Acid-fast Bacilli Smear Research Articles

Treatment Outcomes 24 Months after Initiating Short Bedaquiline- or Injectable-Containing Rifampicin-Resistant Tuberculosis Treatment Regimens: A Retrospective Cohort Study in South Africa

Background: We compared outcomes up to 24 months after treatment initiation for rifampicin-resistant tuberculosis (RR-TB) patients in South Africa treated with a short, all-oral bedaquiline-containing regimen (bedaquiline group), or a short, injectable-containing regimen (injectable group). Methods: RR-TB patients eligible for a short regimen starting treatment between 1 January and 31 December 2017 with a bedaquiline-containing or WHO recommended injectable-containing treatment regimen of 9 to 12 months, registered with their national ID in the drug-resistant TB database and with known age, sex, and HIV status were eligible for study inclusion. To compare regimens, we exactly matched patients on HIV-infection, previous TB treatment history, baseline acid-fast bacilli smear and culture result, and propensity score matched patients on age, sex, and isoniazid susceptibility status, using logistic regression with generalized linear mixed models to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Results: Overall, 1,387 of the 10,152 RR-TB patients treated during 2017 met inclusion criteria, of whom 688 received the bedaquiline-containing regimen and 699 patients received the injectable-containing regimen. Four patients (0.6%) had treatment failure and/or recurrence, 44 (6.4%) were lost to follow-up, and 162 (23.5%) died in the bedaquiline group, compared to 17 (2.4%), 87 (12.4%), and 199 (28.5%), respectively, in the injectable group. Patients in the bedaquiline group had 1.8 (95%CI 1.4 to 2.4) times higher odds of treatment success at 24 months and 0.6 (0.4 to 0.8) times lower odds of loss to follow-up. This was consistent in stratified analyses on HIV-status, AFB smear positivity, and previous treatment history. The bedaquiline group had lower odds of mortality during treatment (0.5, 95%CI 0.4 to 0.7), but not post treatment (1.1, 95%CI 0.7 to 1.7). Conclusion: Patients in the bedaquiline group experienced significantly higher rates of treatment success at 24 months compared to the injectable group. The analysis supports the use of short bedaquiline-containing regimens in eligible patients. Funding: WHO Global TB Programme. Declaration of Interest: We declare no competing interests. Ethical Approval: This analysis was approved by Human Research Ethics Committee, Medical of University of Witwatersrand (#M150340, March 2015).

Profile of Patients With Tuberculous Pleural Effusion in Qatar: A Retrospective Study.

IntroductionTuberculosis (TB) remains one of the top 10 causes of death globally. Around 1.7 billion people are infected with mycobacterium TB worldwide, and almost 90% of cases each year are found in 30 high TB burden countries. Due to the influx of a large expatriate population mainly from the high TB burden countries, there is an increased number of pulmonary TB as well as tuberculous pleural effusion cases reported in Qatar.ObjectivesThe demographic, clinical, laboratory, and histopathological parameters of patients with tuberculous pleural effusion were assessed.MethodsA single-center study was conducted at Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Adults diagnosed to have tuberculous pleural effusion were included, and those with clinical suspicion of tuberculous pleural effusion with positive sputum acid-fast bacillus (AFB) but negative AFB in pleural samples were excluded.ResultsA total of 106 patients were reviewed, of whom 100 were included for the final analysis, with 86% being men. Majority were from the Asian subcontinent, and the mean age was 33.8 years (SD ± 10.3). Main symptoms in decreasing order were cough (77%), fever (56%), and chest pain (54%). Of the patients, 72% had normal BMI, and rest were above the normal range. Anemia and hypoalbuminemia were found in 36.7% and 89.8% of the patients, respectively. Positive AFB culture was observed in pleural biopsy (79%), pleural fluid (13%), and sputum (16%). Positive AFB by polymerase chain reaction (PCR) was observed in pleural biopsy (57%), pleural fluid (3%), and sputum (2.2%), whereas AFB smear was positive in 2% of pleural biopsy samples. Caseating granuloma was seen in 80% of patients. All the three Light's criteria were met by 30% of the patients whereas 52% had two criteria fulfilled. No association between the number of Light's criteria and AFB yield was observed.ConclusionsTPE was more common in healthy young adults. The AFB yield on pleural biopsy, PCR, and culture was significantly higher than that on all other samples. The number of positive Light's criteria did not have any association with positive AFB yield.

