Pulmonary Tuberculosis Infection Research Articles

Characterizing the molecular composition and diagnostic potential of Mycobacterium tuberculosis urinary cell-free DNA using next-generation sequencing

BackgroundUrine cell-free DNA (cfDNA) is an attractive target for diagnosing pulmonary Mycobacterium tuberculosis (MTB) infection, but has not been thoroughly characterized as a biomarker. MethodsThis study was performed to investigate the size and composition of urine cfDNA from tuberculosis (TB) patients with minimal bias using next-generation sequencing (NGS). A combination of DNA extraction and single-stranded sequence library preparation methods demonstrated to recover short, highly degraded cfDNA fragments was employed. Urine cfDNA from 10 HIV-positive patients with pulmonary TB and two MTB-negative controls was examined. ResultsMTB-derived cfDNA was identifiable by NGS from all MTB-positive patients and was absent from negative controls. MTB cfDNA was significantly shorter than human cfDNA, with median fragment lengths of ≤19–52 bp and 42–92 bp, respectively. MTB cfDNA abundance increased exponentially with decreased fragment length, having a peak fragment length of ≤19 bp in most samples. In addition, we identified a larger fraction of short human genomic cfDNA, ranging from 29 to 53 bp, than previously reported. Urine cfDNA fragments spanned the MTB genome with relative uniformity, but nucleic acids derived from multicopy elements were proportionately over-represented. ConclusionsTB urine cfDNA is a potentially powerful biomarker but is highly fragmented, necessitating special procedures to maximize its recovery and detection.

Membranous nephropathy in a patient with pulmonary tuberculosis infection and lung adenocarcinoma: a case report

We report a case of membranous nephropathy (MN) in a patient with tuberculosis infection and lung adenocarcinoma. A 50-year-old Filipino woman underwent a renal biopsy for the evaluation of proteinuria and hematuria. Immunofluorescence analysis revealed positive staining of IgG in the glomerular basement membrane and mesangial matrices, while electron microscopy demonstrated the presence of sub-epithelial deposits, suggesting MN. To screen for secondary causes of MN, we conducted a computed tomography (CT) scan of the chest and abdomen, which revealed a ground-glass opacity in the middle lobe of the right lung and an enlarged paraaortic lymph node. A T-SPOT test was positive, suggesting the possibility of a latent tuberculosis infection, as she was asymptomatic. A follow-up chest CT scan showed persistent presence of the ground-glass opacities, suggesting a non-infectious cause. Video-assisted thoracoscopic resection of the middle right lobe and partial resection of the lower right lobe were performed because the possibility of lung cancer could not be excluded. Notably, pathological analysis of the lung revealed adenocarcinoma in the middle lobe and epithelioid granuloma in the lower lobe, suggesting an active tuberculosis infection. One month after surgery, anti-tuberculosis treatment was initiated. Thereafter, her proteinuria, which had increased to 6g/gCre preoperatively, began to decrease. Five months after surgery, the patient achieved complete remission. The speed of remission suggests that tuberculosis likely played a primary role in the etiology of MN. Our case underscores the importance of screening tests for infections and malignancies in patients with MN, even if suggestive symptoms are absent.

The Clinical Characteristics and Incidence of Pulmonary Tuberculosis of 7632 HIV Patients in Yunnan Province from 2005 to 2017

Objective: To analyze the age and gender distribution characteristics of 7,632 HIV/AIDS patients at the onset of HIV infection-related high-risk intravenous drug abuse and sexual contact in Yunnan province. Methods: Data were collected from the database of Chinese Medicine Treatment of AIDS Pilot Project in Yunnan province. Gender, age and demographics of HIV/AIDS patients were analyzed. Results: The patients were almost in relatively high educational background. The number of male intravenous drug users (12.90%) was more than female, and the earliest average age was 10-14 years. The percentages of men in 10-19 years and 35-59 years were more than that of women. No obvious difference was found in heterosexual sexual contact in both men (48.11%) and women (51.89%), and the earliest ages was 15-19 years in males and 10-14 years in females. The percentage of males at 10-34 years old was less than that of females, just opposite to the age of 35-85 years. Homosexual contact was more in males (92.73%) than that in females (7.27%). The earliest homosexual sexual contact associated with HIV infection was 15-19 years in males and 25-29 years in females. Among 128 AIDS patients with pulmonary tuberculosis infection, intravenous drug abuse accounted for the highest proportion (76.56%) of the three high-risk behaviors related to HIV infection. Conclusions: Reducing risk behaviors and preventing intravenous drug abuse could be effective in preventing AIDS. Compared with other high-risk behaviors, patients with intravenous drug use and AIDS are at greater risk of contracting tuberculosis.

