Sputum Microscopy Research Articles

UNSEEN TUBERCULOSIS: STUDY AMONG INPATIENTS OF A TERTIARY CARE HOSPITAL OF NORTH KARNATAKA

Objective: Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries like India. However, high proportion of people never diagnosed or treated. Delayed diagnosis poses a significant threat to hospital inpatients, health-care workers, and medical trainees. Hence, systematic screening of high-risk groups, including hospital inpatients, has been recommended as a strategy to identify TB. Using signs and symptoms as an independent screening tool remains a global challenge for its relatively low accuracy. However, it could still be of value when it was used in a specific target population like inpatients of hospital. Hence, this study is aimed to determine the proportion of presumptive and active TB cases among inpatients. Methods: A hospital-based cross-sectional study was conducted among inpatients above 18 years of age admitted in non-emergency wards admitted during March to April 2023 at ESIC Hospital in Kalaburagi. A pre-existing TB diagnosis and patients admitted to critical care units were excluded. The convenient sampling method was used to recruit participants. Data were collected through using a pre-designed, semi-structured questionnaire. The patients who presented with one of the four symptoms for screening had undergone investigations such as cartridge-based nucleic acid amplification test, chest X-ray, and sputum microscopy to confirm the diagnosis, and the findings were recorded as proportion. Results: Out of 1363 inpatients, 35 (2.5%) patients had classified as presumptive TB case. Out of 35, 3 (8.57%) were found to be actual TB cases. All patients who had positive results for TB were young patients and belonged to low socioeconomic class. Two of three were rifampicin-sensitive TB cases. Conclusion: Timely screening of the patient’s is of utmost importance to avoid further spread of TB infection among inpatients. The higher prevalence of actual TB cases in younger adults needs further exploration.

Operational feasibility and multi-centric evaluation of ‘TBDetect sputum microscopy kit’ for the direct detection of Mycobacterium tuberculosis in field settings

Background India relies primarily on direct smear microscopy for tuberculosis (TB) diagnosis. However, the low sensitivity of smear microscopy emphasizes the need to improve its performance. We recently described the development of ‘TBDetect’ kit which showed improved performance over direct smear microscopy at National Reference Laboratories (NRLs) in India. Methods The present study was aimed to assess the operational feasibility of ‘TBDetect’ microscopy in field settings. This was evaluated by (i) assessing the performance of ‘TBDetect’ microscopy vs. LED-fluorescence microscopy (LED-FM) on consecutive presumptive pulmonary TB patients (n = 5300) who attended Designated Microscopy Centres (DMCs, n = 13) under 4 NRLs at Bhubaneswar, Bhopal, Chennai, and New Delhi, and (ii) obtaining feedback from Scientists (n = 10) and laboratory technicians (n = 42) using semi-structured questionnaires under the following parameters: feasibility of initiation of ‘TBDetect’ microscopy in DMCs, sample preparation and testing, training, time-to-result, logistics, and troubleshooting. A scoring questionnaire was also used to assess ‘TBDetect’ microscopy vs. LED-FM and statistical significance of the scores was calculated using paired t-test. Results The overall positivity of ‘TBDetect’ microscopy was 10.32% (547/5300) vs. 8.96% (475/5300) of LED-FM at all sites and the increment in positivity was significant (p = 0.019). In addition, ‘TBDetect’ microscopy yielded an increment in smear grade status over LED-FM (p = 0.043). The feedback from the study-in-charge and kit users indicated that ‘TBDetect’ microscopy was easily adapted in point-of-care settings. An analysis of scoring feedback suggested that it was easy to perform and observe in comparison to LED-FM (p < 0.005). Conclusions This study established the feasibility of ‘TBDetect’ microscopy in field settings.

FDG-PET-CT as an early detection method for tuberculosis: a systematic review and meta-analysis

Tuberculosis (TB) causes major public health problems worldwide. Fighting TB requires sustained efforts in health prevention, diagnosis and treatment. Previous literature has shown that conventional diagnostic methods like X-ray and sputum microscopy often miss early or extrapulmonary TB due to their limited sensitivity. Blood tests, while useful, lack the anatomical detail needed for precise localization of TB lesions. A possible step forward in the fight against TB could be the use of Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and Computed Tomography (CT). This meta-analysis discusses the current literature, including the methods, results and implications of using FDG-PET-CT in the early diagnosis of TB. Analysis of the studies showed that the sensitivity of FDG-PET-CT as a potential method for early detection of TB was 82.6%.

Problems of Detecting Tuberculosis by Sputum Microscopy in General Medical Services in the Republic of Karelia

The objective: to determine the effectiveness of detection of patients with pulmonary tuberculosis and prevention of its spread by sputum microscopy in clinical diagnostic laboratories of general medical services of the Republic of Karelia.Results. A reduction in the number of sputum microscopy tests in clinical laboratories of GMS and decrease in the positivity rate to 0.66% was revealed. Among new tuberculosis patients with rifampicin resistance, 51% had abundant bacterial excretion (AFB 2+ and 3+); according to sputum microscopy, tuberculous mycobacteria susceptible to rifampicin were isolated in 38%. In the Republic of Karelia, 31.7% of tuberculosis patients were detected in in-patient units of GMS: 60% of them had cavities, and 28.8% had abundant bacterial excretion (AFB 2+ and 3+). The poor quality of sputum microscopy is the cause of late detection of tuberculosis in the Republic of Karelia and promotes the spread of MDR tuberculosis strains among the population, including nosocomial infection.

