Sputum AFB Research Articles

Tuberculous Spondylodiscitis or Pott's Disease: Diagnostic Problem of Patients Referred to the Reference Health Center (CSRef) Commune III of Bamako for Anti-Tuberculosis Treatment

Introduction: Tuberculosis is an infectious disease that can affect different organs. The spinal disorder is called tuberculous spondylodiscitis (Pott's disease). The objective: Was to elucidate the aspects taken into account by caregivers in the diagnosis of tuberculosis spondylodiscitis in patients referred to the reference health center of commune III of Bamako for anti-tuberculosis treatment. Methodology: This was a descriptive, retrospective study covering all patients referred to CSRef CIII from different health structures with the diagnosis of Pott's disease for treatment during the study period. Results: During the study period, we collected 156 patients. The male sex represented 54% with a sex ratio of 1.18. The average age was 39.3 years with extremes of 12 and 92 years. All patients presented with spinal pain, fever was present in 11.11% of patients and 2.7% had respiratory symptoms. Tuberculin IDR was positive in 95.8% and 2 patients were AFB sputum positive. X-ray (of the lumbar spine) was negative in 18%; there were images of degenerative lesions in 41.6% and only 40.2% of patients had presumptive radiological signs. CT was carried out in all patients revealing 33.33% of sequelae of fractures and degenerative lesions and 55.55% of presumptive signs of tuberculous spondylodiscitis. Only 41.66 of the cases were referred by specialist doctors. Conclusion: In our context, the diagnosis of Pott's disease seems to be based mainly on chronic spinal pain and positive IDR and is not often made by appropriate personnel.

Pulmonary Mucormycosis: A Case Report and Systematic Review of the Literature

The pulmonary mucormycosis (PMM) caused by Mucorales is a highly lethal invasive fungal infection in which early diagnosis and management is imperative. Otherwise, the mortality may exceed 80%. PMM does not have specific symptoms; hence, awareness of the disease and the treating physician’s suspicion can detect or diagnose it earlier. The fungal infection also needs to be differentiated from aspergillosis and other common fungal infections so an appropriate treatment is instituted.Case Report: A 62-year-old male was admitted with a six-month cough with scanty expectoration and a short history of progressive breathlessness for the last five days. He had a known case of diabetes and also an old-treated case of tuberculosis. He had a history of COVID-19 pneumonia (without a positive report). No history of fever, chest pain and hemoptysis. However, chest X-ray and HRCT thorax revealed a fibro-cavitary lesion in the right upper lobe with sputum and CBNAAT negative for AFB. The FOB examination detected complete occlusion with protruded soft yellowish and black material in the right main upper lobe bronchus, which was reported as mucormycosis. The patient was treated with amphotericin and then with oral antifungal.Discussion: An upsurge of mucormycosis was reported in our country during the COVID-19 era, leaving behind aspergillosis and another fungus. The rhino-orbit-cerebral is the most common site for this fungal infection and is essentially reported in an immune-compromised host as happened in our diabetic patient but as PMM. The Post TB sequelae with residual fibro-cavitary lesions, COPD and solid organ transplantation cases are the other risk factors and our country has enough of a vulnerable population. Our case was detected in the post-Covid period and required attention to epidemiological change or something else?Conclusion: An early rapid diagnosis and management of mucormycosis is crucial to minimizing mortality. The treatment by amphotericin is the best choice followed by Posaconazole or Isavuconazole as step-down oral medication. The increasing incidence of this infection in our country is challenging,

IJCM_276A: Determinants of Delayed Sputum Conversion among Tuberculosis Patients in Malappuram District: A Case Control Study

Background: Treatment of drug-sensitive TB consists of an intensive phase of 2 months followed by a continuation phase of 4 months. After completion of intensive phase of therapy, sputum AFB smear microscopy is repeated and presence of smear conversion is suggested as a significant early predictor of treatment effectiveness. Delay in sputum conversion will lead to prolongation of the period of time that patients remain contagious. Objectives: To study the determinants of delayed sputum conversion among Tuberculosis patients in Malappuram district Methodology: A Case control study was conducted among tuberculosis patients residing in Malappuram district of Kerala and registered under NTEP in District Tuberculosis Centre (DTC), Manjeri, Malappuram. After satisfying inclusion and exclusion criteria, 90 tuberculosis patients who failed to achieve sputum smear negativity after completion of 2 months of intensive phase multi drug therapy were taken as cases. Another 90 tuberculosis patients those who achieved sputum smear negativity after completion of 2 months of intensive phase therapy were selected as control group. Data was collected by interview method. Results: Patients with lower socio-economic status (OR = 3.59, 95% CI 1.92- 6.73), low BMI or underweight (OR = 1.98, 95% CI 1.1 - 3.6), multiple symptoms (OR= 5.50, 95% CI 1.98 - 15.28), increased duration of symptoms (OR=4.54, 95% 2.24-9.19), co-morbid condition of diabetes mellitus (OR = 2.25, 95% CI 1.24 - 4.09) are at statistically significant risk of delay in sputum smear conversion after intensive phase of anti-tubercular therapy. Conclusion: Patients with lower socio-economic status, low BMI or underweight, multiple symptoms, increased duration of symptoms, co-morbid condition of diabetes mellitus are at statistically significant risk of delay in sputum smear conversion after intensive phase of anti-tubercular therapy. Treating physicians and public health experts should give special attention to TB patients with these risk factors.