Clinical Analysis of Laryngeal Tuberculosis: Recent 10 Years’ Experience in a Single Institution

Background and Objectives The overall incidence of laryngeal tuberculosis (LT) has generally decreased over the recent years, yet there is still a discrete population of patients newly diagnosed with the disease. This study is aimed to examine the patients with LT over the recent 10 years and to investigate the changes in clinical pattern with respect to the past period. Materials and Method A retrospective review has been performed on 20 patients who have been initially diagnosed with LT between 2005 and 2015. Results The age of the patients ranged from 25 years to 95 years with an average age of 45.6 years. Seventeen patients (85%) showed hoarseness, which was the most common clinical symptom. Most affected lesion was the true vocal cord. Laryngoscopic examination showed various clinical manifestations: polypoid 30%, granulomatous 25%, nonspecific 25%, ulcerative 20%. A variety of methods were used for diagnostic confirmation of LT [acid-fast bacilli (AFB) smear 45%, AFB culture 40%, polymerase chain reaction 30%, surgical pathology 45%]. Coexisting pulmonary tuberculosis (PT) was detected in 10 patients (50%). Relative to the patients with inactive PT or normal lung status, those with active PT showed higher incidence of laryngeal lesions located in areas other than true vocal cord (p=0.050). Conclusion Based on the analytic results from this study, laryngologists should recognize the changes in the recent clinical patterns of LT and always be ready for clinical suspicion of this disease on such atypical laryngeal findings which can often mimic laryngeal malignancies to provide the pertinent treatment. Key words: Laryngeal tuberculosis ㆍ Laryngeal cancer ㆍ Pulmonary tuberculosis 핵심용어: 후두 결핵 ㆍ 후두암 ㆍ 폐결핵

Predictors of smear non-conversion among new-treatment pulmonary tuberculosis: a single center case-control study in Indonesia

BACKGROUND Previous studies concluded predictors of smear non-conversion pulmonary tuberculosis (TB) globally as well as in Indonesia. However, there is a limited data in hospital setting. This study aimed to explore predictors of smear non-conversion pulmonary TB in hospital setting.
 METHODS A case-control study was conducted to explore predictors of smear nonconversion among new-treatment pulmonary TB in Dr. Kariadi General Hospital from 2017 to 2019. Number of cases and controls have been determined consecutively. Data were collected from secondary data accessed in medical records and directly from subjects. Non-conversion status in the case group was defined as a persistent sputum smear-positive after 2 months of intensive phase of treatment. The subjects’ characteristics i.e., age, sex, BMI, education level, occupational status, and predictors of smear non-conversion, i.e., patient’s compliance, smoking status, alcohol consumption, presence of drugs side effects, health care access, first acid-fast bacilli (AFB) smear grading, diabetes mellitus (DM), housing condition, housing density, and household income were observed. Chi-square test and binary logistic regression were used.
 RESULTS 35 subjects were determined in the case group while 76 subjects were the control group and involved in the final analysis. Age, sex, first AFB smear grading, smoking status, housing condition, housing density, and DM were involved in the model of logistic regression. DM (OR = 3.4; 95% CI = 1.19–10.00) and first AFB smear grading (OR = 11.2; 95% CI = 3.86–33.00) were concluded as the predictors of smear nonconversion.
 CONCLUSIONS DM and first AFB smear grading were the predictors of smear nonconversion among new-treatment pulmonary TB subjects.

Impact of Bronchiectasis on Incident Nontuberculous Mycobacterial Pulmonary Disease: A 10-Year National Cohort Study

Impact of Bronchiectasis on Incident Nontuberculous Mycobacterial Pulmonary Disease: A 10-Year National Cohort Study

