Presumptive Diagnosis Of Pulmonary Tuberculosis Research Articles

Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria.

BackgroundSeveral case reports abound in literature about cases of histoplasmosis misdiagnosed as tuberculosis (TB). Nigeria is one of the highest TB-burdened countries, but data on histoplasmosis in Nigeria are sparse in the literature. The aim of this research was to investigate patients with presumptive pulmonary TB in Calabar, Nigeria, for histoplasmosis.MethodsThis was a descriptive cross-sectional study of 213 participants with presumptive diagnosis of pulmonary TB between April 2020 and March 2021. Urine samples were collected from selected patients for Histoplasma antigen test using enzyme immunoassay kits, while sputum samples were collected for GeneXpert test for confirmed diagnosis of TB and conventional polymerase chain reaction (PCR) for the diagnosis of histoplasmosis.ResultsOf the 213 participants enrolled into the study, 94 subjects (44.1%) were confirmed TB patients, 75 (35.2%) were human immunodeficiency virus (HIV) positive, 41 (19.2%) had advanced HIV disease (AHD), and 138 (64.8%) were HIV negative. Twenty-seven of the 213 participants were Histoplasma positive by antigen test and/or PCR, giving an overall prevalence rate of 12.7%. The prevalence of histoplasmosis among confirmed TB patients (7.4% [7/94]) was significantly lower than in unconfirmed TB patients (16.8% [20/119]) (P = .04). Participants on anti-TB therapy also had a significantly lower rate of histoplasmosis compared to those not on anti-TB drugs (P = .00006). The internal transcribed spacer (ITS) sequencing of the Histoplasma revealed a closely relatedness to Histoplasma capsulatum.ConclusionsHistoplasmosis is not uncommon among presumptive TB patients. There should be proper microbiological investigation of patients presenting with symptoms suggestive of TB to exclude cases of histoplasmosis.

Dextrocardia with single atrium misdiagnosed as pulmonary tuberculosis in a 9 year old Nigerian girl: a case report

Single atrium with dextrocardia is an uncommon congenital cardiac defect. The affected persons present with varying degrees of cyanosis and respiratory distress. These symptoms could easily be mistaken for pulmonary tuberculosis. We report the case of a 9 year old fully immunized female who presented to our hospital with a history of cough and difficulty in breathing of 5 months, body swelling of 1 month and weight loss of 2 weeks. There was no history of contact with an adult with chronic cough. There was a history of easy fatigability, cyanosis and recurrent respiratory tract infections noted from the age of 2 years. At the onset of symptoms, she was taken to a general hospital where a chest radiograph was done which showed cardiomegaly with prominent hilar opacities. Other ancillary tests for tuberculosis were not conducted. Based on a presumptive diagnosis of pulmonary tuberculosis, she was commenced on anti-tuberculosis drugs but with no relief of symptoms after 5 months of therapy. On examination, she was in respiratory distress, plethoric, cyanosed with grade 4 digital clubbing and bilateral leg oedema. She had a right sided apical impulse with a grade 5 systolic murmur and a loud second heart sound. Echocardiography done revealed dextrocardia, single atrium with severe regurgitation of the mitral valve and pulmonary hypertension. She was admitted and managed with intranasal oxygen, anti-failure regimen and oral pulmonary vasodilators and discontinued on the anti-tuberculous medications. Though the diagnosis of TB requires a high index of suspicion, confrmation is necessary to avoid misdiagnosis.

Comparison of front-loading versus spot morning sputum microscopy approach among suspected pulmonary tuberculosis cases in tertiary care centre in Uttarakhand

PurposeComparative evaluation of front loading sputum microscopic approach versus standard Revised National Tuberculosis Control Programme (RNTCP) spot morning approach for diagnosis of pulmonary tuberculosis. MethodsAll cases coming to the designated microscopy centre, Microbiology in this tertiary care centre with presumptive diagnosis of pulmonary tuberculosis were enrolled for the study population after taking informed consent. The sputum sample collection, staining and reporting were done according to standard RNTCP guidelines. ResultsThis study shows the probable non-inferiority of the frontloading sputum smear microscopy over the standard RNTCP approach. ConclusionThe front loading smear microscopy could be considered a suitable alternate to standard RNTCP approach in an area with high drop out during diagnostic testing pathway.

