Primary Diagnosis Of Tuberculosis Research Articles

Tracking Mycobacterium tuberculosis sequencing samples using unique spikes of random DNA

In the Netherlands, local laboratories are involved in the primary diagnosis of tuberculosis. Positive Mycobacterium tuberculosis complex cultures are sent to the National Institute for Public Health and the Environment (RIVM) for species identification, epidemiological typing, and screening for resistance by Whole Genome Sequencing (WGS). Occasional sample-swaps and cross-contaminations are known to occur in the diagnostic procedures. Such errors may lead to incorrect diagnoses resulting in the unnecessary or sub-optimal treatment of patients. Internal controls throughout the process ideally allow the early detection of such mistakes.

Аssessment of social risk factors of tuberculosis contamination in HIV-infected people according to epidemiological survey of epidemic foci

Objective. Assessment of tuberculosis (TB) infection conditions for HIV-infected people.Materials and methods. Еpidemiological survey of 38 epidemic foci of HIV-associated tuberculosis, 28 foci of tuberculosis without HIV infection and 20 foci in which the diagnosis of tuberculosis wasn`t confirmed (control-group) were conducted.Results and its discussion. As it turns out that in the most cases of the development of HIV-associated TB, the primary diagnosis of HIV infection preceded the primary diagnosis of tuberculosis. According to the results of the case-control analytical epidemiological study, such risk factors of HIV-infected tuberculosis as lack of family, higher education and regular job, the fact of deprivation of liberty and drug users (as a reflection of the low social status of patients), as well as contact with tuberculosis patient were identified. Risk factors for mycobacteria infection in people without HIV infection were only the lack of family and contact with tuberculosis patients.

A Belief Rule Based Expert System to Assess Tuberculosis under Uncertainty

The primary diagnosis of Tuberculosis (TB) is usually carried out by looking at the various signs and symptoms of a patient. However, these signs and symptoms cannot be measured with 100 % certainty since they are associated with various types of uncertainties such as vagueness, imprecision, randomness, ignorance and incompleteness. Consequently, traditional primary diagnosis, based on these signs and symptoms, which is carried out by the physicians, cannot deliver reliable results. Therefore, this article presents the design, development and applications of a Belief Rule Based Expert System (BRBES) with the ability to handle various types of uncertainties to diagnose TB. The knowledge base of this system is constructed by taking experts’ suggestions and by analyzing historical data of TB patients. The experiments, carried out, by taking the data of 100 patients demonstrate that the BRBES’s generated results are more reliable than that of human expert as well as fuzzy rule based expert system.

Live donor liver transplantation for antitubercular drug-induced acute liver failure.

Antitubercular therapy (ATT)-induced hepatotoxicity is often over looked andactive tuberculosis is considered a contraindication for liver transplantation, however itmight be the only lifesaving option to certain patients of acute liver failure (ALF) due to ATT. We have assessed the outcome of live donor liver transplantation in ATT-induced ALF. A retrospective analysis of all the cases of ALF that underwent liver transplantation from 2006 to 2014 at the Amrita Institute of Medical Sciences was done. A total of seven (7.7%) patients with ATT-induced ALF who had underwent live donor liver transplantation were included in the study. Out of seven patients, three (42.8%) had established diagnosis of tuberculosis and the remaining (58.2%) patients were started on ATT empirically. The median duration of ATT intake was 2months. All the patients underwent live donor liver transplant as they met King's College criteria, and their model for end-stage liver disease score was above 35 on admission, receiving graft from first degree relatives. Histopathology of explant liver showed pan acinar necrosis. Restarting of ATT after transplant was individualized. It was restarted only in two (28%) patients with prior sputum-positive pulmonary tuberculosis after a median time of 27days after transplant. ATT was not restarted in rest of the (72%) patients. Postoperative mortality was seen in two (28%) patients due to conditions that masquerade the ATT-induced acute liver failure. The overall survival rate was 71.4% with a median follow up of 22months. Live donor-related transplantation is feasible option in ATT-induced acute liver failure. Restarting of ATT post liver transplant is feasible and should be individualized along with frequent monitoring of immunosuppressant levels; however, if the primary diagnosis of tuberculosis was empirical, reintroduction of ATT can be omitted.

Diabetes as an increasingly common comorbidity among patient hospitalizations for tuberculosis in the USA.