Diagnostic incremental value of sputum in patients with pleural tuberculosis

Background Pleural effusion (PE) Xpert has limited use in the diagnosis of pleural tuberculosis (TB). However, the diagnostic incremental value of sputum Xpert for pleural TB diagnosis remains unclear. Materials and methods Between March 2018 and October 2019, patients with certain causes (such as TB, malignancy, and pneumonia) of PE were enrolled in our study. Sputum and PE were collected from all patients and sent for acid-fast bacilli smear (Auramine O staining), mycobacterial culture (Lowenstein-Jensen media), and Xpert. The differences in the sensitivities of these TB assays between different groups were examined with the chi-square test. Results One hundred and twenty-seven PE patients were enrolled in the study and then were divided into pleural TB (n = 104) and other causes of PE (excluding TB, referred as non-pleural TB; n = 23). Compared with PE Xpert (11.5%, 12/104), sputum Xpert has a higher sensitivity of 25.0% (26/104, p = .012 < .05). The combination of sputum and PE has a non-significant higher sensitivity of 31.7% (33/104) than Xpert on sputum (p > .05). Culture using both sputum and PE combined has a high sensitivity of 43.3% (45/104). Conclusion Compared to PE Xpert, sputum Xpert showed an incremental diagnostic yield in the diagnosis of pleural TB and is expected to speed up the diagnosis of pleural TB.

Disseminated extrapulmonary MDRTB in a patient with systemic lupus erythematosus initially masquerading as drug-susceptible tuberculosis

Background: Patients with systemic lupus erythematosus (SLE) are at increased risk for opportunistic infections due to impaired cellular immunity inherent to the disease and the immunosuppressive effects of drugs used to treat it. Tuberculosis (TB) is endemic in the Philippines, and multidrug-resistant tuberculosis (MDRTB) is on the rise. SLE patients have a seven-fold higher prevalence of tuberculosis and more commonly develop extrapulmonary tuberculosis (EPTB) more than the general population. Case description: We report a 29-year-old female diagnosed with SLE for seven years who was maintained on daily doses of prednisone 10 mg and hydroxychloroquine 200 mg. With a chronic non-healing ulcer on the right ankle, she had headache, fever, vomiting and photophobia for three weeks. While admitted, she had decreased sensorium and meningeal irritation. Cerebrospinal fluid studies showed lymphocytosis, hypoglycorrhachia, elevated protein level, and positive rifampicin-susceptible TB on Xpert. Patient was started on first-line TB regimen with no improvement of symptoms. Stool was also positive for acid fast bacilli (AFB). Repeat ankle wound aspirate continued to be AFB-positive and culture grew MDRTB. Switching to an MDR anti-TB regimen resulted in marked clinical improvement and recovery. Discussion: Diagnosis and management of TB in SLE is perplexing due to similarities in clinical presentations. This is accounted for by molecular mimicry evidenced by antigen resemblance between mycobacterial cell wall glycolipids and DNA. Moreover, management of MDRTB in SLE is more challenging due to drug toxicities and interactions, and lack of literature. The development of disseminated EPTB MDRTB in our patient may be from the interplay of tuberculosis endemicity, the lupus autoimmunity, and the consequence of immunosuppressive treatment. Fortunately, the TB culture from the repeat debridement of her chronic foot ulcer grew a more clinically-compatible MDRTB, leading to the initiation of a more appropriate treatment regimen. Although this case has a grave prognosis, the patient recovered. Conclusion: To our knowledge, this is the first report of disseminated EPTB (meningitis, musculoskeletal and gastrointestinal) MDRTB in SLE. It is also notable because it demonstrates that MDRTB may appear “drug-susceptible” on TB culture, but should be strongly suspected if AFB smears do not clear, necessitating a repeat TB culture.

Stool-based Xpert MTB/RIF Ultra assay as a tool for detecting pulmonary tuberculosis in children with abnormal chest imaging: A prospective cohort study

To evaluate the diagnostic efficacy of stool-based Xpert MTB/RIF Ultra assay versus other assays for the detection of paediatric pulmonary tuberculosis (PTB). A prospective head-to-head comparative study was conducted from Dec 2017 to May 2019 in Shanghai Public Health Clinical Centre. Samples were collected from children (< 15 years) with abnormal chest imaging (X-ray or CT scan) results for the following tests: Ultra on stool sample (Ultra-Stool), Ultra on respiratory tract sample (Ultra-RTS), Xpert MTB/RIF assay (Xpert) on RTS (Xpert-RTS), acid-fast bacilli smear on RTS (AFB-RTS), and Mycobacterium tuberculosis (Mtb) culture on RTS (Culture-RTS). The results were compared with a composite reference standard. A total of 126 cases with paired results were analysed. Against a composite reference standard, Ultra-RTS demonstrated the highest sensitivity (52%) and specificity (100%). Ultra-Stool showed 84.1% concordance with Ultra-RTS, demonstrating 45.5% sensitivity and 94.7% specificity (kappa = 0.65, 95% CI= 0.51-0.79). The sensitivity of Ultra-Stool was similar to Mtb culture (45.5%, p = 1.000) and higher than AFB-RTS (27.3%, p < 0.05). Assay positivity was associated with age and infiltration range in chest imaging. When RTS is difficult to obtain, stool sample-based Ultra is a comparable alternative.