Late Diagnosis and Treatment of Pulmonary Tuberculosis in Ziguinchor, Southern Region of Senegal

Background: Untreated smear-positive pulmonary tuberculosis constitutes the main source of transmission of the disease in the community. Aims: The aim of our study was to determine the diagnosis delays of smear-positive pulmonary tuberculosis in adults and to identify the factors associated with the diagnosis delay in Ziguinchor, Senegal. Methodology: This is a prospective descriptive and analytical study carried out from January 1, 2019 to December 31, 2022, in cases of pulmonary tuberculosis whose diagnosis was confirmed by the identification of AFB in sputum after Ziehl Nielsen staining and/or detection of Mycobacterium tuberculosis by Genexpert. Delay was defined as a diagnosis confirmed after 36 days. Logistic regression was performed to determine factors associated with diagnosis delay. Results: A total of 141 patients were included. They had an average age of 40 years ± 16 years, (16 years - 86 years). The peak age group was 16-30 years (34.04%). The sex ratio (M/F) was 1.8. The main characteristics of the patients were: a low level of education (34.8%), work in the informal sector (70.2%) and smoking (25.5%). More than half of the patients (78.44%) had their home less than 5 km from the anti-tuberculosis dispensing center. The patients’ initial symptoms were dominated by cough (90.0%), fever (78%) and weight loss (59.6%). The traditional healer was the first source of care in 40.4%, followed by the health post (37.7%), the health center (16%) and regional hospitals (5.8%). HIV serology was positive in 13.5% of cases. The average time between the beginning of symptoms and the tuberculosis diagnosis was 36± 9.22 days (15 - 58 days). The median time to treatment initiation was 1.8± 1.6 days (1 - 6 days). A diagnosis delay was noted in 53.19%. In multivariate analysis with linear regression, age > 50 years (p = 0.021), use of herbal medicine (p = 0.036) and monthly income < 58 USD (p = 0.039) were the factors associated with late diagnosis of tuberculosis. Conclusion: The diagnostic delay in smear-positive tuberculosis cases is significant in our context. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills of caregivers in the health posts and involve after training the traditional healers in the screening and sensitizing process of the population

Sarcoidosis: A Case Report of an Often-Misdiagnosed Clinical Entity from Bangladesh

A chronic granulomatous disease of unknown etiology without any definite diagnostic criteria with an incidence of 1-1,00,000 among Asians affects multiple systems of our body and is often misdiagnosed owing to its elusive nature and resemblance with other granulomatous disease , especially tuberculosis (TB) in our subcontinent .A 38 years old diabetic woman came with the complaints of low grade fever, night sweats, cough, weight loss, migratory joint pain involving multiple small joints of hands without any morning stiffness and painful skin lesions which resolved spontaneously. Investigation showed Hb 11.5 g/dl with normocytic normochromic anaemia, increased sedimentation, increased CRP, insignificant MT, RA and ANA serology, Sputum for AFB didn't reveal any Mycobacteria. CXR revealed Bilateral Hilar Lymphadenopathy (BHL) and HRCT lungs showed bilateral hilar, mediastinal lymphadenopathy and pulmonary inflammatory lesions. Angiotensin Converting Enzyme (ACE)was 163 U/L which was higher than the normal. She was diagnosed as a case of sarcoidosis and was treated in line with oral prednisolone 40mg/day which was gradually tapered over a period of 5 months. Methotrexate 15mg/day once a week was supplemented with folic acid every consecutive day.Vaccination against H.influenzae and S.pneumoniae were advised and on subsequent follow ups she has been improving .The mortality rate is around 5% however, early suspicion, diagnosis and treatment can be life saving for the patient.