Diversity of Fungi and Bacteria Associated with Respiratory Infections among Commercial Bank Tellers in South-Eastern Nigeria

Introduction: Fungi - associated respiratory Infections are serious health challenges that have become inextricably linked with handling of paper currencies in some countries of the world Dermici et al., [1]. Given the quantity of Old-worn-out and mutilated Naira notes in circulation, and other prevailing circumstances in Nigerian banking halls, study was undertaken to evaluate the incidence and spread of fungi -associated respiratory infections among tellers from selected commercial Banks in South-Eastern Nigeria. Methods: A total of 504 Cash Bank Tellers; 196 Males and 308 females aged 25 – 48years (mean age 32.4 years) were evaluated for Fungi-associated infections using Sputum and Nasal secretions-smear Microscopy and Culture simultaneously. Twenty-Seven bacterial strains; Staphylococcus aureus (12), Streptococcus Pneumonia (7) and Klebsiella pneumoniae (8) were tested for their antibiogram Results: One hundred and fifty-nine (31.5%) of the 504 Bank Cash Tellers were diagnosed of respiratory infections due to Aspergillus Sp. (13.5%), Candida albicans (5.8%), Candida tropicalis 6(.4%), Staphylococcus aureus (2.4%), Streptococcus pneumoniae (1.4%), Klebsiella pneumoniae (1.6%), and Nocardia Sp. (0.6%). The yield of micro-pathogens appeared to rise from 18.8% to 55.6% as duration of currency note handling increased from ≤ 6months to 43 – 48 months respectively. Analysis of the differences of the Micro-Pathogens isolated among tellers from Bulk Rooms (42.9%) and those from open Halls (20.2%) was statistically significant (X2cal=68.3) P &lt; 0.05. Forty-eight (88.9%), 26(123.8%), 41(44.6%) and 43(113.2%) Strains of micro-pathogens were isolated from Tellers who indicated with history of respiratory infections, smoking only, alcohol consumption only and smoking/alcohol consumption respectively. The proportions of the micro-pathogens isolated are shown in the Table 1, with Aspergillus sp. yield appearing highest. The antibiogram of the 27 strains of bacteria isolated in the study appeared relatively high; 92.6% for Ofloxacin and 66.7% for Gentamycin, while Streptomycin, Erythromycin, Cephalexin, Ampiclox, and Chloramphenicol responded poorly. Conclusion: The micro-pathogens isolated from this study are important agents of respiratory infections. The relatively high proportions (31.6%) of micro-pathogens isolated may serve as relevant indication that most Nigerian Currency notes in circulation are old, worn-out, mutilated, and are contaminated with micro-pathogens commonly linked with serious public health problems.

Diagnostic accuracy of cartridge-based nucleic acid amplification test and resistance pattern in new and previously treated tuberculosis cases: A prospective observational study

Background: Diagnostic methods, particularly sputum microscopy, are the standard method for diagnosing tuberculosis (TB) in many settings. The emergence of cartridge-based nucleic acid amplification test (CBNAAT) as a newer diagnostic tool for TB has shown promising results. CBNAAT is a rapid molecular test that detects the genetic material of Mycobacterium tuberculosis (MTB), the bacterium causing TB, in sputum samples. It offers higher sensitivity and faster results compared to sputum microscopy. Aim: The study aimed to 1) compare the diagnostic accuracy of CBNAAT in detecting smear-positive and smear-negative pulmonary TB cases, and 2) compare rifampicin resistance prevalence between newly diagnosed and previously treated pulmonary TB patients. Methodology: A hospital-based prospective study was conducted in the Respiratory Medicine Department of Guru Gobind Singh Government Hospital, Jamnagar, on PTB patients from August 2019 to December 2020. Data were collected through a self-structured questionnaire that included detailed clinical history, radiological, biochemical, and microbiological investigations. Descriptive statistical analyses were performed to present data as percentages and frequencies. Diagnostic accuracy analysis was conducted. A P-value &lt;0.05 was considered significant. Results: Out of 150 cases, 104 (69.3 %) were male, while 46 (30.7%) were female. Sixty-one percent of new and 86% of previously treated cases were male, whereas 39% of new and 14% of previously treated cases were female. The sensitivity of sputum smear microscopy is 77.33% in cases of PTB, whereas sputum CBNAAT detected 94% of cases of PTB. The sensitivity of CBNAAT for MTB detection in smear microscopy–positive samples was 93.97%, whereas the sensitivity in smear microscopy–negative samples was 94.12%. Regarding rifampicin resistance, the prevalence was lower in newly diagnosed (3/100) compared to previously treated patients with rifampicin-resistant PTB (3/50). Conclusion: These findings suggest that CBNAAT can be a valuable tool for the detection of TB, particularly in cases where sputum smear microscopy results are negative. However, further research is needed to validate these results and evaluate the clinical implications of using CBNAAT in routine TB diagnostics.