A retrospective cohort study of early mortality among patients with HIV/TB co-infection in Shanghai municipality.

Tuberculosis (TB) is the most common and fatal opportunistic co-infection among HIV-infected individuals. While TB-associated mortality predominantly occurs in the first 90days after admission, such a correlation remains unclear in HIV/TB co-infected patients. Thus, we aimed to investigate the 90-day mortality and associated risk factors among HIV/TB co-infected patients in China. Adult patients with HIV and a newly confirmed TB diagnosis admitted to the Shanghai Public Health Clinical Center between September 2009 and August 2017 were enrolled. Clinical and laboratory characteristics, key treatments and outcomes were collected retrospectively. The associations between different factors and early mortality were analysed. Of the 485 laboratory-confirmed HIV/TB patients [median (range) age = 39 (19-79) years], 413 (85.15%) were male. Diagnosis was confirmed by culture, pathology and acid-fast bacilli smear alone in 362 (74.6%), 6 (1.2%) and 117 (24.1%) patients, respectively. Multiple drug-/rifampin-resistant TB was detected in 21 (5.8%) of the 367 patients with a positive culture. Rifampin or rifabutin was administered to 402 (82.9%) patients. Additionally, 66 (13.6%) and 86 (17.7%) died within 90days and 1year of admission, respectively. Of the 64TB-related deaths, 59 (92.2%) occurred within 90days of admission. In Cox regression, central nervous system (CNS) TB [odds ratio (OR) = 2.49, 95% confidence interval (CI): 1.46-4.23, P<0.001], no antiretroviral therapy (ART) within 3months after admission (OR=11, 95% CI: 6.4-18.9, P<0.001), and plasma albumin level <25g/L (OR=1.91, 95% CI: 1.07-3.40, P=0.021) were associated with early death. Tuberculosis co-infection was prevalent and fatal in HIV-infected patients, with most deaths occurring within 90days of admission. Early mortality was associated with CNS-TB, no ART, and serum albumin level <25g/L.

Evaluation of diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral hospital-based laboratories in Oyo-state, Nigeria

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) are two interrelated infectious diseases that continue to threaten public health in several parts of the world. In Nigeria, a maximum of 52,000 people died from HIV and TB in 2017 which suggests that the two diseases are still a burden on the nation's health. This study sought to evaluate the diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral government-owned secondary hospital-based laboratories in Oyo State, Nigeria. Methods and materials: This study used a descriptive cross-sectional design to evaluate 17 government-owned secondary hospital-based laboratories in Oyo State. A WHO laboratory assessment tool was used to evaluate the study laboratories. Diagnostic capacity was measured on a scale of 100-point in which scores ≤49% were rated low, fair (50–79%), and good (≥80%). A score of 0, 50 and 100 were assigned to no, partial and yes responses respectively and the average score was calculated. Results: Evaluation of diagnostic capacity showed that 11 (64.7%) and 6 (35.3%) of the laboratories had ‘low’ and ‘fair’ capacity respectively to test sputum or cerebrospinal fluid for TB. For HIV, 14 (82.4%) of the laboratories had ‘low capacity’ and 3 (17.6%) had ‘fair capacity’ to test serum for HIV antigen and blood for viral load. Analysis of the type of assay performed at the laboratories indicated that 9 (52.9%) of the laboratories could carry out acid-fast bacilli (AFB) smear using Ziehl-Neelsen stain, 8 (47.1%) Rhodamine/Auramine stain and no laboratory could perform AFB culture and sensitivity. Seven (41.2%) of the laboratories could carry out a serological test for HIV and 3 (17.6%) could test blood for viral load. More than 50% of the laboratories reported that unavailable testing kits/reagents for HIV/TB and lack of culture facilities for AFB were the diagnostic barriers responsible for the ‘low’ and ‘fair’ capacity observed in the laboratories. Conclusion: The low capacity of laboratories in this state underscores the need for interventions to improve the supply of testing kits, reagents and culture facilities which will enhance prompt detection of HIV and TB cases.