Active case finding of pulmonary tuberculosis and HIV infection among prisoners of South Gujarat: A cross sectional study

BackgroundIn a close knit congregation such as prison, Tuberculosis (TB) and HIV can be major health problems. However, their prevalence in Indian prisons is under reported. This study aimed at adopting a camp based, active case finding approach to identify cases of TB, HIV and at risk prisoners in a central prison of South Gujarat. MethodsA multidisciplinary team of public health experts, pulmonologists, social workers and lab technicians conducted a week-long camp to screen 1665 prisoners for TB using clinical examination, sputum smear for AFB, CBNAAT and Chest X-Ray and for HIV through Rapid Antigen Testing. ResultsMajority of participants (1392, 84%) were under trail prisoners, having spent an average of 1.4 years in prison. About 2.9% of participants had previous history of TB, of whom only 59% had completed treatment. About 14% of participants were underweight. Weight reduction was found to be significant in first five years of imprisonment. Of all participants, 3.6% were found to have diabetic range of blood sugar. Seven new active, drug sensitive pulmonary TB cases and three new cases of HIV infection were identified. All new cases of TB, HIV and increased blood sugar levels were linked to treatment. ConclusionCamp based approach is effective in active case finding of pulmonary TB and predisposing factors such as malnourishment, Diabetes and HIV among prisoners. Routine screening of all prisoners at the time of entry and monthly thereafter in a camp based approach should be adopted to identify TB and at risk prisoners.

Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review.

BackgroundDiagnostic testing for respiratory tract infections is a tool to manage the current COVID-19 pandemic, as well as the rising incidence of antimicrobial resistance. At the same time, new European regulations for market entry of in vitro diagnostics, in the form of the in vitro diagnostic regulation, may lead to more clinical evidence supporting health-economic analyses.ObjectiveThe objective of this systematic review was to review the methods used in economic evaluations of applied diagnostic techniques, for all patients seeking care for infectious diseases of the respiratory tract (such as pneumonia, pulmonary tuberculosis, influenza, sinusitis, pharyngitis, sore throats and general respiratory tract infections).MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles from three large databases of scientific literature were included (Scopus, Web of Science and PubMed) for the period January 2000 to May 2020.ResultsA total of 70 economic analyses are included, most of which use decision tree modelling for diagnostic testing for respiratory tract infections in the community-care setting. Many studies do not incorporate a generally comparable clinical outcome in their cost-effectiveness analysis: fewer than half the studies (33/70) used generalisable outcomes such as quality-adjusted life-years. Other papers consider outcomes related to the accuracy of the test or outcomes related to the prescribed treatment. The time horizons of the studies generally are limited.ConclusionsThe methods to economically assess diagnostic tests for respiratory tract infections vary and would benefit from clear recommendations from policy makers on the assessed time horizon and outcomes used.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-021-01054-1.

Mycobacterium tuberculosis (MTB) antigen-induced upregulation of interleukin-35 expression in patients with MTB infection: In vitro blockade of the effects of interleukin-35 on T lymphocyte subsets.