Presumptive Diagnosis and Treatment of Pulmonary Tuberculosis

Tuberculosis is one of the major public health problems in South-East Asian countries with immense socio-economic impacts. The advantage and disadvantage of starting anti-tubercular therapy in presumptive diagnosis of pulmonary tuberculosis is debatable in a resource constrained settings. Even in the face of high prevalence, important pitfalls warrant consideration.Health Renaissance 2014;12(3): 224-226

Tuberculose pulmonar entre usuários de uma unidade de atenção básica

Objective: To evaluate the prevalence of positive bacterial sputum cases of pulmonary tuberculosis among users of a primary healthcare unit. Methods: Cross-sectional, observational study, conducted between February and August 2011 with 1,873 individuals aged above 18 years seen at a Basic Healthcare Unit (BHU) in the city of Rio de Janeiro, Brazil, selected through convenience non-probabilistic sampling. A tool for the presumptive diagnosis of pulmonary tuberculosis was initially applied. The individuals with positive score were submitted to bacilloscopy. Descriptive statistics was performed, with absolute and percentage frequencies, as well as Fisher’s exact test to assess the association between gender, age, and the results of bacterial sputum microscopy. Results: Of the users seen at the studied BHU, 157 individuals were tested positive for the presumptive diagnosis of tuberculosis. Their most frequent symptoms were cough (76.5%, n=13) and chest pain (70.6%, n=12). There was no significant association between positive bacilloscopy, sex (p=0.477), and age (p=0.186). Conclusion: The frequency of positive bacilloscopy cases of pulmonary tuberculosis among individuals with positive score for presumption of that disease was high in the studied health unit.

Non-tuberculous Mycobacterial Lung Disease Presenting as a Solitary Pulmonary Nodule

We report a case of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule (SPN). A 35-year-old male was admitted due to a SPN in the right upper lobe which was detected on the chest radiography being examed due to recurrent cough for 1 year. The computed tomography (CT) revealed a spiculated nodule containing air-bronchogram, which was suspicious of malignancy. We performed transbronchial biopsy and the pathology showed granulomatous inflammation with caseous necrosis. Under the presumptive diagnosis of pulmonary tuberculosis, we started anti-tuberculous medication including isoniazid, rifampin, ethambutol, and pyrazinamide. In one month, however, the sputum culture was positive for Mycobacterium intracellulare. The follow-up chest CT showed slight aggravation of the previous lesions. Under the final diagnosis of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule, we changed the regimen to rifampin, ethambutol, and clarithromycin. The follow-up chest CT after the completion of treatment, revealed resolution of the previous lesions.

An unusual abacavir reaction

An unusual abacavir reaction

Impact of age and radiographic presentation on the presumptive diagnosis of pulmonary tuberculosis

We compared delay in presumptive diagnosing pulmonary tuberculosis (PTB) in elderly and younger patients, yield of diagnosis and whether the yield is influenced by the radiographic presentation, even when PTB was suspected. Time from first complaints to first consideration of PTB was determined as suspicion interval (SI) and from first consideration to diagnosis as recognition interval (RI). Presumptive diagnosis was defined as positive staining for acid-fast bacilli or presence of granulomatous lesions in pulmonary specimens. In the elderly and in the younger patients, the mean SI was 111.1 and 87.8 days respectively ( P=NS), and the mean RI was 5.9 and 8.3 days, respectively ( P=NS). The mean RI was longer in uncharacteristic than in characteristic radiographic findings in both elderly (8.2 and 4.6 days; P=0.007) and younger patients (10.6 and 3.9 days; P=0.0001). A diagnosis was obtained in 89/113 elderly (79%) and in 109/138 younger (79%) patients ( P=NS) and also in 59/80 (73%) patients with uncharacteristic findings and in 139/170 (82%) patients with characteristic findings ( P=NS). In the latter, sputum contributed for 66% of diagnosis, whereas it was only 31% in patients with uncharacteristic findings ( P<0.005). In elderly patients with uncharacteristic radiographic findings, diagnosis was obtained from sputum in 41% and from other specimens in 35% ( P=NS); in the younger group diagnosis was obtained from sputum in 23% and from other specimens in 48% ( P<0.05). In conclusion, there was no difference in SI and RI in elderly patients in comparison with younger patients. Uncharacteristic radiographic findings increased RI in both age groups. Age or radiographic presentation did not influence diagnosing PTB. In patients with characteristic radiographic findings, diagnosis was especially made from examination of sputum, whereas in those with uncharacteristic findings, diagnosis was more often obtained from the complementary investigation of other specimens.

