlation with AFB in the smears. Hence pathologist should search for this, and it should be included in routine cytology reporting of tuberculosis lymphadenitis.

Multifocal Tubercular Osteomyelitis with Tubercular Breast Abscess: An Atypical Presentation of Tuberculosis.

Tuberculosis of spine is common in a developing country like India. However, involvement of spine at multiple levels along with involvement of rib and tubercular breast abscess in an immunocompetent patient without any pulmonary involvement is extremely rare. Here we report a case of 53-year-old immunocompetent lady who presented with quadriparesis and MRI (magnetic resonance imaging) of spine revealed multiple lesions involving cervical, thoracic, lumbar, and sacral region without any involvement of intervertebral disc. On detailed examination she was found to have a lump in right breast. Fine needle aspiration cytology of both paravertebral collection and breast lump revealed presence of acid fast bacilli. She was put on antitubercular drug for one year and she responded well to therapy.

Isolated gastric tuberculosis masquerading as chronic peptic Ulcer: A case report

Abdominal Tuberculosis (TB) most commonly affects ileo-caecal region. Isolated stomach involvement by TB, without pulmonary infection is rare. Clinical presentation of Stomach TB may be non-specific, radiological findings non-contributory and superficial endoscopic biopsies may not be able to settle the diagnosis. Many cases are diagnosed only after histopathological examination of surgical specimens. High degree of suspicion is needed for early diagnosis of gastric tuberculosis, if unnecessary surgical interventions are to be avoided. A young patient who was being treated as a case of chronic peptic ulcer for one year was referred for treatment of gastric outlet obstruction. Histopathological examination of gastrectomy specimen of the patient showed multiple caseating granulomas characteristic of tuberculosis and presence of acid-fast bacilli on Fite-Faraco staining, with no evidence of tuberculosis at pulmonary or other body sites. This case of isolated gastric TB is reported for its rarity.

Isolated tubercular hepatic abscess with diffuse pattern mimicking hepatocellular carcinoma in HIV positive patient: a case report

Isolated hepatic tuberculosis presenting as a mass either with or without fever can be confused with hepatocellular carcinoma. Clinical examination and laboratory investigations are not specific. Radiological investigations such as ultrasound and computed tomography cannot confirm the diagnosis; hence it is vital to always make an effort to demonstrate presence of acid fast bacilli in aspirated pus or necrotic material from a liver mass. We present a case of 50 years old male patient with HIV/AIDS who presented with non-specific symptoms without fever, clinically with hepatomegaly mimicking hepatocellular carcinoma with metastasis. Abdominal ultrasound revealed a mass in the left liver lobe, with diffuse involvement in the right liver lobe. Liver mass histology showed granulomatous pattern with epitheloid cell aggregation. Aspirated blood from fine-needle guided biopsy stained on Ziehl Neelsen for acid fast bacilli turned out positive. Clinical examination did not reveal lymphadenopathy, abdominal ultrasound also ruled out para-aortic lymphadenopathy, and chest x-ray was essentially normal. Evaluation of the patient six months after completing quadruple treatment for tuberculosis showed marked clinical improvement. The objective of this case report is to highlight the importance of considering hepatic tuberculosis as a differential diagnosis in cases of hepatomegaly and initiate appropriate investigations to rule out a possibility of Tuberculosis which is potentially treatable with early diagnosis.

Differentiation between Nocardia spp. and Mycobacterium spp.: Critical aspects for bacteriological diagnosis.

New methodologies were developed for the identification of Nocardia but the initial diagnosis still requires a fast and accurate method, mainly due to the similarity to Mycobacterium, both clinical and bacteriologically. Growth on Löwenstein-Jensen (LJ) medium, presence of acid-fast bacilli through Ziehl-Neelsen staining, and colony morphology can be confusing aspects between Nocardia and Mycobacterium. This study describes the occurrence of Nocardia spp. in a mycobacterial-reference laboratory, observing the main difficulties in differentiating Nocardia spp. from Mycobacterium spp., and correlating isolates with nocardiosis cases. Laboratory records for the period between 2008 and 2012 were analyzed, and the isolates identified as Nocardia sp. or as non-acid-fast filamentous bacilli were selected. Epidemiological and bacteriological data were analyzed as well. Thirty-three isolates identified as Nocardia sp. and 22 as non-acid-fast bacilli were selected for this study, and represented 0.12% of isolates during the study period. The presumptive identification was based on macroscopic and microscopic morphology, resistance to lysozyme and restriction profiles using the PRA-hsp65 method. Nocardia spp. can grow on media for mycobacteria isolation (LJ and BBL MGIT™) and microscopy and colony morphology are very similar to some mycobacteria species. Seventeen patients (54.8%) were reported and treated for tuberculosis, but presented signs and symptoms of nocardiosis. It was concluded that the occurrence of Nocardia sp. during the study period was 0.12%. Isolates with characteristics of filamentous bacilli, forming aerial hyphae, with colonies that may be pigmented, rough and without the BstEII digestion pattern in PRA-hsp65 method are suggestive of Nocardia spp. For a mycobacterial routine laboratory, a flow for the presumptive identification of Nocardia is essential, allowing the use of more accurate techniques for the correct identification, proper treatment and better quality of life for patients.