Immunosuppressive interleukin-35 (IL-35) serum concentrations were analyzed in patients with active pulmonary Mycobacterium tuberculosis (MTB) infections (PTB), PTB patients after two months treatment (stable PTB) and healthy controls. IL-35 concentrations were highest in active PTB followed by stable PTB cases and lowest in healthy control participants (all P <0.01). The same trents were found for supernatants of isolated blood mononuclear cells (PBMCs), with additional enhancements after MTB antigen stimulation only for PBMCs of active and stable PTB patients (P <0.001), for EBI3 and IL-12a transcriptions in PBMCs (P <0.001) and percentages of EBI3 expressing (CD4+CD25+Foxp3+) regulatory T cells (Treg) (P <0.001). IL-35 antibody applications significantly reversed MTB antigen stimulated IL-35 and IL-10 expression in PBMCs of active and stable PTB patients, and reduced Foxp3 expression in CD4+CD25+cells and EBI3 expression in Treg cells, but had no effects on healthy control cells. The percentages of Th1 and Th17 cells in CD4+cells were enhanced after MTB antigen stimulation of cells taken from active and stable PTB patients, which were partly increased only for Th1 cells after IL-35 antibody exposure. MTB antigen-driven upregulation of IL-35 may lead to reduced immune surveillance in PTB patients.

Spontaneous thrombosis of non-tuberculous pulmonary artery mycotic pseudoaneurysm in prolonged childhood pneumonia.

Pulmonary tuberculosis (PTB) is common in tropical country like Malaysia. Prolonged PTB infection may lead to mycotic pulmonary artery pseudoaneurysm (PAP). We report a case of childhood non-tuberculous pulmonary infection causing mycotic PAP which resolved spontaneously after antibiotics therapy. A 1 year 6 months old girl underlying Down syndrome presented with prolonged fever for two weeks , cough and breathlessness. Her leucocytes count were elevated and she developed several hypotensive episodes secondary to septicaemia. Chest radiograph showed loculated right sided pleural effusion. Ultrasound revealed complex pleural collection and initial aspiration revealed a thick stale blood. Thinking of possible vascular cause, ultrasound able to locate a well-defined rounded structure with high flow velocity seen on Doppler ultrasound consistent with pseudoaneurysm and CT thorax confirmed the findings. Pulmonary artery angiogram prior to embolization revealed no evidence of abnormal vasculature or contrast blush at the region of interest. Complimentary ultrasound showed evidence of spontaneous thrombosis within the pseudoaneurysm.Non-tuberculous PAP is a rare but possible life-threatening sequela of pneumonia. Pleural drainage in a haemothorax with concomitant mycotic thoracic pseudoaneurysm may cause loss of pressure tamponade and will end up with devastating consequences. Careful ultrasound image acquisition must be made by the attending radiologist prior to pleural drainage.

Evaluation of screening strategies for pulmonary tuberculosis among hospitalized patients in a low-burden setting: cost-effectiveness of GeneXpert MTB/RIF compared to smear microscopy.

Hospitalized patients undergoing evaluation for pulmonary tuberculosis (TB) require airborne isolation while testing for Mycobacterium tuberculosis (MTB) to reduce risk of nosocomial transmission. GeneXpert MTB/RIF (Xpert) is more rapid and accurate than sputum smear microscopy, but it is not routinely used to 'rule out' infectious pulmonary TB among hospitalized patients in the United States. We sought to evaluate the diagnostic performance and cost-effectiveness of Xpert-based TB evaluation. We conducted a retrospective cohort study of hospitalized adults evaluated for pulmonary TB at a large academic medical center in New York from 2010 to 2017. Using propensity score matching, we compared hospital length-of-stay among patients undergoing conventional smear-based TB evaluation to a control group with non-TB pneumonia. We performed a probabilistic cost-effectiveness analysis to compare Xpert-based versus conventional TB evaluation. In total 1,421 patients were evaluated for TB with airborne isolation and sputum testing; mycobacterial culture was positive for MTB in 49 (3.4%). Conventional TB evaluation was associated with an increase of 4.4 hospital days compared to propensity-matched controls. Xpert-based testing strategies dominated conventional TB evaluation with a cost savings of $5,947 (95% CI, $1,156-$12,540) and $4,445 (95% CI, $696-$9,526) per patient depending on the number of Xpert tests performed (1 vs 2, respectively) and assumptions about the reduction of length of stay achieved. In the evaluation of hospitalized patients for pulmonary TB, Xpert-based testing has superior diagnostic performance and is likely cost-effective compared to smear microscopy due to reduced hospital length-of-stay associated with more rapid test results.