Human-Beta-Defensin-1, Ferritin, Interleukin-6 and their Relationship with Clinical and Laboratory Parameters of the Severity of the Tuberculosis Process

Establishing relationships between clinical and laboratory parameters, such as general patient’s state, parameters of complete blood count and blood biochemistry and markers of the course of tuberculosis in the future can be used to predict the severity of dysfunction of various organs and tissues in patients with tuberculosis and in particular in patients who receive anti-tuberculosis treatment. Objective — to investigate the relationship between biochemical markers, namely Human-beta-defensin-1, ferritin and interleukin-6, and clinical and laboratory indicators of the severity of the tuberculosis process. Materials and methods. 100 patients diagnosed with pulmonary tuberculosis were included in the study. After receiving 60 doses of anti-tuberculosis treatment, the patients were retrospectively divided into 2 groups. Group 1 (n = 77) consisted of patients in whom sputum conversion was observed after 60 doses of treatment, determined by sputum microscopy. Group 2 (n = 23) comprised patients in whom bacterial secretion was maintained after 60 doses of treatment, as detected by microscopy. In addition to the routine studies provided for the monitoring of patients with tuberculosis by the current orders of the Ministry of Health of Ukraine, the levels of Human-beta-defensin-1, ferritin and interleukin-6 (IL-6) in the fasting blood were additionally measured by ELISA at the beginning of treatment and after 60 days. Statistical data processing was carried out using the Statistica 8.0 software environment. Results. A comparison of the investigated parameters between groups at the beginning of treatment showed significantly higher values of Human-beta-defensin-1 (Group 1 — (18.97 ± 2.42) pg/ml, Group 2 — (55.02 ± ± 15.69) pg/ml), ferritin (Group 1 — (94.86 ± 6.02) ng/ml, Group 2 — (141.61 ± 24.66) ng/ml) and IL-6 (Group 1 — (80.33 ± 5.03) pg/ml, Group 2 — (110.13 ± 10.35) pg/ml) in patients with positive sputum micros­copy after 60 doses of treatment, p &lt; 0.05. All studied markers demonstrated a reliable positive relationship with the massiveness of bacterial excretion, a conditional indicator of the severity of clinical symptoms and signs, ESR and urea level, as well as reliable negative correlations with creatinine level. In addition, patients with a lower body mass index were found to have higher levels of Human-beta-defensin-1 and ferritin. Higher levels of Human-beta-defensin-1 and ferritin are associated with lower hemoglobin levels (Human-beta-defensin-1 was also negatively correlated with erythrocyte count). An increase in the leukocytes level is accompanied by a significant increase in the level of Human-beta-defensin-1 and IL-6. Additionally, a significant negative correlation was found between the level of glucose and ferritin, as well as between the level of bilirubin and ferritin and IL-6. Conclusions. The determined significantly higher levels of Human-beta-defensin-1, ferritin and interleukin-6 in patients in whom sputum microscopy was positive after 60 doses of treatment allow considering the investigated biochemical parameters as markers of the ineffectiveness of anti-tuberculosis therapy. The identified positive relationships with the severity of clinical symptoms indicate the possibility of using the studied parameters as markers of the severity of the tuberculosis course. The possibility of using Human-beta-defensin-1 and ferritin as markers of anemia was also found. Correlations with parameters of blood biochemistry allow us to talk about increased levels of Human-beta-defensin-1, ferritin and interleukin-6 against the background of kidney damage.

Urinary lipoarabinomannan in individuals with sputum-negative pulmonary tuberculosis.

Tuberculosis (TB) is a major global cause of ill health. Sputum microscopy for confirmation of presumptive pulmonary TB (PTB) has a reportedly low sensitivity of 22-43 per cent for single smear and up to 60 per cent under optimal conditions. National TB Elimination Programme in India recommends the use of cartridge-based nucleic acid amplification test (CBNAAT) and culture for microbiological confirmation in presumptive PTB individuals with sputum smear negative test. The use of lateral flow urine lipoarabinomannan (LF-LAM) is usually recommended for the diagnosis of TB in HIV-positive individuals with low CD4 counts or those who are seriously ill. The objective of this study was to detect urinary LAM using cage nanotechnology that does not require a physiologic or immunologic consequence of HIV infection for LAM quantification in human urine in 50 HIV-seronegative sputum smear-negative PTB individuals. To study the diagnostic value of urinary LAM in sputum smear negative PTB individuals, a cage based nanotechnology ELISA technique was used for urinary LAM in three different groups of participants. Fifty smears negative PTB clinically diagnosed, 15 smear positive PTB and 15 post TB sequel individuals. Sputum was tested by smear, CBNAAT, and culture along with urine LAM before treatment. The results were interpreted by ROC curve in comparison to the standard tests like CBNAAT and culture. The mean urinary LAM value was 0.84 ng/ml in 37 culture-positive [Mycobacterium tuberculosis (M.tb)] and 0.49 ng/ml in 13 culture-negative (M.tb) smear-negative individuals with PTB, respectively. In 47 smear-negative PTB cases with microbiologically confirmed TB by CBNAAT, the mean urinary LAM was 0.76 ng/ml. The mean urinary LAM in post-TB sequel individuals was 0.47 ng/ml. As per the receiver operating characteristic curve, cut-off value of urinary LAM in individuals with smear-negative PTB microbiologically confirmed by: (i) CBNAAT was 0.695 ng/ml and (ii) culture was 0.615 ng/ml. The findings of this study suggest that individuals with smear-negative PTB and a urinary LAM value of >0.615 ng/ml were most likely to have microbiological confirmed TB while those with a LAM value <0.615 ng/ml >0.478 ng/ml are less likely and those with a value <0.478 ng/ml are unlikely to have microbiological confirmed TB.