Clinical profile of multi-drug reisitance tuberculosis in adults

on 24 march 1884 etiological agent of tuberculosis was discovered by German doctor Dr. Robert Koch, this discovery led to variety of medical applications in diagnosis and management of pulmonary TB. Among many infectious disease prevalent in India, drug resistant TB is one among the important public health problem. There are many factor which influence occurrences of the drug resistant TB, our study conducted mainly to understand those factors which influences the drug resistant TB i.e clinical profile of drug resistant TB in tertiary hospital VIMS, Ballari. The prospective study was conducted in patients admitted in medical college hospitals affiliated to Vijayanagar Institute of Medical Sciences, Ballari over a period of 2 years from November 2016 to October 2018. All patients with sputum AFB and X-ray suggestive of tuberculosis were sent to CBNAAT (Cartridge-based nucleic acid amplification test) for detection of drug resistance. Clinical and radiological characteristics, and risk factors were recorded and further analysis was made. Out of 150 patients with pulmonary tuberculosis 28 of them were detected with drug resistance tuberculosis. Out of 28 drug resistance tuberculosis patients all 28 patients had resistance to isoniazid and rifampicin (MDR-TB). During the study period, among the drug resistant tuberculosis patients the maximum patients belonged to age group 35 to 48yrs of age and males (n=24, 85.7%) outnumbered females (n=4, 14.3%). Fever (n=26, 92.9%) was common symptom. And next common symptom was cough (n=25, 89.2%), loss of appetite, shortness of breath, hemoptysis, loss of weight, chest pain and wheezing. HIV (39.2%) was the common comorbidities among the study patients, followed by diabetes mellitus (35.7%), HTN (35.7%) and COPD (28.5%). About 71.5% of the cases were smokers and 64.3% had history of alcohol consumption and 14.2% were tobacco chewers in this study. About 57.1 % (n=16) were taken ATT previously and not completed treatment and 4 of them were relapse case. This study had shown that, drug resistance tuberculosis is more common than a rare entity and also shows that drug residence is associated with HIV and drug defaulter. Appropriate adherence with ATT and early diagnosis is main determinant in drug resistance TB.

1882. Contact Investigation of Congenital Tuberculosis in a Neonatal Intensive Care Unit in South Korea

Abstract Background Congenital tuberculosis (TB) is uncommon and difficult to detect in neonates due to its nonspecific symptoms. We conducted a contact investigation of infants and healthcare workers (HCWs) exposed to a neonate with congenital TB in a neonatal ICU (NICU) in Korea. Methods A premature infant born was admitted to NICU on September 16, 2022. On October 24, the infant's mother was diagnosed with miliary TB, and infant’s sputum AFB stain showed 4 positive results. All NICU infants and HCWs during the same period were screened for active pulmonary TB using chest radiography (CXR) immediately. Exposed infants were evaluated with a TST and CXR three months after exposure. Interferon-Gamma Release Assay (IGRA) testing was performed on those with a positive TST or abnormal CXR finding. Prophylactic rifampin was provided to the exposed infants for 3 months, as index had isoniazid-resistant M. tuberculosis infection. Exposed HCWs underwent IGRA testing immediately after exposure (1st IGRA) and at 8 to 10 weeks post-exposure (2nd IGRA), and CXR was performed 6 months after exposure. Results Five out of 82 exposed infants had positive TST (≥ 10 mm) results, while all 31 infants who underwent IGRA testing had negative results. All five with positive TST had received BCG vaccination a median 105 days before. Of the 119 exposed HCWs, three had a conversion; two had negative results (on annual IGRA testing performed according to the national TB prevention Act) before exposure and positive at 1st IGRA test, and one had negative 1st IGRA test then positive 2nd IGRA test. None had active TB during 6-month follow-up. Conclusion We found that 6% of exposed infants had positive TST results and 0% had positive IGRA, while 2.5% of exposed HCWs had conversion. Considering the possibility of false positive TST results due to prior BCG vaccination, the chance of transmission to the infants would be 0%; otherwise, it would be 6.1%. Disclosures All Authors: No reported disclosures

FRI330 A Rare Case Of Hypogonadotropic Hypogonadism In A Patient With Disseminated Tberculosis And Tuberculoma Involving Tuberculum Sellae