Increased risk of pulmonary and extrapulmonary tuberculosis infection in patients with polycystic kidney disease: a nationwide population-based study with propensity score-matching analysis

BackgroundPolycystic kidney disease (PKD) is a common renal disorder affecting approximately 1 in 1000 live births. Tuberculosis (TB) is an infectious disease worldwide. This study investigated the risk of TB infection in patients with PKD.MethodsA nationwide population-based cohort study was performed using Taiwan’s National Health Insurance Research Database. We used patients’ hospitalization files for the entire analysis during 2000–2012. As per diagnosis, we divided patients into PKD and non-PKD cohorts and the major outcome was TB infection.ResultsA total of 13,540 participants with 6770 patients in each cohort were enrolled. The PKD cohort had a higher risk of TB infection than did the non-PKD cohort after adjusting for age, sex, and comorbidities (adjusted hazard ratio (aHR) = 1.91, 95% confidence interval [CI] = 1.51–2.43). When classifying by sites of pulmonary TB (PTB) and extrapulmonary TB (EPTB), the PKD cohort demonstrated a significantly higher risk of EPTB (aHR = 2.44, 95% CI = 1.46–4.08) as well as a risk of PTB (aHR = 1.69, 95% CI = 1.29–2.22). When stratified by the presence or absence of a comorbidity, high TB infection risk was noted in the PKD patients without any comorbidity (HR = 2.69, 95% CI = 1.69–4.30).ConclusionsTaken together, our findings suggest that PKD is associated with a 1.91-fold increased risk of TB infection. Medical professionls should maintain a high index of suspicion in daily practice for patients with PKD, particularly those with EPTB infection.

Acetylator Status Among Newly Diagnosed and Recurrent Tuberculosis Patients from Kupang, Eastern Part of Indonesia.

PurposeN-acetyltransferase-2 enzyme in the liver, encoded by NAT2 gene, plays a central role in metabolizing tuberculosis (TB) drug isoniazid (INH). Low compliance of patients toward six-month TB therapy and internal host factors, ie comorbid diseases, immune status, and genetic profiles, are factors leading to treatment failure and recurrence of pulmonary TB infection. This study aimed to explore the NAT2 acetylator status among newly diagnosed and recurrent pulmonary TB patients in eastern part of Indonesia.Patients and MethodsArchived DNA of TB patients (n=124) and healthy controls (n=124) were sequenced, and NAT2 acetylator status was determined, then categorized as fast, intermediate, or slow acetylators. Pulmonary TB patients who had no previous TB treatment history were designated as newly diagnosed pulmonary TB, whereas patients with a history of TB treatment were designated as recurrent pulmonary TB. The demographic, clinical, and microbiological data between pulmonary TB groups were compared, and acetylator status was described among groups.ResultsMale was more significantly prevalent in the recurrent pulmonary TB group (p=0.025), and anemia was more prevalent in new pulmonary TB (p=0.003). The acetylator status in pulmonary TB patients compared to healthy controls were rapid (33.9% vs 48.1%), intermediate (57.8% vs 33.0%), and slow acetylators (8.3% vs 18.9%), respectively. Interestingly, the rapid and intermediate acetylator were significantly more prevalent in pulmonary TB patients than in healthy controls (p=0.023, OR=2.58 (1.12–5.97). Furthermore, no differences were found in acetylator status between new and recurrent pulmonary (p=0.776).ConclusionRapid and intermediate acetylators status predominated the pulmonary TB patients in Kupang, eastern part of Indonesia, postulating different genetic makeup in this area. As the pulmonary TB patients in Kupang exhibit more rapid acetylator phenotype, the acetylator status might be relevant to be checked before TB therapy for adjusting treatment dose to prevent drug resistances.