A case report of secondary pulmonary tuberculosis complicated with COVID-19

To investigate the early diagnosis and treatment of secondary tuberculosis complicated with COVID-19. The clinical manifestation, auxiliary examination, diagnosis and treatment of one case of secondary tuberculosis complicated with COVID-19 admitted to Wuhan Pulmonary Hospital were analyzed retrospectively. The patient had a clear history of COVID-19 exposure. The clinical manifestations were cough, expectoration, fever and gasp. Chest CT showed multiple patch, nodule, spot, strip and cavity shadow in two lungs. COVID-19 was diagnosed as early as possible by detection of SARS-CoV-2 nucleic acid in respiratory specimens. After reasonable anti-tuberculosis combined with antiviral treatment, the detection of SARS-CoV-2 nucleic acid in respiratory specimens and acid-fast bacilli smear of sputum specimens turned negative, the symptoms were relieved and discharged. In the epidemic period of COVID-19, we should pay attention to the identification of secondary pulmonary tuberculosis with COVID-19, the formulation of drug programs for the treatment of two diseases, and avoid the use of rifampicin, a liver drug enzyme inducer, so as to avoid missed treatment due to the weakened efficacy of lopinavir / ritonavir and abidol, etc. 摘要： 探讨继发性肺结核合并新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)的早期诊断和治疗。回顾 性分析武汉市肺科医院收治的1例继发性肺结核合并COVID-19患者的临床表现、辅助检查及诊治经过。患者有明确 的COVID-19的接触史,临床表现为晐嗽、晐痰,发热及气喘,胸部CT可见双肺散在多发的斑片、结节、斑点、条索及空 洞影。通过呼吸道标本新型冠状病毒核酸检测尽早确诊了 COVID-19,通过合理的抗结核联合抗病毒治疗后,呼吸道 标本新型冠状病毒核酸及痰标本结核细菌涂片转阴,症状缓解出院。在COVID-19流行时期,需注意鉴别继发性肺结 核合并COVID-19情况,以及治疗两种疾病药物方案的制定,避免使用肝药酶诱导剂利福平,其会使克力芝(洛匹那韦/利托那韦）、阿比多尔等药效减弱贻误治疗。

Clinical profiles of subclinical disease among pulmonary tuberculosis patients: a prospective cohort study in South Korea

BackgroundSubclinical tuberculosis (TB) is a potential target for public health intervention because its early identification may reduce TB transmission. We aimed to describe the clinical and laboratory findings of subclinical disease among pulmonary TB patients and compared treatment outcomes for subclinical and active diseases.MethodsIn this prospective cohort study, we enrolled adult patients aged ≥ 19 years with pulmonary TB between 2016 and 2018. Subclinical TB was defined as radiographic or microbiologic test results consistent with TB without clinical symptoms. We implemented a two-stage symptom assessment using a predefined TB symptom checklist. Demographic, clinical, and laboratory data were compared between subclinical and active diseases using multivariable binary logistic regression analysis. We evaluated treatment outcomes in the drug-susceptible cohort.ResultsAmong 420 enrolled patients, 81 (19.3%) had subclinical TB. Multivariable analysis showed that age < 65 years was the only variable significantly associated with subclinical disease. Subclinical disease had a significantly lower proportion of acid-fast bacilli smear and culture positivity and multiple lobe involvement compared to active disease. The white blood cell counts, platelet counts, and C-reactive protein levels were significantly higher among patients with active disease than among those with subclinical disease. Among 319 patients with treatment success in the drug-susceptible cohort, six (1.9%) recurrent cases were identified, and all were active disease. Patients with subclinical disease had a higher proportion of favourable outcomes; however, its odds ratio was insignificant.ConclusionsNearly one-fifth of tuberculosis cases were subclinical in South Korea. Despite its milder clinical presentation and lower level of inflammatory markers, the treatment outcomes of subclinical TB were not significantly different from that of active disease.

Risk factors for negative T-SPOT.TB assay results in patients with confirmed active tuberculosis: A retrospective study.