Abstract Disclosure: J.S. Genkil: None. S. Ahsun: None. N. Mohan: None. C. Anastasopoulou: None. Introduction: Central nervous system (CNS) tuberculosis accounts for 1-10% of all tuberculosis (TB) infections and has been known to lead to irreversible consequences. CNS TB may present variably as meningeal tuberculosis, tuberculoma, tuberculous abscess, hydrocephalus, ventricular involvement or cerebritis. Tuberculomas involving the sellar region are amongst the rarest of presentations. We describe a unique case of hypogonadotropic hypogonadism with CNS tuberculoma. Case: A 46-year-old male with depression, alcohol use, tobacco smoking, and daily K2 spice use presented to the hospital with multiple days of upper extremity weakness, seizures, and slurred speech. Head CT was done that showed a soft tissue density with mild hypoattenuation on the right frontal region. MRI of the brain showed 3 round 4-5mm lesions with rim enhancement in the frontal lobes. Chest CT showed apical lung lesion. It was believed that patient had a malignant process with metastasis to the brain. During his course, it was discovered that he had TB exposure from his mother several months ago. Despite multiple negative AFB sputum samples, left lung biopsy confirmed TB diagnosis. He was subsequently diagnosed with tubercular meningitis with tuberculomas, one of them involving tuberculum sellae. The patient was started on antitubercular treatment with isoniazid, rifampin, pyrazinamide, streptomycin, and dexamethasone. Lab revealed normal thyroid studies, but very low total testosterone<20 ng/dl (Normal 220-872 ng/dl), with low FSH=2.6 IU/L (Normal 1-12 IU/L) and LH=0.8 IU/ml (Normal 0.6-12.1 IU/ml), with normal prolactin=7.9 ug/L (Normal 3.5-19.4 ug/L). To treat hypogonadotropic hypogonadism, the patient was started on weekly testosterone supplementation with testosterone cypionate 50 mg subcutaneous injections. Ultimately the patient was discharged to a full-time nursing facility and made significant clinical and functional improvement. Discussion: TB of the CNS is among the least common of extra pulmonary tuberculosis yet is associated with the most devastating manifestations making it a feared complication of TB. These lesions are associated with high rates of morbidity and mortality despite appropriate therapy so prompt diagnosis is key. CNS tuberculomas may present isolated or in combination with pulmonary TB. They are unique as they may masquerade as other intracranial space occupying lesions such as tumors or hematomas, further complicating diagnosis. In particular, sellar and suprasellar region tuberculomas are rare and can present with varied amount of hypopituitarism. In the patient’s case, he developed hypogonadotropic hypogonadism which was successfully treated with testosterone replacement. Hypogonadotropic hypogonadism can only be recognized if there is a high index of suspicion and can result in improvement of the quality of life with preservation of sexual function. Presentation: Friday, June 16, 2023

Comparison of Sputum Evaluation Conversion of Pulmonary TB patients with DM and non-DM in High Burden Setting

ABSTRACT
 Background
 Tuberculosis (TB) remains a global health problem and is one of the leading causes of death worldwide. By 2022, an estimated 10 million people will suffer from TB worldwide. Based on data from the Global Tuberculosis Report in 2022, Indonesia ranks second as a high-burden country in the world after India. An estimated 1.5 million people die from tuberculosis, becoming the 13th leading cause of death worldwide and the second most deadly infectious disease after COVID-19.
 Currently, many new cases of TB are influenced by several risk factors, one of which is Diabetes Mellitus (DM). Pulmonary TB is a potential opportunistic infection for people with Diabetes Mellitus. TB patients with DM are at risk of sputum conversion failure after TB treatment, 1.69 times higher risk of treatment failure, 1.24 times higher risk of anti-TB drug resistance, 3.89 times higher risk of relapse, and 4.95 times higher risk of death during treatment compared to TB patients.
 Aim of Study
 To evaluate the sputum smear conversion results at the end of the second month of treatment of patients with Tuberculosis with Diabetes Mellitus (TB-DM) and Tuberculosis Non-Diabetes Mellitus (TB-NDM).
 Methods
 This research was analytical with a retrospective cohort design by taking secondary data from the Tuberculosis Information System (SITB). The data were recorded in SITB and registered as TB patients undergoing Anti-Tuberculosis Drug treatment and screening for Diabetes Mellitus in all districts in West Nusa Tenggara Province in 2022.
 Results
 Among 200 patients with TB in this study, male patients dominated 62% of TB patients. TB patients are mostly found in the age group 46-55 years with 28,5%. Generally, TB patients come from Mataram, with an 18% percentage. Most TB patients were diagnosed using GeneXpert (80,5%). The sputum conversion rate at the end intensive phase in TB-DM patients reached 95%, while in TB-NDM patients, only 85%. The comparative test showed a significant difference between the AFB Sputum Evaluation conversion results between TB patients and those without DM (p-value: 0.018, p<0.05).
 Conclusion 
 There is a significant difference between the AFB Sputum Evaluation conversion results between TB patients and those without DM.
 