Bovine ownership and reduced pulmonary tuberculosis risk in Nepal: A case-control study.

This case-control study sought to confirm and investigate in more depth protective associations previously found of bovine (cattle and water buffalo) ownership with reduced risk of both pulmonary tuberculosis (PTB) and latent tuberculosis infection (LTBI) in humans. The study recruited male and female PTB cases from a diagnostic centre and a frequency-matched community-based control group in Kaski District, Nepal. Controls were tested for LTBI status and a separate nested case-control study was conducted based on LTBI status. Data were collected on participant household animal ownership. Using logistic regression, animal ownership was investigated for associations with both PTB and LTBI. Data were obtained from 570 PTB cases and 1,224 controls, the latter group providing 396 LTBI-positive and 692 LTBI-negative subjects. Results provided evidence of decreased odds of both PTB and LTBI positivity associated with owning bovines. The evidence was strongest for protection against infection, rather than activation of infection to PTB. Effects were strongest in women, who usually manage the animals in Nepal, and there were exposure-response relationships with numbers of bovines owned. Results suggest that exposure to bovines is protective against LTBI and PTB. A possible mechanism involves boosting the effect of BCG (Bacillus Calmette-Guerin) vaccination, particularly in protecting against tuberculous infection. Additional studies with more extensive data collection are needed to confirm the observed associations.

Lung Tuberculosis with Multi Drug Resistant Risk in Tertiary Hospital in Middle Java

World TB report from World Health Organization (WHO) in 2017 informed that Indonesia was second country with TB case. Multi Drug Resistance pulmonary infection’s case in Indonesia were 12.000. Kariadi hospital is one of tertiary hospital for pulmonary MDR-TB treatment but, there is no study about risk factor of it yet, so it needed to find risk factors of MDR-TB pulmonary infection in Kariadi hospital. Cross Sectional design using secondary data from Medical Record from January 1st - December 31, 2017 with result of Mycobacterium tuberculosis on GeneXpert sputum examination. Bivariate analysis with Chi square test and multivariate analysis was done by multiple logistic regression. The p value was considered significant if &lt;0.05, all analyzes were 2-tailed. Totally 110 patients were obtained during periode, 55 samples for case and 55 samples for control. There were correlation between smoking habit OR = 3,1 (CI 95% 1,1-8,7), malnutrition OR = 2,9 (CI 95% 1,3-6,3), contact with patient with MDR pulmonary TB infection OR = 12,0 (CI 95% 1,5-97,3), past treatment OR = 81,7(CI 95% 23,4-285,2) and ≥6months past treatment OR = 94,5 (CI 95% 12,1-736,2. Risk factor that could influence together were contact with patient with MDR pulmonary TB infection OR = 34,5 (CI 95% 2,6-464,5), past treatment OR = 39,4 (CI 95% 8,3-186,3) and ≥ 6months past treatment OR = 12,4 (CI 95% 1,3-117,7). Risk factors for the incidence of pulmonary MDR TB infection are past contact with patient with MDR pulmonary TB infection, past treatment and ≥ 6months past treatment.

Mortality predictors among patients with HIV-associated pulmonary tuberculosis in Northeast China: A retrospective cohort analysis.

The coexistence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV) infection leads to high morbidity and mortality in these populations. Although antiretroviral therapy (ART) has decreased TB incidence in HIV-infected patients, this coexistence still prevails in China. Patients with HIV-PTB admitted to Beijing You An Hospital from 2014 to 2018 were retrospectively enrolled, and information on demographics, clinical characteristics, and laboratory findings were extracted from medical records. Predictors of death, including age (adjusted hazard ratio [AHR]: 1.03; 95% confidence interval [CI]: 1.00-1.05), tobacco use (AHR: 2.76; 95% CI: 1.54-4.94), history of tuberculosis (AHR: 3.53; 95% CI: 1.82-6.85), not being on ART (AHR: 2.94; 95% CI: 1.31-6.63), extrapulmonary tuberculosis (AHR: 2.391; 95% CI: 1.37-4.18), sputum smear positivity (AHR: 2.84; 95% CI: 1.61-4.99), CD4+ T cell count ≤ 50 cells/µl (AHR: 3.45; 95% CI: 1.95-6.10), and initiating ART ≥ 8 weeks after the initiation of antituberculous therapy (odds ratio: 3.30; 95% CI: 1.09-10.04). By contrast, there were no deaths among the six patients who began ART within 8 weeks after the initiation of antituberculous therapy. Age, tobacco use, not being on ART, extrapulmonary tuberculosis, sputum smear positivity, andCD4+ T cell count ≤50 cells/µl predict those patients at high risk of death among HIV-infected patients with PTB, and the time of initiating ART after the initiation of antituberculous therapy is also important for prognosis.