The interferon-γ release assays as potent adjunct tools for the quick detection of TB in high burden countries is feasible. In this retrospective study, we aimed to identify the risk factors for negative T-SPOT results in confirmed active tuberculosis. We consecutively enrolled 1,021 patients who were positive for acid-fast bacilli smear staining or culture-confirmed mycobacterial infection and simultaneously tested with the T-SPOT.TB assay. All of the included specimens were used to discriminate the Mycobacterium species using the biochip assay. We collected basic clinical characteristics and laboratory results for further analysis. Of the 1,021 patients enrolled in the study, 89 patients were identified as having nontuberculous mycobacteria (NTM). Ninety-nine patients were excluded from the analysis because of indeterminate T-SPOT.TB results, while the remaining 833 patients were identified as having Mycobacterium tuberculosis infection. In total, 159 patients had false-negative T-SPOT.TB results (19.1% of 833). The concordance rate between the T-SPOT.TB results and final diagnoses in females was always lower than that in males. Multivariate logistic regression analysis showed that female sex (OR 1.81; 95% CI 1.19, 2.7; p = 0.006), age (OR 1.02; 95% CI 1.01, 1.03; p = 0.003), acid-fast bacilli (AFB) smear-negative (OR 5.45; 95% CI 3.62, 8.19; p < 0.001), HIV coinfection (OR 6.83; 95% CI 2.73, 17.10; p < 0.001) were associated with negative T-SPOT.TB result. Female is another independent risk factor of negative T-SPOT.TB results, besides to elder, HIV co-infection, acid-fast bacilli (AFB) smear-negative who are suspected of having active TB infection.

Diagnostic Accuracy of Sputum Microscopy in Comparison With GeneXpert in Pulmonary Tuberculosis.

BackgroundTuberculosis (TB) is a major health problem. In Pakistan, the diagnosis of pulmonary tuberculosis mainly relies on acid-fast bacilli (AFB) smear microscopy and Xpert® MTB/RIF assay (Cepheid Inc., Sunnyvale, CA) - a nucleic acid amplification test - where available. There is a wide variation in the reported sensitivity of Ziehl-Neelsen (ZN) smear microscopy across previous studies. This study aimed to determine the accuracy of sputum ZN smear microscopy in diagnosing pulmonary tuberculosis as compared with the sputum GeneXpert (Xpert MTB/RIF assay) as the reference test.Materials and methodsThis is a retrospective cross-sectional study conducted in the outpatient department of the Pakistan Institute of Medical Sciences. This study included 326 patients, aged 12 years and above, who had their sputum samples tested for ZN smear microscopy and GeneXpert during the period January to June 2019. Patients' demographic details, sputum ZN smear microscopy, and GeneXpert test results were collected for data analysis. A case of pulmonary tuberculosis was defined as a patient with positive sputum GeneXpert test result.ResultsOut of the 326 patients, GeneXpert detected MTB deoxyribonucleic acid (DNA) in 50 patients and ZN smear microscopy detected AFB in 30 patients. There was a marginal male predominance among GeneXpert positive cases. Adolescents were the least affected age group. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ZN smear microscopy were 60%, 100%, 100%, 93.24%, and 93.87%, respectively. The positive likelihood ratio was infinite whereas the negative likelihood ratio was 0.4. The area under curve (AUC) for ZN smear microscopy was 0.800 and receiver operating characteristic (ROC) curve analysis revealed a diagonal straight line closer to the left upper corner.ConclusionSputum ZN smear microscopy is a highly specific but moderately sensitive test for the diagnosis of pulmonary tuberculosis. This study recommends the sputum GeneXpert MTB/RIF test to avoid a missed diagnosis of smear-negative pulmonary TB.

Tuberculosis Diagnostics and Susceptibility in Saudi Arabia’s Western Region

Introduction: Saudi Arabia has a moderate infection rate of tuberculosis (TB) in comparison to other countries in the region. The prevalence of TB varies among different parts of the Kingdom, with its western provinces reporting to have the leading rate of incidence.&#x0D; Method : In this retrospective study, Acid-fast bacilli smear (AFB), and nucleic acid amplification test (NAAT) were performed on all positive cultures from 254 identified TB cases from November 2006 to August 2016 in King Faisal Specialist Hospital and Research Center – Jeddah, Saudi Arabia.&#x0D; Results: From the positive cultures for Mycobacterium tuberculosis complex, 99.1% were found to be positive by using NAAT. From the NAAT positive samples, only 36.8% were positive for AFB. TB was predominant among the younger age group (59.4%) compared to the elderly population (35.8%) and pediatrics (4.7%), and it was also observed that males had a higher prevalence of 56.3 % in comparison to females. In regards to the site of infection, 53.1 % were pulmonary and 46.9% from an extrapulmonary. It was noted that resistance to first-line anti-TB drugs individually was found to be 11.0% to Streptomycin, 10.2% to isoniazid, 5.1% to pyrazinamide, 2.4% to Rifampicin, and 1.2% Ethambutol, yet multi-drug resistance (MDR) was found in 2.4% of observed cases.&#x0D; Conclusion: Young age predominance, low direct smear positivity, increased incidence of the extrapulmonary site of infection, and re-emergence of TB resistance all were observed in our study compared to previous national surveys.