 Keywords : Diabetes, diabetes mellitus, sputum conversion, tuberculosis, TB, DM

Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study

BackgroundTuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area.MethodsWe collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables.ResultsWe included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15–44 years (OR 1.817; 95% CI 1.162–2.840; P < 0.01) and 45–59 years (OR 2.175; 95% CI 1.335–3.543; P < 0.01) had significantly higher incidences of drug resistance than children and the elderly. Patients with a cough of ≥ 2 weeks had a significantly higher chance of drug resistance than those with < 2 weeks or no cough symptoms (OR 2.069; 95% CI 1.234–3.469; P < 0.01). Alcoholism (OR 1.741; 95% CI 1.107–2.736; P < 0.05) and high bacterial counts on sputum acid-fast smears (OR 1.846; 95% CI 1.115–3.058; P < 0.05) were significant in the univariate analysis.ConclusionsSputum smear-positive TB predominated in Yi men (15–44 years) with high smoking, alcoholism, and HIV rates. Extrapulmonary TB, especially abdominal TB, prevailed. Recent drug resistance testing revealed higher rates in 15–59 age group and ≥ 2 weeks cough duration. Alcohol abuse and high sputum AFB counts correlated with drug resistance. Strengthen screening and supervision to curb TB transmission and drug-resistant cases in the region.

A Cross Sectional Study to Assess Clinical Profile of Patients with Liver Abscess in Tertiary Care Centre at Central Rajasthan

Introduction: A liver abscess is infective disease of liver parenchyma having collection of purulent material that can develop as a consequence of injury to the hepatic tissue or via portal vein from any source of infection within abdominal cavity. Mostly liver abscess are either due to amoebic infection or pyogenic bacterial infection but in some cases, etiologies like fungal, tubercular or sometimes mixed infections is also seen. Material and Methods: This present cross-sectional study was carried out by recruiting 137 patients diagnosed of having liver abscess at medical OPD at JLN Hospital, Ajmer during the year December 2019 – June 2021. All the patients with confirmed liver abscess were included in this study. Patients age below 18 years, critically ill patient (Including patients having ruptured liver abscess at the time of presentation and requiring surgical intervention), Pregnancy and GI Malignancy Results: 137 liver abscess patients were studied and males from lower middle class with a mean age of 38.41±8.81 years were more affected. Biochemical, serological, stool test, radiological and Mantoux test were performed and the mean alkaline phosphatase, GGT, SGOT, SGPT, bilirubin (Total/Direct/Indirect) and PT/INR were found to be raised. Discussion: Right lobe of liver abscess was solitary. Right side pleural effusion followed by elevation of right hemidiaphragm was the abnormality diagnosed through X-ray. The survival rate was higher either with percutaneous needle drainage or pigtail drainage. E.coli followed by group A beta hemolytic streptococcus, tubercular and fungal etiologies were the most commonly isolated bacteria on pus culture. Blood, urine and stool culture showed positive cultures and some patients with tubercular liver abscess had mantoux test and sputum AFB positive. Conclusion: Liver abscess is most commonly seen in male from lower middle class mostly in 4th decade of life who are non-vegetarian and alcoholic. As non-vegetarian diet and alcoholism were found to be the most common risk factors, it is suggestible to avoid/restrict their intake to avoid liver abscess. Keywords: Liver abscess, usg, Entamoeba histolytica

Tuberculous Meningitis in Male Child and Cavitary Pulmonary Tuberculosis in Mother: Concurrent Familial Infective Disease as Evidence of Recent Transmission from Mother to Baby!

Tuberculosis (TB) is one of the leading causes of mortality in children worldwide, but there remain significant challenges in diagnosing and treating TB infection and disease. Tuberculous (TB) meningitis is the commonest infectious disease of the central nervous system in paediatric and geriatric cases. Childhood TB is an indication of failing TB control in the community. It allows disease persistence in the population. Tuberculosis can be prevented in children by diagnosing and treating cases of active TB amongst adults, as paediatric cases always acquire it passively from household contact of adults suffering from TB as disease in adults is multibacillary. Although significant data is available for the prevention of childhood extra-pulmonary and disseminated TB, offering Bacillus Calmette-Guerin (BCG) vaccination, it is still not routinely offered during vaccination. In this case report, a two-year child with a history of failure to thrive and constitutional symptoms diagnosed with disseminated extra-pulmonary TB presenting as TB meningitis with a history of contact with the mother suffering from active sputum positive pulmonary TB receiving anti-TB treatment. Child was evaluated with CT brain plain and contrast and documented meningeal enhancement. Cerebrospinal fluid analysis revealed tuberculous etiology in presence of lymphocytic predominance and raised ADA level in fluid. CSF fluid sent for cartridge based nucleic acid amplification test documented MTB genome with rifampicin sensitivity. We retrospectively analysed mothers’ sputum examination and observed higher grades of sputum AFB and her cartridge based nucleic acid amplification test revealed MTB genome with rifampicin sensitivity. Child and mother were treated with standard protocol recommended by NTEP (National Tuberculosis elimination program). In conclusion, we recommend BCG vaccination to all newborns, and tuberculin skin testing and isoniazid prophylaxis to the contact of adults with sputum positive pulmonary TB cases in India to prevent transmission of disease from mother to baby. A high index of suspicion is must while evaluating these cases and all possible measures should be taken to confirm tuberculosis to have successful treatment outcome.