Hemostatic parameters in pulmonary tuberculosis patients after intensive phase treatment.

Background:Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis (Mtb). This infection causes the release of proinflammatory cytokines that affect hemostasis. Pulmonary TB infection causes an increased activation of procoagulant factors, decreased anticoagulant factors and suppresses fibrinolysis which causes hypercoagulable. Our study is conducted to assess the association between pulmonary TB infection (PTB) with hemostatic parameters before and after intensive phase treatment.Methods:This was an analytic observational prospective cohort design. The study was conducted at the Community Center for Lung Health in South Sulawesi. Studied subjects were recruited by consecutive sampling, in which the patients who met the inclusion criteria received intensive phase of ATD treatment. PT, aPTT, fibrinogen, and D-dimer were measured before treatment and after the intensive phase of ATD. These data were analyzed using the SPSS Version 22.Results:In this study, 30 subjects are new cases of PTB. Prothrombin time, aPTT and D-dimer levels were higher in far advanced lesions and smear-positive sputum group (p<0.001). There was a significant level decrease in PT, aPTT, fibrinogen, D-dimer after intensive phase treatment (p<0.001).Conclusion:Pulmonary tuberculosis infection is associated with hypercoagulability which is characterized by an increase in hemostatic parameters and has significant improvement after intensive phase of ATD treatment.

The Correlation between the Levels of Family?s Knowledge about Pulmonary Tuberculosis and Efforts in Prevention of Pulmonary Tuberculosis Infection

Pulmonary tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. This study aimed to analyze the correlation between family knowledge about pulmonary TB and efforts to prevent the spread of pulmonary TB infection in health centers. This study was a correlational study with a cross-sectional approach. The population in this study were families with pulmonary TB in Primary Healthcare. The sampling method used purposive sampling and obtained 25 samples. The independent variable in this study was family knowledge about pulmonary TB. The dependent variable was the family's effort to prevent the spread of pulmonary tuberculosis infection. Data were taken using a questionnaire and analyzed by the Spearman rho test with I± ≤ 0.05. This study showed that there was a correlation between family knowledge about pulmonary TB and efforts to prevent the spread of pulmonary tuberculosis infection (p = 0,000, r = 0.695). Higher knowledge can increase family efforts to prevent the spread of pulmonary tuberculosis infections. The results of this study were expected to increase the motivation of nurses to provide health education and counselling to people who still do not understand how to prevent the transmission of pulmonary TB infection.

Harnessing Big Data to Optimize an Algorithm for Rapid Diagnosis of Pulmonary Tuberculosis in a Real-World Setting.