ObjectiveDiabetes is a risk factor for active tuberculosis (TB). The purpose of this paper was to estimate the risk of hospitalization for TB with and without a secondary diagnosis of diabetes in groups with different ethnic backgrounds.Research design and methodsWe used the Nationwide Inpatient Sample from 1998 to 2011, identifying all patients with a primary diagnosis of TB and/or a secondary diagnosis of diabetes (type 1 or type 2) or HIV. Next, we performed logistic regression to investigate the association of diabetes status, HIV status, and race (and the interaction of diabetes and race) with the risk of hospitalization with a primary diagnosis of TB. We also included a time covariate, to determine whether potential risk factors changed during the study period.ResultsControlling for HIV status, diabetes did not increase the odds of TB in white and black patients. However, in Hispanic and Asian/Pacific Islander patients, diabetes increased the odds of TB by a factor of 1.7 (95% CI 1.51 to 1.83). Asian/Pacific Islanders who had diabetes but not HIV experienced 26.4 (95% CI 23.1 to 30.1) times the odds of TB relative to the white males without diabetes or HIV. In addition, the percent of TB cases that belong to these high-risk groups (Asian/Pacific Islander/Hispanic diabetics) has more than doubled from 4.6% in 1998 to 9.6% in 2011.ConclusionsIn specific demographic groups, diabetes was a strong risk factor for hospital admissions for TB.

The Medium for Acceleration of <i>Mycobacterium tuberculosis</i> Growth

This article has described the results of studies conducted on pre-culture samples in a modified environment Shkolnikova Dorozhkova at 37°C during 24 - 48 hours. It was stated that this method helps grow Mycobacterium tuberculosis, which, when sown on the medium give rise visible colonies on the 5th - 7th day. These data confirm the possibility to accelerate the growth of mycobacteria and shorten the terms of diagnosing tuberculosis by 3 or 4 times thanks to pre-culturing of the diagnostic material in the experimental medium. The original conception of the Mycobacterium tuberculosis development step-by-step was elaborated which was based on changeability of mycobacteria and prominent character of their development from division of the bacterial cells to the development of the maturated cells and further biological transformation under conditions of the surrounding factors. This conception gave the explanation of the integrated picture of the biological changeability of Mycobacterium tuberculosis. It was stated that the cocci-like, flask-like, grain-like, virus-like, filtrating forms, L-forms and other agent forms are the stages of the biological development of tuberculosis mycobateria which are not always identified by the routine methods of microbiological diagnostics implemented in the veterinary practice. Thus, the use of the developed method of diagnostics of tuberculosis in animals together with agglutination test, ELISA and PCR allow shortening the terms of primary diagnosis of tuberculosis in animals by bacteriological method by 5 - 7 days.

Diagnostic efficacy of Ziehl-Neelsen method against fluorescent microscopy in detection of acid fast bacilli

To investigate the application of Ziehl-Neelsen (Z-N) and fluorescent microscopy in detection of acid fast bacilli (AFB). Duplicate smears were prepared from 260 sputum samples and stained with Z-N and fluorescent staining (FS) methods. The efficiency of both methods in primary diagnosis of tuberculosis were evaluated. The smears were positive for AFB in 15 (5.77%) samples by Z-N staining method and in 16 (6.15%) samples by FS method. The sensitivity and specificity of Z-N staining method against FS method were 93.75% and 100% respectively. Though lesser cost-effective than Z-N, FS method is a more sensitive and better case finding tool in detection of AFB.

Hospitalizations for Tuberculosis in the United States in 2000: Predictors of In-Hospital Mortality

Despite curative therapy, mortality remains high for hospitalized patients with tuberculosis (TB) in the United States. The purpose of this study was to describe the characteristics of hospitalized patients with TB and to identify patient characteristics associated with in-hospital mortality. Using the 2000 Nationwide Inpatient Sample, representing 20% of US hospital admissions, we identified 2,279 hospital admissions with a primary diagnosis of TB (International Classification of Diseases, ninth revision, codes, 010.xx to 018.xx). Mortality was the main outcome measure. Logistic regression analyses were performed including age, gender, race, insurance status, income, Deyo-adapted Charlson comorbidity index (DCI), HIV status, hospital admission source, and hospital characteristics as explanatory variables. A disproportionate number of patients hospitalized with TB were men (64%), nonwhite (72%), lived in areas with median incomes of < $35,000 (50%), and had publicly funded health insurance (49%) or no health insurance (17%). The mortality rate for patients hospitalized for TB was greater than that for non-TB hospital admissions (4.9% vs 2.4%, respectively; p < 0.001). Patients with TB who died during hospitalization were older (mean age, 65.1 vs 49.4 years, respectively; p < 0.001), had greater comorbid illness (DCI, 1.1 vs 0.55, respectively; p < 0.001), required longer hospitalizations (19.9 vs 13.9 days, respectively; p < 0.001), and accumulated substantially higher charges ($79,585 vs $31,610, respectively; p < 0.001) than did patients with TB who were alive at hospital discharge. In a multivariable analysis, older age, comorbid illnesses, and emergency department admissions were independently associated with mortality. The total charges for TB hospitalizations in the United States in 2000 exceeded $385 million. Despite public health efforts, patients who are hospitalized with TB are frequently admitted through emergency care settings, have a high risk of in-hospital mortality, and incur substantial hospital charges. To improve TB health outcomes, more vigorous clinical management and prevention strategies should especially target older patients and those with comorbid medical conditions.