A CASE REPORT OF KIKUCHI DISEASE RELAPSE IN A YOUNG ADULT

Kikuchi-Fujimoto Disease (KFD) is a rare, benign and self-limited condition affecting lymph nodes predominantly, although extra lymph nodal manifestations are seen. The rst case was reported in 1972 almost simultaneously by Kikuchi and Fujimoto et al. Prevalence is more common in the Asian population, affecting females more than males. The cause of the disease is unknown but thought to be due to autoimmunity triggered by an external stimulus. Few cases are associated with infectious agents like CMV, EBV, Histoplasmosis, and toxoplasmosis. Most commonly associated with tuberculosis, SLE and lymphoma. Cases are managed conservatively, and severe cases &amp; relapses with corticosteroids. Relapse rates are at 3 to 4 per cent in adults. Here we discuss a case of an 18-year-old male with complaints of swelling in the right arm, fever, loss of appetite and generalized weakness with a known diagnosed case of KFD four months back and TB one year back, and on further investigations of normocytic anaemia, predominant lymphocyte leucocytosis, raised ESR (50mm). CRP was normal. Chest X-ray suggests brotic changes (old TB) in the middle zone of the right lung. USG of right arm swelling suggests multiple necrotic lymph nodes with loss of hilum. USG abdomen and pelvis showed splenomegaly of 14.8 cm. sputum for AFB, and the CBNAAT result was negative. On Mantoux, no induration is seen. ANA was positive with homogenous nucleoli (1:80). Complement levels c3 were normal, and c4 was low (7), thought TB lymphadenitis, on biopsy, showedndings suggestive of KFD. The patient was further managed with a short course of corticosteroids and antibiotics and is under observation.

Glycemic Control Effect on Acid-Fast Bacteria Conversion in Diabetic Patients with Tuberculosis

Background Diabetic people have a 2-3 times higher risk of tuberculosis than non-diabetic people. Immunocompromised conditions due to diabetes increase the risk of therapeutic failure and delayed sputum conversion, which may cause by poor glycemic control. This study was conducted to determine the glycemic control effect on AFB conversion in diabetic patients with tuberculosis. Methods A cross-sectional study has been conducted on 100 diabetic patients with the new emergence of pulmonary tuberculosis. All patients were in intensive phase treatment of tuberculosis for two months at Bhayangkara R. Said Sukanto's Hospital. Data collected from medical records were random blood glucose level, percentage of random blood glucose decrement, HbA1C, and the microscopic AFB sputum smear. Fisher exact test analysis was conducted to determine the effect of random blood glucose level, percentage of blood glucose decrement and HbA1C to AFB smear results using SPSS V25.0 software for Windows with a significance level of 0.05. Results The analysis between glycemic control and AFB sputum smear conversion using random blood glucose, percentage of random blood glucose decrement and HbA1C showed a p-value of 0.000, indicating a significant relationship (p&lt;0.05), so it showed that glycemic control affects AFB sputum smear conversion. Conclusions A significant relationship exists between glycemic control and AFB-negative conversion in patients with DM and TB. RBG showed the best sensitivity and specificity as a glycemic control parameter compared to others.

GeneXpert and Acid-Fast Bacilli Smear for Diagnosis of Pulmonary Tuberculosis in a Tertiary Care Center of Rural Nepal

Introduction: Mycobacterium tuberculosis is the second most infectious cause of death in adults globally and is major health trouble in Nepal. The diagnosis of pulmonary tuberculosis is mainly carried by acid-fast bacilli smear microscopy, culture on Lowenstein–Jensen media, and GeneXpert MTB/RIF assay. This study aimed to evaluate the GeneXpert MTB/RIF and Acid-Fast Bacilli stain smear used for the diagnosis of pulmonary tuberculosis.&#x0D; Methods: A cross-sectional study was performed at Karnali Academy of Health Sciences, Jumla, from July 2021 to June 2022. Our study population comprised 390 probable cases of pulmonary tuberculosis from the ages of 2 to 92 years. A total of 390 sputum specimens from suspected presumptive tuberculosis sufferers were tested using the direct smear staining technique of Acid-Fast Bacilli stain smear and GeneXpert for the detection of MTB/RIF. The GeneXpert MTB/RIF technique was compared with the Acid-Fast Bacilli stain smear. Patient’s demographic details, sputum AFB smear, and GeneXpert test results were collected and entered in working Performa. Data were analyzed using SPSS 16.0.&#x0D; Results: Out of 390 samples 13.84% were positive for Mycobacterium tuberculosis via GeneXpert MTB/RIF assay while 5.12% were positive through AFB microscopy which was statistically significant (p&lt;.0001). When compared with GeneXpert, taking GeneXpert as the gold standard in the rural setup of Nepal the sensitivity of AFB staining was 37.03%, while its specificity was 90.81%.&#x0D; Conclusions: GeneXpert MTB/RIF is a rapid test that can aid in the timely diagnosis of Mycobacterium tuberculosis, facilitating the timely treatment in the rural area.