P27 A challenging case of MDR TB infection following a holiday in India

Abstract Background TB is an infection caused by Mycobacterium tuberculosis. MDR TB is caused by strains of M. tuberculosis resistant to isoniazid and rifampicin.1 XDR TB refers to strains resistant to one or more second-line injectable drugs and any fluoroquinolone, whereas pre-XDR TB refers to strains resistant to either a second-line injectable drug or a fluoroquinolone.1 The implications of MDR TB include prolonged treatment requirements, increased morbidity and mortality, and risk of onward transmission to others.2 Case history A woman in her forties with poorly controlled diabetes was admitted to hospital three times in 3 months with respiratory symptoms and pulmonary consolidation. She was treated for recurrent community acquired pneumonia (CAP). On her fourth admission, sputum and stool microscopy detected acid fast bacilli (AFB) and PCR using Xpert MTB/RIF (Cepheid® GeneXpert® systems) confirmed M. tuberculosis with resistance to rifampicin. She had no known TB contacts but had had a 5 week holiday in Goa, India, 2 years prior. Management Phenotypic testing confirmed the M. tuberculosis isolate was resistant to rifampicin, isoniazid and aminoglycosides but susceptible to fluoroquinolones. Following discussion with the British Thoracic Society (BTS) MDR TB advice service she was empirically initiated on linezolid 600 mg BD, bedaquiline 200 mg OD, levofloxacin 1000 mg OD, clofazimine 200 mg OD, cycloserine 250 mg BD, pyrazinamide 2000mg OD, ethambutol 1000 mg OD and pyridoxine 10 mg OD. The isolate was later identified as of New Delhi Central Asia lineage, with additional resistance to pyrazinamide (which was then stopped). This is the first case of this lineage reported in the UK. Therapeutic drug monitoring of linezolid, levofloxacin and cycloserine was performed. Cycloserine was changed to terizidone 250 mg BD after 1 month, due to a national supply issue. She suffered from medication side effects including diarrhoea, nausea, derangement in liver functions tests, worsening of pre-existing peripheral neuropathy, myalgia, hypercalcaemia, itch, renal tubular acidosis and acute kidney injury. These were managed pharmacologically and through cessation of terizidone after 2 months and dose reduction, then cessation, of linezolid after 4 months. Outcomes Clinically she improved and repeat imaging showed gradual resolution of consolidation and C-reactive protein levels decreased. She is 10 months into an anticipated 18–24 month treatment regimen, recommended due to her extensive pulmonary disease. Medication side effects are currently well controlled. The infection prevention and control team screened all contacts from this and prior admissions, with no further cases identified. Conclusions This case highlights the importance of suspicion of TB in patients with chronic cough and radiological changes, particularly with risk factors for TB such as relevant travel history and diabetes. MDR TB infection has significant consequences and treatment remains challenging with the burden of multiple drugs, and their side effects, leading to further patient morbidity.

Evaluation of Effectiveness of 9- and 6-Month Treatment Regimens in Patients with Multiple Drug Resistant or Rifampicin-Resistant Tuberculosis in the Republic of Belarus

The objective: to evaluate the effectiveness of 39- and 24-week treatment regimens in patients with multiple drug resistant or rifampicin-resistant tuberculosis (MDR/RR-TB).Subjects and Methods. We evaluated the effectiveness of 39- and 24-week treatment regimens containing bedaquiline, levofloxacin, linezolid, clofazimine, and cycloserine or delamanid (modified short-course regimens - mSCR) and bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM), in cohorts of patients with MDR/RR-TB. Results. Of the 550 and 139 patients were included in the mSCR and SMARRTT Studies (BPaLM regimen) from December 2019 to October 2021 and from March 2022 to August 2022, 90.7% (487/537) and 94.2% (131/139) achieved a successful treatment outcome, respectively, 13 patients were excluded from the mSCR Study and continued treatment according to an individual regimen. Median (ME) and quartiles [Q1-Q3] of sputum culture conversion time in patients treated with mSCR and BPaLM made 30.0 (25.0-56.0) and 27.0 (25.0-29.8) days (p&lt;0.01) respectively. The prognostic factor for an unfavorable outcome for the BPaLM and mSCR regimens was a positive sputum microscopy result before treatment (OR – 7.92, 95% CI 1.5 – 41.0, p = 0.014; OR – 1.97, 95% CI 1.1–3.5, p=0.02, respectively), and for the mSCR regime, the time of sputum culture conversion &gt;90 days was an additional prognostic factor (OR – 3.35, 95% CI 1.2–9.5, p=0.03) .Conclusions. The effectiveness of the mSCR and BPaLM regimens in patients with MDR/RR-TB is high (90.7% and 94.2%, respectively). Patients with positive sputum microscopy and late sputum culture conversion have a lower chance of cure.

Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE).

Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC). Implementation was interrupted by COVID-19. Cluster-level bacteriologically-confirmed case-notification rate (CNR) ratio within 91 days of ACF was our redefined primary outcome; comparison between arms used Poisson regression with random effects. Secondary outcomes were 91-day CNR ratios comparing all tuberculosis registrations and all non-ACF registrations. Interrupted time series (ITS) analysis of CNRs in the SOC arm examined prevalence survey impact. (ISRCTN11400592). 72 clusters served by 10 study-supported tuberculosis registration centres were randomised to ACF (261,244 adults, 58,944 person-years follow-up) or SOC (256,713 adults, 52,805 person-years). Of 1,192 ACF participants, 13 (1.09%) were smear-positive. Within 91 days, 113 (42 bacteriologically-confirmed) and 108 (33 bacteriologically-confirmed) tuberculosis patients were identified as ACF or SOC cluster residents, respectively. There was no difference by arm, with adjusted 91-day CNR ratios 1.12 (95% CI: 0.61-2.07) for bacteriologically-confirmed tuberculosis; 0.93 (95% CI: 0.68-1.28) for all tuberculosis registrations; and 0.86 (95%CI: 0.63-1.16) for non-ACF (routinely) diagnosed. Of 7,905 ACF and 7,992 SOC pre-intervention survey participants, 12 (0.15%) and 17 (0.21%), respectively, had culture/Xpert-confirmed tuberculosis. ITS analysis showed no survey impact on SOC CNRs. Despite residual undiagnosed tuberculosis of 150 per 100,000 population, there was no increase in tuberculosis notifications from this previously successful approach targeting symptomatic disease, likely due to previous TB ACF and rapid declines in TB burden. In such settings, future ACF should focus on targeted outreach and demand creation, alongside optimised facility-based screening. Trial Registration: ISRCTN11400592.

Utilization of accessible resources in the fabrication of an affordable, portable, high-resolution, 3D printed, digital microscope for Philippine diagnostic applications.

Philippine clinical laboratory licensing requirements mandate that diagnostic microscopy for Tuberculosis (TB) sputum microscopy, urinalysis, pap smears, wet smears, an option for complete blood count, stool exams, and malaria thick and thin smears should be accessible and available in health facilities including primary care centers. However, access to these essential diagnostics is hampered by the lack of trained personnel, relatively high costs for supplies and equipment especially in rural and underserved areas. This served as motivation for our team to utilize accessible resources in the form of affordable 3D printers, available CAD software, and components to build our low-cost Openflexure microscope (OFM) prototype. We successfully fabricated our prototype for a total of 310$ with a weight of 525g. We used pathology teaching slides from the Ateneo School of Medicine and Public Health and examined the OFM prototype imaging capabilities. The calculated image resolution was 13% higher compared to an LED light microscope sample captured by a mobile phone at 40x and 15% for 100x. The sampled slide images had adequate clarity with some identifiable cellular features for Rheumatic Heart Disease (RHD), Tuberculosis in soft tissue, and Ascariasis. We were able to correct the color aberrations of the OFM we built and was able to scan images up to 1000x magnification without using oil. Given the features and cost, the OFM prototype can be an attractive and affordable option as an alternative or augmentation to diagnostic microscopy in Philippine primary care. Moreover, it may enable telepathology to support diagnostic microscopy in frontline care.