Pulmonary tuberculosis in children in a developing country.

We evaluated the clinical and epidemiologic characteristics of Peruvian children presenting with pulmonary tuberculosis (PTB) to determine whether features predictive of confirmed PTB could be identified. This was a cross-sectional study of 135 children (mean age: 6.8 years) presenting to the Hospital del Niño in Lima, Peru, with presumptive diagnosis of PTB. Clinical, epidemiologic, and laboratory findings were compared between 3 groups of pediatric patients with a presumptive diagnosis of PTB: those with positive Mycobacterium tuberculosis (MTB) cultures, those likely to have PTB based on clinical criteria but with negative cultures, and those who did not meet clinical diagnostic criteria or have positive cultures. A total of 50 (37%) patients were diagnosed with definitive PTB based on positive sputum culture. Another 55 (47%) patients were classified as having probable PTB based on meeting at least 2 of the following criteria: cough lasting for at least 2 weeks, typical chest radiograph changes, purified protein derivative (PPD) >/=10 mm, or history of tuberculosis family contact. Patients with definitive or probable PTB were significantly older than patients without clinical PTB, and those with symptomatic disease were significantly older than those with asymptomatic disease. Patients with PTB diagnosed by culture were significantly more likely than those diagnosed using clinical criteria to have cough lasting >/=2 weeks, fever, and a PPD >/=10 mm. The typical presentation of PTB in Peruvian children includes symptoms of active pulmonary disease similar to those seen in adults. This presentation differs significantly from that reported in developed countries, where many children have minimal or no symptoms at the time of presentation. The diagnostic criteria for pediatric PTB must be modified in hyperendemic developing country environments where features may differ from those described in the United States. The triad of cough lasting >/=2 weeks, fever, and a PPD >/=10 mm was highly predictive for culture-positive PTB among children in this low-income Peruvian population.

Evaluation of IgA-Mediated Humoral Immune Response Against the Mycobacterial Antigen P-90 in Diagnosis of Pulmonary Tuberculosis

Serologic methods for diagnosis of tuberculosis have been widely investigated owing to their low cost and rapid technical execution. Sensitivity and specificity of different tests have been reported to be largely variable. To evaluate the IgA-mediated humoral immune response against the mycobacterial antigen P-90 as a tool for diagnosis of pulmonary tuberculosis. Eighty-eight patients with microbiologically confirmed diagnosis of pulmonary tuberculosis (32 with positive sputum smears and 56 with negative sputum smears), 28 patients with a definite nontuberculous lung disease, 12 subjects with healed tuberculosis, and 47 healthy volunteers (24 purified protein derivative negative and 23 positive). Detection of anti-P-90 IgA was performed by enzyme-immunoassay. At a cutoff of 0.221 optical density, determined by a receiver operating characteristic curve, the overall sensitivity and specificity of the test were 70.4% and 91.9%, respectively. Patients with active tuberculosis showed significantly higher titers of anti-P-90 IgA compared with other groups (p < 0.05). The evaluation of IgA-mediated humoral immune response against the antigen P-90 might constitute a useful tool for presumptive diagnosis of pulmonary tuberculosis.