Assessment of Smear-Positive Pulmonary Tuberculosis and Associated Factors among Patients Visiting Health Facilities of Gedeo Zone, Southern Ethiopia: A Cross-Sectional Study.

Tuberculosis (TB) was one of the top causes of ill health and the leading cause of deaths worldwide until the coronavirus (COVID-19) pandemic. Hence, this study is aimed at assessing the prevalence of sputum smear-positive TB and associated factors among TB-suspected patients attending in Gedeo Zone health facilities, Southern Ethiopia. A facility-based cross-sectional study was conducted among 220 TB-suspected patients in Gedeo Zone health facilities from July 01 to Sep 30, 2021. Patients were grouped as smear positive if one sputum out of two was positive or two sputum smears became positive. Various descriptive statistics were computed using the SPSS-25, and factors to smear positivity were identified by multivariable logistic regression analysis. Odds ratio at 95% CI and p values < 0.05 were considered as indicators of statistical association. The overall prevalence of smear-positive TB in Gedeo Zone health facilities was 18.2%, which is significantly high, and the MTB detection rate of GeneXpert was 29.5%. Contact with a TB patient, cigarette smoking, and previously treatment for TB were factors significantly associated with smear-positive TB. The prevalence rate of smear-positive PTB in the study area was 18.2% and 29.5% by direct sputum AFB and sputum GeneXpert, respectively. As a result, we recommend intervention on the identified associated risk factors and further studies to ascertain risk factors and their magnitude at the community level.

Validity of Adenosine Deaminase (ADA) Level in Pleural Fluid for the Diagnosis of Tuberculosis

Introduction: The pleural fluid LDH/ADA ratio, which can be determined from routine biochemical analysis, is highly predictive of TPE at a cut-off level of 16.20. Measurement of this parameter may be helpful for clinicians in distinguishing between TPE and PPE. Despite wide variations in the reported sensitivity and specificity of pleural fluid ADA level, it can be used as a surrogate for pleural biopsy when the latter is not feasible. Adenosine deaminase (ADA) is the most cost-effective pleural fluid marker and is routinely used in high prevalence settings, whereas its value is questioned in areas with low prevalence. The lymphocyte proportion (LP) is known to increase the specificity of ADA for this diagnosis. Objectives: To determine the diagnostic accuracy of ADA level in pleural fluid for the diagnosis of TB as compared to other conventional methods available like gene expert. Materials &amp; Methods: The design of this study was a cross sectional study design. This study was conducted in Medicine Unit III, S.P.H. Quetta and the duration of this study was from 23rd October 2019 to 22nd April 2020. A total of 423 patients with pulmonary TB between the ages of 25 years to 45 years, having developed pleural effusion were included. Patients with pleural effusion due to causes other than TB, having extra pulmonary TB and those with other respiratory infections were excluded. Tests done specifically for TB in our setup include sputum AFB, CXR, and genexpert. These patients’ pleural fluid ADA were then sent. Results: Adenosine deaminase (ADA) found that 217 were True Positive and 13 were False Positive. Among 193, adenosine deaminase (ADA) negative patients, 12 (False Negative) had TB on gene expert whereas 181 (True Negative) had no TB on gene expert (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ADA level in pleural fluid for the diagnosis of TB as compared to other conventional methods available like gene expert was 94.76%, 93.30%, 94.35%, 93.78% and 94.09% respectively. Practical Implication: This study was conducted to determine the validity of ADA levels for the diagnosis of TB and the results of this study if favorable will decrease the need for other laboratory tests usually done which take longer time, thus helping to decrease the need for multiple tests, early availability of report and timely management of the disease. This will further help to reduce the contact rate of TB and the risk of developing MDR TB by starting early treatment. Conclusion: This study concluded that diagnostic accuracy of ADA level in pleural fluid for the diagnosis of TB is quite high. Keywords: Pulmonary Tuberculosis, Pleural Fluid, Adenosine Deaminase, Biochemical, Mycobacterium .