Approach to lymphadenopathy: how to diagnose tuberculosis lymphadenitis

lymphadenopathy is considered as abnormal finding local or generalized that can becaused by neoplasm or infection, as tuberculosis lymphadenitis. Cervical localization has prevalence&#x0D; in the variety of disorders, can has a similar kind of clinical presentation and to differentiate them be-comes extremely difficult. We provided a case report of the new onset of extrapulmonary tuberculosis&#x0D; lymphadenitis in 42-year-old Indian man. The patient complained of multiply enlarged painful lymphnodes on left anterior neck and was also concerned about sore throat persistent for a year. Objectiveexamination and analysis were without evident inflammatory signs. Previous ultrasound, pulmonaryand abdominal CT-scan investigations also revealed conglomerate of left mediastinal lymph nodes,moderate splenomegaly. The preliminary diagnosis of lymphoma was excluded due to confirmationof typical tuberculosis lymphadenitis with specific testing and morphological changes of the resected&#x0D; lymphatic node. Sputum microscopy was found to be negative, which meant that the patient was neg-ative for social transmission of tuberculosis. Affected lymph nodes resolved completely after appro-priate therapy during one-year treatment. This case report of extrapulmonary tuberculosis highlights&#x0D; the importance of tissue diagnosis in unclear situations. We used clinical protocol for unspecifiedlymph node enlargement as complete history taking and physical examination that is preliminary fordiagnosis, while laboratory tests, imaging diagnostic methods and tissue samplings are gold standardevaluation for definite lymphadenopathy. Tuberculosis lymphadenitis is popularly known as collarstud abscess and is the most common benign cause of cervical lymphadenopathy in endemic areas.This observation determined the details of the immunocompromised state of the patient, conclusionwas supported by the evidence of Pseudomonas putida associated pharyngitis. The main differentialsigns between lymphoma as immunoproliferative disorder and infectious tuberculosis lymphadenitiswere provided.

Detection and management of tuberculosis in Tunisia: challenges and outcomes

Abstract Introduction Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. In Tunisia, where TB remains endemic, the national control program ensures free vaccination, free outpatient TB treatment in addition to early detection of cases and directly observed treatment short course. However, available data on these activities and outcomes are limited. The objective of this study was to describe the evolution of TB detection and management indicators and outcomes from 2018 to 2021. Methods We analyzed data collected part of the epidemiological investigations of notified cases and active search for cases over a period of 4 years (2018-2021). In each governorate, dedicated teams collect samples from cases’ contacts for microscopic sputum examination for screening and ensure patients’ follow-up. All data related to contact tracing, treatment and outcomes were collected, entered and analyzed using SPSS-21. Results The number of screened cases decreased from 30337 in 2018 to 16045 in 2021. The number of investigations of reported cases also decreased; from 2408 in 2018 to 1295 in 2021 (proportion of 74.6% to 48.9% respectively). However, the percentage of positives increased from 1.4% to 2.1%. In 2021, therapeutic success was recorded among 81% of cases (compared to 86% in 2018). From 2018 to 2021, there was an increase in three indicators: fatality rate (1.55 to 2.53%), discontinuation of treatment (from 2.5% to 3.2%) and the proportion of multidrug-resistant TB cases (0.45 to 0.69%). Conclusions Despite free care and treatment, our study showed challenges in the prevention and management of TB. Several activities of the national tuberculosis program have decreased, probably due to the pandemic, as noted in general preventive and care activities worldwide. More education and awareness efforts should be made, not only for patients and their contacts, but also for health care professionals, to be more vigilant in early case detection and continued treatment. Key messages • Several activities of the national tuberculosis program have decreased from 2018 to 2021, probably due to the pandemic. • From 2018 to 2021, there was an increase in the fatality rate, discontinuation of treatment and multidrug-resistant TB cases.

Predictive capabilities of baseline radiological findings for early and late disease outcomes within sensitive and multi-drug resistant tuberculosis cases

PurposeThis study compares performance of Timika Score to standardized, detailed radiologist observations of Chest X rays (CXR) for predicting early infectiousness and subsequent treatment outcome in drug sensitive (DS) or multi-drug resistant (MDR) tuberculosis cases. It seeks improvement in prediction of these clinical events through these additional observations. MethodThis is a retrospective study analyzing cases from the NIH/NIAID supported TB Portals database, a large, trans-national, multi-site cohort of primarily drug-resistant tuberculosis patients. We analyzed patient records with sputum microscopy readings, radiologist annotated CXR, and treatment outcome including a matching step on important covariates of age, gender, HIV status, case definition, Body Mass Index (BMI), smoking, drug use, and Timika Score across resistance type for comparison. Results2142 patients with tuberculosis infection (374 with poor outcome and 1768 with good treatment outcome) were retrospectively reviewed. Bayesian ANOVA demonstrates radiologist observations did not show greater predictive ability for baseline infectiousness (0.77 and 0.74 probability in DS and MDR respectively); however, the observations provided superior prediction of treatment outcome (0.84 and 0.63 probability in DS and MDR respectively). Estimated lung abnormal area and cavity were identified as important predictors underlying the Timika Score’s performance. ConclusionsTimika Score simplifies the usage of baseline CXR for prediction of early infectiousness of the case and shows comparable performance to using detailed, standardized radiologist observations. The score’s utility diminishes for treatment outcome prediction and is exceeded by the usage of the detailed observations although prediction performance on treatment outcome decreases especially in MDR TB cases.

Prevalence, predictors, and outcome of pulmonary mucormycosis in COVID-19 associated rhino orbital mucormycosis in a tertiary care center in South India.