Diagnostic implications of bronchial lavage in patients with pleural tuberculosis.

The presence of Mycobacterium tuberculosis in a respiratory specimen is diagnostic in patients with pleural effusion. It is difficult to obtain sputum even after induction in these patients. An alternative method of acquiring respiratory specimens is via bronchial lavage. This study was undertaken to evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, AFB culture, and Xpert assay of bronchial lavage fluid in the workup of pleural tuberculosis patients. All patients who met the inclusion criteria of the study underwent thoracentesis, pleural biopsy, and bronchial lavage. Specimens of pleural fluid, pleural biopsy, and bronchial lavage fluid were sent for acid fast bacilli smear, culture, and Xpert assay. Bronchial lavage AFB smear, culture, and Xpert assay was positive in 9.5%, 17.9%, and 26.2% of patients, respectively. It gave an immediate diagnosis in 22 (26.2%) patients. Bronchial lavage, though not a surrogate to pleural biopsy, offers an additional approach to the early diagnosis of pleural tuberculosis in patients not producing sputum. Besides being diagnostic, this method also has epidemiologic significance in containing the tuberculosis epidemic because detecting Mycobacterium in bronchial lavage confirms that the patient is infectious.

Evaluation of pulmonary complications in patients undergoing allogenic stem cell transplantation

BackgroundMature blood cells can be differentiated from hematopoietic stem cells; thus, the latter can play a crucial role in maintaining defense against different microorganisms. Thus, hematopoietic stem cell transplantation is one of the most important lines of immunotherapy. Major systemic complications may occur post transplantation and could be fatal. Pulmonary complications include infectious and non-infectious complications. The aim of this study was to detect the pulmonary complications in allogeneic stem cell transplantation patients.ResultsWe studied 20 patients after transplantation of allogeneic stem cells with regular follow-up in outpatient clinic of hematology department of Alexandria Main University Hospital. All the studied patients were subjected to history taking, plain x-ray chest PA view, CT chest, complete blood count, serum creatinine, liver enzymes, and serum cytomegalovirus (CMV) detection by antibodies IgG and IgM. Regarding sputum sampling, 7 patients’ samples (35%) were obtained either spontaneously or by induction via hypertonic saline 3%. One patient (5%) had miniBAL done, while bronchoalveolar lavage using fiber optic bronchoscopy was done for 2 patients (10%). Samples could not be obtained from the remaining patients. Samples were analyzed for culture for bacteria, Pneumocystis jiroveci using immunofluorescence test, CMV PCR, fungal culture, and smear for acid fast bacilli (AFB). Among the examined patients, 2 patients (20%) had pulmonary bacterial infection including streptococcus and multidrug-resistant strain of Klebsiella, 3 patients (30%) had pulmonary candida infection, and one patient (10%) had positive result of pulmonary CMV of low count which was considered insignificant. None of our patients had positive results for pulmonary tuberculosis nor Pneumocystis jiroveci. Six patients (30%) had CMV in serum; 3 patients (15.8%) had manifested CMV reactivation. One patient (5%) of our patients had pulmonary graft versus host disease GVHD. One patient (5%) had died during our study course within 12 days post-transplantation due to ARDS followed by multiple organ failure.ConclusionThe prevalence of pulmonary infectious complications after allogenic stem cell transplantation was 50% of all studied patients, while 5% of the studied patients presented with non-infectious pulmonary complications.

Performance of the Xpert® MTB/RIF assay in the rapid diagnosis of tracheobronchial tuberculosis using bronchial washing fluid.