BackgroundThe prompt diagnosis of pulmonary tuberculosis (PTB) remains a challenge in clinical practice. The present study aimed to optimize an algorithm for rapid diagnosis of PTB in a real-world setting.Methods28,171 adult inpatients suspected of having PTB in China were retrospectively analyzed. Bronchoalveolar lavage fluid (BALF) and/or sputum were used for acid-fast bacilli (AFB) smear, Xpert MTB/RIF (Xpert), and culture. A positive mycobacterial culture was used as the reference standard. Peripheral blood mononuclear cells (PBMC) were used for T-SPOT.TB. We analyzed specimen types’ effect on these assays’ performance, determined the number of smears for diagnosing PTB, and evaluated the ability of these assays performed alone, or in combination, to diagnose PTB and nontuberculous mycobacteria (NTM) infections.ResultsSputum and BALF showed moderate to substantial consistency when they were used for AFB smear or Xpert, with a higher positive detection rate by BALF. 3-4 smears had a higher sensitivity than 1-2 smears. Moreover, simultaneous combination of AFB and Xpert correctly identified 44/51 of AFB+/Xpert+ and 6/7 of AFB+/Xpert- cases as PTB and NTM, respectively. Lastly, when combined with AFB/Xpert sequentially, T-SPOT showed limited roles in patients that were either AFB+ or Xpert+. However, T-SPOTMDC (manufacturer-defined cut-off) showed a high negative predicative value (99.1%) and suboptimal sensitivity (74.4%), and TBAg/PHA (ratio of Mycobacterium tuberculosis-specific antigens to phytohaemagglutinin spot-forming cells, which is a modified method calculating T-SPOT.TB assay results) ≥0.3 demonstrated a high specificity (95.7%) and a relatively low sensitivity (16.3%) in AFB-/Xpert- patients.ConclusionsConcurrently performing AFB smear (at least 3 smears) and Xpert on sputum and/or BALF could aid in rapid diagnosis of PTB and NTM infections in a real-world high-burden setting. If available, BALF is preferred for both AFB smear and Xpert. Expanding this algorithm, PBMC T-SPOTMDC and TBAg/PHA ratios have a supplementary role for PTB diagnosis in AFB-/Xpert- patients (moderately ruling out PTB and ruling in PTB, respectively). Our findings may also inform policy makers’ decisions regarding prevention and control of TB in a high burden setting.

Antisynthetase Syndrome associated with mycobacterium tuberculosis infection, presenting as an acute respiratory failure

Antisynthetase syndrome (ASS) is characterized by myositis, interstitial lung disease, Raynaud’s phenomenon, fever and mechanics hands. Diagnosis is confirmed with the detection of an antibody directed against anti–aminoacyl–transfer–RNA synthetases (ARS). The most common anti–ARS antibody is anti–Jo–1. Opportunistic infections are common causes of mortality in patients with autoimmune diseases. Immunosuppressive treatment further contributes to the risk of infection. We report a rare case of a 68 year–old man diagnosed with antisynthetase syndrome associated to a pulmonary tuberculosis infection, revealed with an acute respiratory failure. The diagnosis of this rare combination of a connective tissue disease and tuberculosis revealed with an acute respiratory failure is difficult in a previously asymptomatic patient. Early diagnosis and immunosuppressive therapy associated to antituberculosis treatment started precociously prevented the disease progression and resulted in a good outcome.

Gene Xpert/MTB RIF assay for spinal tuberculosis- sensitivity, specificity and clinical utility

BackgroundXpert MTB/RIF assay is a rapid automated molecular test with excellent reported sensitivity, specificity for diagnosis of pulmonary and extrapulmonary Mycobacterium tuberculosis (MTB) infections. However, the clinical utility and accuracy in STB is not well established. A study was conducted to report on the sensitivity, specificity and clinical utility of the Xpert MTB/RIF assay in spinal tuberculosis (STB). MethodsA retrospective review of medical records was performed for 136 patients that underwent spinal biopsy for suspected spondylodiscitis. Reports for acid fast bacilli (AFB) smear, gram stain, pyogenic culture, MTB culture, histopathology, Xpert MTB/RIF assay, and drug sensitivity testing were reviewed. ‘Reference standard for diagnosis of STB’ was based on positive histopathology and/or MTB culture evidence and was considered as MTB positive. Any samples returning a positive pyogenic or fungal culture were considered as MTB negative. The sensitivity, specificity for Xpert MTB/RIF was assessed against the reference standard. ResultsA total of 125 patients were considered for final analysis, 86 patients met the criteria for ‘Reference standard for diagnosis of TB spine’ (MTB positive). This includes nine patients that were MGIT culture only positive; 45 that were histopathology only positive and 32 were both culture and histopathology positive. There were 39 culture proven (pyogenic-37 and fungal-2) patients included in MTB negative group. The 86 MTB positive patients, included 53 (61.6%) tissue samples and 33 (38.4%) pus samples. The overall analysis showed a 65.1% sensitivity, 100% specificity, 100% PPV and 56.5% NPV for the Xpert MTB/RIF. ConclusionsGene Xpert MTB/RIF showed excellent specificity and was accurate in the identification of drug resistance. The sensitivity was 65% and sampling techniques using pus samples rather than tissue samples could be a possible reason for lower sensitivity.