Presumptive Diagnosis and Treatment of Pulmonary Tuberculosis Based on Radiographic Findings

We analyzed the outcome of therapy for 139 patients who were treated for a presumptive diagnosis of pulmonary tuberculosis based on radiographic abnormalities. Patients who had acid-fast bacilli seen on sputum smears and patients who had received adequate therapy for tuberculosis in the past were excluded from the analysis. Accuracy of the diagnosis was determined by comparison of clinical and radiographic findings after 3 months of isoniazid, rifampin, and ethambutol, as well as the results of sputum cultures. Of 139 patients started on therapy presumptively, 66 (48%) were determined to have current tuberculosis (16 had positive cultures, 43 because of improvement in their chest films, and 7 because of clinical improvement). Adverse reactions requiring change of therapy occurred in six of 72 (8.3%) patients determined to have inactive tuberculosis. One patient had both tuberculosis and carcinoma found at bronchoscopy after 3 months of therapy. For purposes of comparison, chest radiographs of 59 patients documented by culture to have current tuberculosis were reviewed. Of these, 45 (70%) were improved at 3 months. Presumptive therapy is of benefit in that it stops progression of the disease at an early stage and decreases the potential for spread of tuberculous infection. In addition, such therapy coupled with systematic reevaluation of patients substantiates the diagnosis or indicates that further evaluation is needed. These benefits must be weighed against the adverse reactions and costs of overtreating patients with inactive disease. Determining the appropriateness of presumptive therapy must be based on local factors including prevalence of tuberculosis and available resources.

Subcutaneous Nodules in a Man Diagnosed as Having Tuberculosis

REPORT OF A CASE A 27-year-old man was admitted with a two-month history of multiple tender, raised, erythematous, subcutaneous nodules distributed over his arms, legs, and trunk. Five months prior to admission, the patient had presented with symptoms of nonproductive cough, low-grade fever, night sweats, anorexia, and weight loss. A chest roentgenogram at that time revealed a reticulonodular infiltrate in the right upper lobe, and he was found to have a purified protein derivative (PPD) positive at 20 mm. He was treated with rifampin, isoniazid, and pyrazinamide for the presumptive diagnosis of pulmonary tuberculosis. Three sputum cultures for acid-fast bacilli, however, were negative. He initially felt better, but developed similar symptoms in the ensuing months. He noted a 22-lb weight loss during this time period. His medical history was otherwise unremarkable. The subcutaneous nodules reportedly began as small pimples that gradually enlarged and became fluctuant and mildly warm

Congenital Bronchoesophageal Fistula in the Adult

ESOPHAGEAL - RESPIRATORY tract fistula with esophageal atresia in the infant usually necessitates immediate diagnostic and therapeutic action. Fistulas without atresia often have an insidious clinical course that occasionally persists into adult life. This uncommon cause of chronic pulmonary sepsis needs reemphasis. A recent case prompts this report and an updated review of the literature. Report of a Case A 58-year-old man was admitted to Philadelphia General Hospital in August 1975, with complaints of anorexia, night-sweats without fever, cough, hemoptysis, and weakness in both lower extremities. His past history included chronic alcoholism and a presumptive diagnosis of pulmonary tuberculosis based on positive PPD tuberculin test results and an abnormal infiltrate in the right middle lobe. Sputum cultures were negative for acid-fast bacilli. In 1972, he was treated for three months with isoniazid but subsequently failed to return for followup examination. He also told of numerous unsubstantiated episodes of pneumonia many years

Congenital bronchoesophageal fistula in the adult

ESOPHAGEAL - RESPIRATORY tract fistula with esophageal atresia in the infant usually necessitates immediate diagnostic and therapeutic action. Fistulas without atresia often have an insidious clinical course that occasionally persists into adult life. This uncommon cause of chronic pulmonary sepsis needs reemphasis. A recent case prompts this report and an updated review of the literature. <h3>Report of a Case</h3> A 58-year-old man was admitted to Philadelphia General Hospital in August 1975, with complaints of anorexia, night-sweats without fever, cough, hemoptysis, and weakness in both lower extremities. His past history included chronic alcoholism and a presumptive diagnosis of pulmonary tuberculosis based on positive PPD tuberculin test results and an abnormal infiltrate in the right middle lobe. Sputum cultures were negative for acid-fast bacilli. In 1972, he was treated for three months with isoniazid but subsequently failed to return for followup examination. He also told of numerous unsubstantiated episodes of pneumonia many years