ObjectiveTo assess the diagnostic value of the Xpert® MTB/RIF (GeneXpert) assay for tracheobronchial tuberculosis (TBTB) using bronchial washing fluid (BWF).MethodsThis retrospective study enrolled patients suspected of having TBTB and patients with non-TB pulmonary disease as controls. BWF were used to undertake acid-fast bacillus (AFB) smears, the GeneXpert assay and the Lӧwenstein–Jensen (LJ) culture method. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared among BWF AFB smears, BWF GeneXpert and the BWF LJ culture method.ResultsA total of 130 patients with TBTB and 102 patients with non-TB pulmonary disease were enrolled in the study. Sputum AFB smears were positive in 62 of 130 patients (47.7%) with TBTB. Using the clinical diagnosis of TBTB as the gold standard, the sensitivity, specificity, PPV and NPV of the three methods using BWF were as follows: 93.1%, 99.0%, 99.2% and 91.8% for BWF GeneXpert; 73.1%, 100.0%, 100.0% and 74.5% for BWF LJ cultures; 53.8%, 99.0%, 98.6% and 62.7% for BWF AFB smears. The diagnostic yield of BWF GeneXpert was significantly higher compared with BWF cultures for type III and IV TBTB.ConclusionThe Xpert® MTB/RIF assay using BWF exhibited higher sensitivity than bacteriological diagnostic methods and was particularly useful for the early diagnosis of smear-negative TBTB.

A rare case of actinomycotic osteomyelitis of calcaneum: Presented with subtalar arthritis

We are reporting an unusual case of actinomycosis infection which presented with subtalar arthritis. Actinomycosis is a chronic granulomatous disease caused by Gram-positive anaerobic bacteria. Actinomycosis is very rare and of the cases reported Cervicofacial infection is the most frequent clinical presentation. Hematogenous osteomyelitis at distant sites can occur in the rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Case Report: A 39years, female patient presented with pain, swelling around the right ankle for 4 years with healed sinuses over the lateral aspect. She was treated for the discharging sinuses of right ankle and foot 5 years back with antibiotics and surgery elsewhere. She had a history of taking treatment (ATT for 6months) for pulmonary TB, 10years back. X-rays and Magnetic resonance imaging showed a distorted subtalar joint with multifocal intraosseous lesions in the calcaneum. Curettage and subtalar arthrodesis with Cannulated cancellous screws was done and supported with short-term immobilization. The tissue culture, fungus culture, acid-fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results of intraop samples were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was treated with intravenous penicillin for 2 weeks followed by Oral Doxycycline for 6 weeks, given no evidence of active infection intraoperatively. After 1year follow-up, the patient had no signs of recurring infection or complications and she is ambulant pain-free.Conclusion: Actinomycosis of the foot, though rare, can mimic tuberculosis in areas with a high prevalence of tuberculosis. In patients with recurrent discharging sinuses, a high index of suspicion is warranted to early diagnose it.

RISK FACTORS OF PULMONARY TUBERCULOSIS AMONG DIABETES MELLITUS PATIENTS: A CASE-CONTROL STUDY IN DR. KARIADI GENERAL HOSPITAL, SEMARANG, INDONESIA

Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). Prevalence of TB among DM patients ranged from 1.7 % to 36 %. Limited information has been reported regarding TB among DM patients in Indonesia. This case-control study aimed to investigate prevalence and related factors of pulmonary TB among DM patients in Dr. Kariadi General Hospital. Cases of pulmonary TB were defined by a positive acid-fast bacilli smear or molecular rapid test and thorax x-ray. Data were presented as frequency and percentage comparing the case and control group. Chi-square continued by Binary logistic regression analyses were done to determine the relationship between the parameters and TB status performed by the SPSS 16. Prevalence of 8.02% or 72 patients were diagnosed as having pulmonary TB from 898 registered patients with DM. Of the 72 TB patients, 30 completed the data as case group, and 45 DM patients without TB determined as a control group. Comparison between the case and control group study found differences in household contact (63.3 % and 4.4 %, respectively), random plasma glucose (76.7 % and 33.3 %), duration of DM (40 % and 71 %), and treatment compliance (30 % and 68.9 %). The final model in Binary logistic regression involved household contact, random plasma glucose level, and treatment compliance. The prevalence of pulmonary TB among DM patients in Dr. Kariadi General Hospital was 8.02%. Risk factors that were associated with this occurrence were: household contact, high random plasma glucose level, and poor treatment compliance.