Cytotoxic response of phagocytes in patients newly infected with pulmonary Mycobacterium tuberculosis determined using plasma tumor necrosis factor-alpha, malondialdehyde, and superoxide dismutase: an observational study

Abstract Objective: Pulmonary Mycobacterium tuberculosis infection can trigger cellular and humoral innate immune responses, which may cause death of the pathogen and or host cells/tissue. We aimed to determine the cytotoxic response of phagocytes in patients with pulmonary Mycobacterium tuberculosis infection based on plasma tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), and superoxide dismutase (SOD) levels. Methods: In this observational study, patients newly infected with pulmonary Mycobacterium tuberculosis (n = 31; age 37–62 years) and age-matched uninfected volunteers (n = 50) were recruited as test and control volunteers, respectively in Owo, Nigeria. The study protocol was reviewed and approved by the Research and Ethics Committee of the Department of Medical Laboratory Science, Achievers University, Owo, Nigeria (AUO/MLS/VII/2009/212). Anti-hepatitis C virus, human immunodeficiency virus antigen/antibody, hepatitis B virus surface antigen, and plasma TNF-α were determined by enzyme-linked immunosorbent assay, SOD, and MDA were determined by colorimetry, Plasmodium by Giemsa thick blood film staining, and acid-fast bacilli in sputum were detected by Ziehl–Neelsen staining. Results: All participants had normal blood glucose levels and tested negative for human immunodeficiency virus antigen/antibody, anti-hepatitis C virus, hepatitis B virus surface antigen, and Plasmodium spp., and had no medical history of cancer. Infected patients had significantly higher plasma MDA and TNF-α levels and significantly lower SOD levels compared with control subjects (all P &lt; 0.05). Conclusion: Mycobacterium tuberculosis infection elicited a cytotoxic response by phagocytes, evidenced by significant increases in MDA and TNF-α and a significant decrease in SOD levels.

GAMBARAN KADAR HEMOGLOBIN DAN INDEKS ERITROSIT PADA PASIEN TUBERKULOSIS PARU DI RSUD DR. M. HAULUSSY AMBON PERIODE JANUARI 2017 – APRIL 2018

Pulmonary tuberculosis (TB) is an infection disease caused by Mycobacterium tuberculosis. Pulmonary TB remain a major health problem and the most common cause of death in the world especially in developing countries. Pulmonary TB infection could cause clinical manifestation, which is haematology disorders like anemia. Many studies has reported anemia as a common complication in patients with pulmonary TB. This research aims to determine haemoglobin levels and erythrocytes index of patients with pulmonary TB at RSUD Dr. M. Haulussy Ambon in the periods from January 2017 - April 2018. This research uses a descriptive study by using medical records of patients with pulmonary TB. Among 65 patients with pulmonary TB, number of patients with anemia are 44 cases (67,7%) and 21 cases (32,3%) are not anemia. Pulmonary TB with anemia most suffered by male as much 24 cases (72,7%). The age group suffered most is 18-30 years old as much 23 cases (69,7%), but the age group suffered most according to percentage is 51-60 years old as much 80%. The most common types of anemia is hipocromic micrositer as much 23 cases (52,3%). Haemoglobin levels in patients with pulmonary TB are found most below the normal value or anemia and the most common types of anemia is hipocromic micrositer. Needs to be done more research on the analysis of the relation between anemia with pulmonary TB.&#x0D; Keywords: pulmonary tuberculosis, haemoglobin, erythrocytes index