A Study on Sputum Induction in the Diagnosis of Smear Negative or Sputum -Scarce Presumptive Tuberculosis in HIV Patients in A Tertiary Care Center

Background: HIV infection and TB are two major public health problems in most of the developing countries including India. TB also the most common opportunistic infection seen in HIV infected patients in India 1,2. Tuberculosis is a significant increase in the worldwide incidence of TB which is contributed majorly by HIV infection. AIM: To study the role of Sputum Induction to aid in the diagnosis of Smear Negative or Sputum Scare Presumptive Pulmonary Tuberculosis in adults with HIV. Material &amp; Methods: Prospective hospital based observational study. The present study was conducted in the department of TB &amp; Respiratory medicine, Osmania Medical College, Hyderabad. The subjects of the study were selected among the HIV positive with Presumptive Pulmonary Tuberculosis patients who visited the outpatient department or had been admitted in our hospital who agreed for voluntary participation. A total of 50 Presumptive Pulmonary Tuberculosis with HIV co- infection were taken as sample size. Results: The majority of cases (38 %) were in the age group of 31-40 yrs. Mean age of the study group population is 39.76 ± 9.24. The predominant symptom in the present study was loss of appetite. Out of 50 patients 34% (17 patients) were known Diabetic and 10% (5 patients) were known Hypertensive. Most of the patients in my study are smokers (40%). The mean CD4 count in the present study is 182.68. Majority (72%) of patients in the present study did not have previous history of TB. On General examination majority of the patients had Lymphadenopathy. Out of 45 adequate Induced sputum cases, 89% (40 cases) were Negative for Sputum AFB and whereas 11% (5 cases) were Positive for Sputum AFB. Conclusion: Sputum induction is a safe, simple and valuable procedure to obtain adequate sputum samples in suspected cases of pulmonary tuberculosis and can obviate the need for much sophisticated and invasive procedures like bronchoscopy. Sputum induction improves the diagnostic yield for AFB in patients unable to expectorate adequate sputum sample.

Role Of Sputum And Bronchoalveolar Lavage CBNAAT In The Diagnosis Of PTB In Smear Negative Patients

AIM. To study the use of sputum and broncho alveolar lavage (BAL) for CBNAAT, as an adjunct in the diagnosis of pulmonary tuberculosis, in sputum AFB smear negative patients. OBJECTIVE. To calculate and compare the yield of sputum Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and BAL CBNAAT in sputum AFB smear negative patients. MATERIALS and METHODS. 50 Patients with respiratory symptoms which are suspected of pulmonary tuberculosis with Chest X-ray showing changes consistent with active pulmonary TB and Sputum negative for AFB on two samples were subsequently subjected to sputum CBNAAT, in which 23 out of 50, came out to be positive (46% yield). The remaining 27 patients were subjected to bronchoscopy and the BAL was sent for CBNAAT, in which 23 patients came out as positive (Yield 85%). CONCLUSION. Sputum CBNAAT and BAL CBNAAT prove to be useful adjuncts in the diagnosis of presumptive PTB patients who are sputum AFB smear negative. BAL CBNAAT has higher yield than sputum CBNAAT.

Kết quả điều trị của người bệnh lao phổi mới AFB (+) tại Bệnh viện 71 Trung ương giai đoạn 2019-2020

Tuberculosis (TB) is currently a burden of the worldwide and Vietnam in particular. The World Health Organization (WHO) estimated that in 2019 around 10 million people were newly infected with TB globally. Objective: the study aims to describe the treatment results of patients with new pulmonary tuberculosis AFB (+) at 71 Central Hospital in the period 2019-2020. Methods: A cross-sectional was conducted from January 2019 to June 2020. A total of 321 patients was selected, based on retrospective medical records of patients. Results: the study showed that 7.14% of patients had unwanted effects of anti-TB drugs such as rash, joint pain, digestive disorders and vestibular disorders. After 6 months of treatment, the systemic manifestations of high fever and night sweats completely disappeared, the symptoms of hemoptysis, chest pain, cough, shortness of breath, chest pain decreased significantly (p&lt;0.01); Miniature lesions reached a high rate of 98.3%. The rate of negative AFB sputum was 100% with the patients adhering to the treatment. The rate of cure reached 91.6%, no patient died, the rate of treatment abandonment (3.43%) and no evaluation because of transferring to another facility (accounting for 4.98%). Conclusions: it is necessary to well implement the coordination processes between medical facilities and specialized hospitals in TB examination and treatment activities in the area, ensuring the provision of information on diagnosis, treatment and follow-up during treatment and after the patient recovers. Moreover, strengthening IEC to the patients on basic knowledge of infectious diseases, including tuberculosis is also suggested. Keywords: Treatment results, new pulmonary tuberculosis, TB, AFB (+), patient, 71 Central Hospital.