English

year female presented to us with X-ray chest suggestive of right opaque hemithorax. She was on anti-tubercular treatment for the presence of Acid Fast Bacilli (AFB) in pleural fluid. Clinical examination revealed bronchial breathing on right side. CT thorax showed large mass lesion in right hemi thorax with mild pleural effusion. Thoracocentesis and bronchoscopy showed no evidence of malignancy however AFB were detected in bronchial washing. Transthoracic biopsy was positive for malignancy. On Immunohistochemistry (IHC), Thyroid Transcription Factor 1(TTF1) and NAPSIN A were positive, confirming the diagnosis of adenocarcinoma lung. Final diagnosis of primary adenocarcinoma lung with concomitant tuberculosis was established.

Direct identification of Mycobacterium abscessus through 16S rDNA sequence analysis and a citrate utilization test: A case report.

A growing number of nontuberculous mycobacteria infection cases, especially those caused by rapidly growing mycobacteria (RGM), have been reported in the past decade. Conventional methods for mycobacteria diagnosis are inefficient and easily lead to misdiagnosis. New detection methods, such as gene sequencing, have been reported but are not widely used. The aim of the present case report was to provide a quick and exact method of identifying Myobacterium abscessus (M. abscessus) infections. The particular case reported in this study initially manifested as hyperglycemia and papules in the right leg. Routine cultures for fungus were repeatedly negative. However, cultures of the purulent material under aerobic cultivation for five days yielded a rapidly growing, nontuberculous mycobacterium. A Ziehl-Neelsen staining of this mycobacterium revealed the presence of acid-fast bacilli that were finally identified as M. abscessus through 16S rDNA sequence analysis and a citrate utilization test. The current report may help other clinicians to make a quick and accurate diagnosis of RGM infection.

Anemia at the Initiation of Tuberculosis Therapy Is Associated with Delayed Sputum Conversion among Pulmonary Tuberculosis Patients in Dar-es-Salaam, Tanzania

BackgroundPulmonary tuberculosis and anemia are both prevalent in Tanzania. There is limited and inconsistent literature on the association between anemia and sputum conversion following tuberculosis treatment.MethodsNewly diagnosed sputum smear positive pulmonary tuberculosis patients aged ≥15 years initiating on standard anti tuberculosis therapy were recruited from 14 of 54 tuberculosis clinics in Dar es Salaam. Patients were receiving medication according to the recommended short course Directly Observed Therapy (DOT) strategy and were followed up prospectively until completion of treatment (six months). Patients were evaluated before initiation of TB treatment by performing the following; clinical history, physical examination, complete blood counts, serum biochemistry and sputum microscopy. Sputum smears were re-examined at two months of anti-tuberculosis therapy for presence of acid fast bacilli. Anemia was defined as hemoglobin <13 g/dl (males) or <12 g/dl (females). Log-binomial regression was used to assess the association between anemia and sputum conversion at two months.ResultsOf the 1245 patients included in the study, 86% were anemic and 7% were sputum smear positive at two months of anti-tuberculosis therapy. Anemic patients were three times more likely to have sputum positive smear as compared to non-anemic patients at two months (RR = 3.05; 95% CI 1.11–8.40) p = 0.03. The risk for sputum positive smear results increased with severity of anemia (P for trend <0.01).ConclusionBaseline anemia is associated with increased risk for persistent positive sputum smears at two months of tuberculosis treatment. Future studies should evaluate the mechanisms for TB-associated anemia as well as the role of intervention for anemia among TB patients.