India witnessed an explosive rise in mucormycosis following COVID-19 infection. Pulmonary mucormycosis closely followed rhino orbital mucormycosis as the most common presentation. The need for advanced resources and lack of clinical suspicion for COVID-19-associated pulmonary mucormycosis led to widespread underdiagnosis and poor response to late therapy. The present study aimed to assess the prevalence of pulmonary mucormycosis in COVID-19-associated rhino-orbital mucormycosis using non-invasive techniques, such as sputum microscopy and chest imaging. A prospective observational study was conducted at the Institute of Internal Medicine, Rajiv Gandhi Government General Hospital in Chennai, India between June 2021 and July 2021. All hospitalized patients with proven rhino orbital mucormycosis with or without cerebral involvement within three months of confirmed COVID-19 infection who had clinical symptoms compatible with pulmonary mucormycosis were included in this study. These patients were screened for probable and possible COVID-19-associated pulmonary mucormycosis using computed tomography (CT) chest imaging and sputum microscopy within 48 h of hospital admission. Based on the findings, 8 (16%) out of 50 patients with rhino-orbital mucormycosis, had associated possible or probable pulmonary mucormycosis. All 8 patients were diabetics and had characteristic CT chest findings while only half of them had positive sputum microscopy. A higher prevalence of probably disseminated COVID-19-associated mucormycosis was noted among 51-60-year-old males with the use of corticosteroids and oxygen for COVID-19 therapy. The mortality rate was 100% in probably disseminated mucormycosis, 50% in possible disseminated mucormycosis, and only 9.5% in isolated rhino-orbital mucormycosis. Non-invasive and feasible methods, such as sputum microscopy and chest imaging can be considered for early screening and intensive management of probably disseminated mucormycosis to improve prognosis.

Сложность диагностики туберкулеза в учреждениях общей лечебной сети

Aim. The aim of the study is to analyze the reasons for the erroneous diagnostics of TB in the general health care institutions and identify ways to improve diagnostics. Materials and methods. 147 medical cards of inpatients who were in the Donetsk Republican Clinical Tuberculosis Hospital, for whom active TB was excluded were analyzed. Groups were identified: 89 HIV-negative (group 1) and 58 HIV-infected (group 2). Laboratory, radiation and instrumental examinations, sputum examination by microscopy, molecular genetic analysis GeenXpertMBT/Rif, culture on Middlbrook medium and Lowenstein-Jensen medium were performed. Statistical analysis was performed using the MedStat package. Results and discussions. Hospitalization in the anti-tuberculosis hospital was considered justified in 24.7% of HIV-negative and 34.5% of HIV-infected patients due to the similarity of the clinical and radiological picture of the disease, as well as false-positive results of sputum examination before hospitalization (in 49.1% of examined HIV-negative patients). These patients required in-depth examination, and in 18.0% and 10.3%, respectively, test therapy with anti-tuberculosis drugs. Most often, pneumonia and oncological pathology were mistaken for pulmonary tuberculosis: 31.5% and 25.8% in the 1st group and 48.4% and 25.8% in the 2nd group, in both groups the verification of tumor processes was the most difficult: out of 31 cancer patients, 17 (54.8%) people received anti-tuberculosis treatment, of 7 fatal cases, in 6 the diagnosis was verified by autopsy. Development of secondary forms of pulmonary tuberculosis is not accompanied by hilar lymphadenopathy in immunocompetent patients: in group 1 enlarged lymph nodes were observed in 29 (32.6%) patients, of whom oncological pathology was revealed in 11 (37.9%), sarcoidosis – in 8 (27.6%), pneumonia – in 6 (20.7%), interstitial lung diseases (ILD) – in 2 (6.9%). Of 31 HIV-infected patients with suspected pulmonary tuberculosis, 8 (25.8%) were diagnosed with Pneumocystis pneumonia, requiring treatment outside the TB dispensary. The reasons for the erroneous diagnostics of tuberculous meningitis in HIV-infected people were insufficient coverage of neuroimaging, genetic molecular testing of cerebrospinal fluid and serodiagnosis of blood (cerebrospinal fluid). An important counterargument against the tuberculous etiology of CNS damage is the absence of active tuberculosis of the lungs and/or other organs: 77.7% of patients with suspected TM had no fresh changes in the lungs. Conclusion. Improving the quality of sputum microscopy, carrying out, if indicated, antibacterial (antifungal) treatment, diagnostic bronchoscopy, CT/MRT, consultations with specialists can reduce the frequency of erroneous diagnosis of tuberculosis and avoid hospitalization in the anti-tuberculosis infectious diseases department.

New coronavirus infection as a risk-factor for the development of tuberculosis: a clinical observation

A new coronavirus infection is an acute viral disease with a primary lesion of the respiratory tract. Morphological changes in the lungs with a new coronavirus infection are characterized by damage to lymphocytes, endotheliocytes, macrophages, monocytes and diffuse lesions of the alveoli with local hemorrhages and accumulation of fluid and fibrin in their lumen and the development of residual changes in the form of fibrosis. The resulting changes in the target organ can lead to the activation of opportunistic infections, including tuberculosis. The clinical observation of the onset of a tuberculous process in a patient who had a new coronavirus infection with residual changes in the lung tissue in the form of fibrosis. Patient I., 30 years old, was admitted to a tuberculosis hospital for examination and treatment. The result of x-ray examination revealed signs of decay in the sixth segment of the lower lobe of the right lung. A positive sputum microscopy result for acid-fast mycobacteria was also obtained. Molecular genetic study of sputum confirmed the presence of Mycobacterium tuberculosis. From the anamnesis it is known that 5 months ago she suffered a new coronavirus infection, confirmed by a molecular genetic method, with a lesion of the sixth segment of the right lung. At the end of the treatment with COVID-19 were performed computed tomography of the chest organs – residual fibrous changes were noted in the sixth segment of the right lung after pneumonia. This clinical observation showed that the presence of residual fibrotic changes in the lungs after suffering a coronavirus disease in a patient is a risk factor for tuberculosis.