Tuberculosis: Laboratory Diagnosis and Dots Strategy Outcome in an Urban Setting: A Retrospective Study

Pulmonary Tuberculosis (TB) is a global public health threat. It has a worldwide distribution with a very high prevalence in Asian countries. A correct diagnosis forms an important and indispensable part of proper and timely treatment. Detection of acid fast bacilli in direct smears has considerable clinical and epidemiological value and remains the most widely used rapid diagnostic test. In smear negative cases, radiography has an important role to play. Directly Observed Treatment Short Course (DOTS) strategy is one of the most cost-effective health interventions to treat tuberculosis. Samples from clinically suspected cases of TB were screened for the presence of Acid Fast Bacilli (AFB). Radiography and culture was done for the AFB negative cases. 760 cases of pulmonary TB were diagnosed by smear examination and 412 by radiography. 270 cases of pulmonary TB were diagnosed in the study. Of the 1422 patients put on DOTS, out of which 1138 (80.1%) were successfully treated. Thus, smear examination for AFB and radiography should go hand in hand for correct diagnosis and treatment of TB by DOTS which is a very successful regimen for developing countries like India.

An ulcerated mass in the cervix: Carcinoma or tuberculosis

Tubercular involvement of the cervix is rare and the clinical presentation often simulates that of cervical carcinoma leading to misdiagnosis. We report here the case of a 31-year-old female who presented with secondary amenorrhea, post-coital vaginal bleeding, lower abdominal pain, and mild low-grade fever. Cervical examination revealed an unhealthy cervix, with an irregular, ulcerated mass that bled on touch, raising the suspicion of a cervical malignancy. Histopathology of the cervical biopsy revealed typical necrotizing granulomas and also confirmed the presence of acid fast bacilli in the specimen. Antitubercular therapy was started and the patient responded, with rapid amelioration of symptoms and regression of the cervical mass. Tuberculosis of the cervix is an uncommonly encountered entity and presentation may closely resemble that of cervical carcinoma. Tuberculosis should be considered an important differential diagnosis of a malignant-appearing lesion of the cervix, especially in areas where it is endemic.

Cutaneous tuberculosis, tuberculosis verrucosa cutis

Cutaneous tuberculosis because of its variability in presentation, wider differential diagnosis, and difficulty in obtaining microbiological confirmation continues to be the most challenging to diagnose for dermatologists in developing countries. Despite the evolution of sophisticated techniques such as polymerase chain reaction (PCR) and enzyme-linked-immunosorbent serologic assay (ELISA), the sensitivity of new methods are not better than the isolation of Mycobacterium tuberculosum in culture. Even in the 21 st century, we rely on methods as old as the intradermal reaction purified protein derivative standard test and therapeutic trials, as diagnostic tools. We describe a case which has been diagnosed and treated as eczema by renowned physicians for 2 years. Incisional biopsy showed the presence of well-defined granulomas and ZN staining of the biopsy specimen showed the presence of acid fast bacilli; a trial of ATT (antitubercular therapy) for 6 months lead to permanent cure of the lesion.

Is primary tuberculosis of breast a forgotten entity? Series of three cases

The incidence of tuberculosis is high in developing country; primary tuberculosis of breast is extremely rare, 3-4% of all breast lesions. Tuberculosis of breast often mimics breast cancers clinically. We are reporting here three cases of primary tuberculosis of breast presented with painless breast lump. Diagnosis was difficult and made by several parameters in different cases. Made by excision biopsy or the presence of acid-fast bacilli or Tuberculin test or Fine needle aspiration cytology of breast lump depending upon the cases. All the patients responded well to anti-tubercular regimen.

PULMONARY TUBERCULOSIS;

Objective: To assess the frequency of smear positive pulmonary tuberculosis patients diagnosed at private laboratories ofSargodha not included in the national DOTS (Direct Observational Therapy Short Course) programme. Study Design: A retrospectivestudy. Place and Duration of Study: Private laboratories of Sargodha from January 2007 to December 2012. Methodology: Dataanalysis of 3952 patients who reported to private laboratories of Sargodha for staining of sputum for AFB was carried out. They were allself reporting and were either suspects of pulmonary tuberculosis or had a history of contact with a smear positive case of TB. Stainingwas done by Ziehl-Neelson method. The smear results were reported as positive or negative. Results: Out of total 3952 specimens 373(9.21%) were found to be positive for the presence of acid fast bacilli. From these 373 positive cases 164 (44%) were female and 209(56%) were males. The age group most frequently associated with the smear positive result was aged &gt; 55 years (13.89%) followed byage &lt; 15 years (10%). Conclusions: A large number of smear positive patients are diagnosed in private sector. These patients are notregistered in DOTS programme of World Health Organization. Their number is not included in the calculating the prevalence TB in ourcountry. It is recommended that TB case notification should be made mandatory by law by private sector health care providers.