Nonadherence to anti-tuberculosis treatment, reasons and associated factors among pulmonary tuberculosis patients in the communities in Indonesia.

Tuberculosis (TB) is the world's major public health problem. We assessed the proportion, reasons, and associated factors for anti-TB treatment nonadherence in the communities in Indonesia. This national coverage cross-sectional survey was conducted from 2013 to 2014 with stratified multi-stage cluster sampling. Based on the region and rural-urban location. The 156 clusters were distributed in 136 districts/cities throughout 33 provinces, divided into three areas. An eligible population of age ≥15 was interviewed to find TB symptoms and screened with a thorax x-ray. Those whose filtered result detected positive followed an assessment of Sputum microscopy, LJ culture, and Xpert MTB/RIF. Census officers asked all participants about their history of TB and their treatment-defined Nonadherence as discontinuation of anti-tuberculosis treatment for <6 months. Data were analyzed using STATA 14.0 (College Station, TX, USA). Nonadherence to anti-TB treatment proportion was 27.24%. Multivariate analysis identified behavioral factors significantly associated with anti-TB treatment nonadherence, such as smoking (OR = 1.78, 95% CI (1.47-2.16)); place of first treatment received: government hospital (OR = 1.45, 95% CI:1.06-1.99); private hospital (OR = 1.93, 95% CI: 1.38-2.72); private practitioner (OR = 2.24, 95% CI: 1.56-3.23); socio-demographic and TB status included region: Sumatera (OR = 1.44, 95% CI: 1.05-1.98); other areas (OR = 1.84, 95% CI: 1.30-2.61); low level of education (OR = 1.60, 95% CI: 1.27-2.03); and current TB positive status (OR = 2.17, 95% CI: 1.26-3.73). Nonadherence to anti-TB drugs was highly related to the personal perception of the respondents, despite smoking, current TB status, a place for the first treatment, education, and region. The position of the first TB treatment at the private practitioner was significantly associated with the risk of Nonadherence to treatment.

Comparative study of infection control practices in DOTS/sputum microscopy centre in two different districts of state of Uttarakhand and Uttar Pradesh of India

Background & ObjectiveTuberculosis (TB) is endemic in India. TB is transmitted through droplet infection and the transmission occurs when a person inhales droplet nuclei containing of Mycobacterium tuberculosis. Infection control practices play a major role in controlling the TB infection in healthcare settings and further prevents TB infection in the HCWs. The aim of the study is to conduct the cross sectional study for infection control practices in DOTS cum Sputum Microscopy Centre's under NTEP in Ghaziabad (Uttar Pradesh) & Dehradun (Uttarakhand) districts with the objective to assess the compliance of infection control measures by HCWs in DOTS cum Sputum Microscopy Centre's and to suggest the suitable measures and/or model to reduce the transmission of infection to the HCWs and to the community at large. Materials & methodsThe cross sectional study is conducted for two years in two districts of different state having high burden of TB disease in UP and low burden of disease in UK state. All DOTS cum Sputum Microscopy centres of both selected districts i.e. 100% sample size are covered in the study. ResultsHand washing is the most efficient and cost-effective practice for prevention and control of infection. In Dehradun district 66.66% (12) centers and in Ghaziabad district 57.14% (16) centers have adequate hand washing facility available at DOTS and sputum microscopy lab. Unavailability of adequate PPE will lead to the infection. In Dehradun district, 55.56% (10) centers have adequate PPE available whereas in Ghaziabad District 21.43% (6) centers have adequate PPE available. Training on infection prevention and control for HCWs are provided in 27.78% (5) DOTS/sputum microscopy center in Dehradun whereas none of the DOTS/sputum microscopy center in Ghaziabad district are given training on infection prevention & control for HCWs in last one year. Adequate ventilation plays an important role in transmission of TB/MDR TB or any respiratory infection. HCWs working in DOTS/Sputum microscopy center are at risk to contact the TB/MDR TB infection if there is no proper ventilation in their working places. In 33.33% (6) DOTS/sputum microscopy center in Dehradun & 28.57% (8) in Ghaziabad district have adequate ventilation. Layout of DOTS room and for sputum microscopy center are suggested to reduce the risk of transmission of TB/MDR-TB and other respiratory pathogens amongst HCWs who are working in DOTS cum sputum microscopy center. ConclusionDOTS cum Sputum Microscopy Centers of both districts in different states are having deficient infection control practices. Staff is not adequately trained in infection prevention and control practices.